Primary sclerosing cholangitis an independent risk factor for colorectal cancer

Primary sclerosing cholangitis (PSC) poses an increased risk of colorectal cancer (CRC), even in the absence of concomitant inflammatory bowel disease (IBD), according to a retrospective study.

Researchers used the TriNetX database and looked at adult patients with PSC with or without a history of IBD. They performed propensity-score matching to establish the following patient groups: those with PSC with IBD (PSC-IBD cohort), those with PSC without IBD (PSC non-IBD cohort), and those without a history of PSC or IBD (non-PSC/non-IBD group).

The primary outcome of the risk of first diagnosis of CRC was assessed and compared between the patient groups.

Compared with the non-PSC/IBD cohort, PSC patients without IBD had an almost threefold higher risk of CRC (adjusted hazard ratio [aHR], 2.91, 95 percent confidence interval [CI], 1.6–6.0). Notably, the PSC-IBD cohort had an even higher risk of CRC, which rose more than sixfold (aHR, 6.5, 95 percent CI, 3.78–11.2), and this risk increase was particularly observed among PSC patients with ulcerative colitis (aHR, 6.3, 95 percent CI, 3.2–12.4).

PSC was associated with an elevated risk of various gastrointestinal malignancies (aHR, 10.5, 95 percent CI, 7.3–15; p<0.0001), including hepatobiliary cancers, pancreatic cancer, and hepatocellular carcinoma.

The findings warrant additional studies to determine whether patients with isolated PSC may benefit from tailored CRC surveillance strategies.