Long-term risk of advanced neoplasia after colonic low-grade dysplasia in patients with inflammatory bowel disease: a nationwide cohort study.
J Crohns Colitis. 2019 Jun 07;:
Authors: de Jong ME, van Tilburg SB, Nissen LHC, Kievit W, Nagtegaal ID, Horjus CS, Römkens TEH, Drenth JPH, Hoentjen F, Derikx LAAP
BACKGROUND AND AIMS: The long-term risk of high-grade dysplasia (HGD) and colorectal cancer (CRC) following low-grade dysplasia (LGD) in inflammatory bowel disease (IBD) patients is relatively unknown. We aimed to determine the long-term cumulative advanced neoplasia (HGD and/or CRC) incidence, and to identify risk factors for advanced neoplasia in a nationwide IBD cohort with a history of LGD.
METHODS: This is a nationwide cohort study using data from the Dutch National Pathology Registry (PALGA) to identify all IBD patients with LGD between 1991 and 2010 in the Netherlands. Follow-up data were collected until January 2016. We determined the cumulative advanced neoplasia incidence and identified risk factors with multivariable Cox regression analysis.
RESULTS: We identified 4,284 patients with colonic LGD with a median follow-up of 6.4 years after initial LGD diagnosis. Cumulative incidence of subsequent advanced neoplasia was 3.6, 8.5, 14.4 and 21.7%, after 1, 5, 10 and 15 years, respectively. Median time to develop advanced neoplasia after LGD was 3.6 years. Older age (> 55 years) at moment of LGD (hazard ratio (HR) 1.73, 95% CI 1.44-2.06), male gender (HR 1.33, 95% CI 1.10-1.60), and follow-up at an academic (versus non-academic) medical centre (HR 1.37, 95% CI 1.07-1.76) were independent risk factors for advanced neoplasia following LGD.
CONCLUSIONS: In a large nationwide cohort with long-term follow-up of IBD patients with LGD, the cumulative incidence of advanced neoplasia was 21.7% after 15 years. Older age at LGD (>55 years), male gender, and follow-up by a tertiary IBD referral centre were independent risk factors for advanced neoplasia development after initial LGD.
PMID: 31175827 [PubMed – as supplied by publisher]