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Background: Patients with ulcerative colitis (UC) face a heightened risk of colorectal cancer (CRC), though the estimated risk levels differ across UC populations. This study aims to provide updated, population-based estimates of CRC incidence, standardised incidence ratios (SIR), and prevalence in patients with UC. Methods: We searched PubMed, Embase, and Cochrane Library to April 12, 2025, for population-based studies on patients with UC reporting CRC risk. Study quality was assessed using the Newcastle-Ottawa Scale. The primary outcome was CRC risk in UC, evaluated through incidence, SIR, and prevalence. A random-effects model was used for meta-analysis, and meta-regression evaluated the impact of study characteristics. Publication bias was assessed using funnel plots and statistical tests. PROSPERO: CRD42025634800. Findings: = 96.1%). Subgroup analyses revealed similar CRC risk in male (SIR 2.14, 95% CI 0.85-5.38) and female (SIR 2.20, 95% CI 1.52-3.19) patients and an increased risk with extensive colitis, with an SIR of 3.95 (95% CI 2.56-6.09). Interpretation: This systematic review and meta-analysis provides population-based estimates of CRC risk in patients with UC, based on high-quality studies with rigorous methodology. The results offer reliable reference values for incidence, SIR, and prevalence, which are applicable to the broader UC population and relevant to clinical decision-making and public health planning. Nonetheless, substantial heterogeneity across studies and limited geographic representation-particularly from Asia, South America, Africa, and Oceania-highlight the need for additional population-based research in underrepresented regions to improve the global applicability of CRC risk estimates in UC. Funding: This study was supported by State key Laboratory of Digestive Health.
Zhang et al. (Wed,) studied this question.