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Inflammation Level Predicts Cancer Risk in UC

Summary and Comment |
January 9, 2014

Inflammation Level Predicts Cancer Risk in UC

  1. Douglas K. Rex, MD

Each 1-point increase in a histologic inflammation activity scale more than tripled the odds of developing colorectal cancer.

  1. Douglas K. Rex, MD

Previous evidence suggests that increasing extent and severity of inflammation in ulcerative colitis (UC) are associated with increased risk for colorectal cancer (CRC). Treatment with thiopurines, which can reduce inflammation and produce healing in colitis, has also been associated with reduced risk for CRC. Now, investigators have further assessed the relationship between inflammation and risk for CRC in this setting.

In a case-control study, 141 patients with UC without neoplasia and 59 patients with UC who had developed neoplasia were compared. A 6-point histologic inflammatory activity scale was used to score 4449 biopsy fragments.

In a multivariate analysis controlling for risk factors identified from univariate analysis (sex, use of immune modulators, and use of nonsulfasalazine mesalamine), a higher inflammation score was associated with increased risk for colorectal cancer (odds ratio, 3.68 per 1-unit increase in the histologic inflammatory activity scale; P=0.001).

Comment

Factors associated with an increased risk for colorectal cancer in ulcerative colitis have included duration and extent of disease, concomitant primary sclerosing cholangitis, and a family history of colorectal cancer. These findings demonstrate that chronic inflammation by histology is associated with an increased risk. They also confirm that immunomodulators (thiopurines and methotrexate) reduce the risk for colorectal neoplasia, presumably by reducing inflammation.

  • Disclosures for Douglas K. Rex, MD at time of publication Consultant / Advisory board Exact Sciences; Ferring Pharmaceuticals; Given Imaging; Olympus Speaker’s bureau Boston Scientific; Braintree; Ferring Pharmaceuticals Grant / research support Battelle; Braintree; Northwestern University; Olympus America Editorial boards Annals of Gastroenterology and Hepatology; Comparative Effectiveness Research; Expert Review of Gastroenterology and Hepatology; Gastroenterology; Gastroenterology and Hepatology News; Gastroenterology Report; Gastroenterology Research and Practice; Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; World Journal of Gastroenterology; World Journal of Gastrointestinal Oncology; World Journal of Gastrointestinal Pathophysiology; World Journal of Gastrointestinal Pharmacology and Therapeutics

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