Keisuke Hata1, Hiroyuki Anzai1, Hiroki Ikeuchi2, Kitaro Futami3, Kouhei Fukushima4,5, Akira Sugita6, Motoi Uchino2, Daijiro Higashi3, Michio Itabashi7, Kazuhiro Watanabe8, Kazutaka Koganei6, Toshimitsu Araki9, Hideaki Kimura10, Tsunekazu Mizushima11, Takeshi Ueda12, Soichiro Ishihara1, Yasuo Suzuki13. 1. Department of Surgical Oncology, The University of Tokyo, Tokyo, 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. Division of Surgical and Molecular Pathophysiology, Tohoku University, Graduate School of Medicine, Sendai, Japan. 5. Laboratory of Gastrointestinal Reconstruction, Tohoku University, Graduate School of Biomedical Engineering, Sendai, Japan. 6. Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan. 7. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 8. Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan. 9. Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences Mie University Graduate School of Medicine. 10. Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan. 11. Department of Gastroenterological Surgery/Therapeutics for Inflammatory Bowel Diseases, Osaka University Graduate School of Medicine, Osaka, Japan. 12. Department of Surgery, Nara Medical University, Kashihara, Japan. 13. Internal Medicine, Sakura Medical Center, Toho University, Tokyo, Japan.
Abstract
OBJECTIVES: To determine the effectiveness of surveillance colonoscopy (SC) and optimize its use by assessing real-world surgically resected cases of ulcerative colitis (UC)-associated colorectal cancer (CRC) and dysplasia. METHODS: Clinicopathological data of 406 (238 CRC and 168 dysplasia) patients who underwent surgical resection in 10 UC specialized institutions were retrospectively reviewed. The overall survival (OS) rates were compared between the SC and non-SC groups. The incidence of and risk factors for early-onset CRC (<8 years after UC onset) were identified. The distribution of CRC lesions was also assessed. RESULTS: Cancer stages were significantly more advanced in the non-SC group than in the SC group (P < 0.001). The patients in the SC group showed significantly better OS than those in the non-SC group (5-year OS: 89% vs 70%; log-rank test: P = 0.001). Seventeen percent of patients developed CRC within 8 years after UC onset. The age at UC onset was a risk factor and a good predictor of early-onset CRC (<8 years) (P < 0.01; AUC: 0.85). The most common sites of CRC were the rectum (51%) and sigmoid colon (20%). Multiple CRC was identified in 16% of patients. CONCLUSIONS: Surveillance colonoscopy was effective and improved the OS in patients with UC. We recommend that patients with late-onset UC (>40 years) undergo SCs earlier because of the high incidence of CRC within 8 years of UC onset. Moreover, the rectum and sigmoid colon should be more thoroughly examined.
OBJECTIVES: To determine the effectiveness of surveillance colonoscopy (SC) and optimize its use by assessing real-world surgically resected cases of ulcerative colitis (UC)-associated colorectal cancer (CRC) and dysplasia. METHODS: Clinicopathological data of 406 (238 CRC and 168 dysplasia) patients who underwent surgical resection in 10 UC specialized institutions were retrospectively reviewed. The overall survival (OS) rates were compared between the SC and non-SC groups. The incidence of and risk factors for early-onset CRC (<8 years after UC onset) were identified. The distribution of CRC lesions was also assessed. RESULTS: Cancer stages were significantly more advanced in the non-SC group than in the SC group (P < 0.001). The patients in the SC group showed significantly better OS than those in the non-SC group (5-year OS: 89% vs 70%; log-rank test: P = 0.001). Seventeen percent of patients developed CRC within 8 years after UC onset. The age at UC onset was a risk factor and a good predictor of early-onset CRC (<8 years) (P < 0.01; AUC: 0.85). The most common sites of CRC were the rectum (51%) and sigmoid colon (20%). Multiple CRC was identified in 16% of patients. CONCLUSIONS: Surveillance colonoscopy was effective and improved the OS in patients with UC. We recommend that patients with late-onset UC (>40 years) undergo SCs earlier because of the high incidence of CRC within 8 years of UC onset. Moreover, the rectum and sigmoid colon should be more thoroughly examined.
Authors: Lester Tsai; Christopher Ma; Parambir S Dulai; Larry J Prokop; Samuel Eisenstein; Sonia L Ramamoorthy; Brian G Feagan; Vipul Jairath; William J Sandborn; Siddharth Singh Journal: Clin Gastroenterol Hepatol Date: 2020-10-27 Impact factor: 13.576