IBD duration tied to cholangiocarcinoma risk

By David Douglas

NEW YORK (Reuters Health) - The duration of inflammatory bowel disease (IBD) is associated with an increased risk of cholangiocarcinoma in patients who also have primary sclerosing cholangitis, according to researchers at the Mayo Clinic in Rochester, Minnesota.

As Dr. Konstantinos N. Lazaridis explained by email, "Primary sclerosing cholangitis (PSC) is the strongest known risk factor for development of cholangiocarcinoma (CCA), a malignancy associated with high mortality given the lack of early diagnosis and the very limited options of therapy for the latter. In this study, we identified duration of IBD that often co-exists with PSC to be linked with development of CCA in these patients."

Dr. Lazaridis and colleagues reviewed data on 339 patients with PSC-IBD who were seen between 2005 and 2013; 137 patients had a colectomy and 123 patients developed CCA, the team reports in the American Journal of Gastroenterology, online March 22.

After adjustment for age, univariate Cox proportional hazard models showed that colectomy (hazard ratio, 1.53) and duration of IBD (HR, 1.37) were significantly associated with an increased risk of CCA. The increased risk with colonic neoplasia (HR, 1.52) and colectomy for colonic neoplasia (HR, 1.62) approached significance.

In patients with colectomy, compared to medically refractory disease, colonic neoplasia as the indication for surgery was associated with a particularly increased risk of CCA (HR, 2.91). On multivariate analysis, the duration of IBD remained significantly associated with CCA (HR, 1.33). However, colectomy did not modify this risk.

Among limitations of the study, say the researchers, is "the possibility of referral bias given the increased likelihood of patients with severe and complicated disease being seen in specialized centers; our center in particular manages a high volume of patients with CCA."

However, continued Dr. Lazaridis, the findings "could help to better stratify PSC patients who may have a higher risk to develop CCA, and thus, modify our clinical screening for this subset of PSC patients so earlier detection of CCA and hopefully better clinical outcomes would be possible."

SOURCE: http://bit.ly/1V20jZR

Am J Gastroenterol 2016.

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