Abstract
PurposePatients with inflammatory bowel disease (IBD) have an increased risk for colorectal cancer (CRC). In IBD patients, cancer is often diagnosed in advanced stages and conflicting data on survival compared to sporadic CRC have been reported. The aim of this study was to directly compare clinical characteristics and prognosis of patients with IBD-CRC and sporadic CRC.MethodsThe clinical and pathological data of 63 patients with IBD-CRC and 3710 patients with sporadic CRC treated at the University Hospital of Erlangen between 1995 and 2015 were compared. Forty-seven M0 patients with IBD were matched with sporadic CRC patients after curative resection (R0) according to tumor localization, stage, sex, and year of treatment. Overall and disease-free survival were compared.ResultsSixty-three patients presented IBD-CRC. Fifty were affected with ulcerative colitis (UC) and 13 with Crohn’s disease (CD). CRC was diagnosed within 1.45 years since last endoscopic surveillance. Twelve patients (19%) had a diagnosis of primary sclerosing cholangitis. In matched analysis, IBD patients were diagnosed with CRC at younger age compared to sporadic CRC and were more likely to have right-sided CRC (40% versus 23.3%) and rare histological subtypes (19% versus 9.2%). No differences in 5-year overall (78.7 versus 80.9 months) and 5-year disease-free survival (74.5 versus 70.2 months) were noted.ConclusionIBD-CRC patients were younger and more frequently had right-sided carcinomas compared to sporadic CRC. CRC in IBD patients did not show survival difference compared to matched-pair sporadic CRC patients without distant metastases after curative resection. Surveillance might be important for early detection of CRC in IBD patients.
Highlights
Inflammatory bowel disease (IBD) is an established risk factor for the development of colorectal cancer (CRC) [1, 2]
We identified a total of 63 patients with IBD-related CRC (Table 1)
Even though surveillance was performed within the intervals recommended in the guidelines [1], CRC was diagnosed within a mean of 1.45 years after last endoscopy
Summary
Inflammatory bowel disease (IBD) is an established risk factor for the development of colorectal cancer (CRC) [1, 2]. The risk of CRC in long-standing Crohn’s colitis patients is comparable to those with UC, since a meta-analysis of data from population-based studies found a pooled SIR for CRC of 1.7 (95% confidence interval, 1.2–2.2) in all patients with IBD [15]. According to a national nationwide study, patients with IBD who were diagnosed with CRC were younger than sporadic CRC counterparts [16, 17]. They were more likely to have multiple neoplastic lesions and had higher proportions of superficialtype lesions and invasive-type lesions at histology, as well as mucinous or signet ring cell histotypes [17]
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