Tatsuki Noguchi1, Soichiro Ishihara2, Motoi Uchino3, Hiroki Ikeuchi3, Koji Okabayashi4, Kitaro Futami5, Shinji Tanaka6, Hiroki Ohge7, Hisashi Nagahara8, Kazuhiro Watanabe9, Michio Itabashi10, Kinya Okamoto11, Yoshiki Okita12, Tsunekazu Mizushima13, Yusuke Mizuuchi14, Kazutaka Yamada15, Yoshifumi Shimada16, Yu Sato17, Hideaki Kimura18, Kenichi Takahashi19, Koya Hida20, Yusuke Kinugasa21, Junji Okuda22, Koji Daito23, Fumikazu Koyama24, Hideki Ueno25, Takayuki Yamamoto26, Tsunekazu Hanai27, Atsuo Maemoto28, Koji Oba29,30, Yoichi Ajioka31, Kenichi Sugihara32. 1. Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. 2. Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. ishihara-1su@h.u-tokyo.ac.jp. 3. Department of Inflammatory Bowel Disease Surgery, Hyogo College of Medicine, Nishinomiya, Japan. 4. Department of Surgery, Keio University School of Medicine, Tokyo, Japan. 5. Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Japan. 6. Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan. 7. Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan. 8. Department of Gastroenterological 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, Division of Inflammatory Bowel Disease Surgery, Tokyo Women's Medical University, Tokyo, Japan. 11. Department of Coloproctology, Tokyo Yamate Medical Center, Tokyo, Japan. 12. Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan. 13. Department of Gastroenterological Surgery, Graduate School of Medical, Osaka University, Osaka, Japan. 14. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 15. Department of Surgery, Coloproctology Center Takano Hospital, Kumamoto, Japan. 16. Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan. 17. Department of Surgery, Toho University Sakura Medical Center, Chiba, Japan. 18. Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan. 19. Department of Colorectal Surgery, Tohoku Rosai Hospital, Sendai, Japan. 20. Department of Surgery, Kyoto University Hospital, Kyoto, Japan. 21. Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan. 22. Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan. 23. Department of Surgery, Faculty of Medicine, Kindai University, Osaka, Japan. 24. Department of Surgery, Nara Medical University, Kashihara, Japan. 25. Department of Surgery, National Defense Medical College, Tokorozawa, Japan. 26. Inflammatory Bowel Disease Center, Yokkaichi Hazu Medical Center, Yokkaichi, Japan. 27. Department of Surgery, School of Medicine, Fujita Health University, Toyoake, Japan. 28. Inflammatory Bowel Disease Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan. 29. Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 30. Interfaculty Initiative in Information Studies, Graduate School of Interdisciplinary Information Studies, The University of Tokyo, Tokyo, Japan. 31. Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan. 32. Tokyo Medical and Dental University, Tokyo, Japan.
Abstract
BACKGROUND: Patients with longstanding inflammatory bowel disease are at high risk of developing intestinal cancers. In this study, we aimed to elucidate the differences between intestinal cancers associated with ulcerative colitis and Crohn's disease. METHODS: Intestinal cancers in ulcerative colitis and Crohn's disease patients treated between 1983 and 2020 at 43 Japanese institutions were retrospectively analyzed.. RESULTS: A total of 1505 intestinal cancers in 1189 ulcerative colitis and 316 Crohn's disease patients were studied. Almost all of ulcerative colitis-associated cancers (99%) were in the colon and rectum, whereas half of Crohn's disease-associated cancers (44%) were in the anus, with 11% in the small intestine. Ulcerative colitis-associated cancers were diagnosed more frequently by surveillance (67% vs. 25%, P < 0.0001) and at earlier stages (stages 0-1, 71% vs. 27%, P < 0.0001) compared with Crohn's disease-associated cancers. Colorectal cancers associated with Crohn's disease showed a significantly worse 5-year overall survival rate than those associated with ulcerative colitis (stage 2, 76% vs. 89%, P = 0.01, stage 3, 18% vs. 68%, P = 0.0009, and stage 4, 0% vs. 13%, P = 0.04). Surveillance correlated with earlier diagnoses for ulcerative colitis- and Crohn's disease-associated intestinal cancers, whereas shorter intervals between endoscopic examinations correlated with an earlier cancer diagnosis in ulcerative colitis patients but not in Crohn's disease patients. CONCLUSIONS: The clinical and oncological features of ulcerative colitis- and Crohn's disease-associated cancers were very different. Crohn's disease-associated cancers were diagnosed at more advanced stages and were detected less frequently by surveillance. Additionally, they showed a significantly poorer prognosis.
BACKGROUND: Patients with longstanding inflammatory bowel disease are at high risk of developing intestinal cancers. In this study, we aimed to elucidate the differences between intestinal cancers associated with ulcerative colitis and Crohn's disease. METHODS: Intestinal cancers in ulcerative colitis and Crohn's disease patients treated between 1983 and 2020 at 43 Japanese institutions were retrospectively analyzed.. RESULTS: A total of 1505 intestinal cancers in 1189 ulcerative colitis and 316 Crohn's disease patients were studied. Almost all of ulcerative colitis-associated cancers (99%) were in the colon and rectum, whereas half of Crohn's disease-associated cancers (44%) were in the anus, with 11% in the small intestine. Ulcerative colitis-associated cancers were diagnosed more frequently by surveillance (67% vs. 25%, P < 0.0001) and at earlier stages (stages 0-1, 71% vs. 27%, P < 0.0001) compared with Crohn's disease-associated cancers. Colorectal cancers associated with Crohn's disease showed a significantly worse 5-year overall survival rate than those associated with ulcerative colitis (stage 2, 76% vs. 89%, P = 0.01, stage 3, 18% vs. 68%, P = 0.0009, and stage 4, 0% vs. 13%, P = 0.04). Surveillance correlated with earlier diagnoses for ulcerative colitis- and Crohn's disease-associated intestinal cancers, whereas shorter intervals between endoscopic examinations correlated with an earlier cancer diagnosis in ulcerative colitis patients but not in Crohn's disease patients. CONCLUSIONS: The clinical and oncological features of ulcerative colitis- and Crohn's disease-associated cancers were very different. Crohn's disease-associated cancers were diagnosed at more advanced stages and were detected less frequently by surveillance. Additionally, they showed a significantly poorer prognosis.