R. Amri1,2, L. G. Bordeianou1,2, P. Sylla1,2, D. Berger1,2 1Massachusetts General Hospital,General And Gastrointestinal Surgery,Boston, MA, USA 2Harvard Medical School,Surgery,Boston, MA, USA
Introduction:
Inflammatory bowel disease (IBD) is associated with a high risk of developing colon cancer. Its relationship with the eventual outcomes is less evident, although recent reports have indicated that comorbid IBD may be associated with worse survival. We therefore aimed to review characteristics of colon cancer associated with IBD in our population.
Methods:
We evaluated outcomes of a patient cohort operated on for colon cancer between 2004 through 2011 in a public tertiary care center in a state providing universal healthcare, focusing on comparing surgical pathological characteristics and long-term outcomes between IBD patients and the remainder of the population.
Results:
We included 1071 patients, of whom 38 (3.5%) had a concurrent diagnosis of IBD: 21 (2.0%) having Crohn’s, 16 (1.5%) having ulcerative colitis, and 1 patient with a mixed form. IBD patients were significantly younger (median age 59.5 vs. 67 years; P<0.001). These patients had a significantly higher rate of high-grade disease (33.3 vs. 19.4%; P=0.034) and borderline significantly higher rates of AJCC stage I disease (36.8 vs. 24.4%; P=0.06). In terms of outcomes however, no statistically significant differences were encountered between patients with or without IBD. Clinically significant but not statistically significant differences demonstrated lower rates of lymph-node metastasis (31.6 vs. 40.6%; P=0.27) and metastatic presentation (13.2 vs, 17%; P=0.54), as well as better outcomes in terms of metastatic recurrence (9.1 vs. 12.7%; P=0.55), and colon cancer mortality (26.3 vs. 35.6% P=0.27). Point estimates in multivariate analysis adjusted for age and staging where appropriate showed no changes in these trends.
Conclusion:
IBD patients who develop colon cancer appear to have relatively better staging and outcomes compared to non-IBD patients. These differences were present despite significantly higher-grade disease on presentation. More aggressive tumor characteristics in colon cancer patients with comorbid IBD fit the findings in earlier literature, while slightly better outcomes in IBD patients are an uncommon finding. This incongruence may potentially be explained by regular surveillance in patients with IBD, which may provide a protective effect through early detection of cancers. Differences with earlier reports in outcomes and staging could potentially be related to universal healthcare in our state, facilitating comprehensive IBD follow-up at our center. These findings suggest that under adequate and regular follow up, IBD patients are not necessarily inherently worse off when diagnosed with colon cancer.
