Thiopurine Therapy Reduces the Incidence of Colorectal Neoplasia in Patients with Ulcerative Colitis. Data from the ENEIDA Registry.
OBJECTIVE
Patients with ulcerative colitis (UC) are at increased risk of developing colorectal cancer (CRC), but recent studies suggest a lower risk than previously reported. The aim was to evaluate the incidence of dysplasia, CRC and related risk factors in UC patients from a Spanish nationwide database.


METHODS
All UC patients were identified and retrospectively reviewed. Clinical-epidemiological data and the finding of dysplasia and/or CRC were collected.


RESULTS
A total of 831 UC patients were included. Twenty-six cases of CRC in 26 patients and 29 cases of high-grade dysplasia (HGD) in 24 patients were found, accounting for 55 diagnoses of advanced neoplasia (AN = CRC and/or HGD) in 45 patients (33% of them within the first 8 years after UC diagnosis). The cumulative risk of AN was 2, 5.3 and 14.7% at 10, 20 and 30 years, respectively. Concomitant primary sclerosing cholangitis (odds ratio [OR] 10.90; 95% confidence interval [CI] 3.75-31.76, p < 0.001), extensive UC (OR 2.10, 95% CI 1.01-4.38, p = 0.048), UC diagnosis at an older age (OR 2.23, 95% CI 1.03-4.83, p = 0.043) and appendectomy prior to UC diagnosis (OR 2.66, 95% CI 1.06-6.71, p = 0.038) were independent risk factors for AN. Use of thiopurines (OR 0.21, 95% CI 0.06-0.74, p = 0.015) and being in a surveillance colonoscopy programme (OR 0.33; 95% CI 0.16-0.67; p = 0.002) were independent protective factors for AN.


CONCLUSIONS
The risk of AN among UC patients is lower than previously reported but steadily increases from the time of UC diagnosis. The widespread use of thiopurines may have influenced this reduced incidence of UC-related neoplasias.
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
Jordi
J
Gordillo
Hospital Universitari Germans Trias i Pujol, Badalona, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Eduard
E
Cabré
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Esther
E
Garcia-Planella
Hospital Clínic i Provincial, Barcelona, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Elena
E
Ricart
Hospital Universitario Lozano Blesa, Zaragoza, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Yolanda
Y
Ber-Nieto
Parc de Salut del Mar, Barcelona, Spain.
Lucía
L
Márquez
Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Spain.
Francisco
F
Rodríguez-Moranta
Hospital Infanta Leonor, Madrid, Spain.
Ángel
Á
Ponferrada
Hospital Universitario Puerta del Hierro, Madrid, Spain.
Isabel
I
Vera
Hospital Universitario de la Princesa and Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Javier P
JP
Gisbert
Hospital Universitaro Rio Hortega, Valladolid, Spain.
Jesús
J
Barrio
Hospital Mútua de Terrassa, Terrassa, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Maria
M
Esteve
Hospital de Cruces, Bilbao, Spain.
Olga
O
Merino
Complejo Hospitalario de León, León, Spain.
Fernando
F
Muñoz
Hospital Universitari Germans Trias i Pujol, Badalona, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain eugenidomenech@gmail.com.
Eugeni
E
Domènech
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy*; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use*; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain
D007166:Immunosuppressive Agents; D015122:Mercaptopurine
Ulcerative colitis; advanced neoplasia; thiopurines