Crohn's Disease–Associated Anorectal Cancer Has a Poor Prognosis With High Local Recurrence: A Subanalysis of the Nationwide Japanese Study-Reference-Cited by-同舟云学术

Crohn's Disease–Associated Anorectal Cancer Has a Poor Prognosis With High Local Recurrence: A Subanalysis of the Nationwide Japanese Study

Published:2023-03-28 Issue:9 Volume:118 Page:1626-1637
ISSN:0002-9270
Container-title:American Journal of Gastroenterology
language:en
Short-container-title:Am J Gastroenterol

Author:

Ogino Takayuki¹²^ORCID,Mizushima Tsunekazu²,Fujii Makoto³,Sekido Yuki¹,Eguchi Hidetoshi¹,Nezu Riichiro⁴,Ikeuchi Hiroki⁵,Motoi Uchino⁵,Futami Kitaro⁶,Okamoto Kinya⁷,Nagahara Hisashi⁸,Watanabe Kazuhiro⁹,Okabayashi Koji¹⁰,Yamada Kazutaka¹¹,Ohge Hiroki¹²,Tanaka Shinji¹³,Mizuuchi Yusuke¹⁴,Ohkita Yoshiki¹⁵,Sato Yu¹⁶,Ueno Hideki¹⁷,Kono Toru¹⁸,Itabashi Michio¹⁹,Kimura Hideaki²⁰,Hida Koya²¹,Kinugasa Yusuke²²,Takahashi Kenichi²³,Koyama Fumikazu²⁴,Hanai Tsunekazu²⁵,Maeda Kiyoshi²⁶,Noake Toshihiro²⁷,Shimada Yoshifumi²⁸,Yamamoto Takayuki²⁹,Arakaki Junya³⁰,Mastuda Keiji³¹,Okuda Junji³²,Sunami Eiji³³,Akagi Yoshito³⁴,Kastumata Kenji³⁵,Uehara Kay³⁶,Yamada Takeshi³⁷,Sasaki Shin³⁸,Ishihara Soichiro³⁹,Ajioka Yoichi⁴⁰,Sugihara Kenichi⁴¹,

Affiliation:

1. Department of Gastroenterological Surgery, Graduate School of Medical, Osaka University, Osaka, Japan;

2. Department of Therapeutics for Inflammatory Bowel Diseases, Graduate School of Medical, Osaka University, Osaka, Japan;

3. Division of Health Sciences, Graduate School of Medical, Osaka University, Osaka, Japan;

4. Department of Surgery, Osaka Central Hospital, Osaka, Japan;

5. Department of Inflammatory Bowel Disease Surgery, Hyogo College of Medicine, Nishinomiya, Japan;

6. Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Japan;

7. Department of Coloproctology, Tokyo Yamate Medical Center, Tokyo, Japan;

8. Department of Surgery, Osaka City University, Graduate School of Medicine, Osaka, Japan;

9. Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan;

10. Department of Surgery, Keio University, Tokyo, Japan;

11. Department of Surgery, Coloproctology Center Takano Hospital, Kumamoto, Japan;

12. Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan;

13. Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan;

14. Department of Surgery and Oncology, Kyusyu University, Fukuoka, Japan;

15. Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan;

16. Department of Surgery, Toho University Sakura Medical Center, Chiba, Japan;

17. Department of Surgery, National Defense Medical College, Tokorozawa, Japan;

18. Advanced Surgery Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan;

19. Department of Surgery, Division of Inflammatory Bowel Disease Surgery, Tokyo Women's Medical University, Tokyo, Japan;

20. Inflammatory Bowel Disease Center, Yokohama City University Medical Centre, Yokohama, Japan;

21. Department of Surgery, Kyoto University Hospital, Kyoto, Japan;

22. Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan;

23. Department of Colorectal Surgery, Tohoku Rosai Hospital, Sendai, Japan;

24. Department of Surgery, Nara Medical University, Kashihara, Japan;

25. Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan;

26. Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan;

27. Kurume Coloproctology Center, Kurume, Japan;

28. Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan;

29. Inflammatory Bowel Disease Center, Yokkaichi Hazu Medical Center, Yokkaichi, Japan;

30. Center for Gastroenterology, Department of Surgery, Urasoe General Hospital, Urasoe, Japan;

31. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan;

32. Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan;

33. Department of Surgery, Kyorin University, Tokyo, Japan;

34. Department of Surgery, Kurume University Hospital, Kurume, Japan;

35. Department of Surgery, Tokyo Medical University Hospital, Tokyo, Japan;

36. Department of Gastroenterological Surgery, Nagoya University Hospital, Nagoya, Japan;

37. Department of Digestive Surgery, Nippon Medical School, Tokyo, Japan;

38. Department of Coloproctological Surgery, Japanese Red Cross Medical Center, Tokyo, Japan;

39. Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan;

40. Department of Pathology, Niigata University, Niigata, Japan;

41. Tokyo Medical and Dental University, Tokyo, Japan.

Abstract

INTRODUCTION: Colorectal cancer (CRC) is one of the major life-threatening complications in patients with Crohn's disease (CD). Previous studies of CD-associated CRC (CD-CRC) have involved only small numbers of patients, and no large series have been reported from Asia. The aim of this study was to clarify the prognosis and clinicopathological features of CD-CRC compared with sporadic CRC. METHODS: A large nationwide database was used to identify patients with CD-CRC (n = 233) and sporadic CRC (n = 129,783) over a 40-year period, from 1980 to 2020. Five-year overall survival (OS), recurrence-free survival (RFS), and clinicopathological characteristics were investigated. The prognosis of CD-CRC was further evaluated in groups divided by colon cancer and anorectal cancer (RC). Multivariable Cox regression analysis was used to adjust for confounding by unbalanced covariables. RESULTS: Compared with sporadic cases, patients with CD-CRC were younger; more often had RC, multiple lesions, and mucinous adenocarcinoma; and had lower R0 resection rates. Five-year OS was worse for CD-CRC than for sporadic CRC (53.99% vs 71.17%, P < 0.001). Multivariable Cox regression analysis revealed that CD was associated with significantly poorer survival (hazard ratio 2.36, 95% confidence interval: 1.54–3.62, P < 0.0001). Evaluation by tumor location showed significantly worse 5-year OS and RFS of CD-RC compared with sporadic RC. Recurrence was identified in 39.57% of CD-RC cases and was mostly local. DISCUSSION: Poor prognosis of CD-CRC is attributable primarily to RC and high local recurrence. Local control is indispensable to improving prognosis.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Gastroenterology,Hepatology

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