Chronic Tophaceous Gout Increases Risk of Colorectal Cancer

Chronic tophaceous gout was demonstrated to be an independent risk factor linked to the development of colorectal cancer, according to data presented at Digestive Disease Week (DDW) 2023. Investigators believe that uric acid is likely to be one of the main reasons for this association as it can lead to an increased production of reactive oxygen species and promotes tumorigenesis.

Somtochukwu Onwuzo, MD

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“A prospective study performed by Orannapalai et al found that an elevated serum uric acid >7 mg/dL was associated with higher rates of cancer-associated polyps,” wrote Somtochukwu Onwuzo, MD, Internal medicine, Cleveland Clinic, and colleagues. “Gout on the other hand, a notorious disease process with a significant health burden is associated with elevated levels of uric acid. Our study aimed to evaluate whether patients with chronic tophaceous gout had an increased risk of developing colorectal cancer.”

Investigators utilized a validated multicenter and research platform database comprised of more than 360 hospitals from 26 different healthcare systems in the United States (US) from 1999 to 2022 to determine the association between gout and colorectal cancer, the 2nd most common cause of cancer-related death in the US. Patients with a family history of colon cancer, those with familial adenomatous polyposis, and patients with an inflammatory bowel disease (IBD) diagnosis were excluded from the study.

The risk of developing colon cancer was determined via a multivariate regression analysis which accounted for potential confounders, such as alcoholism, obesity, a history of smoking, male gender, patients with type 2 diabetes, and those who had a chronic tophaceous gout diagnosis. A 2-sided P value of <.05 was considered statistically significant.

In total, 80,927,194 patients were screened in the database, of which 70,177,200 were included in the final analysis. Of these patients, 234,840 had a colon cancer diagnosis and 69,942,360 did not. Within the colon cancer cohort, 28.57% were type 2 diabetics, 18.71% were obese, 10.98% were smokers, 3.13% were alcoholics, and a higher percentage of patients had chronic tophaceous gout. All of these characteristics were more common when compared with the no colon cancer group.

Using a multivariate regression analysis, the risk of colon cancer was analyzed for male gender (odds ratio [OR]: 1.02; 95% confidence interval [CI]: 1.01-1.03), alcoholics (OR: 1.40; 95% CI: 1.37-1.43), obese patients (OR: 1.52; 95% CI: 1.50-1.54), smokers (OR: 1.54; 95% CI: 1.52-1.56), patients with type 2 diabetes (OR: 3.53; 95% CI: 3.50-3.57), and patients with a chronic tophaceous gout diagnosis (OR: 1.40; 95% CI: 2.48-3.23).

“Further research is required to assess the prevalence of colon cancer in patients with gout and serum uric acid that is < 7mg/dL,” investigators concluded. “This will promote additional discussion about tighter control of serum uric acid levels in this population in order to decrease the overall risk of colon cancer.”

References

1. ^{Onwuzo S, Boustany A, Alsabbagh Alchirazi K, Abi Saleh S, et al. INCREASED RISK OF COLORECTAL CANCER IN PATIENTS WITH CHRONIC TOPHACEOUS GOUT: A POPULATION-BASED STUDY. Abstract presented at Digestive Disease Week (DDW) 2023 Annual Meeting. Chicago, IL. May 6-10, 2023.}