Ulcerative colitis is linked to increased colorectal cancer risk, mortality

  • Olén O & al.
  • Lancet
  • 11 Jan 2020

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Risks for colorectal cancer (CRC) and CRC mortality are higher in patients with ulcerative colitis (UC).

Why this matters

  • Previous estimates were based on older treatment and surveillance regimens.
  • Previous studies used incident CRC cases and were thus subject to surveillance and lead-time bias.

Study design

  • A population-based cohort study of 96,447 patients with UC and 949,207 unaffected individuals in Sweden and Denmark (1969-2017).
  • Funding: Various nonindustry sources.

Key results

  • Patients with UC had 1.29 incident CRCs per 1000 person-years vs 0.82 in the reference population (aHR, 1.66; 95% CI, 1.57-1.76).
  • Patients with UC had 0.55 CRC-related deaths per 1000 person-years vs 0.38 among the reference population (aHR, 1.59; 95% CI, 1.46-1.72).
  • Overall, patients with UC with CRC were diagnosed with less advanced disease (P<.0001 but had greater risk for crc death when tumor stage at diagnosis was controlled ci>
  • Although the excess risk associated with UC declined over time, in the final 5 years of follow-up, it remained heightened: 
    • Incidence: HR, 1.38 (95% CI, 1.20-1.60).
    • CRC mortality: HR, 1.25 (95% CI, 1.03-1.51).  

Limitations

  • No data on lifestyle factors.