Crohn's Disease-Associated Anorectal Cancer Has a Poor Prognosis With High Local Recurrence: A Subanalysis of the Nationwide Japanese Study

Takayuki Ogino; Tsunekazu Mizushima; Makoto Fujii; Yuki Sekido; Hidetoshi Eguchi; Riichiro Nezu; Hiroki Ikeuchi; Uchino Motoi; Kitaro Futami; Kinya Okamoto; Hisashi Nagahara; Kazuhiro Watanabe; Koji Okabayashi; Kazutaka Yamada; Hiroki Ohge; Shinji Tanaka; Yusuke Mizuuchi; Yoshiki Ohkita; Yu Sato; Hideki Ueno; Toru Kono; Michio Itabashi; Hideaki Kimura; Koya Hida; Yusuke Kinugasa; Kenichi Takahashi; Fumikazu Koyama; Tsunekazu Hanai; Kiyoshi Maeda; Toshihiro Noake; Yoshifumi Shimada; Takayuki Yamamoto; Junya Arakaki; Keiji Mastuda; Junji Okuda; Eiji Sunami; Yoshito Akagi; Kenji Kastumata; Kay Uehara; Takeshi Yamada; Shin Sasaki; Soichiro Ishihara; Yoichi Ajioka; Kenichi Sugihara; Study Group for Inflammatory Bowel Disease Associated Intestinal Cancers by the Japanese Society for Cancer of the Colon and Rectum

doi:10.14309/ajg.0000000000002269

Crohn's Disease-Associated Anorectal Cancer Has a Poor Prognosis With High Local Recurrence: A Subanalysis of the Nationwide Japanese Study

Am J Gastroenterol. 2023 Sep 1;118(9):1626-1637. doi: 10.14309/ajg.0000000000002269. Epub 2023 Mar 28.

Authors

Takayuki Ogino^{1

2}, Tsunekazu Mizushima², Makoto Fujii³, Yuki Sekido¹, Hidetoshi Eguchi¹, Riichiro Nezu⁴, Hiroki Ikeuchi⁵, Uchino Motoi⁵, Kitaro Futami⁶, Kinya Okamoto⁷, Hisashi Nagahara⁸, Kazuhiro Watanabe⁹, Koji Okabayashi¹⁰, Kazutaka Yamada¹¹, Hiroki Ohge¹², Shinji Tanaka¹³, Yusuke Mizuuchi¹⁴, Yoshiki Ohkita¹⁵, Yu Sato¹⁶, Hideki Ueno¹⁷, Toru Kono¹⁸, Michio Itabashi¹⁹, Hideaki Kimura²⁰, Koya Hida²¹, Yusuke Kinugasa²², Kenichi Takahashi²³, Fumikazu Koyama²⁴, Tsunekazu Hanai²⁵, Kiyoshi Maeda²⁶, Toshihiro Noake²⁷, Yoshifumi Shimada²⁸, Takayuki Yamamoto²⁹, Junya Arakaki³⁰, Keiji Mastuda³¹, Junji Okuda³², Eiji Sunami³³, Yoshito Akagi³⁴, Kenji Kastumata³⁵, Kay Uehara³⁶, Takeshi Yamada³⁷, Shin Sasaki³⁸, Soichiro Ishihara³⁹, Yoichi Ajioka⁴⁰, Kenichi Sugihara⁴¹; Study Group for Inflammatory Bowel Disease Associated Intestinal Cancers by the Japanese Society for Cancer of the Colon and Rectum

Affiliations

¹ Department of Gastroenterological Surgery, Graduate School of Medical, Osaka University, Osaka, Japan.
² Department of Therapeutics for Inflammatory Bowel Diseases, Graduate School of Medical, Osaka University, Osaka, Japan.
³ Division of Health Sciences, Graduate School of Medical, Osaka University, Osaka, Japan.
⁴ Department of Surgery, Osaka Central Hospital, Osaka, Japan.
⁵ Department of Inflammatory Bowel Disease Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
⁶ Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Japan.
⁷ Department of Coloproctology, Tokyo Yamate Medical Center, Tokyo, Japan.
⁸ Department of Surgery, Osaka City University, Graduate School of Medicine, Osaka, Japan.
⁹ Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
¹⁰ Department of Surgery, Keio University, Tokyo, Japan.
¹¹ Department of Surgery, Coloproctology Center Takano Hospital, Kumamoto, Japan.
¹² Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan.
¹³ Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
¹⁴ Department of Surgery and Oncology, Kyusyu University, Fukuoka, Japan.
¹⁵ Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan.
¹⁶ Department of Surgery, Toho University Sakura Medical Center, Chiba, Japan.
¹⁷ Department of Surgery, National Defense Medical College, Tokorozawa, Japan.
¹⁸ Advanced Surgery Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.
¹⁹ Department of Surgery, Division of Inflammatory Bowel Disease Surgery, Tokyo Women's Medical University, Tokyo, Japan.
²⁰ Inflammatory Bowel Disease Center, Yokohama City University Medical Centre, Yokohama, Japan.
²¹ Department of Surgery, Kyoto University Hospital, Kyoto, Japan.
²² Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
²³ Department of Colorectal Surgery, Tohoku Rosai Hospital, Sendai, Japan.
²⁴ Department of Surgery, Nara Medical University, Kashihara, Japan.
²⁵ Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan.
²⁶ Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan.
²⁷ Kurume Coloproctology Center, Kurume, Japan.
²⁸ Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
²⁹ Inflammatory Bowel Disease Center, Yokkaichi Hazu Medical Center, Yokkaichi, Japan.
³⁰ Center for Gastroenterology, Department of Surgery, Urasoe General Hospital, Urasoe, Japan.
³¹ Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
³² Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan.
³³ Department of Surgery, Kyorin University, Tokyo, Japan.
³⁴ Department of Surgery, Kurume University Hospital, Kurume, Japan.
³⁵ Department of Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
³⁶ Department of Gastroenterological Surgery, Nagoya University Hospital, Nagoya, Japan.
³⁷ Department of Digestive Surgery, Nippon Medical School, Tokyo, Japan.
³⁸ Department of Coloproctological Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
³⁹ Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
⁴⁰ Department of Pathology, Niigata University, Niigata, Japan.
⁴¹ Tokyo Medical and Dental University, Tokyo, Japan.

Abstract

Introduction: Colorectal cancer (CRC) is one of the major life-threatening complications in patients with Crohn's disease (CD). Previous studies of CD-associated CRC (CD-CRC) have involved only small numbers of patients, and no large series have been reported from Asia. The aim of this study was to clarify the prognosis and clinicopathological features of CD-CRC compared with sporadic CRC.

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anus Neoplasms* / pathology
Colitis-Associated Neoplasms* / pathology
Crohn Disease* / complications
East Asian People
Humans
Prognosis
Rectal Neoplasms* / pathology
Retrospective Studies