Background: Ulcerative colitis (UC) and primary sclerosing cholangitis (PSC) frequently co-occur. Ulcerative colitis in PSC patients represents a distinctive phenotype characterized by a milder clinical course and inflammation but increased risk for colorectal cancer (CRC) and other solid tumors. We aimed to investigate these correlations in our IBD cohort.
Methods: We evaluated medical charts from patients diagnosed with UC alone and PSC/UC in our referral center for inflammatory bowel diseases from 2011–2015. Descriptive statistical analysis was conducted for comparison of clinical characteristics between two groups. Multivariate logistic regression was preformed to identify the association of PSC with overall cancer, CRC and other tumors outside the digestive tract. Analysis was adjusted for age, gender, immunomodulator and biologics use. A two-sided p-value <0.05 indicated independent statistical significance.
Results: A total of 349 patients with UC and 25 with distinctive PSC/UC phenotype were identified. Patients with PSC/UC were younger (38.4±10.85 vs 45.53±16.02; p=0.029), diagnosed for UC at younger age (28.04±9.64 vs 36.35±15.29; p=0.005), more likely to be male compared to the patients with only UC (p=0.013) and have pancolitis at initial presentation (94% vs 43%; p<0.001). PCS/UC patients were less likely to require UC-related hospitalization, steroids, immunomodulators and biologics but these differences were not statistically significant. PSC/UC patients had significantly increased overall risk of cancer compared to UC patients (OR 3.66; 95% CI: 1.17–11.41; p=0.025). Regarding CRC incidence PSC/UC patients revealed also a significantly increased risk compared to UC patients (OR 7.80; 95% CI: 1.75–35.20; p=0.008).
Conclusions: PSC/UC patients represent a distinctive phenotype with male predominance, younger age and pancolitis in most patients. PSC/UC phenotype is associated with increased risk for CRC and increased overall risk for cancer. It is possible that we failed to find the connection between other specific solid tumors and PSC/UC except cholangiocarcinoma due to a relatively small sample size. However, it is important to maintain rigorous surveillance programme in patients with PSC/UC phenotype regarding cancer.