Colorectal cancer and cholangiocarcinoma in patients with primary sclerosing cholangitis and inflammatory bowel disease

Abstract

Objective. Inflammatory bowel disease (IBD) patients with concomitant primary sclerosing cholangitis (PSC) carry an increased risk of colorectal cancer (CRC) and cholangiocarcinoma (CCA). We evaluated the relative risk of these malignancies in IBD patients with PSC, who had been under regular surveillance. Material and methods. The survey involved a cohort of 51 patients with IBD and concomitant PSC. All patients had been under regular surveillance for a median of 19 years. The standardized incidence ratios (SIRs) of CRC and CCA were estimated between 1986 and 2007. Results. During the follow up, three patients (5.9%) developed CRC and five patients (9.8%) developed CCA. SIRs were 20.71 (95% confidence interval [CI]: 5.62–79.70) and 916.63 (95% CI: 297.88–2140.99), respectively. The median age at diagnosis of CRC was 39.5 years. All patients with PSC were <45 years of age at the time of detecting CRC and had other risk factors for CRC. The median age at the time of the CCA diagnosis was 54.0 years. Conclusion. Despite regular surveillance, the relative risks of CCA and CRC remained increased in patients with IBD and PSC. A rigorous endoscopic surveillance is maintained for all patients with PSC, but better indicators of the development of CCA are urgently needed.

Key Words:

• cholangiocarcinoma
• colorectal cancer
• inflammatory bowel diseases
• primary sclerosing cholangitis

Acknowledgments

All authors have made significant contributions to the research described in this manuscript; ALK founded and maintained IBD register. PM carried out the study and data-analysis and drafted the manuscript, HH carried out the statistical analysis, and PC and ALK took part in the planning and designing the study. ALK, PC, JL and PA revised the draft of the manuscript. All authors read and approved the final manuscript.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. This study was financially supported by the Finnish Foundation for Gastroenterological Research, the Mary and Georg Ehrnrooth Foundation, and the Competitive Research Funding of Pirkanmaa Hospital District, Finland (9H166). The sponsor did not have any involvement in study design, collection, analysis, interpretation, writing, or submitting the manuscript.