Tilburg, S. van (Sanne) (2017) Colorectal cancer risk in a nationwide inflammatory bowel disease cohort with indefinite for dysplasia and low grade dysplasia. thesis, Medicine.
Full text available on request.Abstract
Introduction: Patients with long-standing colonic inflammatory bowel disease (IBD) bear an increased colorectal cancer (CRC) risk. Endoscopic surveillance allows early detection and removal of precancerous lesions such as indefinite for dysplasia (IND) and low-grade dysplasia (LGD), and may subsequently prevent CRC. However, the long-term outcome after LGD and the subsequent risk to develop CRC remains uncertain, since most available studies are small and cover a relatively short follow-up period. To this end, a nationwide cohort is established of IBD patients with a history of LGD or IND to 1) determine the cumulative CRC incidence, and 2) identify risk factors for developing CRC. Methods: Using the Dutch National Pathology Registry (PALGA) IBD patients diagnosed with LGD and IND between 1991 and 2005 in the Netherlands were identified. Subsequently, follow-up data were extracted until 2016. The cumulative CRC incidence is determined with 1 minus Kaplan Meier curves censuring patients at the end of colorectal surveillance or colectomy. This was done for LGD and IND patients. A case control study, comparing IBD patients with LGD who developed CRC (cases) versus IBD patients who did not develop CRC (controls), was performed to identify risk factors for developing CRC. This was done for patients with IND as well. Subsequently univariable and multivariable Cox regression analyses with backward elimination were used to identify independent risk factors. Results: We identified 1529 IBD patients with colonic IND and LGD with a median follow-up time of 10,22 years per patient after LGD diagnosis (total follow-up time: 14,216 patient years). 1082 (70.8%) patients had ulcerative colitis, 284 (18.6%) Crohn’s disease and 163 (10.6%) indeterminate colitis. Two hundred nine out of 1529 (13.7%) patients underwent colectomy. CRC developed in 111 out of 1411 LGD patients resulting in a cumulative incidence of 3.2% , 6.9%, 12.6%, 18.7% after 5, 10, 15 and 20 years for these patients. In IND patients, 7/118 (5.9%) developed CRC with a cumulative incidence of respectively 7.6%, 11.1%, and 14.7% after 5, 10 and 15 years. Patients with an IBD duration of more than 5 years before LGD development had a significantly higher cumulative CRC incidence (9.9% after 15 years) compared to those with a shorter IBD duration (5.5% after 15 years; log rank p=0.001). Furthermore, patients with recurrent LGD had a higher CRC risk compared to patients with single LGD (9.5% after 15 years versus 5.3% after 15 years; log rank p=0.023). Multivariable Cox regression identified both a longer IBD duration (hazard ratio 1.86, 95% confidence interval 1.28-2.69) and recurrent LGD (hazard ratio 1.61, 95% confidence interval 1.09-2.37) as independent factors associated with increased CRC risk. Conclusion: A cumulative CRC risk of 18.7% after 20 years was found in a large nationwide cohort of IBD patients with a history of LGD. In IND patients the cumulative risk was 11.1% after 10 years. Both a longer IBD duration and recurrent LGD were identified as independent risk factors for CRC development following LGD. These findings may aid in risk stratification following a diagnosis of LGD in IBD patients.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Borg, Dr. Frank ter and gastroenterologist and hepatologist Deventer hospital (facul |
| Supervisor name: | Derikx, Drs. Lauranne A.A.P. gastroenterologist and hepatolo and Nissen, Drs. Loes H.C.gastroenterologist and hepatologist |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:01 |
| Last Modified: | 25 Jun 2020 11:01 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2091 |
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