Oncological outcomes of Crohn's disease-associated cancers focusing on disease behavior

Akira Yamamoto; Yuji Toiyama; Hiroki Ikeuchi; Motoi Uchino; Kitaro Futami; Kinya Okamoto; Takayuki Ogino; 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:10.1002/ags3.12653

Oncological outcomes of Crohn's disease-associated cancers focusing on disease behavior

Ann Gastroenterol Surg. 2023 Jan 18;7(4):615-625. doi: 10.1002/ags3.12653. eCollection 2023 Jul.

Affiliations

¹ Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine Institute of Life Sciences, Mie University Graduate School of Medicine Tsu Japan.
² Department of Inflammatory Bowel Disease Surgery Hyogo College of Medicine Nishinomiya Japan.
³ Department of Surgery Fukuoka University Chikushi Hospital Chikushino Japan.
⁴ Department of Coloproctology Tokyo Yamate Medical Center Tokyo Japan.
⁵ Department of Gastroenterological Surgery, Graduate School of Medical Osaka University Osaka Japan.
⁶ Department of Surgical Oncology The University of Tokyo Tokyo Japan.
⁷ Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences Niigata University Niigata Japan.
⁸ Tokyo Medical and Dental University Tokyo Japan.

Abstract

Background: The overall risk of colorectal cancer in Crohn's disease (CD) is higher than in the general population, and CD-associated cancer (CDAC) has poorer prognosis than sporadic cancer. Developing treatment strategies for improving the prognosis of CDAC, we evaluated the characteristics of CDAC according to the underlying disease behavior, namely stricturing and penetrating.

Methods: This multicenter retrospective study comprises 316 CDAC patients who underwent surgery between 1985 and 2019. Clinicopathological findings including disease behavior and oncological outcomes were investigated.

Results: There was no association between the preoperative course of CDAC patients and disease behavior; however, postoperative information revealed distinctly different characteristics between CDAC patients with stricturing behavior and those with penetrating behavior (stricturing with lymphatic invasion and peritoneal dissemination recurrence, and penetrating with histologically poorly differentiated and local recurrence). Oncological outcome of patients with CDAC was distinctly different according to disease behavior, as penetrating provided a poor outcome (overall survival [OS]: p = 0.02; relapse-free survival [RFS]: p = 0.002) whereas stricturing had no effect. Furthermore, penetrating behavior was identified as one of the independent risk factors for poor OS and RFS (OS: hazard ratio [HR] 1.89, 95% confidence interval [CI] 1.16-3.09, p = 0.01; RFS: HR 2.15, 95% CI 1.28-3.63, p = 0.004).

Conclusions: Our study highlights the different characteristics of CDAC according to the underlying disease behavior and substantiates the poor prognosis of CDAC patients with penetrating behavior. Treatment planning including screening, surgical procedures, and postoperative treatment, with awareness of these findings, may contribute to improved prognosis for CDAC patients.

Keywords: Crohn's disease; Crohn's disease‐associated cancer; disease behavior; penetrating; stricturing.