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Associations of Statin Use With Colorectal Cancer Recurrence and Mortality in a Danish Cohort.

https://arctichealth.org/en/permalink/ahliterature286110
Source
Am J Epidemiol. 2017 Sep 15;186(6):679-687
Publication Type
Article
Date
Sep-15-2017
Author
Timothy L Lash
Anders H Riis
Eva B Ostenfeld
Rune Erichsen
Mogens Vyberg
Thomas P Ahern
Ole Thorlacius-Ussing
Source
Am J Epidemiol. 2017 Sep 15;186(6):679-687
Date
Sep-15-2017
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cardiovascular Diseases - drug therapy - mortality
Cause of Death
Cohort Studies
Colorectal Neoplasms - drug therapy - mortality - pathology
Confidence Intervals
Denmark
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Male
Middle Aged
Neoplasm Recurrence, Local - chemically induced - mortality
Proportional Hazards Models
Registries
Abstract
In earlier studies of the influence of hydroxymethylglutaryl-coenzyme A reductase inhibitors (also known as statins) on colorectal cancer prognosis, investigators reported a reduced rate of cancer-specific mortality. Studies of recurrence are few and small. Using data from Danish registries, we followed 21,152 patients diagnosed with stage I-III colorectal cancer from 2001 to 2011. We estimated the association between statin use in the preceding year and cancer recurrence, cancer-specific mortality, and all-cause mortality rates. We identified 5,036 recurrences, 7,084 deaths from any cause, and 4,066 deaths from colorectal cancer. After adjustment for potential confounders, statin use was not associated with recurrence (adjusted hazard ratio (aHR) = 1.01, 95% confidence interval (CI): 0.93, 1.09), but it was associated with death from colorectal cancer (aHR = 0.72, 95% CI: 0.65, 0.79) and death from any cause (aHR = 0.72, 95% CI: 0.67, 0.76). Statin use in the year preceding recurrence was associated with a reduced risk of cancer-specific mortality (aHR = 0.83, 95% CI: 0.74, 0.92) but also a reduced risk of death from any other cause (aHR = 0.78, 95% CI: 0.61, 1.00). Statin use was not associated with a reduced rate of colorectal cancer recurrence, but it was associated with a reduced rate of cancer-specific mortality, which suggests that there is no cancer-directed benefit; therefore, there is no basis to prescribe statins to colorectal cancer patients who do not have cardiovascular indications.
PubMed ID
28338891 View in PubMed
Less detail

Characteristics and survival of interval and sporadic colorectal cancer patients: a nationwide population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature112999
Source
Am J Gastroenterol. 2013 Aug;108(8):1332-40
Publication Type
Article
Date
Aug-2013
Author
Rune Erichsen
John A Baron
Elena M Stoffel
Søren Laurberg
Robert S Sandler
Henrik Toft Sørensen
Author Affiliation
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. re@dce.au.dk
Source
Am J Gastroenterol. 2013 Aug;108(8):1332-40
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Cohort Studies
Colonoscopy
Colorectal Neoplasms - diagnosis - mortality - pathology
Comorbidity
Denmark - epidemiology
Female
Humans
Logistic Models
Male
Middle Aged
Neoplasm Staging
Prevalence
Proportional Hazards Models
Registries
Risk factors
Sex Factors
Survival Rate
Abstract
Colorectal cancers (CRCs) diagnosed relatively soon after a colonoscopy are referred to as interval CRCs. It is not clear whether interval CRCs arise from prevalent lesions missed at colonoscopy or represent specific aggressive biology leading to poor survival.
Using Danish population-based medical registries (2000-2009), we investigated patients with "interval" CRC diagnosed within 1-5 years of a colonoscopy, and compared them with cases with colonoscopy =10 years before diagnosis and to "sporadic" CRCs with no colonoscopy before diagnosis. Multivariate logistic regression was used to explore the association between clinical, demographic, and comorbidity characteristics and interval CRC. We assessed survival using Kaplan-Meier methods and mortality rate ratios (MRRs) using Cox regression, adjusting for covariates including the Charlson Comorbidity Index (CCI 0, 1-2, 3+).
