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Long-term Follow-up Reveals Low Incidence of Colorectal Cancer, but Frequent Need for Resection, Among Australian Patients With Inflammatory Bowel Disease

      Background & Aims

      Inflammatory bowel disease can require surgical resection and also lead to colorectal cancer (CRC). We investigated the cumulative incidence of resection surgeries and CRC among patients with ulcerative colitis (UC) or Crohn's disease (CD).

      Methods

      We analyzed data from a cohort of patients who participated in an inflammatory bowel disease study (504 with UC and 377 with CD) at 2 academic medical centers in Sydney, Australia from 1977 to 1992 (before the development of biologic therapies). We collected follow-up data on surgeries and development of CRC from hospital and community medical records or via direct contact with patients during a median time period of 14 years. Cumulative incidences of resection surgeries and CRC were calculated by competing risk survival analysis.

      Results

      Among patients with UC, CRC developed in 24, for a cumulative incidence of 1% at 10 years (95% confidence interval [CI], 0%–2%), 3% at 20 years (95% CI, 1%–5%), and 7% at 30 years (95% CI, 4%–10%). Their cumulative incidence of colectomy was 15% at 10 years (95% CI, 11%–19%), 26% at 20 years (95% CI, 21%–30%), and 31% at 30 years (95% CI, 25%–36%). Among patients with CD, 5 of 327 with colon disease developed CRC, with a cumulative incidence of CRC of 1% at 10 years (95% CI, 0%–2%), 1% at 20 years (95% CI, 0%–2%), and 2% at 30 years (95% CI, 0%–4%). Among all patients with CD, the cumulative incidence of resection was 32% at 5 years (95% CI, 27%–37%), 43% at 10 years (95% CI, 37%–49%), and 53% at 15 years (95% CI, 46%–58%). Of these 168 subjects, 42% required a second resection within 15 years of the first surgery (95% CI, 33%–50%).

      Conclusions

      Patients with UC have a low incidence of CRC during a 30-year period (7% or less); the incidence among patients with CD is even lower. However, almost one-third of patients with UC and about 50% of those with CD will require surgery.

      Keywords

      Abbreviations used in this paper:

      CD (Crohn's disease), CI (confidence interval), CRC (colorectal cancer), HR (hazard ratio), IBD (inflammatory bowel disease), UC (ulcerative colitis)
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      References

        • Mowat C.
        • Cole A.
        • Windsor A.
        • et al.
        Guidelines for the management of inflammatory bowel disease in adults.
        Gut. 2011; 60: 571-607
        • Eaden J.A.
        • Abrams K.R.
        • Mayberry J.F.
        The risk of colorectal cancer in ulcerative colitis: a meta-analysis.
        Gut. 2001; 48: 526-535
        • Jawad N.
        • Direkze N.
        • Leedham S.J.
        Inflammatory bowel disease and colon cancer.
        Recent Results Cancer Res. 2011; 185: 99-115
        • Katsanos K.H.
        • Tatsioni A.
        • Pedersen N.
        • et al.
        Cancer in inflammatory bowel disease 15 years after diagnosis in a population-based European Collaborative follow-up study.
        J Crohns Colitis. 2011; 5: 430-442
        • Hou J.K.
        • Kramer J.R.
        • Richardson P.
        • et al.
        Risk of colorectal cancer among Caucasian and African American veterans with ulcerative colitis.
        Inflamm Bowel Dis. 2012; 18: 1011-1017
        • Canavan C.
        • Abrams K.R.
        • Mayberry J.
        Meta-analysis: colorectal and small bowel cancer risk in patients with Crohn's disease.
        Aliment Pharmacol Ther. 2006; 23: 1097-1104
        • Lémann M.
        Review article: can post-operative recurrence in Crohn's disease be prevented?.
        Aliment Pharmacol Ther. 2006; 24: 22-28
        • Uchino M.
        • Ikeuchi H.
        • Bando T.
        • et al.
        Risk factors for short bowel syndrome in patients with Crohn's disease.
        Surg Today. 2012; 42: 447-452
        • Carlsson E.
        • Bosaeus I.
        • Nordgren S.
        Quality of life and concerns in patients with short bowel syndrome.
        Clin Nutr. 2003; 22: 445-452
        • Egberts J.H.
        • Stroeh A.
        • Alkatout I.
        • et al.
        Preoperative risk evaluation of postoperative morbidity in IBD patients: impact of the POSSUM score.
        Int J Colorectal Dis. 2011; 26: 783-792
        • Stallmach A.
        • Hagel S.
        • Gharbi A.
        • et al.
        Medical and surgical therapy of inflammatory bowel disease in the elderly: prospects and complications.
        J Crohns Colitis. 2011; 5: 177-188
        • Andrews J.M.
        • Norton I.
        • Dent O.
        • et al.
        Inflammatory bowel disease: a retrospective review of a specialist-based cohort.
        Med J Aust. 1995; 163: 133-136
        • Selinger C.P.
        • Andrews J.
        • Dent O.F.
        • et al.
        Cause specific mortality and 30-year relative survival of Crohn's disease and ulcerative colitis.
        Inflammatory Bowel Diseases. 2013; 19: 1880-1888
        • Fine J.P.
        • Gray R.J.
        A proportional hazards model for the subdistribution of a competing risk.
        Journal of the American Statistical Association. 1999; 94: 496-509
        • Gray R.
        Cause-specific cumulative incidence estimation and the Fine and Gray model under both left truncation and right censoring.
        Biometrics. 2011; 67: 39-49
        • Moser G.
        • Tillinger W.
        • Sachs G.
        • et al.
        Disease-related worries and concerns: a study on out-patients with inflammatory bowel disease.
        Eur J Gastroenterol Hepatol. 1995; 7: 853-858
        • Sinclair T.S.
        • Brunt P.W.
        • Mowat N.A.
        Nonspecific proctocolitis in northeastern Scotland: a community study.
        Gastroenterology. 1983; 85: 1-11
      1. Tracey E, Kerr T, Dobrovic A, et al. Cancer in New South Wales: incidence and mortality report 2008. In: Health NSWDo. Sydney: Department of Health, 2010.

