title: Long-term follow-up reveals low incidence of colorectal cancer, but frequent need for resection, among Australian patients with inflammatory bowel disease.
abstract: OBJECTIVE
  Inflammatory bowel disease can require surgical resection and also lead to colorectal cancer (CRC). We investigated the cumulative incidence of resection surgeries and CRC among patients with ulcerative colitis (UC) or Crohn's disease (CD).
  
  
  METHODS
  We analyzed data from a cohort of patients who participated in an inflammatory bowel disease study (504 with UC and 377 with CD) at 2 academic medical centers in Sydney, Australia from 1977 to 1992 (before the development of biologic therapies). We collected follow-up data on surgeries and development of CRC from hospital and community medical records or via direct contact with patients during a median time period of 14 years. Cumulative incidences of resection surgeries and CRC were calculated by competing risk survival analysis.
  
  
  RESULTS
  Among patients with UC, CRC developed in 24, for a cumulative incidence of 1% at 10 years (95% confidence interval [CI], 0%-2%), 3% at 20 years (95% CI, 1%-5%), and 7% at 30 years (95% CI, 4%-10%). Their cumulative incidence of colectomy was 15% at 10 years (95% CI, 11%-19%), 26% at 20 years (95% CI, 21%-30%), and 31% at 30 years (95% CI, 25%-36%). Among patients with CD, 5 of 327 with colon disease developed CRC, with a cumulative incidence of CRC of 1% at 10 years (95% CI, 0%-2%), 1% at 20 years (95% CI, 0%-2%), and 2% at 30 years (95% CI, 0%-4%). Among all patients with CD, the cumulative incidence of resection was 32% at 5 years (95% CI, 27%-37%), 43% at 10 years (95% CI, 37%-49%), and 53% at 15 years (95% CI, 46%-58%). Of these 168 subjects, 42% required a second resection within 15 years of the first surgery (95% CI, 33%-50%).
  
  
  CONCLUSIONS
  Patients with UC have a low incidence of CRC during a 30-year period (7% or less); the incidence among patients with CD is even lower. However, almost one-third of patients with UC and about 50% of those with CD will require surgery.
authors.affiliation: Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, Australia; School of Translational Medicine, University of Manchester, Manchester, United Kingdom. Electronic address: Christian.selinger@web.de.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Selinger
authors.affiliation: IBD Service, Department of Gastroenterology and Hepatology and School of Medicine, University of Adelaide at Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Andrews
authors.affiliation: Department of Mathematics and Statistics, University of Lancaster, Lancaster, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Titman
authors.affiliation: Department of Gastroenterology, Royal North Shore Hospital, Sydney, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Norton
authors.affiliation: Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, Australia.
authors.forename: D Brian
authors.initials: DB
authors.lastname: Jones
authors.affiliation: Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, Australia.
authors.forename: Charles
authors.initials: C
authors.lastname: McDonald
authors.affiliation: Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, Australia.
authors.forename: Gavin
authors.initials: G
authors.lastname: Barr
authors.affiliation: A. W. Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Warwick
authors.initials: W
authors.lastname: Selby
authors.affiliation: Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia.
authors.forename: Rupert W
authors.initials: RW
authors.lastname: Leong
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D055815:Young Adult
keywords: Colon Cancer Risk; Prognosis; Therapy; Treatment