The comparison of the 982 interval CRCs to the 358 patients with CRC =10 years after colonoscopy revealed nearly similar characteristics and mortality. In the comparison with the 35,704 sporadic CRCs, interval cases were slightly older (74 vs. 71 years), more likely to be female (54 vs. 48%), have comorbidities (CCI3+: 28 vs. 15%), have proximal tumors (38 vs. 22%), and tumors with mucinous histology (9.1 vs. 7.0%), but stage was similar (metastatic 23 vs. 24%). In logistic regression analysis, female sex, localized stage at diagnosis, proximal tumor location, and high comorbidity burden were factors independently associated with interval CRC. The 1-year survival was 68% (95% confidence interval (CI): 65%, 71%) in interval and 71% (95% CI: 70%, 71%) in sporadic cases, with an adjusted MRR of 0.92 (95% CI 0.82, 1.0). After 5 years, survival was 41% (95% CI: 37%, 44%) in interval and 43% (95% CI: 42%, 43%) in sporadic cases, and the adjusted 2-5 year MRR was 1.0 (95% CI 0.88, 1.2).
Clinical characteristics and survival among interval CRCs did not suggest aggressive biology, but rather that the majority represented missed lesions.
Notes
Comment In: Am J Gastroenterol. 2013 Aug;108(8):1341-323912407
PubMed ID
23774154 View in PubMed
Less detail

Cholangitis and subsequent gastrointestinal cancer risk: a Danish population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature112739
Source
Gut. 2014 Feb;63(2):356-61
Publication Type
Article
Date
Feb-2014
Author
Kirstine Kobberøe Søgaard
Rune Erichsen
Jennifer Leigh Lund
Dóra Körmendiné Farkas
Henrik Toft Sørensen
Author Affiliation
Department of Clinical Epidemiology, Aarhus University Hospital, , Aarhus, Denmark.
Source
Gut. 2014 Feb;63(2):356-61
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Aged
Cholangitis - complications
Cohort Studies
Denmark - epidemiology
Female
Follow-Up Studies
Gastrointestinal Neoplasms - epidemiology - etiology
Humans
Incidence
Male
Middle Aged
Registries
Risk assessment
Risk factors
Abstract
While patients with gastrointestinal cancer are at increased risk of cholangitis, it is less clear whether cholangitis is also a marker for occult gastrointestinal cancer. If an undiagnosed cancer obstructs the bile duct system and causes cholangitis, the short-term risk of cancer will appear increased. However, an increased long-term risk of cancer may originate from chronic inflammatory processes. We assessed the risk of a gastrointestinal cancer diagnosis subsequent to a cholangitis diagnosis during a 17-year period in Denmark.
We conducted a nationwide population-based cohort study by linking Danish medical registries during 1994-2010. We quantified the excess risk of cancer in cholangitis patients using relative (standardised incidence ratio; SIR) and absolute (excess absolute risk per 1000 person-years at risk; EAR) risk calculations.
4333 patients with cholangitis (including 178 with primary sclerosing cholangitis) were followed for 17 222 person-years. During the follow-up period, 477 gastrointestinal cancers occurred versus 59 expected, corresponding to a SIR of 8.12 (95% CI 7.41 to 8.88). Risk was increased mainly for cancer in the small intestine (SIR 18.2; 95% CI 8.69 to 33.4), liver (SIR 16.3; 95% CI 11.6 to 22.2), gallbladder and biliary tract (SIR 70.9; 95% CI 59.0 to 84.4) and pancreas (SIR 31.7; 95% CI 27.8 to 36.0). During the first 6 months of follow-up, 314 patients were diagnosed with gastrointestinal cancer, corresponding to a SIR of 49.8 (95% CI 44.4 to 55.6) and an EAR of 175.
Cholangitis is a marker of occult gastrointestinal cancer.
PubMed ID
23804559 View in PubMed
Less detail

Clinical and Molecular Characteristics of Post-Colonoscopy Colorectal Cancer: A Population-based Study.

