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Meta-Analysis
. 2017 Jan 3;8(1):1031-1045.
doi: 10.18632/oncotarget.13715.

Chemopreventive effects of 5-aminosalicylic acid on inflammatory bowel disease-associated colorectal cancer and dysplasia: a systematic review with meta-analysis

Xinyun Qiu  1 , Jingjing Ma  1 , Kai Wang  2 , Hongjie Zhang  1
Affiliations
Meta-Analysis

Chemopreventive effects of 5-aminosalicylic acid on inflammatory bowel disease-associated colorectal cancer and dysplasia: a systematic review with meta-analysis

Xinyun Qiu et al. Oncotarget. .

Abstract

Background and aims: The chemopreventive effect of 5-aminosalicylic acid (5-ASA) in patients with inflammatory bowel disease (IBD) has been widely studied; however, the results remain conflicting. The aim of this study was to systematically review the literature and update evidence concerning effects of 5-ASA on the risk of colorectal cancer (CRC) and dysplasia (Dys) in patients with ulcerative colitis (UC) or Crohn's disease (CD).

Results: 5-ASA showed a chemopreventive effect against CRC/Dys in IBD patients (OR = 0.58, 95% CI: 0.45-0.75). However, this effect was significant only in clinical-based studies (OR = 0.51; 95% CI: 0.39-0.65), but not in population-based studies (OR = 0.71; 95% CI: 0.46-1.09). Moreover, this effect was noticeable in patients with UC (OR = 0.46, 95% CI: 0.34-0.61), but not in CD (OR = 0.66, 95% CI: 0.42-1.03), and on the outcome of CRC (OR = 0.54, 95% CI: 0.39-0.74), but not Dys (OR = 0.47; 95% CI: 0.20-1.10). In IBD patients, mesalazine dosage ≥ 1.2 g/day showed greater protective effects against CRC/Dys than dosages < 1.2 g/day. However, Sulphasalazine therapy did not show any noticeable protective function regardless of the dosage administered.

Materials and methods: We performed a systematic review with a meta-analysis of 26 observational studies involving 15,460 subjects to evaluate the risks of developing CRC and Dys in IBD patients receiving 5-ASA treatment. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each evaluation index.

Conclusions: 5-ASA has a chemopreventive effect on CRC (but not Dys) in IBD patients. Moreover, UC patients can benefit more from 5-ASA than CD patients. Mesalazine maintenance dosage ≥ 1.2 g/day is an effective treatment for reducing CRC risk in IBD patients.

Keywords: 5-Aminosalicylic acid; chemopreventive effect; colorectal cancer; dysplasia; inflammatory bowel disease.

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Conflict of interest statement

CONFLICTS OF INTEREST

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow chart of the literature search
Figure 2
Figure 2. Forest plot of sub-analyses of 5-ASA on the risk of CRC/Dys in patients with IBD (UC/CD) between population-based and clinical-based cohort studies
Size of boxes is proportional to weight of the individual study. The relative weighted contribution of each of the studies to the overall pooled adjusted odds ratio is shown on the far right. CI, confidence interval.
Figure 3
Figure 3. Forest plot of sub-analyses of 5-ASA on the risk of CRC, Dys and CRC/Dys in patients with IBD (UC/CD)
Figure 4
Figure 4. Forest plot of sub-analyses of 5-ASA on the risk of CRC/Dys in patients with UC between population-based and clinical-based cohort studies
Figure 5
Figure 5. Forest plot of sub-analyses of 5-ASA on the risk of CRC, Dys and CRC/Dys in patients with UC
Figure 6
Figure 6. Forest plot of sub-analyses of 5-ASA on the risk of CRC/Dys in patients with CD between population-based and clinical-based cohort studies
Figure 7
Figure 7. Forest plot of sub-analyses of 5-ASA on the risk of CRC, Dys and CRC/Dys in patients with CD
Figure 8
Figure 8. Forest plot of sub-analyses of 5-ASA (sulfasalazine and mesalazine) with different dosages (for sulfasalazine, daily dosage less than 2.0 g/d and above 2.0 g/d were estimated separately; for mesalazine, daily dosage less than 1.2 g/d and above 1.2 g/d were estimated separately) on the risk of CRC/Dys in patients with IBD
Figure 9
Figure 9. Forest plot of sub-analyses of 5-ASA on the risk of CRC/Dys in IBD patients from different geographical regions
See this image and copyright information in PMC

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