Serum inflammatory markers and risk of colorectal cancer in patients with inflammatory bowel diseases


Ananthakrishnan AN, Cheng SC, Cai T, Cagan A, Gainer VS, Szolovits P, Shaw SY, Churchill S, Karlson EW, Murphy SN, et al. Serum inflammatory markers and risk of colorectal cancer in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2014;12 :1342-8 e1.

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BACKGROUND & AIMS: Patients with inflammatory bowel diseases (IBDs) (Crohn's disease, ulcerative colitis) are at increased risk of colorectal cancer (CRC). Persistent inflammation is hypothesized to increase risk of CRC in patients with IBD; however, the few studies in this area have been restricted to cross-sectional assessments of histologic severity. No prior studies have examined association between C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) elevation and risk of CRC in an IBD cohort. METHODS: From a multi-institutional validated IBD cohort, we identified all patients with at least one measured CRP or ESR value. Patients were stratified into quartiles of severity of inflammation on the basis of their median CRP or ESR value, and subsequent diagnosis of CRC was ascertained. Logistic regression adjusting for potential confounders was used to identify the independent association between CRP or ESR elevation and risk of CRC. RESULTS: Our study included 3145 patients with at least 1 CRP value (CRP cohort) and 4008 with at least 1 ESR value (ESR cohort). Thirty-three patients in the CRP cohort and 102 patients in the ESR cohort developed CRC during a median follow-up of 5 years at a median age of 55 years. On multivariate analysis, there was a significant increase in risk of CRC across quartiles of CRP elevation (P(trend) = .017; odds ratio for quartile 4 vs quartile 1, 2.72; 95% confidence interval, 0.95-7.76). Similarly higher median ESR was also independently associated with risk of CRC across the quartiles (odds ratio, 2.06; 95% confidence interval, 1.14-3.74) (P(trend) = .007). CONCLUSIONS: An elevated CRP or ESR is associated with increased risk of CRC in patients with IBD.


Ananthakrishnan, Ashwin NCheng, Su-ChunCai, TianxiCagan, AndrewGainer, Vivian SSzolovits, PeterShaw, Stanley YChurchill, SusanneKarlson, Elizabeth WMurphy, Shawn NKohane, IsaacLiao, Katherine PengK08 AR060257/AR/NIAMS NIH HHS/K23 DK097142/DK/NIDDK NIH HHS/K24 AR052403/AR/NIAMS NIH HHS/P60 AR047782/AR/NIAMS NIH HHS/R01 AR049880/AR/NIAMS NIH HHS/U54-LM008748/LM/NLM NIH HHS/Research Support, N.I.H., ExtramuralResearch Support, Non-U.S. Gov't2014/01/11 06:00Clin Gastroenterol Hepatol. 2014 Aug;12(8):1342-8.e1. doi: 10.1016/j.cgh.2013.12.030. Epub 2014 Jan 7.