High risk of colorectal cancer after high-grade dysplasia in inflammatory bowel disease patients

Background: There are limited data on colorectal cancer (CRC) risk after high-grade dysplasia in inflammatory bowel disease.
Aims: To determine the long-term CRC and neoplasia risk after a first diagnosis of high-grade dysplasia in inflammatory bowel disease, and to assess utilisation of high-grade dysplasia treatment strategies over the past three decades.
Methods: In this nationwide retrospective cohort study, patients with colonic inflammatory bowel disease and high-grade dysplasia diagnosis between 1991 and 2021 were extracted from the Dutch nationwide pathology databank (PALGA). The primary outcome was the cumulative incidence of metachronous CRC. Kaplan-Meier curves were used to show proctocolectomy-free survival per decade.
Results: CRC was diagnosed in 348 of 1220 patients (28.5%). Of these, 204 (16.7%) were diagnosed with CRC within 6 months after the first high-grade dysplasia diagnosis and were considered synchronous patients. Metachronous CRC was diagnosed in 144 of 1016 patients (14.2%) after a median of 3.6 years. The 1-, 5- and 10-year cumulative incidences of metachronous CRC after high-grade dysplasia were 2.9%, 9.9% and 15.5%, respectively. The 1-, 5- and 10-year cumulative incidences of metachronous neoplasia were 18.3%, 51.2% and 68.0%, respectively. Proctocolectomy-free survival after high-grade dysplasia decreased over time.

Conclusions: The risk of synchronous and metachronous CRC after a diagnosis of high-grade dysplasia underlines the high-risk profile of this subgroup of patients with inflammatory bowel disease. The possible advantages of colon-sparing treatment should be balanced with the higher risk of metachronous CRC and the subsequent need for stringent endoscopic surveillance.

M.E.W. Derks, Inflammatory Bowel Disease Center, Department of Gastroenterology, Radboud University, Medical Center, Nijmegen, The Netherlands, e-mail: monica.derks@radboudumc.nl

DOI: 10.1111/apt.70429

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