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. 2015 Oct;110(10):1461-71; quiz 1472.
doi: 10.1038/ajg.2015.248. Epub 2015 Sep 29.

Low-grade dysplasia in ulcerative colitis: risk factors for developing high-grade dysplasia or colorectal cancer

Chang-ho Ryan Choi  1   2 , Ana Ignjatovic-Wilson  3 , Alan Askari  4 , Gui Han Lee  4 , Janindra Warusavitarne  4 , Morgan Moorghen  5 , Siwan Thomas-Gibson  3 , Brian P Saunders  3 , Matthew D Rutter  6 , Trevor A Graham  2 , Ailsa L Hart  1
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Low-grade dysplasia in ulcerative colitis: risk factors for developing high-grade dysplasia or colorectal cancer

Chang-ho Ryan Choi et al. Am J Gastroenterol. 2015 Oct.

Abstract

Objectives: The aim of this study was to identify risk factors associated with development of high-grade dysplasia (HGD) or colorectal cancer (CRC) in ulcerative colitis (UC) patients diagnosed with low-grade dysplasia (LGD).

Methods: Patients with histologically confirmed extensive UC, who were diagnosed with LGD between 1993 and 2012 at St Mark's Hospital, were identified and followed up to 1 July 2013. Demographic, endoscopic, and histological data were collected and correlated with the development of HGD or CRC.

Results: A total of 172 patients were followed for a median of 48 months from the date of initial LGD diagnosis (interquartile range (IQR), 15-87 months). Overall, 33 patients developed HGD or CRC (19.1% of study population; 20 CRCs) during study period. Multivariate Cox proportional hazard analysis revealed that macroscopically non-polypoid (hazard ratio (HR), 8.6; 95% confidence interval (CI), 3.0-24.8; P<0.001) or invisible (HR, 4.1; 95% CI, 1.3-13.4; P=0.02) dysplasia, dysplastic lesions ≥1 cm in size (HR, 3.8; 95% CI, 1.5-13.4; P=0.01), and a previous history of "indefinite for dysplasia" (HR, 2.8; 95% CI, 1.2-6.5; P=0.01) were significant contributory factors for HGD or CRC development. Multifocal dysplasia (HR, 3.9; 95% CI, 1.9-7.8; P<0.001), metachronous dysplasia (HR, 3.5; 95% CI, 1.6-7.5; P=0.001), or a colonic stricture (HR, 7.4; 95% CI, 2.5-22.1; P<0.001) showed only univariate correlation to development of HGD or CRC.

Conclusions: Lesions that are non-polypoid or endoscopically invisible, large (≥1 cm), or preceded by indefinite dysplasia are independent risk factors for developing HGD or CRC in UC patients diagnosed with LGD.

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Figures

Figure 1
Figure 1
Lesion shape categorization. Discrete sessile, (a) pedunculated (b), or sub-pedunculated lesions (c) that were well circumscribed from the surrounding mucosa were classifi ed as “polypoid” LGD. Superfi cially raised (d and e), visible fl at (f), irregular, or plaque-like lesions were classifi ed as “nonpolypoid” LGD.
Figure 2
Figure 2
Kaplan–Meier plots showing cumulative risk of developing high-grade dysplasia (HGD) or colorectal cancer (CRC). (a) Overall cumulative risk. (b) Cumulative risk by low-grade dysplasia (LGD) lesion shape. (c) Cumulative risk by LGD lesion size. (d) Cumulative risk depending on the presence or absence of preceding indefinite dysplasia.
Figure 3
Figure 3
Kaplan–Meier plot showing the cumulative risk of high-grade dysplasia (HGD) or colorectal cancer (CRC) development depending on total number of risk factors present (i.e., any combinations of nonpolypoid or invisible low-grade dysplasia (LGD), LGD sized ≥1 cm, and/or preceding indefinite dysplasia).
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References

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