Histologic Inflammation Is a Risk Factor for Progression to Colorectal Neoplasia in Ulcerative Colitis: A Cohort Study

Background & Aims: Although inflammation is presumed to contribute to colonic neoplasia in ulcerative colitis (UC), few studies have directly examined this relationship. Our aim was to determine whether severity of microscopic inflammation over time is an independent risk factor for neoplastic p...

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Veröffentlicht in:Gastroenterology (New York, N.Y. 1943) N.Y. 1943), 2007-10, Vol.133 (4), p.1099-1105
Hauptverfasser: Gupta, Roopali Bansal, Harpaz, Noam, Itzkowitz, Steven, Hossain, Sabera, Matula, Sierra, Kornbluth, Asher, Bodian, Carol, Ullman, Thomas
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container_end_page 1105
container_issue 4
container_start_page 1099
container_title Gastroenterology (New York, N.Y. 1943)
container_volume 133
creator Gupta, Roopali Bansal
Harpaz, Noam
Itzkowitz, Steven
Hossain, Sabera
Matula, Sierra
Kornbluth, Asher
Bodian, Carol
Ullman, Thomas
description Background & Aims: Although inflammation is presumed to contribute to colonic neoplasia in ulcerative colitis (UC), few studies have directly examined this relationship. Our aim was to determine whether severity of microscopic inflammation over time is an independent risk factor for neoplastic progression in UC. Methods: A cohort of patients with UC undergoing regular endoscopic surveillance for dysplasia was studied. Degree of inflammation at each biopsy site had been graded as part of routine clinical care using a highly reproducible histologic activity index. Progression to neoplasia was analyzed in proportional hazards models with inflammation summarized in 3 different ways and each included as a time-changing covariate: (1) mean inflammatory score (IS-mean), (2) binary inflammatory score (IS-bin), and (3) maximum inflammatory score (IS-max). Potential confounders were analyzed in univariate testing and, when significant, in a multivariable model. Results: Of 418 patients who met inclusion criteria, 15 progressed to advanced neoplasia (high-grade dysplasia or colorectal cancer), and 65 progressed to any neoplasia (low-grade dysplasia, high-grade dysplasia, or colorectal cancer). Univariate analysis demonstrated significant relationships between histologic inflammation over time and progression to advanced neoplasia (hazard ration (HR), 3.0; 95% CI: 1.4–6.3 for IS-mean; HR, 3.4; 95% CI: 1.1–10.4 for IS-bin; and HR, 2.2; 95% CI: 1.2–4.2 for IS-max). This association was maintained in multivariable proportional hazards analysis. Conclusions: The severity of microscopic inflammation over time is an independent risk factor for developing advanced colorectal neoplasia among patients with long-standing UC.
doi_str_mv 10.1053/j.gastro.2007.08.001
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Our aim was to determine whether severity of microscopic inflammation over time is an independent risk factor for neoplastic progression in UC. Methods: A cohort of patients with UC undergoing regular endoscopic surveillance for dysplasia was studied. Degree of inflammation at each biopsy site had been graded as part of routine clinical care using a highly reproducible histologic activity index. Progression to neoplasia was analyzed in proportional hazards models with inflammation summarized in 3 different ways and each included as a time-changing covariate: (1) mean inflammatory score (IS-mean), (2) binary inflammatory score (IS-bin), and (3) maximum inflammatory score (IS-max). Potential confounders were analyzed in univariate testing and, when significant, in a multivariable model. Results: Of 418 patients who met inclusion criteria, 15 progressed to advanced neoplasia (high-grade dysplasia or colorectal cancer), and 65 progressed to any neoplasia (low-grade dysplasia, high-grade dysplasia, or colorectal cancer). Univariate analysis demonstrated significant relationships between histologic inflammation over time and progression to advanced neoplasia (hazard ration (HR), 3.0; 95% CI: 1.4–6.3 for IS-mean; HR, 3.4; 95% CI: 1.1–10.4 for IS-bin; and HR, 2.2; 95% CI: 1.2–4.2 for IS-max). This association was maintained in multivariable proportional hazards analysis. Conclusions: The severity of microscopic inflammation over time is an independent risk factor for developing advanced colorectal neoplasia among patients with long-standing UC.