Clinicopathological features and cancer-specific survival in young patients with ulcerative colitis-associated colorectal neoplasia: a nationwide cohort study in Japan.
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Shinagawa Takahide, Komatsu Koichi, Uchino Motoi, Ikeuchi Hiroki, Shigeta Kohei, Oka Shiro, Higashi Daijiro, Ogawa Shimpei, Watanabe Kazuhiro, Shibutani Masatsune, Okita Yoshiki, Wakai Toshifumi, Mizuuchi Yusuke, Okamoto Kinya, Yamada Kazutaka, Sato Yu, Ogino Takayuki, Kimura Hideaki, Takahashi Kenichi, Hida Koya, Kinugasa Yusuke, Ishida Fumio, Okuda Junji, Daito Koji, Yamamoto Takayuki, Yamamoto Seiichiro, Koyama Fumikazu, Hiro Junichiro, Komori Koji, Shida Dai, Arakaki Junya, Fujita Fumihiko, Matsuyama Takatoshi, Ueno Hideki, Ochiai Hiroki, Maemoto Atsuo, Nezu Riichiro, Sasaki Shin, Sunami Eiji, Noguchi Tatsuki, Sugihara Kenichi, Ajioka Yoichi, Ishihara Soichiro, Study Group for Inflammatory Bowel Disease Associated Intestinal Cancers by Japanese Society for Cancer of the Colon and Rectum
Аннотация
METHODS: We retrospectively analyzed 1212 patients with UCAN treated at 43 institutions in Japan during the period from 1983 to 2020. Patients were categorized as young (<40 years) or non-young (≥40 years). Clinicopathological features, cancer-specific survival (CSS), relapse-free survival (RFS), and survival after recurrence (SAR) were compared.
RESULTS: Young-onset UCAN accounted for 252 patients (20.8%) and showed a shorter interval from UC onset to carcinogenesis (14.0 vs 17.0 years; P < .001), more frequent pancolitis (81.3% vs 74.8%; P = .012), and a higher proportion of poorly differentiated, mucinous, or signet-ring cell carcinoma (20.2% vs 13.3%; P < .001). Five-year CSS was significantly lower in young patients (85.1% vs 89.8%; P = .039), whereas RFS was comparable (86.2% vs 86.3%; P = .750). Minimally invasive surgery (MIS) was independently associated with improved CSS (hazard ratio [HR], 0.593; 95% CI, 0.356-0.987; P = .045). The SAR remained poor in both age groups (23.6% vs 28.5%; P = .468).
CONCLUSIONS: When diagnosed in patients aged <40 years, UCAN is characterized by earlier carcinogenesis, extensive disease, and aggressive histology, with worse CSS. The potential role of MIS in improving prognosis warrants further prospective investigation, while the outcome of SAR remains poor irrespective of patient age.