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Original Article Colitis-associated colorectal neoplasia in ulcerative colitis with primary sclerosing cholangitis: a nationwide study
Koichi Komatsu1orcid, Takahide Shinagawa1orcid, Motoi Uchino2orcid, Hiroki Ikeuchi2orcid, Koji Okabayashi3orcid, Shiro Oka4orcid, Kitaro Futami5orcid, Michio Itabashi6orcid, Kazuhiro Watanabe7orcid, Masatsune Shibutani8orcid, Yoshiki Okita9orcid, Toshifumi Wakai10orcid, Yusuke Mizuuchi11orcid, Kinya Okamoto12orcid, Kazutaka Yamada13orcid, Yu Sato14orcid, Takayuki Ogino15orcid, Hideaki Kimura16orcid, Kenichi Takahashi17orcid, Koya Hida18orcid, Yusuke Kinugasa19orcid, Fumio Ishida20orcid, Junji Okuda21orcid, Koji Daito22orcid, Takayuki Yamamoto23orcid, Seiichiro Yamamoto24orcid, Fumikazu Koyama25orcid, Tsunekazu Hanai26orcid, Koji Komori27orcid, Dai Shida28orcid, Junya Arakaki29orcid, Yoshito Akagi30orcid, Shigeki Yamaguchi31orcid, Hideki Ueno32orcid, Keiji Matsuda33orcid, Atsuo Maemoto34orcid, Riichiro Nezu35orcid, Shin Sasaki36orcid, Eiji Sunami37orcid, Tatsuki Noguchi1orcid, Kenichi Sugihara38orcid, Yoichi Ajioka39orcid, Soichiro Ishihara1orcid, the Study Group for Inflammatory Bowel Disease Associated Intestinal Cancers by the Japanese Society for Cancer of the Colon and Rectum

DOI: https://doi.org/10.5217/ir.2025.00133
Published online: February 12, 2026

1Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan

2Department of Inflammatory Bowel Disease Surgery, Hyogo Medical University, Nishinomiya, Japan

3Department of Surgery, Keio University School of Medicine, Tokyo, Japan

4Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

5Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Japan

6Saitama Saiseikai Kazo Hospital, Kazo, Japan

7Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan

8Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan

9Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan

10Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

11Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

12Department of Coloproctology, Tokyo Yamate Medical Center, Tokyo, Japan

13Department of Surgery, Coloproctology Center Takano Hospital, Kumamoto, Japan

14Department of Surgery, Toho University Sakura Medical Center, Sakura, Japan

15Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan

16Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan

17Department of Colorectal Surgery, Tohoku Rosai Hospital, Sendai, Japan

18Department of Surgery, Kyoto University Hospital, Kyoto, Japan

19Department of Gastrointestinal Surgery, Graduate School of Medicine, Institute of Science Tokyo, Tokyo, Japan

20Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan

21Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan

22Department of Surgery, Faculty of Medicine, Kindai University, Sayama, Japan

23Inflammatory Bowel Disease Center, Yokkaichi Hazu Medical Center, Yokkaichi, Japan

24Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan

25Department of Surgery, Nara Medical University, Nara, Japan

26Department of Surgery, Fujita Health University, School of Medicine, Kariya, Japan

27Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Kariya, Japan

28Department of Surgery, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

29Center for Gastroenterology, Department of Surgery, Urasoe General Hospital, Urasoe, Japan

30Department of Surgery, Kurume University Hospital, Kurume, Japan

31Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan

32Department of Surgery, National Defense Medical College, Tokorozawa, Japan

33Department of Surgery, The Fraternity Memorial Hospital, Tokyo, Japan

34Inflammatory Bowel Disease Center, Sapporo-Higashi Tokushukai Hospital, Sapporo, Japan

35Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan

36Department of Coloproctological Surgery, Japanese Red Cross Medical Center, Tokyo, Japan

37Department of Surgery, Kyorin University, Tokyo, Japan

38Institute of Science Tokyo, Tokyo, Japan

39Department of Pathology, Niigata University, Niigata, Japan

Correspondence to Koichi Komatsu, Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail: komatsuk-sur@h.u-tokyo.ac.jp
• Received: July 14, 2025   • Revised: September 4, 2025   • Accepted: September 21, 2025

