Epidemiological and clinical characteristics in patients with ulcerative colitis associated colorectal cancer (CRC) in Veszprém county

Background: There is an increased risk of colorectal cancer (CRC) in UC. The prevalence of UC associated CRC is different in various geographical regions. The risk depends primarily on the duration and extent of disease. The aim of the study was to find additional data of the epidemiological and clinical characteristics on the basis of our patients with UC and CRC.

Patients and results: From our thirty-year IBD database we retrospectively studied the relevant epidemiological data of UC patients. Of 669 patients (m/f: 350/319) CRC was diagnosed in 13 patients (male: 6, female: 7) during follow-up. The onset of UC in patients with UC associated CRC was 34.5 (13–61) years, significantly, 4.4 years younger compared to UC patients without CRC (p<0.001). Mean age of UC-CRC patients at diagnosis of CRC 50.8 (27–70) years (mean duration of UC: 16.3 (0–33) years), more than 15 years younger than the average in sporadic CRC population in Hungary. The location of UC was left-sided in 4 patients and pancolitis in 9. Six patients were ex-smokers, seven were non-smokers. The rate of familial disease was 3.9% in our UC patients, while no familial disease was present in the UC-CRC patients. Of the 13 UC patient with primary sclerosing cholangitis (PSC) CRC developed in 4 patients, reflecting an increased risk for CRC in this subgroup of patients. Six of the UC-CRC patients participated in regular surveillance colonoscopy, seven refused it because of the symptom-free disease. All patients underwent colon surgery, 2 patients metastasectomy as well. The stages of CRC were Dukes A in 2, B in 4, C in 5 and D in 2 patients. Seven patients are still alive (mean survival: 5.7 (1–14) years), five patients died because of CRC (mean survival: 10.3 months), one died due to unrelated disease after 10 years of the diagnosis of CRC. The cumulative risk of CRC after 10 years was 0.8%, after 20 years 5.0%, and after 30 years 19.7%, respectively.

Conclusion: The cumulative risk of CRC was higher in our UC patients, that in the average Hungarian population. Most of the UC-CRC patients had extensive and long-standing disease. PSC seems to be risk factor for CRC in UC. The stage of CRC was better in patients taking part in regular surveillance colonoscopy.