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Patients with Endoscopically Visible Polypoid Adenomatous Lesions Within the Extent of Ulcerative Colitis Have an Increased Risk of Colorectal Cancer Despite Endoscopic Resection

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Abstract

Objectives

Ulcerative colitis (UC) is associated with an increased risk of colorectal cancer (CRC). Few studies have looked at long-term outcomes of endoscopically visible adenomatous lesions removed by endoscopic resection in these patients. We aimed to assess the risk of developing CRC in UC patients with adenomatous lesions that develop within the segment of colitis compared to the remainder of an ulcerative colitis cohort.

Methods

We identified patients with a confirmed histological diagnosis of UC from 1991 to 2004 and noted outcomes till June 2011. The Kaplan–Meier method was used to estimate cumulative probability of subsequent CRC. Factors associated with risk of CRC were assessed in a Cox proportional hazards model.

Results

Twenty-nine of 301 patients with UC had adenomatous lesions noted within the segment of colitis. The crude incidence rate of developing colon cancer in patients with UC was 2.45 (95 % CI 1.06–4.83) per 1000 PYD and in those with UC and polypoid adenomas within the extent of inflammation was 11.07 (95 % CI 3.59–25.83) per 1000 PYD. Adjusted hazards ratio of developing CRC on follow-up in UC patients with polypoid dysplastic adenomatous lesions within the extent of inflammation was 4.0 (95 % CI 1.3–12.4).

Conclusions

The risk of developing CRC is significantly higher in UC patients with polypoid adenomatous lesions, within the extent of inflammation, despite endoscopic resection. Patients and physicians should take the increased risk into consideration during follow-up of these patients.

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Author Contributions

VS, RP, and CF contributed to study concept and design. VS, SC, FE, and AB collected the data. VS performed statistical analysis, wrote the first draft of the paper, and edited the manuscript. All authors approved the final version.

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Authors and Affiliations

  1. Molecular Gastroenterology, Leeds Institute Biomedical and Clinical Sciences, St James University Hospital, University of Leeds, Leeds, UK

    Venkataraman Subramanian

  2. Department of Gastroenterology, St George’s Healthcare NHS Trust, Tooting, London, UK

    Venkataraman Subramanian, Sukhdev Chatu, Fabian Echterdiek, Ashwini Banerjee & Richard C. G. Pollok

  3. Department of Histopathology, St George’s Healthcare NHS Trust, Tooting, London, UK

    Caroline Finlayson

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  1. Venkataraman Subramanian
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  2. Sukhdev Chatu
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  6. Richard C. G. Pollok
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Correspondence to Richard C. G. Pollok.

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Subramanian, V., Chatu, S., Echterdiek, F. et al. Patients with Endoscopically Visible Polypoid Adenomatous Lesions Within the Extent of Ulcerative Colitis Have an Increased Risk of Colorectal Cancer Despite Endoscopic Resection. Dig Dis Sci 61, 3031–3036 (2016). https://doi.org/10.1007/s10620-016-4246-7

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  • DOI: https://doi.org/10.1007/s10620-016-4246-7

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