Outcomes of colorectal cancer resection in patients with inflammatory bowel disease: a national population‐based analysis in England and Wales

Abstract

Aim:The aim was to compare early postoperative outcomes and 2-year cancer-specific mortality following colorectal cancer (CRC) resection in patients with and without inflammatory bowel disease (IBD) in England and Wales.Method: Records for patients in the National Bowel Cancer Audit who had major CRC resection between April 2014 and December 2017 were linked to routinely collected hospital level administrative datasets and chemotherapy and radiotherapy datasets.Multivariable regression models were used to compare outcomes with adjustment for patient and tumour characteristics.Results: In all, 63 365 patients were included. 1285 (2.0%) had an IBD diagnosis: 839 (65.3%) ulcerative colitis, 435 (33.9%) Crohn's disease and 11 (0.9%) were indeterminate.IBD patients were younger, had more advanced cancer staging and a higher proportion of right-sided tumours. They also had a higher proportion of emergency resection, total/ subtotal colectomy, open surgery and stoma formation at resection, with longer hospital admissions and higher rates of unplanned readmission and reoperation. Fewer rectal cancer patients with IBD received neoadjuvant radiotherapy (24.8% vs. 36.0%, P = 0.005) whilst similar proportions of Stage III colon cancer patients received adjuvant chemotherapy. Ninety-day postoperative mortality was similar, but unadjusted 2-year cancerspecific mortality was significantly higher in patients with IBD (subdistribution hazard ratio 1.35, 95% CI 1.18-1.55). Risk adjustment for patient and tumour factors reduced this association (adjusted subdistribution hazard ratio 1.22, 95% CI 1.05-1.43). Conclusion:Patients with IBD and CRC are a distinct patient group who develop CRC at a younger age and undergo more radical surgery. They have worse cancer survival, with the difference in prognosis appearing after the early postoperative period.

Inflammatory Bowel Disease and Colorectal Cancer: Epidemiology, Etiology, Surveillance, and Management

“…Another population-based analysis conducted by Birch et al showed that the patients with IBD-CRC were younger at cancer diagnosis (median; 66 vs. 72 years, p < 0.01), presented a tendency toward emergency cancer diagnosis (25.1% vs. 16.7%, p < 0.01), and had an increased prevalence of right-sided tumors (37.4% vs. 31.5%, p < 0.01) [ 4 ]. A recently conducted population-based study also demonstrated that patients with IBD-CRC had a significantly increased 2-year cancer-specific mortality rate compared to that of patients with sporadic CRC (HR, 1.35; 95% CI, 1.18–1.55) [ 78 ]. Lu et al conducted a systematic review and meta-analysis and reported that patients with IBD-CRC had significantly decreased overall survival (HR, 1.33; 95% CI, 1.20–1.47) and cancer-specific survival (HR, 2.17; 95% CI, 1.68–2.78) compared with those with sporadic CRC.…”

ATP6AP1 as a potential prognostic biomarker in CRC by comprehensive analysis and verification

“…CRC patients typically have microsatellite stability/instability and exhibit long interspersed nuclear elements (LINE-1) hypomethylation and gene sequence variations, including TP53, KRAS, BRAF, and APC 6 – 8 . Currently, the treatment strategies for CRC mainly include neoadjuvant chemotherapy, surgical resection, and targeted therapy, which have favorable effects on CRC 9 – 11 . However, the death rate of CRC remains high for postoperative recurrence and metastasis.…”

Multifunctionality of Calebin A in inflammation, chronic diseases and cancer

“…As a result of these mono-targeting strategy and due to long treatment durations, cancer cells can become less receptive to the administered drugs or even develop resistance (2,3), often leading to loss of control of the cancer disease. Thereby, inflammation and inflammatory processes are considered as the key drivers of health problems in many diseases, including chronic disorders such as rheumatoid arthritis (4), bowel diseases (5) as well as cancer (6). In general, acute inflammations can become chronic, consequently resulting in cell degeneration (7) development.…”