CRC screening guidelines inadequate for patients with ulcerative colitis

  • Rottoli M & al.
  • Dig Liver Dis
  • 30 sept. 2019

  • de Craig Hicks
  • Clinical Essentials
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Takeaway

  • Colorectal cancer secondary to ulcerative colitis (UC) is more likely to feature lymph node involvement (N+) in patients who have cancer in the left colon, who have colonic strictures, or who are younger at surgery.
  • Risk factors identified in current screening guidelines (duration, extension, and severity of disease) are not associated with N+.

Why this matters

  • Current screening guidelines are not adequate for identifying patients with UC prone to early-onset cancer or those diagnosed with lymph node involvement at surgery despite surveillance.

Study design

  • Researchers studied the health records of patients who underwent curative surgery for UC (N=130; 60.8% men; median age at diagnosis, 28 years; age range, 9-73 years), comparing those who were N+ with N control patients.
  • Funding: None.

Key results

  • 30.8% (n=40) of patients were N+ at surgery.
  • Median age of these patients was significantly lower than that of N patients (47 vs 54 years; P=.036).
  • Other factors associated with N+ risk included:
    • Left colon location (OR, 2.44; P=.045).
    • Colonic stricture (OR, 5.07; P=.002).

Limitations

  • The study was retrospective, and surveillance history for each patient was limited to the last 2 colonoscopies.