        • Cosnes J.
        • Nion-Larmurier I.
        • Beaugerie L.
        • et al.
        Impact of the increasing use of immunosuppressants in Crohn's disease on the need for intestinal surgery.
        Gut. 2005; 54: 237-241
        • Ramadas A.V.
        • Gunesh S.
        • Thomas G.A.
        • et al.
        Natural history of Crohn's disease in a population-based cohort from Cardiff (1986-2003): a study of changes in medical treatment and surgical resection rates.
        Gut. 2010; 59: 1200-1206
        • Winther K.V.
        • Jess T.
        • Langholz E.
        • et al.
        Long-term risk of cancer in ulcerative colitis: a population-based cohort study from Copenhagen County.
        Clin Gastroenterol Hepatol. 2004; 2: 1088-1095
        • Jess T.
        • Loftus E.V.
        • Velayos F.S.
        • et al.
        Risk of intestinal cancer in inflammatory bowel disease: a population-based study from Olmsted county, Minnesota.
        Gastroenterology. 2006; 130: 1039-1046
        • Lakatos L.
        • Mester G.
        • Erdelyi Z.
        • et al.
        Risk factors for ulcerative colitis-associated colorectal cancer in a Hungarian cohort of patients with ulcerative colitis: results of a population-based study.
        Inflamm Bowel Dis. 2006; 12: 205-211
        • Doubeni C.A.
        • Laiyemo A.O.
        • Major J.M.
        • et al.
        Socioeconomic status and the risk of colorectal cancer: an analysis of more than a half million adults in the National Institutes of Health-AARP Diet and Health Study.
        Cancer. 2012; 118: 3636-3644
        • Farmer R.G.
        • Easley K.A.
        • Rankin G.B.
        Clinical patterns, natural history, and progression of ulcerative colitis: a long-term follow-up of 1116 patients.
        Dig Dis Sci. 1993; 38: 1137-1146
        • Leijonmarck C.E.
        • Persson P.G.
        • Hellers G.
        Factors affecting colectomy rate in ulcerative colitis: an epidemiologic study.
        Gut. 1990; 31: 329-333
        • Langholz E.
        • Munkholm P.
        • Davidsen M.
        • et al.
        Colorectal cancer risk and mortality in patients with ulcerative colitis.
        Gastroenterology. 1992; 103: 1444-1451
        • Höie O.
        • Schouten L.J.
        • Wolters F.L.
        • et al.
        Ulcerative colitis: no rise in mortality in a European-wide population based cohort 10 years after diagnosis.
        Gut. 2007; 56: 497-503
        • Hoie O.
        • Wolters F.L.
        • Riis L.
        • et al.
        Low colectomy rates in ulcerative colitis in an unselected European cohort followed for 10 years.
        Gastroenterology. 2007; 132: 507-515
        • Krishnaprasad K.
        • Andrews J.M.
        • Lawrance I.C.
        • et al.
        Inter-observer agreement for Crohn's disease sub-phenotypes using the Montreal Classification: how good are we? A multi-centre Australasian study.
        J Crohns Colitis. 2012; 6: 287-293
        • Lakatos P.L.
        • Golovics P.A.
        • David G.
        • et al.
        Has there been a change in the natural history of Crohn's disease? Surgical rates and medical management in a population-based inception cohort from western Hungary between 1977-2009.
        Am J Gastroenterol. 2012; 107: 579-588
        • Bernstein C.N.
        • Loftus E.V.
        • Ng S.C.
        • et al.
        Hospitalisations and surgery in Crohn's disease.
        Gut. 2012; 61: 622-629