P1524 - Gastrointestinal Cancer Incidence in Primary Sclerosing Cholangitis: Impact of Inflammatory Bowel Disease Status

Abdelrahman Yakout, MD¹, Tarek Odah, MD, MPH², Kristin Clift, MA³, Aasma Shaukat, MD, MPH, FACG⁴, Nayantara Coelho-Prabhu, MBBS, FACG⁵, Francis A.. Farraye, MD, MSc, MACG², Jana G. Hashash, MD, MSc, FACG², Fadi F.. Francis, MD²
1Mayo Clinic, Gainesville, GA; 2Mayo Clinic, Jacksonville, FL; 3Mayo Clinic, Jacksonville, GA; 4NYU Grossman School of Medicine, Division of Gastroenterology and Hepatology, New York, NY; 5Mayo Clinic, Rochester, MN

Introduction: Primary sclerosing cholangitis (PSC) is a chronic liver disease associated with increased risk of
gastrointestinal (GI) cancers, particularly cholangiocarcinoma and colorectal cancer. A large
proportion of PSC patients also have inflammatory bowel disease (IBD). We aim to compare the
incidence of GI malignancy in patients with PSC compared to those with PSC and IBD.

Methods: We conducted a multicenter retrospective study on adult patients with PSC between 1/2000 and
5/2024. Collected data included demographics, medical history, and incidence of GI cancers.
Primary outcome was the incidence and timing of GI cancer following PSC diagnosis. Fisher’s
exact test was used.

Results: Among 612 patients with PSC, 99 (16.2%) developed GI cancers following PSC diagnosis. Patients were categorized into 3 groups: PSC-only, PSC-first (PSC preceding IBD or both diagnoses within 3 months), and IBD-first (IBD diagnosed before PSC). The incidence of GI cancer was proportionally highest in the PSC-only group (18.1%), followed by IBD-first (16.9%) and PSC-first (11.8%). Across the entire cohort, cholangiocarcinoma was the most common malignancy (n=72), followed by colorectal cancer (n=19), gallbladder cancer (n=6), and liver cancer (n=5). Cholangiocarcinoma occurred in 12.8% of IBD-first, 12.6% of PSC-only, and 7.6% of PSC-first patients.

Comparing PSC-only to those with IBD (IBD-first + PSC-first), there was no significant difference in GI cancer (p=0.50) or cholangiocarcinoma (p=0.76). No significant differences were seen between PSC-first and IBD-first groups for GI cancer (p=0.194) or cholangiocarcinoma (p=0.138). The mean age at GI cancer diagnosis was highest in the PSC-only group (56.8±15.6 years), compared to 45.4±12.0 in IBD-first and 43.6±17.2 in PSC-first groups. Time from PSC diagnosis to GI cancer was longest in PSC-first (12.3±11.9 years) while it was shortest in IBD-first group (6.0±7.3 years).

Discussion: GI cancers occurred in nearly 1 in 6 PSC patients, with cholangiocarcinoma being most common, followed by colorectal and gallbladder cancers. PSC-only and IBD-first groups had similar GI cancer proportions, though IBD-first patients were younger at diagnosis and had a shorter interval from PSC to cancer. These findings suggest differences in cancer presentation by IBD status and support the need for individualized surveillance strategies in PSC.


Figure: *Nine patients in the IBD-first PSC group developed both cholangiocarcinoma and another cancer following PSC diagnosis (seven with colorectal cancer and two with gallbladder cancer), while one patient in the PSC-first group developed both colorectal and appendiceal cancer.
Abbreviations: SD, standard deviation; BMI, body mass index; PSC, primary sclerosing cholangitis; IBD, inflammatory bowel disease; UC, ulcerative colitis; CD, Crohn's disease; GI, gastrointestinal.

Disclosures:
Abdelrahman Yakout indicated no relevant financial relationships.
Tarek Odah indicated no relevant financial relationships.
Kristin Clift indicated no relevant financial relationships.
Aasma Shaukat: Freenome inc – Consultant.
Nayantara Coelho-Prabhu indicated no relevant financial relationships.
Francis Farraye: Astellas – Advisory Committee/Board Member. Avalo – Advisory Committee/Board Member. Bausch – Advisory Committee/Board Member. BMS – Advisory Committee/Board Member. Braintree Labs – Advisory Committee/Board Member. Fresenius Kabi – Advisory Committee/Board Member. GI Reviewers – Independent Contractor. IBD Educational Group – Independent Contractor. Iterative Health – Advisory Committee/Board Member, Stock Options. Janssen – Advisory Committee/Board Member. Lilly – DSMB. Pfizer – Advisory Committee/Board Member. Pharmacosmos – Advisory Committee/Board Member. Sandoz – Advisory Committee/Board Member. Viatris – Advisory Committee/Board Member.
Jana Hashash: BMS – Ad Board.
Fadi Francis indicated no relevant financial relationships.

Abdelrahman Yakout, MD¹, Tarek Odah, MD, MPH², Kristin Clift, MA³, Aasma Shaukat, MD, MPH, FACG⁴, Nayantara Coelho-Prabhu, MBBS, FACG⁵, Francis A.. Farraye, MD, MSc, MACG², Jana G. Hashash, MD, MSc, FACG², Fadi F.. Francis, MD². P1524 - Gastrointestinal Cancer Incidence in Primary Sclerosing Cholangitis: Impact of Inflammatory Bowel Disease Status, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.