https://arctichealth.org/en/permalink/ahliterature283032
Source
Gastroenterology. 2016 Nov;151(5):870-878.e3
Publication Type
Article
Date
Nov-2016
Author
Elena M Stoffel
Rune Erichsen
Trine Frøslev
Lars Pedersen
Mogens Vyberg
Erika Koeppe
Seth D Crockett
Stanley R Hamilton
Henrik T Sørensen
John A Baron
Source
Gastroenterology. 2016 Nov;151(5):870-878.e3
Date
Nov-2016
Language
English
Publication Type
Article
Keywords
Adenocarcinoma - diagnosis - epidemiology - genetics - pathology
Adenoma - diagnosis - epidemiology - genetics - pathology
Adult
Aged
Aged, 80 and over
Colonoscopy
Colorectal Neoplasms - diagnosis - epidemiology - genetics - pathology
Cross-Sectional Studies
DNA Mismatch Repair
DNA Repair-Deficiency Disorders - diagnosis - epidemiology
Denmark - epidemiology
Female
Humans
Incidence
Logistic Models
Male
Middle Aged
Registries
Time Factors
Abstract
Colonoscopy provides incomplete protection from colorectal cancer (CRC), but determinants of post-colonoscopy CRC are not well understood. We compared clinical features and molecular characteristics of CRCs diagnosed at different time intervals after a previous colonoscopy.
We performed a population-based, cross-sectional study of incident CRC cases in Denmark (2007-2011), categorized as post-colonoscopy or detected during diagnostic colonoscopy (in patients with no prior colonoscopy). We compared prevalence of proximal location and DNA mismatch repair deficiency (dMMR) in CRC tumors, relative to time since previous colonoscopy, using logistic regression and cubic splines to assess temporal variation.
Of 10,365 incident CRCs, 725 occurred after colonoscopy examinations (7.0%). These were more often located in the proximal colon (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.90-2.89) and were more likely to have dMMR (OR, 1.26; 95% CI, 1.00-1.59), but were less likely to be metastatic at presentation (OR, 0.65; 95% CI, 0.48-0.89) compared with CRCs diagnosed in patients with no prior colonoscopy. The highest proportions of proximal and/or dMMR tumors were observed in CRCs diagnosed 3-6 years after colonoscopy, but these features were still more frequent among cancers diagnosed up to 10 years after colonoscopy. The relative excess of dMMR tumors was most pronounced in distal cancers. In an analysis of 85 cases detected after colonoscopy, we found BRAF mutations in 23% of tumors and that 7% of cases had features of Lynch syndrome. Colonoscopy exams were incomplete in a higher proportion of cases diagnosed within
Notes
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Comment In: Transl Gastroenterol Hepatol. 2017 Feb 15;2:928275741
PubMed ID
27443823 View in PubMed
Less detail

Coexisting liver disease is associated with increased mortality after surgery for diverticular disease.

https://arctichealth.org/en/permalink/ahliterature265407
Source
Dig Dis Sci. 2015 Jun;60(6):1832-40
Publication Type
Article
Date
Jun-2015
Author
Jonathan Montomoli
Rune Erichsen
Lisa L Strate
Lars Pedersen
Tove Nilsson
Henrik Toft Sørensen
Source
Dig Dis Sci. 2015 Jun;60(6):1832-40
Date
Jun-2015
Language
English
Publication Type
Article
Keywords
Aged
Cohort Studies
Denmark - epidemiology
Diverticulum, Colon - complications - mortality - surgery
Female
Hospital Mortality
Humans
Liver Diseases - complications - mortality
Male
Middle Aged
Recurrence
Registries
Reoperation - statistics & numerical data
Risk factors
Abstract
Coexistence of liver disease in patients undergoing surgery for diverticular disease (DD) may increase the risk of postoperative complications, but the evidence is limited.
To investigate the impact of liver disease on mortality and reoperation rates following surgery for DD.
We performed a cohort study based on medical databases of all patients undergoing surgery for DD in Denmark during 1977-2011, categorizing them into three cohorts according to history of liver disease: patients with non-cirrhotic liver disease, those with liver cirrhosis, and those without liver disease (comparison cohort). Using the Kaplan-Meier method, we computed mortality in each cohort for 0-30, 31-60, and 61-90 days following surgery for DD. We used a Cox regression model to compute hazard ratios as measures of the relative risk (RR) of death, controlling for potential confounders, including other comorbidities. In addition, we assessed the reoperation rate within 30 days of initial surgery.