© 2026 Korean Association for the Study of Intestinal Diseases.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Background/Aims
    Ulcerative colitis (UC)-associated colorectal neoplasia (UCAN) in patients with UC and primary sclerosing cholangitis (PSC) has not been studied well in Japan. This retrospective study examined the clinicopathological features and prognosis of UCAN in patients with PSC-UC.
  • Methods
    A total of 808 patients with UCAN were enrolled from 1983 to 2020 and categorized into PSC (PSC-UCAN, n = 26) and no PSC (UCAN-alone, n = 782) groups. Clinicopathological features were compared between the 2 groups, and the 10-year overall survival (OS) and cancer-specific survival (CSS) were analyzed.
  • Results
    The PSC-UCAN group had a shorter UC duration before UCAN diagnosis (12.8 years vs. 16.9 years, P= 0.044), were younger at UCAN diagnosis (47.8 years vs. 53.3 years, P= 0.046), and developed UCAN more frequently in the right-sided colon (34.6% vs. 15.9%, P= 0.028) than the UCAN-alone group. The PSC-UCAN group showed a trend toward a lower proportion of high-grade dysplasia (19.2% vs. 30.7%) and a higher proportion of early-stage cancers (53.9% vs. 31.2%). The 10-year OS (64.6% vs. 79.3%, P=0.080) and CSS (80.8% vs. 83.9%, P=0.60) were comparable.
  • Conclusions
    Patients with PSC-UCAN showed earlier and younger development of UCAN than patients with only UCAN, with a high prevalence in the right-sided colon. Early-stage cancer was more frequently observed in the PSC-UCAN group, despite the shorter duration of UC. Patients with PSC-UC probably benefit from early initiation of surveillance colonoscopy.
  • Keywords: Cholangitis, sclerosing; Ulcerative colitis; Colorectal neoplasms; Colitis-associated neoplasms
Primary sclerosing cholangitis (PSC) is associated with inflammatory bowel disease, especially ulcerative colitis (UC) and Crohn’s disease. The prevalence of PSC among patients with inflammatory bowel disease varies by region, being higher in Europe and the United States but lower in East Asia, including Japan [1]. A study reported a lower UC complication rate in the Japanese PSC cohort than in western countries [2]. Although PSC is a significant risk factor for UC-associated colorectal neoplasia (UCAN) [3], there is limited research on patients with UCAN with UC and PSC in Japanese cohorts due to the rarity of such patients. Therefore, this study aims to determine the clinicopathological features and prognosis of UCAN cases with PSC in the largest UCAN cohort in Japan [4].
1. Data Collection and Definition
This retrospective cohort study, conducted by the Japanese Society for Cancer of the Colon and Rectum (JSCCR), included 1,222 patients with UC who underwent treatment for UCAN from January 1983 to December 2020 across 43 institutions in Japan. The following patient data were collected from medical records at each institution: age, sex, concomitant PSC diagnosis, UC disease duration, extent of UC, Mayo endoscopic subscore at the most recent endoscopy before UCAN treatment, date of UCAN diagnosis, medications for UC within 1 year before UCAN treatment, diagnostic procedure for UCAN, location of UCAN, pathological findings of UCAN, treatment procedures, prognosis, and other information related to UCAN risk. The follow-up period was determined by the date of the death by any cause or the date of the last visit at each hospital. This study included only patients with UC-associated colorectal cancer and high-grade dysplasia (HGD). Patients with only UC-associated low-grade dysplasia or those with missing data on concomitant PSC, UC disease duration, UCAN histological type or location, pathological stage of UC-associated colorectal cancer, or prognosis were excluded (Fig. 1).
The diagnoses of PSC, UC, and UCAN were based on clinical and pathological findings at each institution. The location of UCAN was categorized as the right-sided colon (cecum and ascending and transverse colon), left-sided colon (descending and sigmoid colon), rectum, or other (appendix and anal canal). HGD was defined as neoplastic epithelium that did not invade beyond the basal lamina. Poorly differentiated adenocarcinoma, mucinous adenocarcinoma, and signet ring cell carcinoma were categorized as cancer irrespective of the depth of invasion.
2. Statistical Analysis
Data were analyzed using the JMP Pro 17.0 software (SAS Institute, Cary, NC, USA). Continuous variables were compared using Student t test, and categorical variables were analyzed with Pearson’s chi-square or Fisher exact test. The Kaplan-Meier method and log-rank test were used for survival analysis and assessing the time to development of UCAN after UC diagnosis. The 10-year overall survival (OS) and cancer-specific survival (CSS) after treatment were compared between patients with and without PSC. In the CSS analysis, deaths from UC-associated colorectal cancer were considered as events, whereas deaths caused by other malignancies were censored.
3. Ethics Statement
