Dysplasia Grade and Colorectal Cancer risk in IBD: Cohort Summary

An analysis of a Swedish registry cohort reported that the histologic grade at first detection of colorectal dysplasia in people with inflammatory bowel disease (IBD) was associated with subsequent risk of advanced colorectal neoplasia.

Pathology-reported dysplasia categories were used as the starting point for estimating how often patients later developed high-grade dysplasia or colorectal cancer during follow-up. The central observation presented is that higher initial dysplasia grade aligned with higher subsequent occurrence of advanced colorectal neoplasia and colorectal cancer.

The analysis used nationwide registry data from Sweden and included 54,534 people diagnosed with IBD. Participants were grouped by the initial dysplasia assessment recorded in pathology reports, with categories described as no dysplasia (ND), indefinite for dysplasia (IND), low-grade dysplasia (LGD), and high-grade dysplasia (HGD). Groups were then followed longitudinally, with a median follow-up of 13.3 years, to observe later development of advanced colorectal neoplasia, defined as HGD or colorectal cancer.

Within that framework, the abstract describes a graded pattern in subsequent outcomes by initial histology. Low-grade dysplasia was associated with a 3.5-fold higher hazard of future advanced colorectal neoplasia compared with no dysplasia (adjusted hazard ratio 3.51, 95% CI 2.77–4.45). For those categorized as having high-grade dysplasia at baseline, the report states that 40% developed colorectal cancer over follow-up (adjusted hazard ratio 47.88, 95% CI 25.53–89.80). These estimates were presented as a stepwise gradient in later advanced neoplasia and cancer corresponding to the initial dysplasia grade.

The abstract also notes that the statistical analyses accounted for other factors, including sex, age, extent of colitis, primary sclerosing cholangitis, and histologic inflammation, when estimating risk by dysplasia grade. The authors were quoted describing an interest in developing a personalized risk calculator and suggesting that, if validated, grade-specific estimates might help inform individualized colonoscopy surveillance planning. Lastly, adjusted, grade-specific risk estimates were positioned as a basis for future personalization concepts rather than a set of prespecified surveillance intervals.

Key Takeaways:

• Research reports an association in which higher initial colorectal dysplasia grade in IBD corresponded to higher subsequent occurrence of advanced dysplasia or colorectal cancer.
• The findings were described in a nationwide registry cohort categorized by pathology-reported dysplasia status and followed longitudinally over a long time horizon.
• Adjusted analyses were reported, and authors discussed potential personalization and tailoring concepts (including a risk-calculator idea) in relation to grade-specific risk estimates.