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J Crohns Colitis. 2019 Jun 7. pii: jjz114. doi: 10.1093/ecco-jcc/jjz114. [Epub ahead of print]

Long-term risk of advanced neoplasia after colonic low-grade dysplasia in patients with inflammatory bowel disease: a nationwide cohort study.

Author information

1
Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Radboud university medical centre, Nijmegen, The Netherlands.
2
Department of Gastroenterology and Hepatology, Jeroen Bosch hospital, 's-Hertogenbosch, The Netherlands.
3
Department of Pathology, Radboud university medical centre, Nijmegen, The Netherlands.
4
Department of Gastroenterology and Hepatology, Rijnstate hospital, Arnhem, The Netherlands.

Abstract

BACKGROUND AND AIMS:

The long-term risk of high-grade dysplasia (HGD) and colorectal cancer (CRC) following low-grade dysplasia (LGD) in inflammatory bowel disease (IBD) patients is relatively unknown. We aimed to determine the long-term cumulative advanced neoplasia (HGD and/or CRC) incidence, and to identify risk factors for advanced neoplasia in a nationwide IBD cohort with a history of LGD.

METHODS:

This is a nationwide cohort study using data from the Dutch National Pathology Registry (PALGA) to identify all IBD patients with LGD between 1991 and 2010 in the Netherlands. Follow-up data were collected until January 2016. We determined the cumulative advanced neoplasia incidence and identified risk factors with multivariable Cox regression analysis.

RESULTS:

We identified 4,284 patients with colonic LGD with a median follow-up of 6.4 years after initial LGD diagnosis. Cumulative incidence of subsequent advanced neoplasia was 3.6, 8.5, 14.4 and 21.7%, after 1, 5, 10 and 15 years, respectively. Median time to develop advanced neoplasia after LGD was 3.6 years. Older age (> 55 years) at moment of LGD (hazard ratio (HR) 1.73, 95% CI 1.44-2.06), male gender (HR 1.33, 95% CI 1.10-1.60), and follow-up at an academic (versus non-academic) medical centre (HR 1.37, 95% CI 1.07-1.76) were independent risk factors for advanced neoplasia following LGD.

CONCLUSIONS:

In a large nationwide cohort with long-term follow-up of IBD patients with LGD, the cumulative incidence of advanced neoplasia was 21.7% after 15 years. Older age at LGD (>55 years), male gender, and follow-up by a tertiary IBD referral centre were independent risk factors for advanced neoplasia development after initial LGD.

KEYWORDS:

Colorectal cancer; Crohn’s disease; High-grade dysplasia; Ulcerative colitis

PMID:
31175827
DOI:
10.1093/ecco-jcc/jjz114

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