The risk of colorectal cancer in ulcerative colitis: a meta-analysis

Abstract

Background and aims-Controversy surrounds the risk of colorectal cancer (CRC) in ulcerative colitis (UC). Many studies have investigated this risk and reported widely varying rates. Methods-A literature search using Medline with the explosion of references identified 194 studies. Of these, 116 met our inclusion criteria from which the number of patients and cancers detected could be extracted. Overall pooled estimates, with 95% confidence intervals (CI), of cancer prevalence and incidence were obtained using a random eVects model on either the log odds or log incidence scale, as appropriate. Results-The overall prevalence of CRC in any UC patient, based on 116 studies, was estimated to be 3.7% (95% CI 3.2-4.2%). Of the 116 studies, 41 reported colitis duration. From these the overall incidence rate was 3/1000 person years duration (pyd), (95% CI 2/1000 to 4/1000). The overall incidence rate for any child was 6/1000 pyd (95% CI 3/1000 to 13/1000). Of the 41 studies, 19 reported results stratified into 10 year intervals of disease duration. For the first 10 years the incidence rate was 2/1000 pyd (95% CI 1/1000 to 2/1000), for the second decade the incidence rate was estimated to be 7/1000 pyd (95% CI 4/1000 to 12/1000), and in the third decade the incidence rate was 12/1000 pyd (95% CI 7/1000 to 19/1000). These incidence rates corresponded to cumulative probabilities of 2% by 10 years, 8% by 20 years, and 18% by 30 years. The worldwide cancer incidence rates varied geographically, being 5/1000 pyd in the USA, 4/1000 pyd in the UK, and 2/1000 pyd in Scandinavia and other countries. Over time the cancer risk has increased since 1955 but this finding was not significant (p=0.8). Conclusions-Using new meta-analysis techniques we determined the risk of CRC in UC by decade of disease and defined the risk in pancolitics and children. We found a non-significant increase in risk over time and estimated how risk varies with geography. (Gut 2001;48:526-535)

Proinflammatory cytokines and IL-10 in inflammatory bowel disease and colorectal cancer patients

“…At the same time, deficiency of IL-10, an anti-inflammatory cytokine, seems to contribute to persistent intestinal inflammation (Li and He 2004;Shih and Targan 2008). Clinical reports have well document an increased risk of intestinal cancer in UC and CD patients (Askling et al 2001;Eaden et al 2001;Jess et al 2005). However, it is still unclear if any relationship exists between pro-inflammatory cytokine and IL-10 expression in IBD and the development of intestinal neoplasms.…”

Ulcerative colitis and cancer

“…Patients with UC are at an increased risk for the development of colorectal cancer (CRC) and the incidence worldwide varies. In the USA, the incidence is approximately 4/1,000 pyd and the overall prevalence in any UC patients is about 3.5% [1,2]. Excess mortality and morbidity in the setting of IBD is due to increased incidence of CRC [2].…”

“…Unlike FAP and HNPCC [and sporadic CRC (SCRC)], the risk of CRC is primarily related to logstanding chronic inflammation [3]. The risk of CRC increases with increased duration and extent of UC [1,2,4]. Eaden et al [1] in a metaanalysis of 116 studies observed that the incidence of CRC based on cumulative probabilities is 2% at 10 years, 8% at 20 years, and 18% at 30 years irrespective of disease extent.…”

“…The risk of CRC increases with increased duration and extent of UC [1,2,4]. Eaden et al [1] in a metaanalysis of 116 studies observed that the incidence of CRC based on cumulative probabilities is 2% at 10 years, 8% at 20 years, and 18% at 30 years irrespective of disease extent. The highest risk of cancer is in patients with pancolonic disease.…”

Getting a Low Grade for Missing High-Grade Dysplasia and Colorectal Cancer in IBD

“…Inflammatory bowel disease (IBD) is associated with an increased risk of developing colorectal cancer (CRC) associated with the duration and extent of the disease [1]. Unlike sporadic CRC, CRC in IBD patients is often difficult to detect, due to the presence of ill-defined margins and often atypical gross and endoscopic appearances [2].…”