We conducted this study in compliance with the principles of the Declaration of Helsinki. This study was approved by the Ethics Committee of the University of Tokyo (No. 2019220NI-(2)) and JSCCR. If necessary, the ethics committees of all participating institutions also approved the study. The requirement for written informed consent was waived due to the retrospective nature of the study.
1. Patient Characteristics
Overall, 808 eligible patients with UCAN were divided into PSC-UCAN (n=26) and UCAN-alone (n=782) groups (Fig. 1). Both groups showed a similar age at UC diagnosis (PSC-UCAN: 34.8 years, UCAN-alone: 36.8 years). However, the PSC-UCAN group was younger at UCAN diagnosis (47.8 years) and had a shorter duration of UC (12.8 years) than the UCAN-alone group (53.3 and 16.9 years, respectively) (Table 1). A greater proportion of patients had a disease duration of less than 8 years in the PSC-UCAN group compared with the UCAN-alone group (26.9% vs. 17.7%); however, this difference did not reach statistical significance (P=0.23). Total colitis was the predominant disease extent in both groups (PSC-UCAN: 80.8%, UCANalone: 77.2%), followed by left-sided colitis (PSC-UCAN: 11.5%, UCAN-alone: 17.7%) (Table 1). The most recent endoscopy conducted before UCAN treatment revealed no significant difference in Mayo endoscopic subscore between the 2 groups. Regarding medications used within one year prior to UCAN treatment, there were no significant differences between groups for 5-aminosalicylic acid, prednisolone, immunomodulators, or biologics. Most UCAN cases in both groups were diagnosed via surveillance colonoscopy (PSC-UCAN: 65.4%, UCAN-alone: 67.5%), with approximately one-fourth diagnosed based on symptoms (PSC-UCAN: 23.1%, UCANalone: 26.0%) (Table 1).
2. Location and Pathological Findings of UCAN
The proportion of right-sided UCAN cases was more than twice as high in the PSC-UCAN group (34.6%) compared to the UCAN-alone group (15.9%). There were no differences in histological findings between the 2 groups (HGD: PSC-UCAN, 19.2% and UCAN-alone, 30.7%; highly differentiated carcinoma, well or moderately differentiated adenocarcinoma: PSC-UCAN, 65.4% and UCAN-alone, 52.7%; and poorly differentiated carcinoma, poorly differentiated adenocarcinoma, mucinous adenocarcinoma, or signet ring cell carcinoma: PSC-UCAN, 15.4% and UCAN-alone, 16.1%) (Table 1). Although not statistically significant, there was a trend toward a lower proportion of HGD (19.2%) and a higher proportion of early pStage (pStage 0–1; 53.9%) in the PSC-UCAN group than in the UCAN-alone group (HGD; 30.7% and early pStage; 31.2%) (Table 1).
3. Treatment and Prognosis
Treatment procedures showed no significant differences between the PSC-UCAN and UCAN-alone groups. Total proctocolectomy was the major procedure in both groups (PSC-UCAN: 73.1%, UCAN-alone: 77.9%) (Table 1), followed by partial colectomy (PSC-UCAN: 15.4%, UCAN-alone: 8.5%) and subtotal colectomy (PSC-UCAN: 7.7%, UCAN-alone: 6.7%).
The 10-year OS (PSC-UCAN: 64.6%, UCAN-alone: 79.3%) and 10-year CSS (PSC-UCAN: 80.8%, UCAN-alone: 83.9%) after treatment were similar between the 2 groups (Fig. 2). In patients with HGD, the 10-year OS rates were 100.0% versus 95.8%, and the 10-year CSS rates were 100.0% versus 99.3% in the PSC-UCAN versus UCAN-alone groups (Fig. 3). In the subgroup analysis restricted to the cases with pStage 1-3, OS was significantly worse in the PSC-UCAN group than in the UCAN-alone group (64.6% vs. 81.0%, P=0.041), whereas CSS did not differ significantly between the 2 groups (80.8% vs. 85.9%, P=0.42) (Supplemental Fig. 1). There were one and two deaths due to biliary tract cancer and liver failure respectively in the PSC-UCAN group.
This study highlighted the characteristics of patients with PSC-complicated UCAN in Japan. Previous reports of UCAN in patients with PSC from Japan were limited to a few case reports [5-7] and 1 case series study [8]. Although several studies from other East Asian countries have been reported, including 2 reports from Korea [9,10] and 1 report from China [11], none of them described the details of UCAN. The present study included the largest cohort of UCAN cases in patients with UC and PSC in Asia.
In accordance with a previous report from a Dutch cohort, the present study demonstrated that the duration of UC at the time of UCAN diagnosis was significantly shorter in the PSC-UCAN group compared with the UCAN-alone group [12]. The European Crohn’s and Colitis Organisation (ECCO) guidelines recommend initiation of surveillance colonoscopy 8 years after diagnosis in patients with UC without PSC [13]. The present cohort included exclusively PSC-UC cases who had already developed UCAN; consequently, precluding accurate estimation of the absolute cumulative risk of UCAN development in patients with PSC-UC. UC is sometimes diagnosed prior to PSC [14], which suggests that patients with PSC-UC already have a substantial duration of UC by the time PSC is diagnosed [15]. The subclinical course of UC in patients with PSC may provoke apprehension regarding a potential delay in the diagnosis of UC [16]. Moreover, PSC-UCAN