COLORECTAL-CANCER IN PATIENTS WITH ULCERATIVE-COLITIS - A PROSPECTIVECOHORT STUDY IN ITALY

Background. The aim of this study was to assess the development of dys plasia or cancer in patients with ulcerative colitis and to determine the effectiveness of colonoscopy and biopsy follow-up in colon cancer surveillance. Methods. From 1980 to 1986, 65 patients who had ulcerati ve colitis for 7 years or more participated in a surveillance program of colonoscopy and biopsy. This cohort was followed until December 199 2. Forty-nine patients (75.4%) had extensive colitis and 16 (24.6%) le ft-sided colitis. The mean disease duration was 17.2 years. Three hund red four colonoscopies were performed. During each endoscopy, random b iopsies were performed. Results. Seven patients had definite dysplasia of the colorectal mucosa. Four of them had high grade lesions and und erwent surgery. In all of these patients, colon cancer (3 Dukes' Stage A, 1 Dukes' Stage B) was found. No cancer was found in the other pati ents. Pedunculated adenomas were excised from 6 other patients during colonoscopy. When dysplasia was diagnosed, these patients were older t han those who were dysplasia free, whereas the age at onset of colitis was significantly higher in the former (P < 0.01). Fifteen patients d iscontinued follow-up. Two of them developed colon cancer diagnosed at an advanced stage. Conclusions. Dysplasia, especially of high grade, is a marker of colon cancer risk in patients with longstanding ulcerat ive colitis. Intensive colonoscopy and biopsy surveillance can lead to the diagnosis of colon cancer at a potentially curable stage. In this series, older age appeared to be an additional risk factor. A careful selection of patients with ulcerative colitis seems mandatory to mini mize the cost and optimize the benefit of colon cancer surveillance pr ograms.