PRIMARY sclerosing cholangitis (PSC) raises colorectal cancer (CRC) risk even in patients without inflammatory bowel disease (IBD), according to new findings presented at the American College of Gastroenterology (ACG) 2024 Annual Meeting.
Patients with PSC often have IBD, a combination known to increase CRC risk, but CRC risk in PSC patients without IBD has been less clear. To clarify this link, the team conducted a retrospective analysis using the TriNetX database and dividing patients into three groups: PSC with IBD (PSC-IBD), PSC without IBD (PSC non-IBD), and a control group without PSC or IBD. The study analysed the primary outcome of CRC risk within 14 years of PSC diagnosis and looked at secondary outcomes, including risks of other gastrointestinal cancers and how CRC risk varied by gender and age.
Results showed a significant CRC risk in PSC patients without IBD compared to controls (adjusted hazard ratio [aHR]: 2.9; 95% CI: 1.6–6.0). Of the 2,662 PSC non-IBD patients (mean age: 51.6; 47.2% female), males showed a notably increased CRC risk (aHR: 4.17; 95% CI: 1.4–12.5), while females did not display a statistically significant risk increase (aHR: 2.1; 95% CI: 0.8–6.1). Patients with PSC were also found to be at higher risk for various gastrointestinal cancers, including hepatocellular carcinoma and hepatobiliary cancers, and pancreatic cancer (aHR: 10.5; 95% CI: 7.3–15; P<0.0001).
These findings suggest that PSC is an independent risk factor for CRC, regardless of IBD status. Researchers advocate for updating CRC screening guidelines to include all patients with PSC, which may enable earlier cancer detection and better outcomes. Further research could focus on preventive strategies to address gastrointestinal cancer risks in patients with PSC, aiming to improve long-term patient care and quality of life.
Ada Enesco, EMJ
Reference
Alsakarneh S et al. Primary sclerosing cholangitis in the absence of inflammatory bowel disease increases the risk of colorectal cancer: a propensity-matched cohort study. ACG 2024 Annual Meeting, 25-20 October, 2024.
