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. 2009 Nov 17;101(10):1671-5.
doi: 10.1038/sj.bjc.6605359. Epub 2009 Oct 13.

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

M W M D Lutgens  1 , B Oldenburg, P D Siersema, A A van Bodegraven, G Dijkstra, D W Hommes, D J de Jong, P C F Stokkers, C J van der Woude, F P Vleggaar
Affiliations

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

M W M D Lutgens et al. Br J Cancer. .

Abstract

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=0.042). In the surveillance group, only one patient died as a consequence of CRC compared with 29 patients in the control group (P=0.047). In addition, more early tumour stages were found in the surveillance group (P=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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Figures

Figure 1
Figure 1
Survival analysis for CRC-related and overall mortality. The Tarone–Ware test of equality of survival distribution was used to compare survival between the two groups. CRC-related mortality is presented by solid squares and line. Overall mortality is presented by outlined squares and line. For CRC-related mortality, the 5-year survival in the surveillance group (solid squares) was 100% compared with 74% in the non-surveillance group (solid black line) (P=0.029); the primary end point was date of death due to CRC; cases were censored for date of end of study, date of death related to any other primary malignancy, date of death related to colectomy, date of death by any other cause, and date of lost to follow-up. For overall mortality, the 5-year survival in the surveillance group (outlined squares) was 100% compared with 65% in the non-surveillance group (outlined line; P=0.042); the primary end point was date of death; cases were censored for date of end of study period and date of lost to follow-up. CRC, colorectal cancer.
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