cases were characterized by a lower proportion of HGD and a higher proportion of early-stage carcinoma, suggesting that the detection of HGD prior to progression to invasive carcinoma may be inherently difficult in PSC-UC. Taken together, the most appropriate and evidence-based strategy in clinical practice remains adherence to the ECCO guideline recommendation of commencing surveillance immediately following PSC diagnosis in patients with UC. The absence of a difference between the groups in the proportion of cases diagnosed by surveillance may be plausibly explained by the fact that the majority of patients in the UC-alone group (>80%) had a disease duration exceeding 8 years, suggesting that patients, irrespective of concomitant PSC status, may have participated in surveillance programs to a similar extent.
The endoscopic activity of UC was similar between the PSCUCAN and UCAN-alone groups. Moreover, the diagnosis of UCAN was triggered by symptoms in approximately 25% of patients in the PSC-UCAN group. A previous study reported more subclinical endoscopic activity in UC patients with PSC [16]. Although patients with UC and PSC have a milder disease course than patients with only UC in Japan [17], patients with PSC who develop UCAN may experience a greater burden of inflammation in the colon and rectum.
UCAN occurred more frequently in the right-sided colon in the PSC-UCAN group than in the UCAN-alone group. Interestingly, in our Japanese cohort, UCAN occurred in the left-sided colon and rectum with frequencies comparable to those in the right-sided colon in the PSC-UCAN group. Previous reports of UCAN in patients with PSC from Europe [18] and the United States [19,20] have shown that the right-sided colon is the dominant location for UCAN occurrence. This difference between the current study and previous studies may be due to a limited number of cases or geographical variations. Hence, further accumulation of cases is warranted.
No significant differences in OS or CSS were observed between the PSC-UCAN and UCAN-alone groups. Previous reports demonstrated that patients with PSC-UC have a poorer prognosis than those with UC alone [21]. Similar result was also described in a cohort of Japanese patients with PSC [22]. This unfavorable prognosis is likely attributable not only to PSC being a high-risk factor for UCAN but also to its strong association with cholangiocarcinoma and the occurrence of liver failure related to PSC [23]. Liver transplantation is an effective treatment for PSC-related liver failure, and previous reports have suggested that transplantation may reduce the risk of UCAN development in PSC-UC patients [24]; however, information regarding transplantation was not available in our cohort. Liu et al. [20] found no differences in OS between colitis-associated colorectal cancer patients with and without PSC. However, among pStage I-III cases, OS tended to be worse in the PSC group, largely due to deaths related to PSC itself or to sepsis [20]. In accordance with the previous report, our cohort also demonstrated similar results. The discrepancy in OS and CSS among pStage I-III cases was likely explained by deaths from cholangiocarcinoma and liver failure that occurred in the PSC-UCAN group. Moreover, in addition to the recommended initiation of surveillance colonoscopy, ECCO guidelines also suggest the recommended intervals for its implementation [13]. In Japan, however, particularly at academic centers, surveillance colonoscopy is often performed annually or at least every 2 years [25]. In our study as well, among patients with available interval data, approximately 80% had undergone colonoscopy within the 2 years preceding their UCAN diagnosis in both of the 2 groups (data not shown). Such intensive surveillance may have contributed to the reduced proportion of advanced-stage cancer in both groups and might help account for the absence of a significant difference in CSS.
This study highlights the characteristics of UCAN in patients with PSC in Japan. The duration of UC was shorter, and UCAN was diagnosed at a younger age in the PSC-UCAN group than in the UCAN-alone group. Regarding the location of UCAN, the PSC-UCAN group had more than twice the proportion of the right-sided colon than the UCAN-alone group. Early-stage cancer was more frequently observed in the PSC-UCAN group, despite the shorter duration of UC. Our results suggested that it is beneficial for patients with PSC-UC to undergo earlier surveillance colonoscopy than for patients with only UC even in Japan. The 10-year OS and CSS were comparable between the 2 groups.
This study had some limitations. First, detailed information regarding PSC was missing because data collection at registration was focused on UCAN. Second, the diagnosis of PSC, UC, and UCAN was not standardized. Finally, the surveillance strategy for UCAN detection varied depending on the institution. Despite these limitations, this study provides valuable information on the characteristics of UCAN complicated with PSC from the largest cohort of UCAN cases in Asia.

