Abstract
Cancer morbidity and all cause mortality were studied prospectively in all patients with definite and probable ulcerative colitis and indeterminate colitis diagnosed from 1958 to 1982, in the city of Malmö, Sweden. The follow-up to Jan. 1, 1990 was complete for all but ten patients. Nine of the 471 patients with ulcerative colitis and three of the 100 patients with indeterminate colitis developed colo-rectal cancer. The incidence of colorectal cancer in ulcerative colitis was 1.4 per 1000 person-years. The observed number of cases was 2.1 times higher than expected; (95% C.I. 1.0–4.1), based on the age- and sex-specific cancer incidence in the city during the study period. Indeterminate colitis was associated with a higher colorectal cancer risk than ulcerative colitis; 2.4 per 1000 person-years; (SMR 8.6, 95% C.I. 1.8–25.1). Both conditions were associated with a slight increased mortality rate, for ulcerative colitis 12.6 per 1000 person-years; (SMR 1.3, 95% C.I. 1.0–1.5), and for indeterminate colitis 11.7 per 1000 person-years; (SMR 2.7, 95% C.I. 1.6–4.4). Complications of colitis were the main cause of death in both groups. The cancer risk was related to extent of disease, duration of disease and female gender. Ten out of the 12 cases with cancer had or developed total colitis. However, only seven of the 134 cases with total ulcerative colitis and two of 87 cases with total indeterminate colitis developed cancer. Considering these low frequencies and the low cancer incidence per 1000 person years, it is suggested that proctocolectomy to prevent cancer is not to be recommended simply at the basis of the extent of the disease.
Résumé
La morbidité par cancer et toutes les causes de mortalité ont été étudiées prospectivement chez tous les patients chez lesquels un diagnostic définitif ou probable de colite ulcéreuse et de colite indéterminée a été posé entre 1958 et 1982 dans la ville de Malmö en Suède. Le follow-up jusqu'au ler janvier 1990 a été complet pour tous les cas à l'exception de 10 patients. Neuf des 471 patients avec colite ulcéreuse et 3 des 100 patients avec colite indéterminée ont développé un cancer colo-rectal. L'incidence du cancer colo-rectal dans la colite ulcéreuse est de 1,4 par 1000 années/patient. Le nombre de cas observés était 2,1 fois supérieur à l'incidence attendue (95% C.I. 1.0–4.1) en se basant sur l'incidence de cancer selon l'âge et le sexe durant la période d'étude à Malmö. La colite indéterminée était associée avec une incidence de cancer colo-rectal plus élevée que la colite ulcéreuse: 2,4 par 1000 années-patient (SMR 8,6, 95% C.I. 1,8–25,1). Les deux conditions étaient associées avec une légère augmentation de la mortalité, 12,6 par 1000 années-patient en cas de colite ulcéreuse (SMR 1,3, 95% C.I. 1,0–1,5) et de 11,7 par 1000 années-patient pour la colite indéterminée (SMR 2,7, 95% C.I. 1,6–4,4). Les complications de la colite constituent la cause essentielle de mortalité dans les deux groupes. Le risque de cancer est en relation directe avec l'étendue de la maladie, sa durée et le sexe féminin. Dix de 12 cas de cancer avaient ou développèrent une pancolite. Sept des 134 cas de pancolites ulcéreuses et 2 des 87 cas de pancolites indéterminées développèrent un cancer. Tenant compte de ces fréquences basses et de l'incidence basse du cancer par 1000 années-patient, il est suggéré que la proctocolectomie ne doit pas être recommandée comme mesure de prévention du cancer sur la seule base de l'étendue de l'affection.
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Stewénius, J., Adnerhill, I., Anderson, H. et al. Incidence of colorectal cancer and all cause mortality in non-selected patients with ulcerative colitis and indeterminate colitis in Malmö, Sweden. Int J Colorect Dis 10, 117–122 (1995). https://doi.org/10.1007/BF00341210
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DOI: https://doi.org/10.1007/BF00341210