This article is more than 5 years old. Information may no longer be current.

Prolonged IBD increases risk for cholangiocarcinoma in patients with primary sclerosing cholangitis

Patients with long duration of inflammatory bowel disease and primary sclerosing cholangitis had an increased risk for development of cholangiocarcinoma, according to data from a retrospective review.

“Identifying robust risk factors associated with [cholangiocarcinoma] among patients with [primary sclerosing cholangitis] is important to allow clinicians to risk stratify patients and guide surveillance strategies … The primary outcome was time to development of [cholangiocarcinoma] and our goal was to determine whether the risk differed between patients with and without colectomy,” Aliya F. Gulamhusein, MD, gastroenterology specialist at Mayo Clinic, Rochester, Minnesota, and colleagues wrote.

The researchers conducted a retrospective review of 399 patients with primary sclerosing cholangitis (PSC)-inflammatory bowel disease (IBD) seen at the Mayo Clinic between January 2005 and May 2013. Of these patients, 137 underwent colectomy.

One hundred twenty-three patients developed cholangiocarcinoma during the course of the study.

Univariate Cox proportional hazard models showed that colectomy (HR = 1.53; 95% CI, 1.05–2.22) and duration of IBD (HR = 1.37; 95% CI, 1.15–1.63) were associated with an increased risk for cholangiocarcinoma, after adjusting for age. Absolute risk for cholangiocarcinoma increased with age and was higher among patients who had colectomy (39%) compared with those who did not (27%).

Further analysis showed that colonic neoplasia (HR = 1.52; 95% CI, 0.97–2.37) and colectomy for colonic neoplasia (HR = 1.62; 95% CI, 1.01–2.61) approached significance. Colonic neoplasia indicative for surgery among patients with a history of colectomy was associated with an increased risk for cholangiocarcinoma (HR = 2.91; 95% CI, 1.24–6.84) compared with medically refractory disease.

Duration of IBD remained associated with cholangiocarcinoma (HR = 1.33; 95% CI, 1.11–1.60) on multivariate analysis. The influence of IBD duration on cholangiocarcinoma risk was not modified after colectomy, according to the research.

“Prolonged inflammatory bowel disease duration is an independent predictor of increased risk of CCA in patients with PSC-IBD and this risk persists after colectomy,” the researchers concluded. “Identifying patients with early CCA has significant prognostic implications as curative treatment options, such as liver transplantation, are only available for early stage disease.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.