Is colonoscopic surveillance reducing colorectal cancer mortality in ulcerative colitis? A population based case control study

Karlén, Per; Kornfeld, Dan; Broström, Olle; Löfberg, Robert; Persson, P G; Ekbom, Anders

doi:10.1136/gut.42.5.711

Cited by 261 publications

(134 citation statements)

References 29 publications

(10 reference statements)

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“…In their series, as in ours, CRC was detected at a significantly earlier stage in patients who had undergone colonoscopic surveillance. Karlen et al, (1998) identified a trend towards a protective effect of colonoscopic surveillance.…”

Section: Discussionmentioning

confidence: 99%

“…We feel that it is prudent to join the ulcerative colitis and Crohn's colitis data, because there is increasing evidence that the pathogenesis and natural behaviour of inflammation-associated dysplasia in ulcerative colitis and Crohn's disease do not differ, and the risk of CRC is increased in both (1,2). A recent systematic review (Collins et al, 2006) by the Cochrane collaboration detected only three papers (Lashner et al, 1990;Choi et al, 1993;Karlen et al, 1998) that properly addressed the question of surveillance effectiveness for patients with ulcerative colitis. Other surveillance studies lacked valid control groups (Rosenstock et al, 1985;Lofberg et al, 1990;Nugent et al, 1991;Jonsson et al, 1994;Friedman et al, 2001;Biasco et al, 2002;Hata et al, 2003) or were not designed to answer this question (Eaden et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

“…A recent review by the Cochrane Collaboration (Collins et al, 2006) identified three studies that presented indirect evidence for improved survival from colonoscopic surveillance in ulcerative colitis patients (Lashner et al, 1990;Choi et al, 1993;Karlen et al, 1998). These studies either had a low number of patients with IBD-associated CRC or a low number of patients in a surveillance programme, which prevented the outcomes from reaching statistical significance.…”

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Colonoscopic surveillance improves survival after colorectal cancer diagnosis in inflammatory bowel disease

et al. 2009

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BACKGROUND: Colonoscopic surveillance provides the best practical means for preventing colorectal cancer (CRC) in inflammatory bowel disease (IBD) patients. Strong evidence for improved survival from surveillance programmes is sparse. METHOD: The aim of this study was to compare tumour stage and survival of IBD patients with CRC who were a part of a surveillance programme with those who were not. A nationwide pathology database (PALGA (pathologisch anatomisch landelijk geautomatiseerd archief)) was consulted to identify IBD patients with CRC treated in all eight university hospitals in The Netherlands over a period of 15 years. Patients were assigned to the surveillance group when they had undergone one or more surveillance colonoscopies before a diagnosis of CRC. Patients who had not undergone surveillance served as controls. Tumour stage and survival were compared between the two groups. RESULTS: A total of 149 patients with IBD-associated CRC were identified. Twenty-three had had colonoscopic surveillance before CRC was discovered. The 5-year CRC-related survival rate of patients in the surveillance group was 100% compared with 74% in the non-surveillance group (P ¼ 0.042). In the surveillance group, only one patient died as a consequence of CRC compared with 29 patients in the control group (P ¼ 0.047). In addition, more early tumour stages were found in the surveillance group (P ¼ 0.004). CONCLUSIONS: These results provide evidence for improved survival from colonoscopic surveillance in IBD patients by detecting CRC at a more favourable tumour stage.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Colonoscopic surveillance improves survival after colorectal cancer diagnosis in inflammatory bowel disease

et al. 2009

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“…First, no prior studies have indicated improved survival among UC patients with CRC when compared to those with sporadic CRC, as Shaukat et al [14] suggested. Studies by Karlen et al [21] and Choi et al [22] determined that colonoscopic surveillance is associated with an improved CRC survival in patients with UC when compared to UC patients not undergoing colonoscopic surveillance. These studies did not compare CRC survival in UC patients versus patients in the general population.…”

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confidence: 99%

“…These studies did not compare CRC survival in UC patients versus patients in the general population. As discussed above, these studies [21,22] along with a study by Lashner et al [23] were included in a Cochrane Collaboration analysis [19] that found no survival benefit in UC-CRC patients who underwent colonoscopic surveillance versus those who did not. Second, Shaukat et al assessed only 3-year CRC survival, whereas previous studies reported 5-year survival.…”

