P278 Risk factors analysis for progression of low-grade dysplasia to advanced neoplasia in patients with ulcerative colitis according to the SCENIC terminology

AbstractBackground and AimsThe long-term risk of high-grade dysplasia [HGD] and colorectal cancer [CRC] following low-grade dysplasia [LGD] in inflammatory bowel disease [IBD] patients is relatively unknown. We aimed to determine the long-term cumulative incidence of advanced neoplasia [HGD and/or CRC], and to identify risk factors for advanced neoplasia in a nationwide IBD cohort with a history of LGD.MethodsThis is a nationwide cohort study using data from the Dutch National Pathology Registry [PALGA] to identify all IBD patients with LGD between 1991 and 2010 in the Netherlands. Follow-up data were collected until January 2016. We determined the cumulative incidence of advanced neoplasia and identified risk factors via multivariable Cox regression analysis.ResultsWe identified 4284 patients with colonic LGD with a median follow-up of 6.4 years after initial LGD diagnosis. The cumulative incidence of subsequent advanced neoplasia was 3.6, 8.5, 14.4 and 21.7%, after 1, 5, 10 and 15 years, respectively. The median time to develop advanced neoplasia after LGD was 3.6 years. Older age [≥ 55 years] at moment of LGD (hazard ratio [HR] 1.73, 95% confidence interval [CI] 1.44–2.06), male sex [HR 1.33, 95% CI 1.10–1.60], and follow-up at an academic [vs non-academic] medical centre [HR 1.37, 95% CI 1.07–1.76] were independent risk factors for advanced neoplasia following LGD.ConclusionsIn a large nationwide cohort with long-term follow-up of IBD patients with LGD, the cumulative incidence of advanced neoplasia was 21.7% after 15 years. Older age at LGD [≥55 years], male sex and follow-up by a tertiary IBD referral centre were independent risk factors for advanced neoplasia development after initial LGD.

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Progression of Flat Low-Grade Dysplasia to Advanced Neoplasia in Patients with Ulcerative Colitis

Advances in Anatomic Pathology ◽

10.1097/00125480-200407000-00010 ◽

2004 ◽

Vol 11 (4) ◽

pp. 225-226

Author(s):

Mary P Bronner ◽

John R Goldblum

Keyword(s):

Ulcerative Colitis ◽

Low Grade ◽

Advanced Neoplasia ◽

Low Grade Dysplasia

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Progression of low-grade dysplasia to advanced neoplasia based on the location and morphology of dysplasia in ulcerative colitis patients with extensive colitis under colonoscopic surveillance

Journal of Crohn s and Colitis ◽

10.1016/j.crohns.2013.06.006 ◽

2013 ◽

Vol 7 (12) ◽

pp. e684-e691 ◽

Cited By ~ 44

Author(s):

Udayakumar Navaneethan ◽

Ramprasad Jegadeesan ◽

Norma G. Gutierrez ◽

Preethi G.K. Venkatesh ◽

Jeffrey P. Hammel ◽

...

Keyword(s):

Ulcerative Colitis ◽

Low Grade ◽

Colonoscopic Surveillance ◽

Advanced Neoplasia ◽

Low Grade Dysplasia

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Progression of flat low-grade dysplasia to advanced neoplasia in patients with ulcerative colitis

Gastroenterology ◽

10.1053/j.gastro.2004.03.037 ◽

2004 ◽

Vol 126 (5) ◽

pp. 1493

Author(s):

Kamran Badizadegan

Keyword(s):

Ulcerative Colitis ◽

Low Grade ◽

Advanced Neoplasia ◽

Low Grade Dysplasia

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DOP41 Low-grade dysplasia prognosis and predictive factors for advanced neoplasia progression in the 21st century: A large multi-centre retrospective cohort study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.080 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S078-S079

Author(s):

M Kabir ◽

K Curtius ◽

I Al-Bakir ◽

J Hartono ◽

M Johnson ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Endoscopic Resection ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Study Endpoint ◽

Low Grade ◽

Advanced Neoplasia ◽

Low Grade Dysplasia

Abstract Background Recent advances in ulcerative colitis (UC) endoscopic surveillance such as high-definition imaging and greater chromoendoscopy (CE) use have led to an increase in detection and resection of visible dysplasia. An updated study of prognosis of low-grade dysplasia (LGD) is needed to address uncertainty as to the accuracy of progression rates based on historical studies. Methods This retrospective cohort study involved four UK IBD centres. Hospital and endoscopy pathology databases were searched between 1 January 2001 and 30 December 2018 to identify adult patients with UC who had their first LGD diagnosis diagnosed within the extent of colitis. Only patients followed up with at least one colonoscopy or colectomy by 30 August 2019 were included. The study endpoint was time to high-grade dysplasia (HGD) or cancer (CRC), i.e. advanced neoplasia (AN), or end of follow-up. Survival analyses were performed using Kaplan–Meier estimation and Cox proportional hazards (PH) models. Results In total, 460 patients met the inclusion criteria and were followed up for a median of 4.1 years (IQR 6), equating to 2,232 patient-years. A mean of 3.7 (range 0–17) subsequent colonoscopies was performed per patient. Seventy-seven per cent of patients had CE surveillance. Complete endoscopic resection was achieved in 94% and 64% of the polypoid and non-polypoid LGD, respectively. There was progression to AN in 88 cases (19%) during follow-up. There was no significant difference in AN progression between centres. Unresectable non-polypoid or invisible LGD carried the greatest risk of AN development (Figure 1). On univariate Cox PH analysis, CE use was protective against AN progression (HR 0.5; 95% CI 0.3–1.0; p = 0.04). However, only highly significant predictors of LGD progression to AN on univariate analysis (Bonferroni adjusted p < 0.003), were entered into the multivariate model: Cumulative risk of AN increased with the number of risk factors (Figure 2). Conclusion This is the largest study examining prognosis of LGD, based on endoscopic features, in this century. Five-year cumulative incidence of AN is low after complete endoscopic resection of visible LGD without surrounding dysplasia. Lesion size of 1 cm or more, invisibility, multifocality and unresectability of LGD are significant risk factors for progression to AN. These factors should be taken into consideration when discussing management options with patients.

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