PSC Without IBD Linked to Elevated Colorectal Cancer Risk, New Findings Show

Primary sclerosing cholangitis (PSC), a chronic liver disease, has been associated with an elevated colorectal cancer (CRC) risk, particularly when combined with inflammatory bowel disease (IBD). However, new findings presented at the American College of Gastroenterology (ACG) 2024 Annual Meeting suggest that PSC may increase CRC risk even in the absence of IBD. This discovery challenges existing assumptions about cancer risk in PSC patients and could have implications for future screening protocols.

Study Highlights CRC Risk in PSC Patients Without IBD

To better understand CRC risk among PSC patients without IBD, researchers conducted a large-scale retrospective analysis using the TriNetX database. Patients were divided into three groups: those with both PSC and IBD (PSC-IBD), those with PSC but no IBD (PSC non-IBD), and a control group without PSC or IBD. The study followed these groups over a 14-year period to assess CRC incidence and other gastrointestinal cancers. Findings showed that PSC patients without IBD had a nearly threefold increase in CRC risk compared to controls (adjusted hazard ratio [aHR]: 2.9; 95% CI: 1.6–6.0). Within this group, males exhibited a particularly high CRC risk (aHR: 4.17; 95% CI: 1.4–12.5), whereas the increased risk among females was not statistically significant.

The study also revealed that PSC patients face additional cancer risks. Rates of hepatocellular, hepatobiliary, and pancreatic cancers were elevated in PSC patients, with a notable aHR of 10.5 (95% CI: 7.3–15), underscoring the broad oncologic risks linked to PSC.

Implications for Screening and Clinical Practice

The findings suggest that current CRC screening guidelines may need updating to reflect these new insights. Traditionally, PSC has been monitored for CRC primarily when accompanied by IBD. However, this study indicates that all PSC patients could benefit from enhanced CRC screening regardless of IBD status. Researchers propose that screening protocols be revised to include regular CRC monitoring for all individuals with PSC, potentially facilitating earlier detection and improved survival outcomes.

Future Directions in PSC Management

The study’s findings highlight PSC as a potential independent CRC risk factor. Given the broad cancer risks associated with PSC, the researchers suggest that future studies explore preventive strategies, focusing on cancer monitoring and early detection protocols that could improve long-term outcomes and quality of life for PSC patients. Enhanced awareness and updated screening practices may be essential steps in addressing the comprehensive cancer risks that PSC patients face, informing more effective care plans.