The risk for cancer or dysplasia in ulcerative colitis patients with primary sclerosing cholangitis

Am J Gastroenterol. 1999 Jun;94(6):1643-9. doi: 10.1111/j.1572-0241.1999.01156.x.


Objectives: Recent studies have implicated primary sclerosing cholangitis (PSC) as a risk factor for colorectal cancer (CRC) in ulcerative colitis (UC). Our study was designed to define both the risk and the risk factors for CRC or dysplasia in a large UC cohort with PSC.

Methods: Patients with UC and PSC were compared with a random sample of UC controls without PSC. Patients were analyzed from the inception of disease until an outcome or censor.

Results: Thirty-three (25%) of 132 UC patients with PSC developed CRC or dysplasia compared with 11 (5.6%) of 196 controls (adjusted relative risk 3.15, 95% confidence interval 1.37-7.27). Possible risk factors were chronic disease activity and lack of folate supplementation. Of 17 CRCs in the PSC group, 76% occurred proximal to the splenic flexure and 35% presented at an advanced stage, compared with one of five (20%) CRCs in controls being proximal and none being advanced. Six (4.5%) PSC patients, and no controls, died of CRC (p < 0.01).

Conclusions: UC patients with PSC are at increased risk of developing CRC or dysplasia. Chronically active disease may be a risk factor, whereas folate could have a protective effect. CRCs associated with PSC are more likely to be proximal, to be diagnosed at a more advanced stage, and to be fatal.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cholangitis, Sclerosing / complications*
  • Cholangitis, Sclerosing / physiopathology
  • Cholangitis, Sclerosing / surgery
  • Cohort Studies
  • Colectomy
  • Colitis, Ulcerative / complications*
  • Colorectal Neoplasms / etiology*
  • Colorectal Neoplasms / pathology
  • Female
  • Humans
  • Liver Transplantation
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Risk Factors
  • Survival Analysis