Risk of Colorectal Cancer in Patients With Ulcerative Colitis: A Meta-analysis of Population-Based Cohort Studies

doi:10.1016/j.cgh.2012.01.010

Clinical Gastroenterology and Hepatology

Volume 10, Issue 6, June 2012, Pages 639-645

https://doi.org/10.1016/j.cgh.2012.01.010 Get rights and content

Background & Aims

Patients with ulcerative colitis (UC) have an increased risk of developing colorectal cancer (CRC). Studies examining the magnitude of this association have yielded conflicting results. We performed a meta-analysis of population-based cohort studies to determine the risk of CRC in patients with UC.

Methods

We used MEDLINE, EMBASE, Cochrane, and CINAHL to perform a systematic literature search. We included 8 studies in the meta-analysis on the basis of strict inclusion and exclusion criteria. We calculated pooled standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) for risk of CRC in patients with UC and performed meta-regression analyses of the effect of cohort size, calendar period, observation time, percentage with proctitis, and rates of colectomy on the risk of CRC.

Results

An average of 1.6% of patients with UC was diagnosed with CRC during 14 years of follow-up. SIRs ranged from 1.05 to 3.1, with a pooled SIR of 2.4 (95% CI, 2.1–2.7). Men with UC had a greater risk of CRC (SIR, 2.6; 95% CI, 2.2–3.0) than women (SIR, 1.9; 95% CI, 1.5–2.3). Young age was a risk factor for CRC (SIR, 8.6; 95% CI, 3.8–19.5; although this might have resulted from small numbers), as was extensive colitis (SIR, 4.8; 95% CI, 3.9–5.9). In meta-regression analyses, only cohort size was associated with risk of CRC.

Conclusions

In population-based cohorts, UC increases the risk of CRC 2.4-fold. Male sex, young age at diagnosis with UC, and extensive colitis increase the risk.

Section snippets

Literature Search

To identify articles on risk of CRC in unselected cohorts of patients with UC, a systematic MEDLINE, EMBASE, CINAHL, and Cochrane Library search was conducted without restrictions on language, as outlined in Figure 1. We limited the search to items with abstracts only. Abstract books from the American Digestive Diseases Week (2006–2011) and the United European Gastroenterology Week (2006–2010) were searched manually, examining all abstracts on UC and CRC in the inflammatory bowel disease (IBD)

Overall Risk of Colorectal Cancer

The eight included population-based cohort studies of CRC risk in patients with UC (Table 1) that reported overall ratios of observed to expected numbers of CRC varying from 1.05 (95% CI, 0.56–1.79)¹² to 2.7 (95% CI, 2.3–3.2)¹⁸ (Table 2). The 8 studies were pooled by using a random effects model (heterogeneity test, χ² = 14.2, P = .048; I² = 50.7%), and the pooled estimate showed a significantly increased risk of CRC in UC of 2.4 (95% CI, 2.1–2.7; Figure 2). The Swedish study by Söderlund et al

Discussion

This meta-analysis was conducted to produce a reliable and unbiased estimate of the risk of CRC among patients with UC. The risk was 2.4-fold increased and was related to male gender, young age at diagnosis, and extensive disease. Still, only 1.6% of UC patients developed CRC during follow-up (including sporadic cases). Meta-regression analyses revealed an effect of cohort size on risk of CRC (positive correlation), but not of calendar period, disease duration, or colectomy rates.

The strength

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: Conflicts of interest The authors disclose no conflicts.

: Funding Dr Jess is supported by a Female Research Leader Grant from the Danish Council of Independent Research.

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Original article—alimentary tractRisk of Colorectal Cancer in Patients With Ulcerative Colitis: A Meta-analysis of Population-Based Cohort Studies

Background & Aims

Methods

Results

Conclusions

Section snippets

Literature Search

Overall Risk of Colorectal Cancer

Discussion

Clin Gastroenterol Hepatol

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Am J Gastroenterol

Gastroenterology

Rev Epidemiol Sante Publique

Gastroenterology

Intestinal inflammation and cancer

Gastroenterology

Chronic ulcerative colitis associated with malignant disease, 1928

Dis Colon Rectum

Ulcerative colitis: epidemiology and aetiology, course and prognosis

Br Med J

The risk of colorectal cancer in ulcerative colitis: a meta-analysis

Gut

Ulcerative colitis-associated colorectal cancer shows a poorer survival than sporadic colorectal cancer: a nationwide Japanese study

Inflamm Bowel Dis

Survival after colorectal cancer in patients with ulcerative colitis: a nationwide population-based Danish study

Am J Gastroenterol

Review article: insurance risks for patients with ulcerative colitis or Crohn's disease

Aliment Pharmacol Ther

Classification of inflammatory bowel disease

Scand J Gastroenterol Suppl

Ulcerative colitis in Olmsted County, Minnesota, 1940-1993: incidence, prevalence, and survival

Gut

Original article—alimentary tract
Risk of Colorectal Cancer in Patients With Ulcerative Colitis: A Meta-analysis of Population-Based Cohort Studies