Clinical Study

British Journal of Cancer (2009) 101, 1671–1675. doi:10.1038/sj.bjc.6605359 www.bjcancer.com
Published online 13 October 2009

Colonoscopic surveillance improves survival after colorectal cancer diagnosis in inflammatory bowel disease

M W M D Lutgens1, B Oldenburg1, P D Siersema1, A A van Bodegraven2, G Dijkstra3, D W Hommes4, D J de Jong5, P C F Stokkers6, C J van der Woude7 and F P Vleggaar1 On behalf of the Initiative on Crohn and Colitis (ICC)

  1. 1Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands
  2. 2Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
  3. 3Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
  4. 4Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
  5. 5Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
  6. 6Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  7. 7Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands

Correspondence: Dr FP Vleggaar, University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. E-mail: f.vleggaar@umcutrecht.nl

Received 16 June 2009; Revised 27 August 2009; Accepted 4 September 2009; Published online 13 October 2009.

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Abstract

Background:

  

Colonoscopic surveillance provides the best practical means for preventing colorectal cancer (CRC) in inflammatory bowel disease (IBD) patients. Strong evidence for improved survival from surveillance programmes is sparse.

Method:

  

The aim of this study was to compare tumour stage and survival of IBD patients with CRC who were a part of a surveillance programme with those who were not. A nationwide pathology database (PALGA (pathologisch anatomisch landelijk geautomatiseerd archief)) was consulted to identify IBD patients with CRC treated in all eight university hospitals in The Netherlands over a period of 15 years. Patients were assigned to the surveillance group when they had undergone one or more surveillance colonoscopies before a diagnosis of CRC. Patients who had not undergone surveillance served as controls. Tumour stage and survival were compared between the two groups.

Results:

  

A total of 149 patients with IBD-associated CRC were identified. Twenty-three had had colonoscopic surveillance before CRC was discovered. The 5-year CRC-related survival rate of patients in the surveillance group was 100% compared with 74% in the non-surveillance group (P=0.042). In the surveillance group, only one patient died as a consequence of CRC compared with 29 patients in the control group (P=0.047). In addition, more early tumour stages were found in the surveillance group (P=0.004).

Conclusions:

  

These results provide evidence for improved survival from colonoscopic surveillance in IBD patients by detecting CRC at a more favourable tumour stage.

Keywords:

inflammatory bowel disease, colorectal cancer, surveillance, survival, tumour stage, IBD, CRC