What factors most strongly predict advanced colorectal neoplasia in IBD?
The lifetime risk of colorectal neoplasia varies among IBD patients. A better understanding of its predictors can help tailor surveillance strategies.
Wijnands AM, de Jong ME, Lutgens MWMD, et al. Prognostic Factors for Advanced Colorectal Neoplasia in Inflammatory Bowel Disease: Systematic Review and Meta-analysis. Gastroenterol. 2020;160(5):1584–98; https://doi.org/10.1053/j.gastro.2020.12.036
This Dutch systematic review and meta-analysis included 120 cohort studies and 44 case-control studies examining advanced colorectal neoplasia (aCRN) in patients with IBD. The authors analyzed 31 potential variables on the risk of aCRN, grading the strength of evidence as weak, moderate, or strong depending on the magnitude of the correlation, its statistical strength and the number of studies supporting that association.
The authors found strong evidence supporting the correlation between aCRN and extensive ulcerative colitis (UC) (Odds Ratio: 2.43; 95% Confidence Interval [CI], 2.01–2.93 for extensive vs. left-sided UC). They found a moderate level of evidence showing a higher risk of aCRN with a history of low-grade dysplasia (OR: 10.85; 95% CI, 5.13–22.97), strictures (OR: 7.78; 95% CI, 3.74–16.18), concomitant primary sclerosing cholangitis (OR: 4.14; 95% CI, 2.85–6.01), a family history of colorectal carcinoma (OR: 2.62; 95% CI, 1.93–3.57) and UC (OR: 1.5; 95% CI, 1.09–2.06 vs. Crohn’s disease).
There was a weak level of evidence supporting the association between aCRN and colon resection (OR: 6.46; 95% CI, 1.32–31.61), aneuploidy (OR: 5.17; 95% CI, 0.72–8.48), male sex (OR: 1.27; 95% CI, 1.12–1.44), increasing age (OR: 1.03; 95% CI, 1.02–1.05 for each year increase) and histologic inflammation (OR: 2.51; 95% CI, 1.75–3.61).
The authors identified several protective factors that had a moderate level of evidence supporting the association, including participation in colonoscopic surveillance (multivariate OR: 0.43; 95% CI, 0.2–-0.7) and use of 5-ASA drugs (OR: 0.53; 95% CI, 0.39–0.72) and thiopurines (OR: 0.55; 95% CI, 0.37–0.82). There was weak evidence of a protective effect for patients using statin medications (multivariate OR: 0.39; 95% CI, 0.22–0.7).
Study Design: Systematic review
Level of Evidence: 2a
The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.