Annual Scientific Meeting
Prior studies have suggested that the risk of colorectal cancer (CRC) may be increased in individuals with cirrhosis and chronic liver disease (CLD). It is well known that a diagnosis of PSC has increased risk of CRC, but there is little date as to whether other causes of CLD have increased CRC risk as well. Some prior studies have been limited by small sample sizes, and to our knowledge no large study has been performed comparing CRC risk between the different causes of chronic liver disease.
We queried a commercial database (Explorys Inc, Cleveland, OH), an aggregate of Electronic Health Record data from 26 major integrated healthcare systems in the United States from 1999 to 2019. We identified an aggregated patient cohort of eligible patients with “Diagnosis: Alcoholic liver cirrhosis”, “Diagnosis: Chronic Viral hepatitis”, “Diagnosis: Autoimmune hepatitis”, and “Diagnosis: PBC” followed by a diagnosis of “Primary malignant neoplasm of colon and/or rectum” between May 2014 and May 2019, based on Systematized Nomenclature Of Medicine – Clinical Terms (SNOMED-CT).
Results: Of the 36,813,060 individuals active in the database between May 2014 and 2019, we identified 7,350 individuals with PBC with an overall prevalence rate of 20.0 per 100,000 persons; 66,160 individuals with alcoholic cirrhosis (AC) with overall prevalence rate of 180 per 100,000 persons; 186,840 individuals with chronic viral hepatitis (CVH) with overall prevalence rate of 508 per 100,000 persons; and 13,540 individuals with autoimmune hepatitis (AH) with overall prevalence rate of 36.8 per 100,00 persons. In the PBC group, 60 were found to have CRC with overall prevalence rate of 816/100,000, OR 2.1 [ 95%CI (1.62 to 2.64) P< 0.0001]. In the AC group 400 were found to have CRC with overall prevalence rate of 605/100,000, OR 1.54 [ 95%CI (1.40 to 1.70) P< 0.0001]. In the CVH group 890 were found to have CRC with overall prevalence of 473/100,000, OR 1.21 [ 95%CI (1.41 to 1.30) P< 0.0001]. In the AH group 50 were found to have CRC with overall prevalence of 369/100,000, OR 0.94 [ 95%CI (0.712 to 1.24) P=0.6647].
To our knowledge, this is one of the first large studies to describe the epidemiology of CRC in chronic alcoholic, viral, and autoimmune diseases. We found that the estimated prevalence of CRC to be the highest in the PBC group at 816/100,000 and that CRC in the PBC and AC groups had increased risk compared to non liver disease with ORs of 2.1 and 1.54 respectively.