Funding Source

This work was supported by the Japanese Society for Cancer of the Colon and Rectum.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Data Availability Statement

The data underlying this article will be shared after all the analyses are completed on reasonable request to the corresponding author.

Author Contributions

Conceptualization: Komatsu K, Ishihara S. Data curation: Komatsu K. Project administration: all authors. Writing–original draft: Komatsu K. Writing–review & editing: all authors. Approval of final manuscript: all authors.

Additional Contributions

We appreciate all the involved doctors for their great contributions in the following institutions: Department of Inflammatory Bowel Disease Surgery, Hyogo Medical University; Department of Surgery, Keio University School of Medicine; Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University; Department of Surgery, Fukuoka University Chikushi Hospital; Department of Surgery, Division of Inflammatory Bowel Disease Surgery, Tokyo Women’s Medical University; Department of Surgery, Tohoku University Graduate School of Medicine; Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine; Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine; Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences; Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University; Department of Coloproctology, Tokyo Yamate Medical Center; Department of Surgery, Coloproctology Center Takano Hospital; Department of Surgery, Toho University Sakura Medical Center; Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University; Inflammatory Bowel Disease Center, Yokohama City University Medical Center; Department of Colorectal Surgery, Tohoku Rosai Hospital; Department of Surgery, Kyoto University Hospital; Department of Gastrointestinal Surgery, Graduate School of Medicine, Institute of Science Tokyo; Digestive Disease Center, Showa University Northern Yokohama Hospital; Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University; Department of Surgery, Faculty of Medicine, Kindai University; Inflammatory Bowel Disease Center, Yokkaichi Hazu Medical Center; Department of Gastroenterological Surgery, Tokai University School of Medicine; Department of Surgery, Nara Medical University; Department of Surgery, Fujita Health University, School of Medicine; Department of Gastroenterological Surgery, Aichi Cancer Center Hospital; Department of Surgery, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo; Center for Gastroenterology, Department of Surgery, Urasoe General Hospital; Department of Surgery, Kurume University Hospital; Department of Gastroenterological Surgery, Saitama Medical University International Medical Center; Department of Surgery, National Defense Medical College; Department of Surgery, Teikyo University School of Medicine; Inflammatory Bowel Disease Center, Sapporo-Higashi Tokushukai Hospital; Department of Surgery, Nishinomiya Municipal Central Hospital; Department of Coloproctological Surgery, Japanese Red Cross Medical Center; Department of Surgery, Kyorin University; Department of Gastroenterological Surgery, Osaka City General Hospital; Kurume Coloproctology Center; Department of Colorectal Surgery, National Cancer Center Hospital; Department of Surgery, National Center for Global Health and Medicine; Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University; Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine; Department of Gastroenterological Surgery, Yamagata Prefectural Central Hospital; Division of Gastroenterological Surgery, Saitama Cancer Center; First Department of Surgery, Faculty of Medical Sciences, University of Fukui; Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School. We also thank Keisuke Hata for his advice on the interpretation of the analyzed data.

Supplementary materials are available at the Intestinal Research website (https://www.irjournal.org).

Supplemental Fig 1.

