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Colorectal Cancer in Inflammatory Bowel Diseases: A Population-Based Study in Utah

Abstract

Background and Aims

The molecular, endoscopic, and histological features of IBD-associated CRC differ from sporadic CRC. The objective of this study was to describe the prevalence, clinical features, and prognosis of IBD-associated CRC compared to patients with sporadic CRC in a US statewide population-based cohort.

Methods

All newly diagnosed cases of CRC between 1996 and 2011 were obtained from Utah Cancer Registry. IBD was identified using a previously validated algorithm, from statewide databases of Intermountain Healthcare, University of Utah Health Sciences, and the Utah Population Database. Logistic regression was performed to identify risk factors associated with IBD-associated cancer and Cox regression for differences in survival.

Results

Among 12,578 patients diagnosed with CRC, 101 (0.8%) had a prior history of IBD (61 ulcerative colitis and 40 Crohn’s disease). The mean age at CRC diagnosis was greater for patients without IBD than those with IBD (67.1 vs 52.8 years, P < 0.001). Individuals with IBD-associated CRC were more likely to be men (odds ratio [OR] 1.90, 95% CI 1.23–2.92), aged less than 65 years (OR 6.77, 95% CI 4.06–11.27), and have CRC located in the proximal colon (OR 2.79, 95% CI 1.85–4.20) than those with sporadic CRC. Nearly 20% of the IBD-associated CRCs had evidence of primary sclerosing cholangitis. After adjustment for age, gender, and stage at diagnosis, the excess hazard of death after CRC diagnosis was 1.7 times higher in IBD than in non-IBD patients (95% CI 1.27–2.33).

Conclusions

The features of patients with CRC and IBD differ significantly from those without IBD and may be associated with increased mortality.

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Acknowledgments

The study was funded by the Crohn’s and Colitis Foundation of America, National Cancer Institute, American College of Gastroenterology, and the Huntsman Cancer Foundation. The funding sources did not play a role in the design, conduct, or reporting of the study or in the decision to submit the manuscript for publication.

Funding/support

Support for this project was provided by the Crohn’s and Colitis Foundation of America Senior Research Award (NJS), NCI Grants P01-CA073992 (RWB), R01-CA040641 (RWB), and a Junior Faculty Career Development Award from the American College of Gastroenterology (NJS). Partial support for the Utah Population Database and this project was provided by the Huntsman Cancer Institute Cancer Center Support Grant P30CA042014 from the National Cancer institute and the Huntsman Cancer Foundation. Support for the Utah Cancer Registry is provided by Contract #HHSN 261201000026C from the National Cancer Institute with additional support from the Utah Department of Health and the University of Utah.

Author’s contribution

Drs. Samadder and Curtin had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analyses. NJS, RWB, KS, JV, SG, CNB, and HS contributed to study concept and design; KS, KC, KR, JW, YW, RWB, and NJS acquired, analyzed, and interpreted the data; NJS drafted the manuscript; KC, KS, RWB, CU, CB, SG, HH, MB, and KR critically revised the manuscript for important intellectual content; LP, KB, and KS contributed to statistical analysis; and NJS and RWB obtained funding.

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Correspondence to N. Jewel Samadder.

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Conflict of interest

NJS is a consultant for Cook Medical. CNB has consulted to Abbvie Canada, Ferring Canada, Janssen Canada, Pfizer Canada, Shire Canada, Takeda Canada, Mylan Pharmaceuticals, and Bristol Myers Squibb. HS has consulted to Pendopharm and received a Research Grant from Merck Canada. No other authors have a conflict of interest to disclose.

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Jewel Samadder, N., Valentine, J.F., Guthery, S. et al. Colorectal Cancer in Inflammatory Bowel Diseases: A Population-Based Study in Utah. Dig Dis Sci 62, 2126–2132 (2017). https://doi.org/10.1007/s10620-016-4435-4

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Keywords

  • Inflammatory bowel disease
  • Crohn’s disease
  • Ulcerative colitis
  • Colorectal cancer