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. 2023 May 1;118(5):848-854.
doi: 10.14309/ajg.0000000000002099. Epub 2022 Dec 23.

Increased Proportion of Colorectal Cancer in Patients With Ulcerative Colitis Undergoing Surgery in the Netherlands

Lianne Heuthorst  1 , Houda Harbech  1 , Harmanna J Snijder  1   2   3   4 , Aart Mookhoek  5 , Geert R D'Haens  2 , Séverine Vermeire  3 , André D'Hoore  4 , Willem A Bemelman  1 , Christianne J Buskens  1
Affiliations

Increased Proportion of Colorectal Cancer in Patients With Ulcerative Colitis Undergoing Surgery in the Netherlands

Lianne Heuthorst et al. Am J Gastroenterol. .

Abstract

Introduction: The aim of the current study was to assess whether there is an indication shift for surgery in patients with ulcerative colitis (UC) from refractory disease to malignant degeneration over the past 3 decades.

Methods: All patients with histologically confirmed UC who underwent a colorectal resection between 1991 and 2020 were extracted from the nationwide Dutch Pathology Registry. The primary outcome was the proportion of colorectal cancer (CRC) in the colon specimens. Outcomes were compared between 3 periods (P1: 1991-2000, P2: 2001-2010, and P3: 2011-2020).

Results: Overall, 6,094 patients with UC were included of which 4,854 underwent a (procto)colectomy and 1,240 a segmental resection. In 1,031 (16.9%) patients, CRC was demonstrated in the pathological resection specimen after a median disease duration of 11 years (IQR 3.0-19.0). The proportion of CRC increased from 11.3% in P1, to 16.1% in P2, and 22.8% in P3 ( P < 0.001). Median disease duration at the time of resection increased from 4 years in P1, to 10 years in P2, and 17 years in P3 ( P < 0.001). The proportion of patients diagnosed with advanced malignancy (pT3/T4) (P1: 61.2% vs P2: 65.2% vs P3: 62.4%, respectively, P = 0.633) and lymph node metastasis (N+) (P1: 33.0% vs P2: 41.9% vs P3: 38.2%, respectively, P = 0.113) did not change over time.

Discussion: This nationwide pathology study demonstrated an increased proportion of surgery for CRC over the past 3 decades. We hypothesize that the expanding therapeutic armamentarium for UC leads to exhausting medical options and hence postponed colectomy. This, however, might be at the expense of an increased risk of CRC in the long term.

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Conflict of interest statement

Guarantor of the article: Christianne J. Buskens, MD, PhD.

Specific author contributions: L.H., W.A.B., and C.J.B.: created the study concept and design. L.H. and H.H.: collected the data and conducted the analyses. L.H.: drafted the manuscript. All authors participated in the critical revision of the manuscript for intellectual content and approved the final version.

Financial support: This study was supported by a research grant from the European Crohn's and Colitis Organization.

Potential competing interests: L.H., H.H., H.J.S., and A.M. have no competing interests. G.R.D. has served as advisor for AbbVie, Ablynx, Active Biotech AB, AgomAb Therapeutics, Alimentiv, Allergan, Alphabiomics, Amakem, Amgen, AM Pharma, Applied Molecular Therapeutics; Arena Pharmaceuticals, AstraZeneca, Avaxia, Biogen, Bristol Myers Squibb/Celgene, Boehringer Ingelheim, Celltrion, Cosmo, DSM Pharma; Echo Pharmaceuticals, Eli Lilly, Engene, Exeliom Biosciences; Ferring, DrFALK Pharma, Galapagos, Genentech/Roche, Gilead, GlaxoSmithKline, Gossamerbio, Pfizer, Immunic, Johnson and Johnson, Kintai Therapeutics, Lument, Lycera, Medimetrics, Takeda, Medtronic, Mitsubishi Pharma, Merck Sharp & Dohme, Mundipharma, Nextbiotics, Novo Nordisk, Otsuka, PhotoPll, ProciseDx, Prodigest, Prometheus Laboratories/Nestle, Progenity, Protagonist, RedHill, Salix, Samsung Bioepis, Sandoz, Seres/Nestec/Nestle, Setpoint, Shire, Teva, Tigenix, Tillotts, Topivert, Versant, and Vifor. Received speaker fees from AbbVie, Biogen, Ferring, Galapagos/Gilead, Johnson and Johnson, Merck Sharp & Dohme, Mundipharma, Norgine, Pfizer, Samsung Bioepis, Shire, Millennium/Takeda, Tillotts, and Vifor. S.V. has received grants from AbbVie, J&J, Pfizer, Galapagos, and Takeda and has received consulting and/or speaking fees from AbbVie, AbolerIS Pharma, AgomAb, Alimentiv, Arena Pharmaceuticals, AstraZeneca, Avaxia, BMS, Boehringer Ingelheim, Celgene, CVasThera, Dr. Falk Pharma, Ferring, Galapagos, Genentech-Roche, Gilead, GSK, Hospira, Imidomics, Janssen, J&J, Lilly, Materia Prima, MiroBio, Morphic, MrMHealth, Mundipharma, MSD, Pfizer, Prodigest, Progenity, Prometheus, Robarts Clinical Trials, Second Genome, Shire, Surrozen, Takeda, Theravance, Tillots Pharma AG, and Zealand Pharma. A.D. has no competing interests. W.A.B. has received research funding from VIFOR; served as a consultant for Takeda and Braun; and received speakers fees from Takeda, Johnson, Braun, and Medtronic. C.J.B. has an unrestricted grant from Boehringer Ingelheim and Roche AND has received consultancy fees or speaker's honoraria from AbbVie, Merck Sharp & Dohme, Tillotts, Janssen, and Takeda.

Figures

Figure 1.
Figure 1.
Selection of study population. IBD, inflammatory bowel disease; PALGA, Dutch Pathology Registry; UC, ulcerative colitis.
Figure 2.
Figure 2.
Proportion of patients with ulcerative colitis undergoing resection for CRC per period (P < 0.001). CRC, colorectal cancer.
See this image and copyright information in PMC

References

    1. Dulai PS, Sandborn WJ, Gupta S. Colorectal cancer and dysplasia in inflammatory bowel disease: A review of disease epidemiology, pathophysiology, and management. Cancer Prev Res (Phila) 2016;9(12):887–94. - PMC - PubMed
    1. Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: A meta-analysis. Gut 2001;48(4):526–35. - PMC - PubMed
    1. Jess T, Rungoe C, Peyrin–Biroulet L. Risk of colorectal cancer in patients with ulcerative colitis: A meta-analysis of population-based cohort studies. Clin Gastroenterol Hepatol 2012;10(6):639–45. - PubMed
    1. Lutgens MWMD, van Oijen MGH, van der Heijden GJMG, et al. . Declining risk of colorectal cancer in inflammatory bowel disease: An updated meta-analysis of population-based cohort studies. Inflamm Bowel Dis 2013;19(4):789–99. - PubMed
    1. Castaño-Milla C, Chaparro M, Gisbert JP. Systematic review with meta-analysis: The declining risk of colorectal cancer in ulcerative colitis. Aliment Pharmacol Ther 2014;39(7):645–59. - PubMed

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