Crohn's Disease-Associated Anorectal Cancer Has a Poor Prognosis With High Local Recurrence: A Subanalysis of the Nationwide Japanese Study.
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Ogino Takayuki, Mizushima Tsunekazu, Fujii Makoto, Sekido Yuki, Eguchi Hidetoshi, Nezu Riichiro, Ikeuchi Hiroki, Motoi Uchino, Futami Kitaro, Okamoto Kinya, Nagahara Hisashi, Watanabe Kazuhiro, Okabayashi Koji, Yamada Kazutaka, Ohge Hiroki, Tanaka Shinji, Mizuuchi Yusuke, Ohkita Yoshiki, Sato Yu, Ueno Hideki, Kono Toru, Itabashi Michio, Kimura Hideaki, Hida Koya, Kinugasa Yusuke, Takahashi Kenichi, Koyama Fumikazu, Hanai Tsunekazu, Maeda Kiyoshi, Noake Toshihiro, Shimada Yoshifumi, Yamamoto Takayuki, Arakaki Junya, Mastuda Keiji, Okuda Junji, Sunami Eiji, Akagi Yoshito, Kastumata Kenji, Uehara Kay, Yamada Takeshi, Sasaki Shin, Ishihara Soichiro, Ajioka Yoichi, Sugihara Kenichi, Study Group for Inflammatory Bowel Disease Associated Intestinal Cancers by the Japanese Society for Cancer of the Colon and Rectum
Аннотация
METHODS: A large nationwide database was used to identify patients with CD-CRC (n = 233) and sporadic CRC (n = 129,783) over a 40-year period, from 1980 to 2020. Five-year overall survival (OS), recurrence-free survival (RFS), and clinicopathological characteristics were investigated. The prognosis of CD-CRC was further evaluated in groups divided by colon cancer and anorectal cancer (RC). Multivariable Cox regression analysis was used to adjust for confounding by unbalanced covariables.
RESULTS: Compared with sporadic cases, patients with CD-CRC were younger; more often had RC, multiple lesions, and mucinous adenocarcinoma; and had lower R0 resection rates. Five-year OS was worse for CD-CRC than for sporadic CRC (53.99% vs 71.17%, P < 0.001). Multivariable Cox regression analysis revealed that CD was associated with significantly poorer survival (hazard ratio 2.36, 95% confidence interval: 1.54-3.62, P < 0.0001). Evaluation by tumor location showed significantly worse 5-year OS and RFS of CD-RC compared with sporadic RC. Recurrence was identified in 39.57% of CD-RC cases and was mostly local.
DISCUSSION: Poor prognosis of CD-CRC is attributable primarily to RC and high local recurrence. Local control is indispensable to improving prognosis.