Crohn’s disease linked to CRC incidence, mortality

  • Olén O & al.
  • Lancet Gastroenterol Hepatol
  • 13 Feb 2020

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Patients with Crohn's disease are at greater risk for colorectal cancer (CRC) diagnosis and CRC mortality.

Why this matters

  • The study updates risk in the context of changes in diagnostic workup for Crohn's disease, CRC surveillance, and Crohn's and CRC treatment.

Study design

  • A nationwide cohort study in Denmark and Sweden (1969-2017; n=47,035 with Crohn's disease; n=463,187 reference individuals).
  • Funding: Various nonindustry sources.

Key results

  • More CRC deaths in the Crohn's disease cohort than among control individuals:
    • 0.47 vs 0.31 per 1000 person-years.
    • aHR, 1.74 (95% CI, 1.54-1.96).
  • More CRC diagnoses in the Crohn's disease cohort than among control individuals:
    • 0.82 vs 0.64 per 1000 person-years.
    • aHR, 1.40 (95% CI, 1.27-1.53).
  • Among those diagnosed with CRC, those with comorbid Crohn's disease were at greater risk for CRC mortality:
    • aHR, 1.42 (95% CI, 1.16-1.75).
  • Among patients with Crohn's disease eligible for CRC surveillance according to current guidelines, the risk for CRC was higher among those:
    • Diagnosed with Crohn's before age 40 years.
    • With disease activity only in the colon. 
    • With primary sclerosing cholangitis.

Limitations

  • Death certificates may have attributed death to CRC more often in patients with Crohn's disease than in reference patients.