Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2015; 21(12): 3644-3649
Published online Mar 28, 2015. doi: 10.3748/wjg.v21.i12.3644
Colorectal cancers in ulcerative colitis from a low-prevalence area for colon cancer
Devendra Desai, Sudeep Shah, Abhijit Deshmukh, Philip Abraham, Anand Joshi, Tarun Gupta, Ramesh Deshpande, Varun Khandagale, Siji George
Devendra Desai, Abhijit Deshmukh, Philip Abraham, Anand Joshi, Tarun Gupta, Varun Khandagale, Siji George, Division of Gastroenterology, P.D Hinduja Hospital, Mumbai 400016, India
Sudeep Shah, Division of Gastrointestinal surgery, Department of Surgery, P.D Hinduja Hospital, Mumbai 400016, India
Ramesh Deshpande, Division of Pathology, Department of Pathology, P.D Hinduja Hospital, Mumbai 400016, India
Author contributions: Desai D contributed to concept of the database on inflammatory bowel disease and this study, data collection and analysis, drafting and revision of the article; Deshmukh A collected and analyzed the data; Abraham P contributed to conceptualization of this study, drafting and revision of the article; Joshi A, Gupta T and Khandagale V contributed to data collection, drafting and revision of the article; Shah S contributed to data collection, drafting and revision of the article, and surgical input; Deshpande R review the pathology slides, collected the data and revised the article; and George S collected the data and drafted the article.
Ethics approval: The study was reviewed and approved by the National Health and Education Society (P D Hinduja Hospital) Institutional Review Board.
Conflict-of-interest: The study received no financial support from any source. None of the authors has any conflict of interest to declare.
Data sharing: No additional data is available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Devendra Desai, MD, Division of Gastroenterology, P D Hinduja Hospital, DNB (Gastroenterology) Room No 1106, OPD Block, Veer Savarkar Marg, Mahim, Mumbai 400016, India.
Telephone: +91-22-24447106
Received: August 31, 2014
Peer-review started: September 1, 2014
First decision: September 27, 2014
Revised: October 11, 2014
Accepted: January 8, 2015
Article in press: January 8, 2015
Published online: March 28, 2015

AIM: To determine the incidence and risk factors for colorectal cancer (CRC) in patients with ulcerative colitis from a low prevalence region for CRC.

METHODS: Our prospective database yielded a cohort of 430 patients [age: 44 ± 14.6 years; 248 men (57.7%)] with ulcerative colitis (median disease duration 6, range: 1-39 years) for analysis. Of these, 131 (30.5%) had left-sided colitis and 159 (37%) extensive colitis. Patients with histologically confirmed CRC within the segment with colitis were compared with those without CRC, to determine the risk factors for the development of CRC.

RESULTS: Twelve patients (2.8%) developed CRC. The overall incidence density was 3.56/1000 patient-years of disease - 3/1000 in the first 10 years, 3.3/1000 at 10 to 20 years, and 7/1000 at > 20 years. Three of our 12 patients developed CRC within 8 years of disease onset. On univariate analysis, extensive colitis, longer duration of disease, and poor control of disease were associated with development of CRC. On multivariate analysis, duration of disease and extent of colitis remained significant.

CONCLUSION: CRC occurred in 2.8% of patients with ulcerative colitis in our population - an incidence density similar to that in Western countries in spite of a low overall prevalence of colon cancer in our population. The risk increased with extent and duration of disease.

Keywords: Colon cancer, Dysplasia, Epidemiology, Inflammatory bowel disease, Malignancy

Core tip: From an area with low prevalence of colon cancer, the risk of colorectal cancer (CRC) in patients with ulcerative colitis was as high as in those with high risk of CRC. Some patients developed CRC before the recommended commencement of colonoscopic surveillance for CRC.