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. 2022 Jan 30;14(3):721.
doi: 10.3390/cancers14030721.

Incident Colorectal Cancer in Inflammatory Bowel Disease

Benedetto Neri  1 , Maria Lia Scribano  2 , Alessandro Armuzzi  3 , Fabiana Castiglione  4 , Renata D'Incà  5 , Ambrogio Orlando  6 , Stefano Festa  7 , Gabriele Riegler  8 , Walter Fries  9 , Gianmichele Meucci  10 , Patrizia Alvisi  11 , Filippo Mocciaro  12 , Claudio Papi  7 , Michelangela Mossa  1 , Giorgia Sena  1 , Luisa Guidi  13 , Anna Testa  4 , Sara Renna  6 , Iris Frankovic  6 , Anna Viola  9 , Marta Patturelli  8 , Carlo Chiaramonte  14 , Livia Biancone  1 , On Behalf Of Ig-Ibd Italian Group For The Study Of Inflammatory Bowel Disease
Affiliations

Incident Colorectal Cancer in Inflammatory Bowel Disease

Benedetto Neri et al. Cancers (Basel). .

Abstract

Colorectal cancer (CRC) risk is increased in Inflammatory Bowel Disease (IBD) and surveillance needs to be tailored according to individual risk. The open issues include the role of the characteristics of IBD and CRC in determining the long-term outcome. These issues were assessed in our multicenter study, including a cohort of 56 IBD patients with incident CRC. The clinical and histopathological features of IBD patients and of CRC were recorded. Incident CRC in IBD occurred at a young age (≤40 years) in 25% of patients (median age 55.5 (22-76)). Mucinous signet-ring carcinoma was detected in 6 out of the 56 (10.7%) patients, including 4 with Ulcerative Colitis (UC) and 2 with Crohn's disease (CD). CRC was more frequently diagnosed by colonoscopy in UC (85.4% vs. 50%; p = 0.01) and by imaging in Crohn's Disease CD (5.8% vs. 31.8%; p = 0.02). At onset, CRC-related symptoms occurred in 29 (51.9%) IBD patients. The time interval from the diagnosis of IBD to CRC was shorter in UC and CD patients with >40 years (p = 0.002; p = 0.01). CRC-related death occurred in 10 (29.4%) UC and in 6 (27.2%) CD patients (p = 0.89), with a short time interval from CRC to death (UC vs. CD: 6.5 (1-68) vs. 14.5 (8-40); p = 0.85; IBD: 12 months (1-68)). CRC occurring at a young age, a short time interval from the diagnosis of IBD to CRC-related death in the elderly, CRC-symptoms often mimicking IBD relapse and the observed high mortality rate may support the need of closer surveillance intervals in subgroups of patients.

Keywords: Inflammatory Bowel Disease; clinical outcome; colorectal cancer; incident cancer.

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Conflict of interest statement

The study was not supported by any grant and any of the below reported disclosures are related to the study. L.B.: Lecture fees and/or Advisory Board for Janssen, AbbVie, Ferring, Pfizer, Takeda. A.A. received consultancy fees from AbbVie, Allergan, Amgen, Arena, Biogen, Bristol-Myers Squibb, Celgene, Celltrion, Eli-Lilly, Ferring, Galapagos, Gilead, Janssen, M.S.D., Mylan, Pfizer, Roche, Samsung Bioepis, Sandoz, Takeda; lecture fees from AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Ferring, Galapagos, Gilead, Janssen, M.S.D., Mitsubishi Tanabe, Novartis, Pfizer, Roche, Samsung Bioepis, Sandoz, Takeda, Tigenix; research grants from M.S.D., Pfizer, Takeda; M.L.S.: lecture fees and/or advisory board for Celltrion, Janssen, Pfizer, Takeda; F.C.: Lecture fees/Adv. Board: Takeda, Pfizer, Janssen, Biogen, Fresenius, Sandoz; F.M. Grant: Pfizer, AbbVie, Jansen. A.O. received lecture grants and/or served as an advisory board member for: AbbVie, Chiesi, Janssen, Galapagos, M.S.D., Pfizer, Samsung Bioepis, Sofar and Takeda Pharmaceuticals. P.A.: Conference fee from Bioprojet Nutricia; G.R.: Advisory Board: M.S.D., Janssen, AbbVie, Takeda; W.F.: Advisory boards or fundings from Ferring Italia, Janssen, Sandoz, Pfizer, Takeda, Abbvie; F.M.: Lecture fees: Pfizer, Takeda e Jannsen. L.G.: Consulting and/or lecture fees: AbbVie, Janssen, M.S.D., Shire, Takeda, Pfizer, Vifor Pharma. A.T.: Lecture fees: Takeda and Jannsen. S.R.: Lecture fees from AbbVie, M.S.D., Takeda Pharmaceuticals, Janssen and Pfizer. The remaining authors disclose no conflicts of interest.

Figures

Figure 1
Figure 1
Survival curve showing that the time interval between the diagnosis of Inflammatory Bowel Disease (IBD) and the diagnosis of colorectal cancer (CRC) was comparable in Ulcerative Colitis (UC) vs. Crohn’s Disease (p = 0.72).
Figure 2
Figure 2
(panels a–d): Survival curves showing the time interval from: panel (a). Diagnosis of UC to diagnosis of CRC, comparable between patients with left-sided vs. extensive UC (E2 vs. E3: p = 0.66); panel (b). Diagnosis of CD to diagnosis of CRC, comparable between patients with different CD behaviors (B1 vs. B2 vs. B3: p = 0.80); panel (c). Diagnosis of CD to diagnosis of CRC, significantly longer in patients with vs. without perianal (PA) disease (p = 0.04); panel (d). Diagnosis of CRC to CRC-related death, comparable between CD patients with vs. without PA disease (p = 0.61).
Figure 2
Figure 2
(panels a–d): Survival curves showing the time interval from: panel (a). Diagnosis of UC to diagnosis of CRC, comparable between patients with left-sided vs. extensive UC (E2 vs. E3: p = 0.66); panel (b). Diagnosis of CD to diagnosis of CRC, comparable between patients with different CD behaviors (B1 vs. B2 vs. B3: p = 0.80); panel (c). Diagnosis of CD to diagnosis of CRC, significantly longer in patients with vs. without perianal (PA) disease (p = 0.04); panel (d). Diagnosis of CRC to CRC-related death, comparable between CD patients with vs. without PA disease (p = 0.61).
Figure 3
Figure 3
(panels a,b) Kaplan–Meier analysis showing that the time interval between the diagnosis of IBD and the diagnosis of CRC was significantly shorter in patients with IBD diagnosed with >40 vs. ≤40 years, both in UC (p = 0.002) (panel a) and in CD (p = 0.01) (panel b).
Figure 4
Figure 4
(panels (a,b)) Kaplan–Meier analysis showing that the time interval between the diagnosis of CRC and CRC death did not differ between UC and CD (p = 0.84) (panel (a)) and between IBD patients subgrouped according to a positive vs. negative history of symptoms leading to a diagnosis of CRC (p = 0.96) (panel (b)).
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