Dynamic Prediction of Advanced Colorectal Neoplasia in Inflammatory Bowel Disease

Anouk M Wijnands; Bas B L Penning de Vries; Maurice W M D Lutgens; Zeinab Bakhshi; Ibrahim Al Bakir; Laurent Beaugerie; Charles N Bernstein; Ryan Chang-Ho Choi; Nayantara Coelho-Prabhu; Trevor A Graham; Ailsa L Hart; Joren R Ten Hove; Steven H Itzkowitz; Julien Kirchgesner; Erik Mooiweer; Seth R Shaffer; Shailja C Shah; Sjoerd G Elias; Bas Oldenburg; Dutch Initiative on Crohn and Colitis (ICC)

doi:10.1016/j.cgh.2024.02.014

Dynamic Prediction of Advanced Colorectal Neoplasia in Inflammatory Bowel Disease

Clin Gastroenterol Hepatol. 2024 Feb 29:S1542-3565(24)00214-3. doi: 10.1016/j.cgh.2024.02.014. Online ahead of print.

Authors

Anouk M Wijnands¹, Bas B L Penning de Vries², Maurice W M D Lutgens³, Zeinab Bakhshi⁴, Ibrahim Al Bakir⁵, Laurent Beaugerie⁶, Charles N Bernstein⁷, Ryan Chang-Ho Choi⁸, Nayantara Coelho-Prabhu⁴, Trevor A Graham⁹, Ailsa L Hart¹⁰, Joren R Ten Hove¹, Steven H Itzkowitz¹¹, Julien Kirchgesner⁶, Erik Mooiweer¹², Seth R Shaffer⁷, Shailja C Shah¹³, Sjoerd G Elias², Bas Oldenburg¹⁴; Dutch Initiative on Crohn and Colitis (ICC)

Collaborators

Dutch Initiative on Crohn and Colitis (ICC):
Adriaan A van Bodegraven, Herma H Fidder, Meike M C Hirdes, Frank Hoentjen, Jeroen M Jansen, Nofel Mahmmod, Andrea E van der Meulen-de Jong, Cyriel Y Ponsioen, Fiona D M van Schaik, C Janneke van der Woude

Affiliations

¹ Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
² Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
³ Department of Gastroenterology and Hepatology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
⁴ Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
⁵ Department of Gastroenterology, Chelsea and Westminster Hospital, London, United Kingdom.
⁶ Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hôpital Saint-Antoine, Paris, France.
⁷ University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
⁸ Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
⁹ Evolution and Cancer Laboratory, Centre for Genomics and Computational Biology, Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; Genomics and Evolutionary Dynamics Laboratory, Centre for Evolution and Cancer, Institute of Cancer Research, London, United Kingdom.
¹⁰ Inflammatory Bowel Disease Unit, St Mark's Hospital, London, United Kingdom.
¹¹ Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
¹² Department of Gastroenterology and Hepatology, Hospital St Jansdal, Harderwijk, The Netherlands.
¹³ Division of Gastroenterology, University of California, San Diego, La Jolla, California; Gastroenterology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California.
¹⁴ Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands. Electronic address: boldenbu@umcutrecht.nl.

PMID: 38431223
DOI: 10.1016/j.cgh.2024.02.014

Abstract

Background & aims: Colonoscopic surveillance is recommended in patients with colonic inflammatory bowel disease (IBD) given their increased risk of colorectal cancer (CRC). We aimed to develop and validate a dynamic prediction model for the occurrence of advanced colorectal neoplasia (aCRN, including high-grade dysplasia and CRC) in IBD.

Methods: We pooled data from 6 existing cohort studies from Canada, The Netherlands, the United Kingdom, and the United States. Patients with IBD and an indication for CRC surveillance were included if they underwent at least 1 follow-up procedure. Exclusion criteria included prior aCRN, prior colectomy, or an unclear indication for surveillance. Predictor variables were selected based on the literature. A dynamic prediction model was developed using a landmarking approach based on Cox proportional hazard modeling. Model performance was assessed with Harrell's concordance-statistic (discrimination) and by calibration curves. Generalizability across surveillance cohorts was evaluated by internal-external cross-validation.

Results: The surveillance cohorts comprised 3731 patients, enrolled and followed-up in the time period from 1973 to 2021, with a median follow-up period of 5.7 years (26,336 patient-years of follow-up evaluation); 146 individuals were diagnosed with aCRN. The model contained 8 predictors, with a cross-validation median concordance statistic of 0.74 and 0.75 for a 5- and 10-year prediction window, respectively. Calibration plots showed good calibration. Internal-external cross-validation results showed medium discrimination and reasonable to good calibration.

Conclusions: The new prediction model showed good discrimination and calibration, however, generalizability results varied. Future research should focus on formal external validation and relate predicted aCRN risks to surveillance intervals before clinical application.

Keywords: Crohn’s Disease; Prognosis; Screening; Ulcerative Colitis.