• KK Leung et al. Hepatology. 2026; 84(3):658-671. Open Access! Understanding hepatopancreatobiliary cancer risks in a population-based primary sclerosing cholangitis-inflammatory bowel disease cohort
• MB Khalid. Hepatology 2026; 84(3):p 621-622. The road less traveled: Mapping the complex trajectories of PSC-IBD

Methods: This population-based study, using an administrative database that covered >99% of 15 million residents, identified 476 incident patients with PSC-IBD. Patients were identified between 2002-2018 with followup through 2021. Median age at PSC diagnosis was 36 years and for IBD 34 years. 73% were diagnosed with IBD and had a median time to PSC diagnosis of 3.2 years. In the 27% with an initial diagnosis of PSC, the median time to IBD diagnosis was 0.9 years. The background comparator group consisted of 54,591 individuals diagnosed with IBD alone.

Key findings:

• 54% probability of remaining event-free at 10 years. 
• There were 98 (21%) deaths and 80 (17%) who underwent liver transplant.
• There were 36 (7.5%) hepatopancreatobiliary cancers (HPBCa) in this cohort
• A diagnosis of HPBCa was associated with higher progression rates to liver transplant (TIR 20.9) and mortality (TIR 75.0).
• PSC–IBD patients had approximately 300-fold higher HPBCa and 4-fold higher CRC rates than IBD alone, underscoring their comparative substantial cancer burden.
• Mortality occurred more frequently post-colectomy (TIR 3.08) and post-cholecystectomy (TIR 3.85) relative to event-free PSC–IBD, but there were no differences in post-surgery incidence of cancer or transplant.

My take: This provides more granular data on the likely outcomes in individuals with PSC-IBD. Identifying individuals who are likely to develop a complicated course is not currently feasible. Current strategies rely on ongoing surveillance.

Related blog posts:

• Dr. Jim Squires: Practical Approach to Pediatric PSC and Pointers on Unconjugated Hyperbilirubinemia (Part 1)
• ESPGHAN Guidelines for PSC in Children (2025)
• AASLD 2023 Practice Guidance for Primary Sclerosing Cholangitis and Cholangiocarcinoma
• Liver Transplantation for PSC: Long-term Outcomes and Complications
• Development of Primary Sclerosing Cholangitis in Pediatric Patients with Inflammatory Bowel Disease
• PSC in IBD
• How Primary Sclerosing Cholangitis Alters Outcomes in Inflammatory Bowel Disease | gutsandgrowth
• Cholangiocarcinoma Risk in Pediatric PSC-IBD Plus one
• Aspen Webinar 2021 Part 5 -Autoimmune Liver Disease & PSC | gutsandgrowth
• Online Aspen Webinar (Part 3) -Primary Sclerosing Cholangitis
• Big Study of Primary Sclerosing Cholangitis -Pediatrics 2017
• Active Colitis More Likely in Children in Clinical Remission Who Have PSC and IBD
• Easy Advice for Pediatric Hepatologists: PSC Guidelines from AGA  Best practice advice 6: “Surveillance for cholangiocarcinoma should not be performed in PSC patients with small-duct PSCs or those younger than age 20.”
• Liver Problems with Inflammatory Bowel Disease