title: Malignancies and mortality in 200 patients with primary sclerosering cholangitis: a long-term single-centre study.
abstract: BACKGROUND
  The outcome of primary sclerosing cholangitis (PSC) has improved by liver transplantation (LT), but patients often develop malignancies. We analysed morbidity and mortality patterns to define strategies to prevent complications.
  
  
  METHODS
  Two hundred consecutive patients diagnosed before October 2005 were studied.
  
  
  RESULTS
  Malignancies developed in 40 (20%) and led to death in 28 patients (45.9% of the 61 mortalities). Cholangiocarcinoma (CCa) developed in 13 patients, and was detected shortly after the diagnosis of PSC in 31%. Colorectal carcinomas were documented in 10 and dysplastic adenomas in four patients; eight had ulcerative colitis, two Crohn's colitis, one unclassified inflammatory bowel disease (IBDu), three had no IBD. Five died of colorectal cancer. Three carcinomas and two adenomas were localized in the caecum or ascending colon, but most (n=10) in the recto-sigmoidal region. Hepatocellular carcinoma developed in three patients with advanced fibrosis/cirrhosis, and pancreatic cancer in five. LT has been carried out in 42 patients, 6.1 years (median, 0.5-25) after the diagnosis of PSC. Mortality was due to hepatic complications in 13 patients. Within 5 years of the diagnosis, deaths were because of malignancy in 12 patients and to hepatobiliary decompensation in only three, whereas 18 had been transplanted.
  
  
  CONCLUSIONS
  Since the use of transplantation, malignancies are the major cause of death. CCa has to be searched for in any new symptomatic patient. Colorectal malignancy occurs frequently. Colonoscopy at the diagnosis of PSC is obligatory and should be repeated at 1-2 years interval in the patients with IBD and every 5 years in those without IBD.
authors: Department of Hepatology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium. johan.fevery@med.kuleuven.be
authors: Johan
authors: J
authors: Fevery
authors: Liesbet
authors: L
authors: Henckaerts
authors: Robin
authors: R
authors: Van Oirbeek
authors: Séverine
authors: S
authors: Vermeire
authors: Paul
authors: P
authors: Rutgeerts
authors: Frederik
authors: F
authors: Nevens
authors: Werner
authors: W
authors: Van Steenbergen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D018281:Cholangiocarcinoma / Q000209:etiology / Q000401:mortality; D015209:Cholangitis, Sclerosing / Q000401:mortality* / Q000601:surgery; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000209:etiology / Q000401:mortality; D015897:Comorbidity; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology / Q000401:mortality*; D011183:Postoperative Complications; D015996:Survival Rate; D055815:Young Adult