Work

Incidence, Risk Factors, and Outcome of Advanced Neoplasia in Patients Ulcerative Colitis with Low-Grade Dysplasia: A Systematic Review and Meta-analysis

Year: 2016

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Introduction: The natural history of low-grade dysplasia (LGD) in ulcerative colitis (UC) is not well characterized, and the optimal management of these patients remains controversial. Through a systematic review and meta-analysis, we estimated the (a) incidence and risk factors of progression to colorectal cancer (CRC) and/or high-grade dysplasia (HGD) (in surveillance cohorts), and (b) prevalence of dysplasia-related findings among patients who underwent colectomy for LGD (surgical cohorts). Methods: We performed a systematic review and meta-analysis (PROSPERO CRD42016033500) of multiple electronic databases through December 31, 2015 to identify surveillance and surgical cohorts studies of adult patients with UC and LGD. We estimated pooled incidence rates for CRC and/or HGD individually and as a composite outcome of advanced neoplasia, and when reported risk factors, associated with dysplasia progression. Results: In 14 surveillance cohort studies of 671 patients with UC-LGD, 91 patients developed advanced neoplasia over a total follow-up of 4238 patient-years. Estimated pooled annual incidence rate of advanced neoplasia and CRC was 6.5% (95% confidence interval [CI], 4.1-8.8) and 3.7% (95% CI, 2.3-5.1), respectively, with substantial heterogeneity between studies. Invisible dysplasia (vs. visible dysplasia) (OR, 1.87; 95% CI, 1.04-3.36) and primary sclerosing cholangitis (OR, 2.96; 95% CI, 1.23-7.08) were significantly associated with progression to advanced neoplasia, whereas there was no significant association between age at diagnosis of UC or LGD, sex, disease duration and distal (vs. proximal) location were not associated with risk of progression. In 13 surgical cohort studies of 472 patients who underwent colectomy for LGD, findings at time of surgery were: no dysplasia, 35.9% (95% CI, 27.9-44.8; 198/472; I2=43%), LGD, 34.1% (95% CI, 26.4-42.6; 157/472; I2=37%), HGD, 14.6% (95% CI, 11.6-18.1; 64/472; I2=0%) and CRC, 18.6% (95% CI, 9.0-34.6; 43/472; I2=79%). Among patients who developed CRC, 91% patients had a curative intent treatment. Conclusion: Among patients with UC with LGD under surveillance, the estimated rate of progression to advanced neoplasia and CRC was 6.5% and 3.7% annually, respectively. Among those who undergo surgery for LGD, over 2/3rd of patients have either no dysplasia or LGD; 18.6% of patients have synchronous CRC. Invisible dysplasia and concomitant primary sclerosing cholangitis are associated with higher risk of progression to advanced neoplasia.

Source: The American Journal of Gastroenterology

DOI: 10.14309/00000434-201610001-00657