Steroid-Independent Crohn’s Disease Patients Also Benefit From Combination Therapy of Infliximab Plus Azathioprine

Abstract

the standard histologic report by our single pathologist that residual adenoma components exist or not, to maintain consistency. In addition, invasive cancers among early colorectal cancers in our subjects were 79% (15/19) in de novo cancer and 36% (23/64) in polyp cancer, indicating that the difficulties in finding de novo cancer at earlier stages of mucosa-limited lesions with colonoscopy. We are confident in the ability of our pathologist to diagnose invasive cancer as cancer and its residual adenomatous components. Our result of lifetime risk of early colorectal cancer, which was similar with SEER lifetime risk of colorectal cancer, supports our histologic diagnosis indirectly. The questioner quoted the retrospective case reports.3 First, we must address that the definition of nonpolypoid growth applied in that article is not the same as that of de novo cancer in our article. In addition, nonpolypoid growth is applied to advanced cancer as well as early cancer in that article. We already know this type of case report is much of suggestion. We recognize the difficulties of distinguishing de novo cancer among advanced cancers because of their morphologic changes in their progression to advanced stages, as we pointed to in our article. We also recognize the diversity of tumor growth speed. We think we must examine earlier stage cancer when we discuss de novo cancer. That is the reason that our subjects are limited to early colorectal cancer to increase the credibility of diagnosis for de novo cancer with our definition. Our definition is focused on the 2 histologic criteria in early colorectal cancers, enhanced by genetic analysis of co-author’s previous article as we noted in our article. We know that any definition does not guarantee complete accuracy. We think our definition is most credible to estimate the proportion of de novo colorectal cancer using colonoscopy in general population when this type of research is attempted; our results are the basis for discussion. We have begun a prospective study—Japan polyp study—as we pointed in our article. This prospective study is designed as surveillance after 2-time clean colon by colonoscopy intervention to remove the risk of missing the important lesions. This would be another method for estimation of de novo cancer. At present, colorectal cancer treatment is based on the fact that most colorectal cancers arise from adenomatous polyps, which is evidence based in Western countries. If de novo cancers are not able to be ignored in Japan, we think that the recommended interval for colonoscopy should be shorter in Japan.