WESTPORT, Jun 17 (Reuters Health) - Among patients with ulcerative colitis, those with primary sclerosing cholangitis have an increased risk for colorectal cancer or dysplasia, according to a report in the June issue of the American Journal of Gastroenterology.
In a historical cohort study of 328 patients with ulcerative colitis, Dr. Bret A. Lashner and colleagues from the Cleveland Clinic Foundation, in Cleveland, Ohio, compared the risk for colorectal cancer or dysplasia in 132 patients with primary sclerosing cholangitis (PSC) with that in a control group of 196 patients without PSC.
Patients with PSC were younger when their ulcerative colitis began, had the disease longer, and had more extensive colitis than those without PSC. Colorectal cancer or dysplasia developed in 25% of patients with PSC and in 5.6% of the control group.
Among those who developed cancer, tumors were proximal to the splenic flexure in 76% of patients with PSC and in 20% of those without PSC. Patients with PSC also presented with more advanced cancer at diagnosis (35% at Dukes' stage C or D); none of the control group presented with advanced disease.
Six of the patients in the PSC group died of colorectal cancer within 25 years, and 2 died of cholangiocarcinoma. None of the control group died from these malignancies.
"[P]atients with PSC and [ulcerative colitis] are at significantly higher risk for developing colorectal cancer or dysplasia, for presenting at an advanced cancer stage, and subsequently for dying from this cancer," the authors conclude.
Am J Gastroenterol 1999;94:1643-1649.