The Risk of Colonic Neoplasia in IBD-PSC Patients Is Dependent on Disease Presentation Phenotype
Adriana Krizova, David F Schaeffer, Sara Hafezi-Bakhtiari, Hala Girgis, Hala El-Zimaity. University Health Network, Toronto, ON, Canada; University of British Columbia, Vancouver, BC, Canada
Background: Patients with inflammatory bowel disease (IBD) and associated primary sclerosing cholangitis (PSC) have a perceived elevated risk of developing colorectal neoplasia or invasive cancer than patients with only IBD. Thus, the frequency of neoplasia surveillance is currently recommended at an annual interval, but there are surprisingly few data to support this practice. Since we have recently demonstrated that IBD associated with PSC has a different phenotype depending on primary disease presentation (IBD preceding PSC vs. PSC preceding IBD), we studied whether the risk of colonic neoplasia is also dependent on disease presentation.
Design: We identified patients with PSC and IBD seen and followed up at the University Health Network, Toronto between 1985 and 2011 and divided them into two groups based on site of primary disease presentation (hepatic vs. colonic). The control group was comprised of patients with IBD, but without PSC. Primary outcome parameter was the development of colonic neoplasia.
Results: The average colitis follow up period was 10 years for PSC patients that developed colitis (PSC-IBD), 19 years for IBD patients that developed PSC (IBD-PSC), and 13 years for the control IBD group without PSC. Colonic neoplasia incidence was higher in IBD patients that subsequently developed PSC as compared to PSC patients that developed IBD (p= 0.005).
|Disease presentation phenotype||Neoplasia in UC||Neoplasia in Crohn's disease||Total|
|IBD-PSC (n=51)||4 of 41 (10%)||2 of 10 (2%)||6 of 51 (12%), p=0.18|
|PSC-IBD (n=62)||0 of 55 (0%)||0 of 7 (0%)||0 of 62 (0%), p=0.15|
|Control group (n=102)||2 of 58 (3%)||3 of 44 (7%)||5 of 102 (5%)|