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

被引：7

作者：

Ogino, Takayuki ^{[1
,2
]}

Mizushima, Tsunekazu ^{[2
]}

Fujii, Makoto ^{[3
]}

Sekido, Yuki ^{[1
]}

Eguchi, Hidetoshi ^{[1
]}

Nezu, Riichiro ^{[4
]}

Ikeuchi, Hiroki ^{[5
]}

Motoi, Uchino ^{[5
]}

Futami, Kitaro ^{[6
]}

Okamoto, Kinya ^{[7
]}

Nagahara, Hisashi ^{[8
]}

Watanabe, Kazuhiro ^{[9
]}

Okabayashi, Koji ^{[10
]}

Yamada, Kazutaka ^{[11
]}

Ohge, Hiroki ^{[12
]}

Tanaka, Shinji ^{[13
]}

Mizuuchi, Yusuke ^{[14
]}

Ohkita, Yoshiki ^{[15
]}

Sato, Yu ^{[16
]}

Ueno, Hideki ^{[17
]}

Kono, Toru ^{[18
]}

Itabashi, Michio ^{[19
]}

Kimura, Hideaki ^{[20
]}

Hida, Koya ^{[21
]}

Kinugasa, Yusuke ^{[22
]}

Takahashi, Kenichi ^{[23
]}

Koyama, Fumikazu ^{[24
]}

Hanai, Tsunekazu ^{[25
]}

Maeda, Kiyoshi ^{[26
]}

Noake, Toshihiro ^{[27
]}

Shimada, Yoshifumi ^{[28
]}

Yamamoto, Takayuki ^{[29
]}

Arakaki, Junya ^{[30
]}

Mastuda, Keiji ^{[31
]}

Okuda, Junji ^{[32
]}

Sunami, Eiji ^{[33
]}

Akagi, Yoshito ^{[34
]}

Kastumata, Kenji ^{[35
]}

Uehara, Kay ^{[36
]}

Yamada, Takeshi ^{[37
]}

Sasaki, Shin ^{[38
]}

Ishihara, Soichiro ^{[39
]}

Ajioka, Yoichi ^{[40
]}

Sugihara, Kenichi ^{[41
]}

机构：

[1] Osaka Univ, Grad Sch Med, Dept Gastroenterol Surg, Osaka, Japan

[2] Osaka Univ, Grad Sch Med, Dept Therapeut Inflammatory Bowel Dis, Osaka, Japan

[3] Osaka Univ, Grad Sch Med, Div Hlth Sci, Osaka, Japan

[4] Osaka Cent Hosp, Dept Surg, Osaka, Japan

[5] Hyogo Coll Med, Dept Inflammatory Bowel Dis Surg, Nishinomiya, Japan

[6] Fukuoka Univ, Dept Surg, Chikushi Hosp, Chikushino, Japan

[7] Tokyo Yamate Med Ctr, Dept Coloproctol, Tokyo, Japan

[8] Osaka City Univ, Grad Sch Med, Dept Surg, Osaka, Japan

[9] Tohoku Univ, Grad Sch Med, Dept Surg, Sendai, Japan

[10] Keio Univ, Dept Surg, Tokyo, Japan

[11] Coloproctol Ctr Takano Hosp, Dept Surg, Kumamoto, Japan

[12] Hiroshima Univ Hosp, Dept Infect Dis, Hiroshima, Japan

[13] Hiroshima Univ Hosp, Dept Endoscopy, Hiroshima, Japan

[14] Kyushu Univ, Dept Surg & Oncol, Fukuoka, Japan

[15] Mie Univ, Inst Life Sci, Grad Sch Med, Dept Gastrointestinal & Pediat Surg, Tsu, Japan

[16] Toho Univ, Sakura Med Ctr, Dept Surg, Chiba, Japan

[17] Natl Def Med Coll, Dept Surg, Tokorozawa, Japan

[18] Sapporo Higashi Tokushukai Hosp, Adv Surg Ctr, Sapporo, Japan

[19] Tokyo Womens Med Univ, Dept Surg, Div Inflammatory Bowel Dis Surg, Tokyo, Japan

[20] Yokohama City Univ, Med Ctr, Inflammatory Bowel Dis Ctr, Yokohama, Japan

[21] Kyoto Univ Hosp, Dept Surg, Kyoto, Japan

[22] Tokyo Med & Dent Univ, Dept Gastrointestinal Surg, Tokyo, Japan

[23] Tohoku Rosai Hosp, Dept Colorectal Surg, Sendai, Japan

[24] Nara Med Univ, Dept Surg, Kashihara, Japan

[25] Fujita Hlth Univ, Sch Med, Dept Surg, Toyoake, Japan

[26] Osaka City Gen Hosp, Dept Gastroenterol Surg, Osaka, Japan

[27] Kurume Coloproctol Ctr, Kurume, Japan

[28] Niigata Univ, Grad Sch Med & Dent Sci, Div Digest & Gen Surg, Niigata, Japan

[29] Yokkaichi Hazu Med Ctr, Inflammatory Bowel Dis Ctr, Yokaichi, Japan

[30] Urasoe Gen Hosp, Ctr Gastroenterol, Dept Surg, Urasoe, Japan

[31] Teikyo Univ, Sch Med, Dept Surg, Tokyo, Japan

[32] Osaka Med Coll, Dept Gen & Gastroenterol Surg, Takatsuki, Japan

[33] Kyorin Univ, Dept Surg, Tokyo, Japan

[34] Kurume Univ Hosp, Dept Surg, Kurume, Japan

[35] Tokyo Med Univ Hosp, Dept Surg, Tokyo, Japan

[36] Nagoya Univ Hosp, Dept Gastroenterol Surg, Nagoya, Japan

[37] Nippon Med Sch, Dept Digest Surg, Tokyo, Japan

[38] Japanese Red Cross Med Ctr, Dept Coloproctol Surg, Tokyo, Japan

[39] Univ Tokyo, Dept Surg Oncol, Tokyo, Japan

[40] Niigata Univ, Dept Pathol, Niigata, Japan

[41] Tokyo Med & Dent Univ, Tokyo, Japan

来源：

AMERICAN JOURNAL OF GASTROENTEROLOGY | 2023年 / 118卷 / 09期

关键词：

Crohn's disease; colorectal cancer; recurrence;

D O I：

10.14309/ajg.0000000000002269

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

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.

引用

页码：1626 / 1637

页数：12

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