title: Serum inflammatory markers and risk of colorectal cancer in patients with inflammatory bowel diseases.
abstract: OBJECTIVE
  Patients with inflammatory bowel diseases (IBDs) (Crohn's disease, ulcerative colitis) are at increased risk of colorectal cancer (CRC). Persistent inflammation is hypothesized to increase risk of CRC in patients with IBD; however, the few studies in this area have been restricted to cross-sectional assessments of histologic severity. No prior studies have examined association between C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) elevation and risk of CRC in an IBD cohort.
  
  
  METHODS
  From a multi-institutional validated IBD cohort, we identified all patients with at least one measured CRP or ESR value. Patients were stratified into quartiles of severity of inflammation on the basis of their median CRP or ESR value, and subsequent diagnosis of CRC was ascertained. Logistic regression adjusting for potential confounders was used to identify the independent association between CRP or ESR elevation and risk of CRC.
  
  
  RESULTS
  Our study included 3145 patients with at least 1 CRP value (CRP cohort) and 4008 with at least 1 ESR value (ESR cohort). Thirty-three patients in the CRP cohort and 102 patients in the ESR cohort developed CRC during a median follow-up of 5 years at a median age of 55 years. On multivariate analysis, there was a significant increase in risk of CRC across quartiles of CRP elevation (P(trend) = .017; odds ratio for quartile 4 vs quartile 1, 2.72; 95% confidence interval, 0.95-7.76). Similarly higher median ESR was also independently associated with risk of CRC across the quartiles (odds ratio, 2.06; 95% confidence interval, 1.14-3.74) (P(trend) = .007).
  
  
  CONCLUSIONS
  An elevated CRP or ESR is associated with increased risk of CRC in patients with IBD.
authors.affiliation: Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: aananthakrishnan@partners.org.
authors.forename: Ashwin N
authors.initials: AN
authors.lastname: Ananthakrishnan
authors.affiliation: Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Su-Chun
authors.initials: SC
authors.lastname: Cheng
authors.affiliation: Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Tianxi
authors.initials: T
authors.lastname: Cai
authors.affiliation: Research IS and Computing, Partners HealthCare, Charlestown, Massachusetts.
authors.forename: Andrew
authors.initials: A
authors.lastname: Cagan
authors.affiliation: Research IS and Computing, Partners HealthCare, Charlestown, Massachusetts.
authors.forename: Vivian S
authors.initials: VS
authors.lastname: Gainer
authors.affiliation: Massachusetts Institute of Technology, Cambridge, Massachusetts.
authors.forename: Peter
authors.initials: P
authors.lastname: Szolovits
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Stanley Y
authors.initials: SY
authors.lastname: Shaw
authors.affiliation: i2b2 National Center for Biomedical Computing, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Susanne
authors.initials: S
authors.lastname: Churchill
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Karlson
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Research IS and Computing, Partners HealthCare, Charlestown, Massachusetts; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Shawn N
authors.initials: SN
authors.lastname: Murphy
authors.affiliation: Harvard Medical School, Boston, Massachusetts; i2b2 National Center for Biomedical Computing, Brigham and Women's Hospital, Boston, Massachusetts; Children's Hospital Boston, Boston, Massachusetts.
authors.forename: Isaac
authors.initials: I
authors.lastname: Kohane
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Liao
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis*; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: C-reactive Protein; Colorectal Cancer; Crohn’s Disease; ESR; Ulcerative Colitis