P148. Incidence and predictors of colorectal dysplasia and cancer in a population-based cohort of IBD patients in Romania
L. Gheorghe1, A. Constantinescu1, R. Vadan1, R. Cerban1, C. Gheorghe1
1Fundeni Clinical Institute, Gastroenterology and Hepatology Center, Bucharest, Romania
Background: Extensive data in the literature have shown an increasing cumulative risk of developing colorectal dysplasia (as premalignant lesion) and cancer in patients with IBD during the disease progression/course. Patients with IBD are six times more likely to develop colon cancer as compared with general population. Since data from Eastern Europe are scarce and outdated, the aim of our study was to assess the incidence and risk factors of IBD-associated colorectal cancer (CRC) and colorectal dysplasia (CRD) in a Romanian cohort of IBD patients registered in an IBD Prospective Database.
Methods: Data from 463 prospectively included patients between Jan 2008 Jan 2011 were reviewed and analyzed. Demographic (current age, age at diagnosis, sex, smoking state, urban/rural residence, first degree relatives with IBD or CCR) and disease characteristics (type: ulcerative colitis UC or Crohn's disease CD, extent, duration) were noted. All patients were evaluated by standard colonoscopy and target biopsies were taken. The diagnosis of CRC or CRD was made based on pathological report from biopsies taken during colonoscopy and/or after surgical resection and dysplasia was classified as low grade (LGD) and high grade (HGD).
Results: 211 patients with UC and 252 patients with CD were evaluated. CRC was diagnosed in 3 patients (0.64%, 1.71/1000 patient-years), 2 with ileocolonic CD and one with left sided colitis, in all cases duration of disease being less than 10 years. CRD was diagnosed in 18 patients (3.88%, 10.3/1000 patient-years): 9 patients with UC (all with LGD, 6 with sessile and 2 with pedunculated adenomatous polyps, one case of dysplasia associated lesion/mass DALM) and 9 patients with CD (7 cases of LGD‑4 with sessile polyps, 2 pedunculated adenomatous polyps, 1 DALM and 2 cases of HGD one DALM and one pedunculated adenomatous polyp). Duration of disease did not differ significantly between IBD patients with and without CRD or CRC. Young age at onset of disease, disease extension, stenosing CD pattern, and smoking habit, family history of CCR or IBD did not correlate with the presence of neoplasia or dysplasia.
Conclusions: The incidence of dysplasia and cancer in IBD patients is low and is not different between UC and CD patients. Since short duration of disease can be associated with the presence of dysplasia/cancer, periodic colonoscopy even in the first 10 years of disease evolution is an important tool in colorectal cancer prevention in IBD patients.