Original ResearchFull Report: Clinical—Alimentary TractRisk of Colorectal High-Grade Dysplasia and Cancer in a Prospective Observational Cohort of Patients With Inflammatory Bowel Disease
Section snippets
CESAME Cohort Design and Population
Details on the design and demographics of the cohort are available elsewhere.23 In brief, from May 2004 to June 2005, six hundred and eighty French gastroenterologists (38.4% with a full-time hospital practice, 24.3% with a mixed public and private practice, and 37.3% with a full-time private practice) enrolled, on an unpaid basis, 19,486 consecutive IBD patients from their individual practices. There were no exclusion criteria.
Data were collected on an electronic case report form. The
Patient Population and Follow-up Time
The patient characteristics, according to IBD subtype and long-standing extensive colitis status are provided in Table 1. At baseline, 2841 (14.6%) IBD patient had long-standing extensive colitis and 16,645 (85.4%) patients did not have long-standing extensive colitis. Compared with patients without long-standing extensive colitis, patients with long-standing extensive colitis tended, as expected, to be older (P < .0001) and to have been younger at the time of IBD onset (P < .0001). Median
Discussion
This is the first prospective study of the epidemiology of colorectal HGD and cancer in IBD in the thiopurine era. The results show that the risk of high-grade dysplasia and CRC is still markedly elevated in IBD patients with long-standing extensive colitis, although to a lesser extent in the subset of patients receiving thiopurines. In contrast, patients without long-standing extensive colitis have a CRC risk similar to that of general population, but they can develop early IBD-related lesions.
Acknowledgments
English editing (Nature Publishing Group Language Editing) was supported by funding of the CESAME cohort.
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Conflicts of interest These authors disclose the following: Laurent Beaugerie has received lecture fees from Abbott, MSD, Ferring Pharmaceuticals, and consulting fees from Abbott. Philippe Seksik has received consulting fees from Biocodex, Ferring Pharmaceutical, MSD, and Abbott. Matthieu Allez has received lecture or consulting fees from MSD, Abbott, Novo Nordisk, Ferring, Pfizer, and GSK. Hedia Brixi has received lecture and consulting fees from Abbott. Bernard Duclos has received lectures fees from Abbott, MSD, and consulting fees from Abbott and MSD. Arnaud Bourreille has received consulting or advisory board fees from Ferring Laboratories, Given Imaging, lecture fees from Abbott Laboratories, Biocodex, Merck, Norgine, Scherring-Plough, Therakos, Vifor, grant support from Abbott, Merck, and Vifor. Laurent Peyrin-Biroulet has received lecture and consulting fees from Abbott, Merck, UCB-Pharma, Tillots, Ferring, Norgine, and Shire. Fabrice Carrat has received consultancy fees from Novartis, GSK, and Laboratoires Boiron. The remaining authors disclose no conflicts.
Funding The CESAME project was supported by grants from Programme Hospitalier de Recherche Clinique National (AOM05157), Association François Aupetit, Délégation Inter-Régionale de la Recherche Clinique Ile de France-AP-HP, Ligue Contre le Cancer, and Fonds de Recherche de la Société Nationale Française de Gastro-Entérologie.