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confidence: 99%

Survival in Elderly Patients with Ulcerative Colitis and Colorectal Cancer

Błoński

Lichtenstein

2012

Dig Dis Sci

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Patients with ulcerative colitis (UC) have an increased risk of developing colorectal cancer (CRC). A meta-analysis by Eaden et al. [1] that included 116 studies determined an overall prevalence of CRC in any UC patients of 3.7% and cumulative probabilities of CRC of 2% by 10 years, 8% by 20 years, and 18% by 30 years of UC duration. It also observed a geographic variability in CRC incidence rates from 5/1,000 person-years duration in the US, 4/1,000 person-years duration in UK and 2/1,000 person-years duration in Scandinavia and other countries [1]. Several other factors have also been suggested to influence the risk of CRC in patients with UC. A population-based cohort study by Anders Ekbom and his group from Sweden observed an increased risk of CRC in association with more anatomically extensive UC [2]. Patients with pancolitis (SIR 14.8,) and left-sided colitis (SIR 2.8, 95% CI 1.6-4.4) had a 15-fold and threefold increase in standardized incidence ratio, respectively, whereas those with UC limited to the rectum had lower risk of CRC (SIR 1.7, 95% CI 0.8-3.2) [2]. Another report from a combined Swedish and English population cohort observed a significantly increased 19.2 excess risk of CRC in those with pancolitis (p = 0.001) and 3.6 (p = 0.01) in those with left-sided colitis [3]. Younger age at the onset of UC was also found to significantly impact the risk of CRC based on data from population-based cohort [2]. Patients younger than 15 years at the time of UC diagnosis had the highest risk of CRC (SIR 118.3, 95% CI 63.0-202.3) [2]. An absolute risk of CRC was 40% in patients younger than 15 years of age at the time of initial UC diagnosis, 25% for those aged 15-39 years, and 15% for those aged more than 40 years [2]. Multivariable logistic regression identified that among analyzed variables, age at the time of UC diagnosis, extent of UC at diagnosis, and duration of follow-up only age younger than 15 years (adjusted SIR 4.03, 95% CI 2.07-7.85) and presence of pancolitis (adjusted SIR 5.27, 95% CI 3.22-8.61) at the time of initial UC diagnosis were significantly associated with four-fivefold increased risk of CRC [2]. The risk of CRC adjusted for extent of disease at the time of initial diagnosis decreased with each increase in age group at diagnosis (age \15, 15-29, 30-39, 40-49, 50-59, and 60 years and above) [2]. An analysis of the cohort from an academic referral center determined that severity of histologic inflammation within the colon of UC patients increases the risk of CRC threefold (HR 3.0, 95% CI 1.4-6.3) [4]. Data from tertiary referral center casecontrol study found that increasing severity of both endoscopically visible and histological colonic inflammation are associated with 2.5-fold (OR 2.5, 95% CI 1.45-4.44) and fivefold (5.13, 95% CI 2.36-11.14) increased risk of CRC among UC patients when compared to non-CRC UC controls, respectively [5].Another important risk factor for CRC observed in population-based studies in patients with UC was a family history of CRC in a first-degree relative. ...

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Strategies for detecting colon cancer and/or dysplasia in patients with inflammatory bowel disease

Mpofu

Watson

Rhodes

2004

Cochrane Database of Systematic Reviews

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Is colonoscopic surveillance reducing colorectal cancer mortality in ulcerative colitis? A population based case control study

Abstract: (Gut 1998;42:711-714)

Cited by 261 publications

References 29 publications

Colonoscopic surveillance improves survival after colorectal cancer diagnosis in inflammatory bowel disease

Colonoscopic surveillance improves survival after colorectal cancer diagnosis in inflammatory bowel disease

Survival in Elderly Patients with Ulcerative Colitis and Colorectal Cancer

Strategies for detecting colon cancer and/or dysplasia in patients with inflammatory bowel disease

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