Histomorphological features and prognosis of colitis-associated colorectal cancer in patients with primary sclerosing cholangitis

Scand J Gastroenterol. 2015;50(11):1389-96. doi: 10.3109/00365521.2015.1052094. Epub 2015 Jun 10.


Background: Histomorphology of colitis-associated colorectal cancer (CAC) in patients with primary sclerosing cholangitis (PSC) remains to be systemically characterized and prognosis in these patient needs to be further defined.

Aim: To examine the impact of PSC on histomorphology and to assess prognosis of CAC-PSC patients.

Methods: A cohort of CAC patients were identified from the Pathology Database (1994-2010) at Cleveland Clinic; histomorphological features and other relevant data were collected by retrospective review of pathology slides and medical records.

Results: A total of 87 CAC patients were included, with 11 patients having PSC (the study group) and 76 patients without PSC (the control group). The overall median follow up was 6 (range: 0-20) years. The patients in the study group had a longer median duration of inflammatory bowel disease prior to CAC diagnosis (p = 0.046). In study group, seven (63.6%) patients had right-sided CAC (vs. 36.8% in the control group, p = 0.11). Background high-grade dysplasia was noted less (9.1% vs. 44.7%), while low-grade dysplasia was detected more in the study group (72.7% vs. 28.9%) (p = 0.02). All histomorphological features were comparable between groups. The overall survival (OS) and progression-free survival (PFS) showed no statistical difference between CAC patients with or without PSC. After excluding TNM stage IV patients, patients with PSC showed a trend toward shorter OS and PFS (p = 0.07 and p = 0.1).

Conclusion: In CAC, histomorphology appeared to be independent of PSC. PSC is associated with a trend toward shorter OS and PFS in CAC patients with stage I-III diseases.

Keywords: Crohn’s disease; colorectal cancer; inflammatory bowel disease; primary sclerosing cholangitis; prognosis; survival; ulcerative colitis.

MeSH terms

  • Adenocarcinoma / pathology*
  • Adenocarcinoma / surgery
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cholangitis, Sclerosing / complications*
  • Colorectal Neoplasms / pathology*
  • Colorectal Neoplasms / surgery
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Inflammatory Bowel Diseases / complications*
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Young Adult