Colorectal tumour characteristics and oncological outcome in patients with inflammatory bowel disease

Abstract

AbstractIntroductionPatients with inflammatory bowel disease (IBD) may be at higher risk of colorectal cancer (CRC), but it is unclear whether they have worse surgical and oncological outcomes compared with patients with sporadic colorectal cancer (SCRC). The aim of this paper is to determine whether there are differences in surgical and oncological outcomes following treatment for IBD‐CRC and SCRC.MethodsA tertiary referral hospital′s cancer database from 2004 to 2014 was retrospectively reviewed. Patient records as well as electronic radiological, pathological and administrative sources were used to collect data on patient demographics, tumour characteristics, surgical treatment, cancer recurrence and survival. Survival analyses (Kaplan Meier and Cox regression) were carried out to compare disease free and overall survival between IBD‐CRC and SCRC patient groups.ResultsA total of 1911 patients underwent surgery for CRC over the study period. Of these, 81 patients (4.2%) had a diagnosis of IBD. There was a significant difference in terms of patient demographics and surgical outcomes between the two groups. Colorectal cancer patients with IBD were younger at time of diagnosis (median age IBD‐CRC 57 years, median age SCRC 69 years, P < .001), were more likely to have an open procedure (P < .001), had a higher rate of stoma formation (P < .001) and had a longer length of hospital stay (P = <.001). Patients with IBD‐CRC more frequently exhibited poorly differentiated tumours (30.9% compared with 10.0%, P < .001). South Asian patients had a higher rate of IBD‐CRC than SCRC (33.3% compared with 17.4%, P = .015). At the end of follow up 69.2% (n = 1266/1830) of sporadic and 81.5% (n = 66/81) patients were alive. In this institutional case series, IBD was not demonstrated to be an independent predictor of disease free survival (HR 0.67, CI 0.33–1.36, P = .267) or overall survival (HR 0.78, 95% CI 0.46–1.30, P = .335).ConclusionPatient and tumour characteristic differences exist between patients presenting with IBD‐CRC and SCRC. IBD‐CRC patients are more likely to be diagnosed with CRC at a younger age, are more likely to have poorly differentiated tumours and have worse surgical outcomes. There were no differences in overall survival between IBD‐CRC and SCRC although due to small sample size in the IBD‐CRC group, results of the survival analysis should be interpreted with caution.