Kaplan-Meier analysis in patients with pStage I-III for (A) 10-year overall survival and (B) 10-year cancer-specific survival. PSC, primary sclerosing cholangitis; UC, ulcerative colitis; UCAN, UC-associated colorectal neoplasia.
ir-2025-00133-Supplementary-Fig-1.pdf
Fig. 1.
Study flowchart. PSC, primary sclerosing cholangitis; UC, ulcerative colitis; UCAN, UC-associated colorectal neoplasia.
ir-2025-00133f1.jpg
Fig. 2.
Kaplan-Meier analysis in patients with cancer for (A) 10-year overall survival and (B) 10-year cancer-specific survival. PSC, primary sclerosing cholangitis; UC, ulcerative colitis; UCAN, UC-associated colorectal neoplasia.
ir-2025-00133f2.jpg
Fig. 3.
Kaplan-Meier analysis in patients with high-grade dysplasia for (A) 10-year overall survival and (B) 10-year cancer-specific survival. PSC, primary sclerosing cholangitis; UC, ulcerative colitis; UCAN, UC-associated colorectal neoplasia.
ir-2025-00133f3.jpg
Table 1.
Clinicopathological Features of Each Group
Variable Subgroup PSC-UCAN (n=26) UCAN-alone (n=782) P-value
Sex, No. (%) Male 20 (76.9) 492 (62.9) 0.145
Age at UC diagnosis (yr), mean (range) 34.8 (7–67) 36.8 (9–83) 0.541
Disease duration (yr), mean (range) 12.8 (1–37) 16.9 (0–57) 0.044
Age at UCAN diagnosis (yr), mean (range) 47.8 (23–79) 53.3 (19–89) 0.046
Disease extent, No. (%) Total colitis 21 (80.8) 604 (77.2) 0.329
Left-sided colitis 3 (11.5) 138 (17.7)
Proctitis 0 23 (2.9)
Others 1 (3.9) 9 (1.2)
Unknown 1 (3.9) 8 (1.0)
Mayo endoscopic subscorea, No. (%) 0–1 12 (46.1) 439 (56.1) 0.532
2–3 8 (30.8) 175 (22.4)
Unknown 6 (23.1) 168 (21.5)
Treatment for UC, No. (%) 5-ASA 17 (65.4) 500 (63.9) 0.366
PSL 9 (34.6) 185 (23.7) 0.203
IM 1 (3.9) 75 (9.6) 0.324
Biologics 1 (3.9) 26 (3.3) 0.884
Diagnostic procedure, No. (%) Surveillance 17 (65.4) 533 (68.1) 0.700
Symptom 6 (23.1) 199 (25.5)
Other 3 (11.5) 47 (6.0)
Unknown 0 3 (0.4)
Location of UCAN, No. (%) Right-side colon 9 (34.6) 124 (15.9) 0.028
Left-side colon 10 (38.5) 246 (31.5)
Rectum 7 (26.9) 400 (51.1)
Others 0 12 (1.5)
Histological type, No. (%) HGD 5 (19.2) 240 (30.7) 0.573
wel/mod 17 (65.4) 412 (52.7)
por/muc/sig 4 (15.4) 126 (16.1)
Others 0 4 (0.5)
pStage, No. (%) HGD 5 (19.2) 240 (30.7) 0.051
Early: 0-I 14 (53.9) 244 (31.2)
Advanced: II-IV 7 (26.9) 298 (38.1)
Treatment procedure, No. (%) TPC 19 (73.1) 609 (77.9) 0.636
Subtotal colectomy 2 (7.7) 52 (6.7)
Partial colectomy 4 (15.4) 67 (8.5)
Others 1 (3.9) 23 (2.9)
Unknown 0 31 (4.0)

a The most recent endoscopic finding before UCAN treatment.

PSC, primary sclerosing cholangitis; UC, ulcerative colitis; UCAN, UC-associated colorectal neoplasia; 5-ASA, 5-aminosalicylic acid; PSL, prednisolone; IM, immunomodulator; HGD, high-grade dysplasia; wel, well differentiated adenocarcinoma; mod, moderately differentiated adenocarcinoma; por, poorly differentiated adenocarcinoma; muc, mucinous adenocarcinoma; sig, signet ring cell carcinoma; TPC, total proctocolectomy.

