Colorectal cancer in Crohn\u2019s colitis is associated with advanced tumor invasion and a poorer survival compared with ulcerative colitis: a retrospective dual-center study

Leonie E Vetter,Christian Krautz,Georg F Weber,Nicolas Schlegel,Robert Grützmann,Susanne Merkel,Klaus Weber,Maximilian Brunner,Anke Mittelstädt,Alan Bénard,Armin Wiegering,Christoph-Thomas Germer

doi:10.1007/s00384-020-03726-4

Leonie E Vetter, Christian Krautz + Show 10 more

Open Access

https://doi.org/10.1007/s00384-020-03726-4

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Abstract

PurposeColorectal cancer is a well-recognized complication of inflammatory bowel diseases (IBD), such as ulcerative colitis (UC) and Crohn’s colitis (CC). In this study, we assess the clinico-pathological features and outcomes of patients with colorectal cancer from UC in comparison with CC.MethodsData of all patients with colitis-associated cancer (CAC) who underwent surgery at Erlangen or Würzburg University Clinic between 1995 and 2015 were selected. Clinical, histopathological, and survival data were analyzed retrospectively.ResultsOf all 88 patients with CAC, 20 patients had Crohn’s colitis and 68 patients had ulcerative colitis. We observed a young median age at tumor diagnosis (49.5 years UC; 45.5 years CC, p = 0.208) in both diseases and a long median disease duration before CAC (19 years UC; 18 years CC; p = 0.840). Patients with CC suffered more often from rectal cancer (14 (70.0%) in CC; 23 (33.8%) in UC; p = 0.005) and advanced tumor stages (8 (47.0%) pT4 in CC; 14 (25.0%) pT4/ypT4 in UC; p = 0.008). Five-year overall survival rate was 39.3% for CC and 67.1% for UC (p = 0.009 for difference between the groups). Survival did not differ significantly between UC and CC in the multivariate analysis after correction for UICC tumor stage.ConclusionCAC in CC showed advanced tumor stages associated with reduced survival compared with CAC in UC. This may be explained by less intense surveillance in patients with CC leading to delayed cancer diagnosis.

Highlights

Colorectal cancer is the third common malignancy worldwide with a prevalence rate of 1.4 million cases per year [1]
Thirty-two (46.7%) patients with ulcerative colitis (UC) were diagnosed with cancer during routine colonoscopy, whereas 14 (70.6%) patients with Crohn’s colitis (CC) showed symptoms like weight loss or intestinal obstruction, which led to the cancer detection (p = 0.013)
This might be due to a lower risk of colorectal cancer in CC (SIR 2.4 in UC, but 1.9 in CC)

Summary

Introduction

Colorectal cancer is the third common malignancy worldwide with a prevalence rate of 1.4 million cases per year [1]. As it is characteristic for the inflammatory bowel diseases (IBD) ulcerative colitis (UC) and Crohn’s colitis (CC), is a well-recognized risk factor for the development of Colorectal Cancer, called colitisassociated cancer (CAC). Pro-inflammatory transcription factors and cytokines like NF-κB and IL-6 have been shown to play a crucial role in CAC promotion and are overexpressed in epithelial cells of patients with active colitis [9, 10]. While comparisons of sporadic colorectal cancer with CAC regarding tumor characteristics and outcome has widely been reported, only few studies exist—to the best of our knowledge—that compare colorectal cancer in patients with UC with those with CC. We compare the clinico-pathological features and outcome of CAC in patients with UC with those with CC in a dual-center study using retrospective analysis

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