Yip Han Chin1, Sneha Rajiv Jain2, Ming Hui Lee3, Cheng Han Ng2, Snow Yunni Lin2, Aaron Shengting Mai2, Mark Dhinesh Muthiah2,4, Fung Joon Foo2,5, Raghav Sundar2,6, David Eng Hui Ong2,4, Wei Qiang Leow7,8, Rupert Leong9,10, Webber Pak Wo Chan11. 1. Yong Loo Lin School of Medicine, 10 Medical Dr, Singapore, 117597, Singapore. yiphan97@gmail.com. 2. Yong Loo Lin School of Medicine, 10 Medical Dr, Singapore, 117597, Singapore. 3. Faculty of Science, National University of Singapore, Singapore, Singapore. 4. National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore. 5. Department of General Surgery, Sengkang General Hospital, Singapore, Singapore. 6. Department of Haematology-Oncology, National University Health System, Singapore, Singapore. 7. Division of Pathology, Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore. 8. Department of Anatomical Pathology, Duke-NUS Medical School, Singapore General Hospital, Singapore, Singapore. 9. The University of Sydney, Sydney, NSW, Australia. 10. Concord Repatriation General Hospital, Sydney, NSW, Australia. 11. Department of Gastroenterology, Singapore General Hospital, 16 College Road, Block 6 Level 6, Singapore, 169854, Singapore. webber.chan.p.w@singhealth.com.sg.
Abstract
BACKGROUND AND AIMS: Small bowel adenocarcinoma (SBA) is a rare neoplasm that is associated with Crohn's disease (CD). This study aims to quantify the prevalence of CD-SBA, review the current evidence of histopathology and molecular analysis findings, and identify the clinical presentation and outcomes of CD-SBA. METHODS: Electronic databases Medline and Embase were searched for articles describing SBA in inflammatory bowel disease patients. The histopathology, molecular analysis findings, clinical presentation, prevalence, and outcomes of CD-SBA were extracted, and results were pooled with random effects. RESULTS: In total, 33 articles were included in the analysis. Prevalence of SBA was 1.15 (CI: 0.31-2.33) per 1000 CD patients. Only 11% (CI: 0.04-0.21) of CD-SBA patients had observable radiological features. CD-SBA was most commonly found in the ileum (84%), diagnosed at stage 2 (36%), with main presenting complaints including obstruction, weight loss, and abdominal pain. Significant histopathological findings included adjacent epithelial dysplasia, and an equal distribution of well-differentiated (49%) and poorly differentiated subtypes (46%). Most prevalent genetic mutation was KRAS mutation (18%), followed by mismatch repair deficiency (9.7%). The 5-year overall survival for CD-SBA patients was 29% (CI: 0.18-0.41), and 33% (CI: 0.26-0.41) for de novo SBA. No statistically significant increase in risk for CD-SBA was noted for treatment with thiopurines, steroids, and 5-ASA. CONCLUSION: Our meta-analysis found the prevalence of CD-SBA to be 1.15 per 1000 CD patients. The 5-year overall survival for CD-SBA was poor. The presenting symptoms were non-specific, and therefore the diagnosis requires a high index of suspicion.
BACKGROUND AND AIMS: Small bowel adenocarcinoma (SBA) is a rare neoplasm that is associated with Crohn's disease (CD). This study aims to quantify the prevalence of CD-SBA, review the current evidence of histopathology and molecular analysis findings, and identify the clinical presentation and outcomes of CD-SBA. METHODS: Electronic databases Medline and Embase were searched for articles describing SBA in inflammatory bowel disease patients. The histopathology, molecular analysis findings, clinical presentation, prevalence, and outcomes of CD-SBA were extracted, and results were pooled with random effects. RESULTS: In total, 33 articles were included in the analysis. Prevalence of SBA was 1.15 (CI: 0.31-2.33) per 1000 CD patients. Only 11% (CI: 0.04-0.21) of CD-SBA patients had observable radiological features. CD-SBA was most commonly found in the ileum (84%), diagnosed at stage 2 (36%), with main presenting complaints including obstruction, weight loss, and abdominal pain. Significant histopathological findings included adjacent epithelial dysplasia, and an equal distribution of well-differentiated (49%) and poorly differentiated subtypes (46%). Most prevalent genetic mutation was KRAS mutation (18%), followed by mismatch repair deficiency (9.7%). The 5-year overall survival for CD-SBA patients was 29% (CI: 0.18-0.41), and 33% (CI: 0.26-0.41) for de novo SBA. No statistically significant increase in risk for CD-SBA was noted for treatment with thiopurines, steroids, and 5-ASA. CONCLUSION: Our meta-analysis found the prevalence of CD-SBA to be 1.15 per 1000 CD patients. The 5-year overall survival for CD-SBA was poor. The presenting symptoms were non-specific, and therefore the diagnosis requires a high index of suspicion.
Authors: Begoña Diosdado; Tineke E Buffart; Russell Watkins; Beatriz Carvalho; Bauke Ylstra; Marianne Tijssen; Anne S Bolijn; Fraser Lewis; Karen Maude; Caroline Verbeke; Iris D Nagtegaal; Heike Grabsch; Chris J J Mulder; Phil Quirke; Peter Howdle; Gerrit A Meijer Journal: Clin Cancer Res Date: 2010-02-23 Impact factor: 12.531
Authors: Jordan E Axelrad; Ola Olén; Michael C Sachs; Rune Erichsen; Lars Pedersen; Jonas Halfvarson; Johan Askling; Anders Ekbom; Henrik Toft Sørensen; Jonas F Ludvigsson Journal: Gut Date: 2020-05-30 Impact factor: 23.059
Authors: Tine Jess; Edward V Loftus; Fernando S Velayos; W Scott Harmsen; Alan R Zinsmeister; Thomas C Smyrk; Cathy D Schleck; William J Tremaine; L Joseph Melton; Pia Munkholm; William J Sandborn Journal: Gastroenterology Date: 2006-04 Impact factor: 22.682
Authors: Gaël Piton; Jacques Cosnes; Elisabeth Monnet; Laurent Beaugerie; Philippe Seksik; Guillaume Savoye; Guillaume Cadiot; Bernard Flourie; Philippe Capelle; Philippe Marteau; Marc Lemann; Jean Frédéric Colombel; Elie Khouri; Bruno Bonaz; Franck Carbonnel Journal: Am J Gastroenterol Date: 2008-06-28 Impact factor: 10.864
Authors: Karl Y Bilimoria; David J Bentrem; Jeffrey D Wayne; Clifford Y Ko; Charles L Bennett; Mark S Talamonti Journal: Ann Surg Date: 2009-01 Impact factor: 12.969