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        Colitis-associated colorectal neoplasia in ulcerative colitis with primary sclerosing cholangitis: a nationwide study
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      Colitis-associated colorectal neoplasia in ulcerative colitis with primary sclerosing cholangitis: a nationwide study
      Image Image Image
      Fig. 1. Study flowchart. PSC, primary sclerosing cholangitis; UC, ulcerative colitis; UCAN, UC-associated colorectal neoplasia.
      Fig. 2. Kaplan-Meier analysis in patients with cancer for (A) 10-year overall survival and (B) 10-year cancer-specific survival. PSC, primary sclerosing cholangitis; UC, ulcerative colitis; UCAN, UC-associated colorectal neoplasia.
      Fig. 3. Kaplan-Meier analysis in patients with high-grade dysplasia for (A) 10-year overall survival and (B) 10-year cancer-specific survival. PSC, primary sclerosing cholangitis; UC, ulcerative colitis; UCAN, UC-associated colorectal neoplasia.

      Fig. 1.

      Fig. 2.

      Fig. 3.

      Colitis-associated colorectal neoplasia in ulcerative colitis with primary sclerosing cholangitis: a nationwide study
      Variable Subgroup PSC-UCAN (n=26) UCAN-alone (n=782) P-value
      Sex, No. (%) Male 20 (76.9) 492 (62.9) 0.145
      Age at UC diagnosis (yr), mean (range) 34.8 (7–67) 36.8 (9–83) 0.541
      Disease duration (yr), mean (range) 12.8 (1–37) 16.9 (0–57) 0.044
      Age at UCAN diagnosis (yr), mean (range) 47.8 (23–79) 53.3 (19–89) 0.046
      Disease extent, No. (%) Total colitis 21 (80.8) 604 (77.2) 0.329
      Left-sided colitis 3 (11.5) 138 (17.7)
      Proctitis 0 23 (2.9)
      Others 1 (3.9) 9 (1.2)
      Unknown 1 (3.9) 8 (1.0)
      Mayo endoscopic subscorea, No. (%) 0–1 12 (46.1) 439 (56.1) 0.532
      2–3 8 (30.8) 175 (22.4)
      Unknown 6 (23.1) 168 (21.5)
      Treatment for UC, No. (%) 5-ASA 17 (65.4) 500 (63.9) 0.366
      PSL 9 (34.6) 185 (23.7) 0.203
      IM 1 (3.9) 75 (9.6) 0.324
      Biologics 1 (3.9) 26 (3.3) 0.884
      Diagnostic procedure, No. (%) Surveillance 17 (65.4) 533 (68.1) 0.700
      Symptom 6 (23.1) 199 (25.5)
      Other 3 (11.5) 47 (6.0)
      Unknown 0 3 (0.4)
      Location of UCAN, No. (%) Right-side colon 9 (34.6) 124 (15.9) 0.028
      Left-side colon 10 (38.5) 246 (31.5)
      Rectum 7 (26.9) 400 (51.1)
      Others 0 12 (1.5)
      Histological type, No. (%) HGD 5 (19.2) 240 (30.7) 0.573
      wel/mod 17 (65.4) 412 (52.7)
      por/muc/sig 4 (15.4) 126 (16.1)
      Others 0 4 (0.5)
      pStage, No. (%) HGD 5 (19.2) 240 (30.7) 0.051
      Early: 0-I 14 (53.9) 244 (31.2)
      Advanced: II-IV 7 (26.9) 298 (38.1)
      Treatment procedure, No. (%) TPC 19 (73.1) 609 (77.9) 0.636
      Subtotal colectomy 2 (7.7) 52 (6.7)
      Partial colectomy 4 (15.4) 67 (8.5)
      Others 1 (3.9) 23 (2.9)
      Unknown 0 31 (4.0)
      Table 1. Clinicopathological Features of Each Group

      The most recent endoscopic finding before UCAN treatment.

      PSC, primary sclerosing cholangitis; UC, ulcerative colitis; UCAN, UC-associated colorectal neoplasia; 5-ASA, 5-aminosalicylic acid; PSL, prednisolone; IM, immunomodulator; HGD, high-grade dysplasia; wel, well differentiated adenocarcinoma; mod, moderately differentiated adenocarcinoma; por, poorly differentiated adenocarcinoma; muc, mucinous adenocarcinoma; sig, signet ring cell carcinoma; TPC, total proctocolectomy.

      Table 1.

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