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Cited by 183Liver Diseases and ImmunityInflammatory Bowel DiseaseIgG4-Related and Inflammatory Diseases

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Effects of Primary Sclerosing Cholangitis on Risks of Cancer and Death in People With Inflammatory Bowel Disease, Based on Sex, Race, and Age

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Trivedi, Palak J., Crothers, Hannah, Mytton, Jemma, Bosch, Sofie, Iqbal, Tariq, Ferguson, James, Hirschfield, Gideon M.·2020·Gastroenterology
DOI 10.1053/j.gastro.2020.05.049
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Abstract

Background & aims There are insufficient population-level data on the effects of primary sclerosing cholangitis (PSC) in patients with inflammatory bowel disease (IBD).Methods We identified incident cases of IBD, with PSC (PSC-IBD) and without, from April 2006 to April 2016 and collected data on outcomes through April 2019. We linked data from national health care registries maintained for all adults in England on hospital attendances, imaging and endoscopic evaluations, surgical procedures, cancer, and deaths. Our primary aim was to quantify the effects of developing PSC in patients with all subtypes of IBD and evaluate its effects on hepatopancreatobiliary disease, IBD-related outcomes, and all-cause mortality, according to sex, race, and age.Results Over 10 years, we identified 284,560 incident cases of IBD nationwide; of these, 2588 patients developed PSC. In all, we captured 31,587 colectomies, 5608 colorectal cancers (CRCs) 6608 cholecystectomies, and 41,055 patient deaths. Development of PSC was associated with increased risk of death and CRC (hazard ratios [HRs], 3.20 and 2.43, respectively; P < .001) and a lower median age at CRC diagnosis (59 y vs 69 y without PSC; P < .001). Compared to patients with IBD alone, patients with PSC-IBD had a 4-fold higher risk of CRC if they received a diagnosis of IBD at an age younger than 40 years; there was no difference between groups for patients diagnosed with IBD at an age older than 60 years. Development of PSC also increased risks of cholangiocarcinoma (HR, 28.46), hepatocellular carcinoma (HR, 21.00), pancreatic cancer (HR, 5.26), and gallbladder cancer (HR, 9.19) (P < .001 for all). Risk of hepatopancreatobiliary cancer-related death was lower among patients with PSC-IBD who received annual imaging evaluations before their cancer diagnosis, compared to those who did not undergo imaging (HR, 0.43; P = .037). The greatest difference in mortality between the PSC-IBD alone group vs the IBD alone group was for patients younger than 40 years (incidence rate ratio >7), in contrast to those who received a diagnosis of IBD when older than 60 years (incidence rate ratio, <1.5). Among patients with PSC-IBD we observed 173 first liver transplants. Liver transplantation and PSC-related events accounted for approximately 75% of clinical events when patients received a diagnosis of PSC at an age younger than 40 years vs 31% of patients who received a diagnosis when older than 60 years (P < .001). African Caribbean heritage was associated with increased risks of liver transplantation or PSC-related death compared with white race (HR, 2.05; P < .001), whereas female sex was associated with reduced risk (HR, 0.74; P = .025).Conclusions In a 10-year, nationwide study, we confirmed that patients with PSC-IBD have increased risks of CRC, hepatopancreatobiliary cancers, and death compared to patients with IBD alone. In the PSC-IBD group, diagnosis of IBD at age younger than 40 years was associated with greater risks of CRC and all-cause mortality compared with diagnosis of IBD at older ages. Patients who receive a diagnosis of PSC at an age younger than 40 years, men, and patients of African Caribbean heritage have an increased incidence of PSC-related events.

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Authors
Trivedi, P. J., Crothers, H., Mytton, J., Bosch, S., Iqbal, T., Ferguson, J., & Hirschfield, G. M.
Affiliations
  • National Health Service (GB)
  • University Hospitals Birmingham NHS Foundation Trust (GB)
  • Amsterdam UMC Location University of Amsterdam (NL)
  • University Health Network (CA)
Corresponding author
  • Trivedi, Palak J.
  • Hirschfield, Gideon M.
ORCID
Venue
Gastroenterology
Publisher
Elsevier BV
Published
2020-09
Volume
159
Issue
3
Pages
915-928
ISSN
0016-5085 (ISSN-L)
DOI
10.1053/j.gastro.2020.05.049
OpenAlex
W3027906267
Cited by
183
References
50
Citations by year
2026: 27 · 2025: 35 · 2024: 29 · 2023: 31 · 2022: 31 · 2021: 25 · 2020: 5
FWCI
13.52
Type
journal article
Language
en
Open access
Licence
Locations
  • Gastroenterology (publishedVersion)
  • PubMed (publishedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by-nc-nd)
Funders
University of Birmingham
Topics
  • Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
  • Health Sciences › Medicine › Gastroenterology › Inflammatory Bowel Disease
  • Health Sciences › Medicine › Rheumatology › IgG4-Related and Inflammatory Diseases
Keywords
primary sclerosing cholangitis, inflammatory bowel disease, colorectal cancer, hepatopancreatobiliary cancer, cholangiocarcinoma, hepatocellular carcinoma, pancreatic cancer, gallbladder cancer, all-cause mortality, cancer risk, age at diagnosis, sex differences, racial disparities, colectomy, cholecystectomy
MeSH terms
Adult, Age Factors, Aged, England, Female, Humans, Longitudinal Studies, Male, Middle Aged, Mortality, Neoplasms, Prospective Studies, Registries, Risk Factors, Sex Factors, State Medicine, Cholangitis, Sclerosing, Inflammatory Bowel Diseases, Incidence, Age of Onset, Risk Assessment, Racial Groups, Young Adult

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