Of 14,408 patients undergoing surgery for DD, 233 (1.6 %) had non-cirrhotic liver disease and 91 (0.6 %) had liver cirrhosis. Thirty-day mortality was 9.9 % in patients without liver disease and 14.6 % in patients with non-cirrhotic liver disease [adjusted RR = 1.64 (95 % confidence interval [CI] 1.16-2.31)]. Among patients with liver cirrhosis, mortality was 24.2 % [adjusted RR = 2.70 (95 % CI 1.73-4.22)]. Liver cirrhosis had an impact on mortality up to 60 days after surgery for DD. The reoperation rate was approximately 10 % in each cohort.
Preexisting liver disease has a major impact on postoperative mortality following surgery for DD.
PubMed ID
25559756 View in PubMed
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Colorectal cancer and risk of atrial fibrillation and flutter: a population-based case-control study.

https://arctichealth.org/en/permalink/ahliterature130779
Source
Intern Emerg Med. 2012 Oct;7(5):431-8
Publication Type
Article
Date
Oct-2012
Author
Rune Erichsen
Christian Fynbo Christiansen
Frank Mehnert
Noel Scott Weiss
John Anthony Baron
Henrik Toft Sørensen
Author Affiliation
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark. re@dce.au.dk
Source
Intern Emerg Med. 2012 Oct;7(5):431-8
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Atrial Fibrillation - epidemiology - etiology
Atrial Flutter - epidemiology - etiology
Case-Control Studies
Child
Child, Preschool
Colorectal Neoplasms
Denmark - epidemiology
Female
Humans
Infant
Male
Middle Aged
Odds Ratio
Registries
Risk assessment
Young Adult
Abstract
Colorectal cancer has recently been associated with an increased atrial fibrillation risk, but evidence is very sparse. So, we conducted a population-based case-control study in northern Denmark (population 1.7 million) during 1998-2006 to estimate the atrial fibrillation/flutter risk in colorectal cancer patients. We identified 28,333 atrial fibrillation/flutter cases and 283,260 sex-, age-, and county-matched population controls. We searched the databases for a prior colorectal cancer diagnosis, a prior cancer diagnosis other than colorectal cancer, and performance of surgery within 30 days prior to atrial fibrillation/flutter. We used conditional logistic regression to estimate the OR of atrial fibrillation/flutter in patients with colorectal cancer, cancers other than colorectal and in patient with surgery. Among cases, 0.59% (n = 168) had a colorectal cancer diagnosis within 90 days before their atrial fibrillation/flutter diagnosis, compared with 0.05% (n = 155) of controls (adjusted OR = 11.8; 95% CI 9.3-14.9). Beyond the first 90 days after a colorectal cancer diagnosis, atrial fibrillation/flutter risk was no longer increased. There was likewise an increased atrial fibrillation/flutter risk in patients diagnosed with another cancer form in the prior 90 days (OR = 7.0, 95% CI 6.3-7.8). Furthermore, the atrial fibrillation/flutter risk was elevated fivefold in patients who had undergone surgery, whether or not cancer-related. We therefore conclude that colorectal cancer patients are at increased atrial fibrillation/flutter risk exclusively in the first 90 days after cancer diagnosis, but to no greater an extent than are patients with other cancers. The performance of surgery probably plays an important role in this association.
PubMed ID
21968511 View in PubMed
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Colorectal cancer, comorbidity, and risk of venous thromboembolism: assessment of biological interactions in a Danish nationwide cohort.

https://arctichealth.org/en/permalink/ahliterature272904
Source
Br J Cancer. 2016 Jan 12;114(1):96-102
Publication Type
Article
Date
Jan-12-2016
Author
Thomas P Ahern
Erzsébet Horváth-Puhó
Karen-Lise Garm Spindler
Henrik Toft Sørensen
Anne G Ording
Rune Erichsen
Source
Br J Cancer. 2016 Jan 12;114(1):96-102
Date
Jan-12-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cohort Studies
Colorectal Neoplasms - complications - pathology
Comorbidity
Denmark
Female
Humans
Incidence
Male
Middle Aged
Neoplasm Staging
Risk
Venous Thromboembolism - epidemiology - etiology
Abstract
Venous thromboembolism (VTE) is a major source of morbidity and mortality in cancer patients. Incident colorectal cancer (CRC) and comorbidity both predict VTE, but potential synergy between these factors has not been explored.
Danish nationwide cohort study of CRC cases diagnosed in 1995-2010 and a matched general population reference cohort of subjects without CRC who matched cases on age, sex, and comorbidities. We calculated the Charlson Comorbidity Index using diagnoses recorded in the Danish National Patient Registry. We calculated standardised incidence rates (SIRs) and interaction contrasts (IC) to measure additive interaction between comorbidity and CRC status with respect to 5-year VTE incidence.
Among 56?189 CRC patients, 1372 VTE cases were diagnosed over 145?211 person-years (SIR=9.5 cases per 1000 person-years). Among 271?670 reference subjects, 2867 VTE cases were diagnosed over 1?068 ?860 person-years (SIR=2.8 cases per 1000 person-years). CRC and comorbidity were positively and independently associated with VTE, but there was no evidence for biological interaction between these factors (e.g., comparing the 'severe comorbidity' stratum with the 'no comorbidity' stratum, IC=0.8, 95% CI: -3.3, 4.8).
There is neither a deficit nor a surplus of VTE cases among patients with both comorbidity and CRC, compared with rates expected from these risk factors in isolation.
Notes
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PubMed ID
26625005 View in PubMed
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Colorectal cancer in Crohn's disease: a Scandinavian population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature306898
Source
Lancet Gastroenterol Hepatol. 2020 05; 5(5):475-484
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
05-2020
Author
Ola Olén
Rune Erichsen
Michael C Sachs
Lars Pedersen
Jonas Halfvarson
Johan Askling
Anders Ekbom
Henrik Toft Sørensen
Jonas F Ludvigsson
Author Affiliation
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden. Electronic address: ola.olen@ki.se.
Source
Lancet Gastroenterol Hepatol. 2020 05; 5(5):475-484
Date
05-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Age Factors
Case-Control Studies
Cholangitis, Sclerosing - epidemiology
Cohort Studies
Colorectal Neoplasms - epidemiology - mortality
Crohn Disease - diagnosis - epidemiology
Denmark - epidemiology
Female
Humans
Incidence
Male
Middle Aged
Population Surveillance
Proportional Hazards Models
Registries
Risk factors
Sweden - epidemiology
Young Adult
Abstract
Crohn's disease is a risk factor for colorectal cancer (CRC). However, available studies reflect older treatment and surveillance strategies, and most have assessed risks for incident CRC without taking surveillance and lead-time bias into account. Such biases can be accounted for by assessing CRC incidence by tumour stage and CRC mortality by tumour stage. We aimed to assess rates of incident CRC and CRC mortality among patients with Crohn's disease compared with the general population.
For this nationwide register-based cohort study, we used International Classification of Disease codes in national patient registers and pathology reports to identify incident cases of Crohn's disease. In Denmark we searched for incident cases between January, 1977, and December, 2011, and in Sweden between January, 1969, and December, 2017. For each patient with Crohn's disease, we identified up to ten reference individuals in national population registers and matched them by sex, age, calendar year, and place of residence. Matched reference individuals had to be alive and free of inflammatory bowel disease at the start of follow-up of index patients with Crohn's disease, and stopped contributing to reference person-years if they were diagnosed with inflammatory bowel disease. Our main outcome was death from CRC (main or contributory cause of death) as captured in the cause-of-death registers. Our secondary outcome was incident CRC, as defined by the cancer registers. We used Cox regression to estimate hazard ratios (HRs) for incident CRC and CRC mortality, taking tumour stage into account. We used a series of Cox models to estimate cause-specific HRs of the different competing outcomes (CRC diagnosis, CRC death, and other causes of death) and adjusted for tumour stage at CRC diagnosis.
During the 1969-2017 study period, we identified 47?035 patients with incident Crohn's disease (13?056 in Denmark and 33?979 in Sweden) and 463?187 matched reference individuals. During follow-up, 296 (0·47 per 1000 person-years) CRC deaths occurred among individuals with Crohn's disease compared with 1968 (0·31 per 1000 person-years) in reference individuals, corresponding to an overall adjusted HR of 1·74 (1·54-1·96). 499 (0·82 per 1000 person-years) cases of incident CRC were diagnosed in patients with Crohn's disease compared with 4084 (0·64 per 1000 person-years) cases in reference individuals, corresponding to an overall adjusted HR of 1·40 (95% CI 1·27-1·53). Patients with Crohn's disease who were diagnosed with CRC were at increased risk of CRC mortality compared with reference individuals also diagnosed with CRC (HR 1·42 [1·16-1·75] when adjusted for tumour stage), and tumour stage at CRC diagnosis did not differ between groups (p=0·27). Patients with Crohn's disease who had follow-up of 8 years or longer or who were diagnosed with primary sclerosing cholangitis (PSC) and hence were potentially eligible for CRC surveillance had an increased overall risk of CRC death (HR 1·40 [1·16-1·68]) or CRC diagnosis (HR 1·12 [0·98-1·28]). However, in patients potentially eligible for CRC surveillance we only found significantly increased risks in patients diagnosed with Crohn's disease before the age of 40 years, patients with disease activity in the colon only, or patients with PSC.
Patients with Crohn's disease are at increased risk of CRC diagnosis and CRC death. Patients with Crohn's disease who have CRC have a higher mortality than patients without Crohn's disease who are also diagnosed with CRC. CRC surveillance should likely be focused on patients diagnosed with Crohn's disease before the age of 40 years, on patients with colon inflammation, and on those who have PSC.
Swedish Medical Society, Karolinska Institutet, Regional Agreement on Medical Training and Clinical Research between Stockholm County Council and Karolinska Institutet (ALF), Forte Foundation, Swedish Cancer Foundation, and Independent Research Fund Denmark.
Notes
CommentIn: Lancet Gastroenterol Hepatol. 2020 May;5(5):424-425 PMID 32066531
PubMed ID
32066530 View in PubMed
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Colorectal cancer in ulcerative colitis: a Scandinavian population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature307327
Source
Lancet. 2020 01 11; 395(10218):123-131
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Date
01-11-2020
Author
Ola Olén
Rune Erichsen
Michael C Sachs
Lars Pedersen
Jonas Halfvarson
Johan Askling
Anders Ekbom
Henrik Toft Sørensen
Jonas F Ludvigsson
Author Affiliation
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden. Electronic address: ola.olen@ki.se.
Source
Lancet. 2020 01 11; 395(10218):123-131
Date
01-11-2020
Language
English
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Aged
Cohort Studies
Colitis, Ulcerative - complications - epidemiology - mortality
Colorectal Neoplasms - epidemiology - mortality - pathology
Denmark - epidemiology
Female
Humans
Incidence
Male
Middle Aged
Neoplasm Staging
Proportional Hazards Models
Registries
Sweden - epidemiology
Young Adult
Abstract
Ulcerative colitis (UC) is a risk factor for colorectal cancer (CRC). However, available studies reflect older treatment and surveillance paradigms, and most have assessed risks for incident CRC without taking surveillance and lead-time bias into account, such as by assessing CRC incidence by tumour stage, or stage-adjusted mortality from CRC. We aimed to compare both overall and country-specific risks of CRC mortality and incident CRC among patients with UC.
In this population-based cohort study of 96?447 patients with UC in Denmark (n=32 919) and Sweden (n=63?528), patients were followed up for CRC incidence and CRC mortality between Jan 1, 1969, and Dec 31, 2017, and compared with matched reference individuals from the general population (n=949?207). Patients with UC were selected from national registers and included in the analysis if they had two or more records with a relevant International Classification of Disease in the patient register (in the country in question) or one such record plus a colorectal biopsy report with a morphology code suggestive of inflammatory bowel disease. For every patient with UC, we selected matched reference individuals from the total population registers of Denmark and Sweden, who were matched for sex, age, birth year, and place of residence. We used Cox regression to compute hazard ratios (HRs) for incident CRC, and for CRC mortality, taking tumour stage into account.
During follow-up, we observed 1336 incident CRCs in the UC cohort (1·29 per 1000 person-years) and 9544 incident CRCs in reference individuals (0·82 per 1000 person-years; HR 1·66, 95% CI 1·57-1·76). In the UC cohort, 639 patients died from CRC (0·55 per 1000 person-years), compared with 4451 reference individuals (0·38 per 1000 person-years; HR 1·59, 95% CI 1·46-1·72) during the same time period. The CRC stage distribution in people with UC was less advanced (p
Notes
CommentIn: Lancet. 2020 Jan 11;395(10218):92-94 PMID 31929018
PubMed ID
31929014 View in PubMed
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