Predictive and Protective Factors Associated With Colorectal Cancer in Ulcerative Colitis: A Case-Control Study

doi:10.1053/j.gastro.2006.03.028

Gastroenterology

Volume 130, Issue 7, June 2006, Pages 1941-1949

Presented in part at the 106th Annual Meeting of the American Gastroenterological Association, May 14–19, 2005, Chicago, IL (Gastroenterology 2005;128(4 Suppl 2):A328).

https://doi.org/10.1053/j.gastro.2006.03.028 Get rights and content

Background & Aims: Predictive and protective factors associated with colorectal cancer in chronic ulcerative colitis are not well described. Surveillance colonoscopy and 5-aminosalicylic acid therapy may mitigate cancer risk, but there is debate because these variables have not been evaluated in the same study. The presence of postinflammatory pseudopolyps and use of other anti-inflammatory medications may be important variables that influence risk, but data are sparse. Methods: Variables associated with colorectal cancer were registered in 188 patients with ulcerative colitis-related cancer and matched controls. Conditional logistic regression, adjusted for age at colitis diagnosis and colitis duration, identified a final set of variables independently associated with colorectal cancer. Results: In the final multiple variable model, the most important factors associated with colorectal cancer were a history of pseudopolyps (OR, 2.5; 95% CI: 1.4–4.6), 1 or 2 surveillance colonoscopies (OR, 0.4; 95% CI: 0.2–0.7), smoking (OR, 0.5; 95% CI: 0.2–0.9) and use of corticosteroids (OR, 0.4; 95% CI: 0.2–0.8), aspirin (OR, 0.3; 95% CI: 0.1–0.8), nonsteroidal anti-inflammatory drugs (OR, 0.1; 95% CI: 0.03–0.5), and 5-aminosalicylic acid agents (OR, 0.4; 95% CI: 0.2–0.9), although the latter was not statistically significant after 5 years. Primary sclerosing cholangitis and immunosuppressive use were not statistically significant. Conclusions: These results suggest that, in a population matched for extent and duration of chronic ulcerative colitis, surveillance colonoscopy and use of anti-inflammatory medications may reduce the risk of colorectal cancer. A history of postinflammatory pseudopolyps appears to be a predictive factor for cancer.

Section snippets

Source Population

The Institutional Review Board of the Mayo Foundation approved the research protocol. A comprehensive Mayo Clinic centralized diagnostic index, utilizing inpatient and outpatient discharge diagnoses, pathology reports, and endoscopic reports, identified all patients with CUC evaluated at the Mayo Clinic Rochester between January 1, 1976, and December 31, 2002 (N = approximately 11,800). Inclusion into the study as either a case or control required a clinical, histologic, and endoscopic or

Study Population

Controls were gender- and disease extent-matched (Table 1). They were chosen to be similar to matched cases with respect to the duration of CUC. The majority of the study population was male and white. Most patients had extensive colitis; only 2 cases and 2 controls (1%) had proctitis. The distribution of geographic residence was approximately equal among cases and controls and evenly spread across the 3 categories. Approximately half of the cases were diagnosed before the midpoint of the study

Discussion

To identify potentially important CRC prevention strategies and high-risk subgroups, we investigated several predictive and protective factors associated with CRC. In a large tertiary care population of CUC patients, the 2 most important predictive factors for CRC (after matching for anatomic extent and duration of disease) were having a first-degree relative with CRC and having a prior diagnosis of pseudopolyps. The most influential protective factors (again after matching for anatomic extent

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: Supported in part by Procter and Gamble Pharmaceuticals and the Mayo Foundation for Medical Education and Research.

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Clinical–alimentary tractPredictive and Protective Factors Associated With Colorectal Cancer in Ulcerative Colitis: A Case-Control Study

Section snippets

Source Population

Study Population

Discussion

Gastroenterology

Gastroenterology

Gastroenterology

Am J Gastroenterol

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Am J Gastroenterol

Gastroenterology

Gastroenterology

Clin Gastroenterol Hepatol

Gastroenterology

Inflammation and cancer IV. Colorectal cancer in inflammatory bowel disease: the role of inflammation

Am J Physiol Gastrointest Liver Physiol

Ulcerative colitis and colorectal cancer. A population-based study

N Engl J Med

Cancer morbidity in ulcerative colitis

Gut

Colorectal cancer prevention in ulcerative colitisa case-control study

Aliment Pharmacol Ther

Is there an excess risk for colorectal cancer in patients with ulcerative colitis and concomitant primary sclerosing cholangitis? A population based study

Gut

Primary sclerosing cholangitis and colorectal carcinoma in patients with chronic ulcerative colitisa case-control study

Cancer

Clinical–alimentary tract
Predictive and Protective Factors Associated With Colorectal Cancer in Ulcerative Colitis: A Case-Control Study