Colitis-associated DNA aneuploidy and dysplasia in Crohn's disease and risk of colorectal cancer.
BACKGROUND
There is uncertainty about how patients with Crohn's colitis should be monitored for colorectal cancer (CRC). By analogy to ulcerative colitis, regular colonoscopy with biopsies for dysplasia has been used. We describe the occurrence of dysplasia and DNA aneuploidy in a cohort of patients with Crohn's colitis.


METHODS
In all, 245 patients with extensive colitis (225 with a firm diagnosis of Crohn's disease, and 20 diagnosed as indeterminate colitis) at Stockholm Söder Hospital and Karolinska University Hospital, Huddinge were included. They were followed with regular colonoscopies with biopsies both for dysplasia and DNA aneuploidy. The cumulative occurrence of DNA aneuploidy and dysplasia was estimated using Kaplan-Meier curves. Time sequences and interactions between DNA aneuploidy, dysplasia, and CRC were studied using Cox regression analysis, adjusted for age, sex, and age at diagnosis.


RESULTS
During a median follow-up time of 9.2 person-years, DNA aneuploidy was found in 53 patients (22%), with 10 patients having multifocal aneuploidy and high S-phase values. Dysplasia was found in 42 patients (17%), 10 having multifocal dysplasia. Relative risk (RR) of dysplasia given DNA aneuploidy was 5.3 (95% confidence interval [CI] 2.3-12). RR of CRC given dysplasia was 10 (95% CI 2-50), and RR of CRC given aneuploidy was 1.5 (95% CI 0.3-9.3).


CONCLUSIONS
Dysplasia and DNA aneuploidy including S-phase analysis may complement stratification of patients with Crohn’s
Söderlund
Sverre
S
Department of Medicine, Karolinska Institutet, Stockholm Söder Hospital, Stockholm, Sweden. sverresoderlund@hotmail.com
Tribukait
Bernhard
B
Öst
Åke
Å
Broström
Olle
O
Karlén
Per
P
Löfberg
Robert
R
Askling
Johan
J
Sjöqvist
Urban
U
D000293:Adolescent; D000328:Adult; D000368:Aged; D000782:Aneuploidy; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003092:Colitis / Q000453:epidemiology* / Q000235:genetics* / Q000473:pathology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000235:genetics* / Q000473:pathology; D003424:Crohn Disease / Q000453:epidemiology* / Q000235:genetics* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000453:epidemiology / Q000235:genetics / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult