Study Highlights Increased Colorectal Cancer Risk in Primary Sclerosing Cholangitis Patients Without IBD

A study presented at the American College of Gastroenterology, reveals that primary sclerosing cholangitis (PSC) independently increases the risk of colorectal cancer (CRC), even in the absence of inflammatory bowel disease (IBD). The study, utilizing a large national database, underscores the need for tailored screening guidelines for PSC patients, regardless of IBD status. 

The retrospective cohort study analyzed 2,662 PSC patients without IBD, comparing them to a propensity score-matched group without PSC or IBD. Researchers also evaluated CRC risk in PSC patients with IBD, including subgroups for ulcerative colitis (UC) and Crohn’s disease (CD). Using Kaplan-Meier analysis, the study assessed time-to-event rates for CRC and other gastrointestinal malignancies over a 14-year period. 

Findings showed that PSC patients without IBD were nearly three times more likely to develop CRC than those without PSC or IBD (adjusted hazard ratio [aHR] = 2.9; 95% CI: 1.6–6.0). The increased risk was more pronounced in men (aHR = 4.17; 95% CI: 1.4–12.5) than in women (aHR = 2.1; 95% CI: 0.8–6.1). 

As expected, CRC risk was higher in PSC patients with IBD, particularly those with UC (aHR = 6.3; 95% CI: 3.2–12.4). Moreover, patients with PSC demonstrated an elevated risk for other gastrointestinal cancers, including hepatobiliary cancers, pancreatic cancer, and hepatocellular carcinoma (aHR = 10.5; 95% CI: 7.3–15; P < .0001). 

This study confirms that PSC is an independent risk factor for CRC, emphasizing the need for enhanced surveillance protocols for patients with PSC, even in the absence of IBD. These findings may prompt revisions to current CRC screening guidelines to account for the unique risks posed by PSC. 

Reference
Saqr Alsakarneh, Jaber F, Faye AS, Hashash JG, Bilal M, Shaukat A. Primary sclerosing cholangitis in the absence of inflammatory bowel disease increases the risk of colorectal cancer: A propensity-matched cohort study. The American Journal of Gastroenterology. 2024;119(10S):S267-S267. doi:https://doi.org/10.14309/01.ajg.0001030872.34112.8a

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