Abstract
Background Ulcerative colitis (UC) patients have an increased risk for the development of colorectal cancer (CRC). Our aim was to assess the risk of CRC in UC patients compared with disease extent, disease duration, and geographic variation. Methods In this systematic review and meta-analysis, we searched PubMed, scientific meetings, and the bibliographies of identified articles, with English language restrictions for studies published from 1988 to 2018, and assessed the risk of CRC in UC patients. Patients with Crohn's disease, family history of CRC, and colorectal adenomatous polyp (CAP) were excluded from this research. The study was registered with PROSPERO, number CRD42018102213. Findings We included 58 studies that included 267566 UC patients. Extensive UC and left-sided UC had a higher risk of CRC than proctitis UC. Geography also played a role in UC-associated CRC development. The time of malignant transformation in Asian UC patients started after 10-20 years of this disease duration. North American UC-associated CRC patients significantly increased in more than 30 years of this disease duration. Conclusion In a systematic review of the literature, we found that disease extent, disease duration, and geography were strong, independent risk factors in UC-associated CRC development.
Highlights
Ulcerative colitis (UC) is an idiopathic, chronic inflammatory disorder of the colonic mucosa, which started in the rectum and generally extended proximally in a continuous manner through part of, or the entire, colon [1]
Disease extent-specific risk estimates for colorectal cancer (CRC) in UC were reported in of the 58 studies, which show that extensive UC and leftsided UC had a higher risk of CRC (SIR: 1.42, 95% CI: 0.832.42; standardised incidence ratio (SIR): 0.56, 95% CI: 0.38-0.83) than proctitis UC (SIR: 0.18, 95% CI: 0.01-0.03) (P < 0:01) (Tables 2 and 3)
Reporting time Article (n) Proportion time, we found that the risk of CRC in UC patients was higher in 1988-1995
Summary
Ulcerative colitis (UC) is an idiopathic, chronic inflammatory disorder of the colonic mucosa, which started in the rectum and generally extended proximally in a continuous manner through part of, or the entire, colon [1]. Due to limited understanding of the natural history of UC-associated CRC, the knowledge concerning the CRC risk in UC patients was still inadequate. Ulcerative colitis (UC) patients have an increased risk for the development of colorectal cancer (CRC). Our aim was to assess the risk of CRC in UC patients compared with disease extent, disease duration, and geographic variation. English language restrictions for studies published from 1988 to 2018, and assessed the risk of CRC in UC patients. The time of malignant transformation in Asian UC patients started after 10-20 years of this disease duration. North American UC-associated CRC patients significantly increased in more than 30 years of this disease duration. In a systematic review of the literature, we found that disease extent, disease duration, and geography were strong, independent risk factors in UC-associated CRC development
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