</description><identifier>ISSN: 0016-5085</identifier><identifier>EISSN: 1528-0012</identifier><identifier>DOI: 10.1053/j.gastro.2007.08.001</identifier><identifier>PMID: 17919486</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Cohort Studies ; Colitis, Ulcerative - complications ; Colitis, Ulcerative - pathology ; Colonoscopy ; Colorectal Neoplasms - etiology ; Colorectal Neoplasms - pathology ; Databases as Topic ; Disease Progression ; Female ; Follow-Up Studies ; Gastroenterology and Hepatology ; Humans ; Inflammation - complications ; Inflammation - pathology ; Male ; Proportional Hazards Models ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Time Factors</subject><ispartof>Gastroenterology (New York, N.Y. 1943), 2007-10, Vol.133 (4), p.1099-1105</ispartof><rights>AGA Institute</rights><rights>2007 AGA Institute</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c582t-a3e76398eee6605c5af2a746e9838b6309f56b49c9c983c7a9504ea843bae7843</citedby><cites>FETCH-LOGICAL-c582t-a3e76398eee6605c5af2a746e9838b6309f56b49c9c983c7a9504ea843bae7843</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1053/j.gastro.2007.08.001$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17919486$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gupta, Roopali Bansal</creatorcontrib><creatorcontrib>Harpaz, Noam</creatorcontrib><creatorcontrib>Itzkowitz, Steven</creatorcontrib><creatorcontrib>Hossain, Sabera</creatorcontrib><creatorcontrib>Matula, Sierra</creatorcontrib><creatorcontrib>Kornbluth, Asher</creatorcontrib><creatorcontrib>Bodian, Carol</creatorcontrib><creatorcontrib>Ullman, Thomas</creatorcontrib><title>Histologic Inflammation Is a Risk Factor for Progression to Colorectal Neoplasia in Ulcerative Colitis: A Cohort Study</title><title>Gastroenterology (New York, N.Y. 1943)</title><addtitle>Gastroenterology</addtitle><description>Background &amp; Aims: Although inflammation is presumed to contribute to colonic neoplasia in ulcerative colitis (UC), few studies have directly examined this relationship. 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Results: Of 418 patients who met inclusion criteria, 15 progressed to advanced neoplasia (high-grade dysplasia or colorectal cancer), and 65 progressed to any neoplasia (low-grade dysplasia, high-grade dysplasia, or colorectal cancer). Univariate analysis demonstrated significant relationships between histologic inflammation over time and progression to advanced neoplasia (hazard ration (HR), 3.0; 95% CI: 1.4–6.3 for IS-mean; HR, 3.4; 95% CI: 1.1–10.4 for IS-bin; and HR, 2.2; 95% CI: 1.2–4.2 for IS-max). This association was maintained in multivariable proportional hazards analysis. 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Aims: Although inflammation is presumed to contribute to colonic neoplasia in ulcerative colitis (UC), few studies have directly examined this relationship. Our aim was to determine whether severity of microscopic inflammation over time is an independent risk factor for neoplastic progression in UC. Methods: A cohort of patients with UC undergoing regular endoscopic surveillance for dysplasia was studied. Degree of inflammation at each biopsy site had been graded as part of routine clinical care using a highly reproducible histologic activity index. Progression to neoplasia was analyzed in proportional hazards models with inflammation summarized in 3 different ways and each included as a time-changing covariate: (1) mean inflammatory score (IS-mean), (2) binary inflammatory score (IS-bin), and (3) maximum inflammatory score (IS-max). Potential confounders were analyzed in univariate testing and, when significant, in a multivariable model. Results: Of 418 patients who met inclusion criteria, 15 progressed to advanced neoplasia (high-grade dysplasia or colorectal cancer), and 65 progressed to any neoplasia (low-grade dysplasia, high-grade dysplasia, or colorectal cancer). Univariate analysis demonstrated significant relationships between histologic inflammation over time and progression to advanced neoplasia (hazard ration (HR), 3.0; 95% CI: 1.4–6.3 for IS-mean; HR, 3.4; 95% CI: 1.1–10.4 for IS-bin; and HR, 2.2; 95% CI: 1.2–4.2 for IS-max). This association was maintained in multivariable proportional hazards analysis. Conclusions: The severity of microscopic inflammation over time is an independent risk factor for developing advanced colorectal neoplasia among patients with long-standing UC.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>17919486</pmid><doi>10.1053/j.gastro.2007.08.001</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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subjects Adult
Cohort Studies
Colitis, Ulcerative - complications
Colitis, Ulcerative - pathology
Colonoscopy
Colorectal Neoplasms - etiology
Colorectal Neoplasms - pathology
Databases as Topic
Disease Progression
Female
Follow-Up Studies
Gastroenterology and Hepatology
Humans
Inflammation - complications
Inflammation - pathology
Male
Proportional Hazards Models
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
title Histologic Inflammation Is a Risk Factor for Progression to Colorectal Neoplasia in Ulcerative Colitis: A Cohort Study
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