title: Age at diagnosis of inflammatory bowel disease influences early development of colorectal cancer in inflammatory bowel disease patients: a nationwide, long-term survey.
abstract: BACKGROUND
  Data on clinical characteristics of patients with inflammatory bowel disease (IBD)-related colorectal cancer (CRC) are scarce and mainly originate from tertiary referral centres. We studied patient and disease characteristics of IBD-related CRC in a nationwide IBD cohort in general hospitals. Main outcome parameters were time to develop CRC, and factors associated with early CRC development.
  
  
  METHODS
  All IBD patients diagnosed with CRC between 1 January 1990 and 1 July 2006 were identified using a nationwide automated pathology database (PALGA). Patient charts were assessed to confirm diagnosis and collect clinical data. Early CRC was defined as CRC diagnosed less than 8 years after IBD diagnosis. Statistical analysis was performed using descriptive statistics, independent t tests, binary logistic regression and Cox-regression analysis.
  
  
  RESULTS
  Diagnosis of IBD-related CRC was confirmed in 251 patients (171 ulcerative colitis, 77 Crohn's disease, 3 unclassified colitis), 161 males (64 %). Median time from IBD diagnosis to CRC diagnosis was 12 years (IQR 4-20); 89 patients (35 %) developed early CRC. Type of IBD, gender, concomitant PSC, pseudopolyps, extent of inflammation, and medication use were not related to early CRC (p > 0.05). IBD diagnosis at older age (HR for 10 years older age 2.25; 95 % CI 1.92-2.63) was related to early CRC. Twenty-three patients (12 %) had been included in a surveillance programme prior to CRC diagnosis. Patients in the surveillance group had a significantly better tumor stage (p = 0.004).
  
  
  CONCLUSIONS
  We emphasize the problem of a high proportion of IBD-associated CRCs developing before the recommended start of surveillance. Therefore, we suggest that older age at IBD onset could be an additional factor to start surveillance in IBD patients.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, 's Gravendijkwal 230, Room Ba 393, 3015 CE Rotterdam, The Netherlands. j.baars@erasmusmc.nl
authors.forename: J E
authors.initials: JE
authors.lastname: Baars
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: M
authors.initials: M
authors.lastname: van Haastert
authors.forename: J J
authors.initials: JJ
authors.lastname: Nicolaï
authors.forename: A C
authors.initials: AC
authors.lastname: Poen
authors.forename: C J
authors.initials: CJ
authors.lastname: van der Woude
mesh_terms: D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D003093:Colitis, Ulcerative / Q000150:complications; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D003424:Crohn Disease / Q000150:complications; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult