Histological healing favors lower risk of colon carcinoma in extensive ulcerative colitis

Table 1 Demographics, decades of surveillance, and probable influence of advances in drug therapy

Characteristics	Group 1CA/HGD	Group 2Non-CA/HGD
n = 68	20	48
Gender (% female)	50%	46%
Age at diagnosis (yr), range	27.3 (8-51)	25 (6-61)
Disease duration (yr), range	27.3 (12-54)	29.6 (16-48)
Treatment with 6 MP/IFX
Subjects/decades of diagnosis of UC	Subjects received1	Subjects received2
1930-1949	1	0
1950-1959	1	0
1960-1969	7	5
1970-1979	9	17
1980-1989	2	16
1990-1999	0	10

¹1970-1989, 6-mercaptopurine (6MP) = 55%, infliximab (IFX) = 0%;

²1960-1999, 6MP = 79%; 1980-1999, IFX = 27%. CA: Carcinoma; HGD: High-grade dysplasia; UC: Ulcerative colitis.

Table 2 Summary of colonoscopic outcomes with and without neoplasia n (%)

Colonoscopic outcome	Group 1(n = 20)	Group 2(n = 48)	Total(n = 68)
Colonoscopies after 10 yr of UC	120	550	670
	Range 3-14 median 6	Range 3-28 median 11.5
Colonoscopies with endoscopically active colitis	87 (72.5)	243 (44.2)	330 (49.2)
Colonoscopies without endoscopically active colitis but with histological inflammation1	29 (24.2)	180 (32.7)	209 (31.2)
Colonoscopies without gross/endoscopic or histological inflammation	4 (3.3)	127 (23.1)	131 (19.6)
% of endoscopically negative colonoscopies with histological inflammation2	29 (88)	180 (59)

¹Prevalence in all colonoscopies;

²Prevalence in all colonoscopies. UC: Ulcerative colitis.

Table 3 Segments of colon showing histological inflammation and its degree when endoscopically normal

Case-index	Cecum	Asc colon	Trans colon	Desc colon	Sigmoid	Rectum
1N	2	2	2	2	2	2, 4, 5
2N	2, 4	2, 4	2	2, 4	2, 4	2, 4
3N	3	3	3	3	3	3, 4
4N	1	1	1	1	1, 5	1, 5
5N	3	3	3	3, 4	3, 5	3, 4, 5
6N	2	2	3, 5	3	3, 5	2
7N	1	1	1	1	2, 4, 5	2, 4
8N	2	2	3, 5	3	3, 5	2
9N	2	2	2	2	2, 4	2, 4
10N	3	3	3	3, 4	3	3
11N	3	3	3	3	3,5	3
12N	1	1, 5	1, 4, 5	2	2	2
13N	3, 5	3, 5	3	3	3	3
14N	1	2, 5	2, 4	2, 4	1, 4	1
15N	2	2	2	2, 5	2	2
16N	2	2	2	3	3, 4, 5	3, 5
17N	2	2	2	3	3	3, 5
18N	1	1	1	1	2, 4, 5	2
19N	3	3	3	3	3	3, 5
20N	3	3	3	3	3, 4, 5	3, 5
1	1	1	3	2	3	3
2	0	0	0	0	0	1
3	0	0	1	1	0	1
4	2	0	1	1	0	3
5	1	0	2	2	2	2
6	3	3	0	0	1	2
7	0	0	0	0	0	0
8	2	2	0	0	1	1
9	0	0	1	1	1	1
10	1	1	1	1	1	1
11	1	1	1	1	1	1
12	0	1	2	2	2	1
13	1	1	3	2	2	0
14	0	0	0	0	0	0
15	1	0	0	1	1	1
16	0	0	2	1	1	0
17	1	2	2	2	2	2
18	0	0	0	0	0	0
19	1	1	1	1	1	1
20	2	2	0	2	2	0
21	2	0	2	2	1	2
22	0	0	1	1	1	1
23	1	1	1	1	0	0
24	1	1	1	1	1	0
25	0	0	1	1	2	2
26	1	1	1	3	0	2
27	0	0	2	2	2	2
28	1	1	1	2	1	1
29	1	1	2	1	1	3
30	1	1	1	1	1	1
31	0	0	0	1	1	1
32	2	0	2	2	1	1
33	2	2	0	2	2	2
34	0	0	0	1	0	0
35	1	1	1	3	1	1
36	1	1	1	2	3	2
37	1	1	0	0	2	2
38	0	0	1	1	1	0
39	1	1	1	1	1	0
40	1	1	1	1	2	2
41	0	0	3	0	0	0
42	1	0	2	2	2	2
43	1	1	1	0	1	1

Group 1 = 1N→20N (29 colonoscopies); Group 2 = 1→43 (180 colonoscopies). Degree of inflammation: 0, none; 1, mild; 2, moderate; 3, severe; 4, dysplasia; 5, cancer.

Table 4 Features of 20 patients with high grade dysplasia or carcinoma of colon

Case	High grade dysplasia	Multiple sites of dysplasia	Low grade dysplasia	Colon cancer	Location of cancer
1	+	1	0	0	-1
2	+	1	0	0	-1
3	+	0	0	0	-1
4	+	0	0	+	Recto-sigmoid
5	+	1	0	+	Sigmoid
6	+	1	0	+	Sigmoid
7	+	1	0	+	Sigmoid
8	0	0	0	+	Distal transverse
9	0	1	1	+	Ileo-Anal pouch
10	+	1	0	+	Sigmoid
11	0	0	0	+	Sigmoid
12	0	0	0	+	Prox transverse
13	+	1	1	+	Cecum
14	0	0	1	+	Ascending
15	0	0	0	+	Descending
16	+	0	1	+	Recto-sigmoid
17	+	1	1	+	Rectum
18	0	0	0	+	Sigmoid
19	0	0	0	+	Rectum
20	+	0	0	+	Sigmoid
Totals	12	9	5	17

¹High grade dysplasia at multiple sites, not cancer.

Table 5 Features of the patients with carcinoma of colon

Features	Colectomies
Cancer discovered at endoscopy led to colectomy	8
Colectomy for high grade dysplasia also disclosed cancer	8
Colectomy for high grade dysplasia did not disclose cancer	3
Cancer discovered by metastases (no colectomy)	1
Most cancers in sigmoid and rectum	12/17
Multiple areas of dysplasia	6
Low grade as well as high grade dysplasia	6
Alive in 2012	9
High grade dysplasia at multiple sites, not cancer	3/20