Survival Outcomes and Clinicopathological Features in Inflammatory Bowel Disease-associated Colorectal Cancer

Abstract

Objective: The aim of our study was to conduct a systematic review and meta-analysis comparing the survival outcomes of IBD-associated and non-IBD-associated CRC. Summary of Background Data: Investigations comparing the prognosis in CRC patients with and without IBD have yielded conflicting results. Methods: PubMed/MEDLINE, Embase, Web of Science, Cochrane Library were searched for studies evaluating the prognostic outcomes between CRC patients with IBD and those without IBD. Estimates of survival-related outcomes and clinicopathological features in IBD-CRC and non-IBD CRC were pooled through random-effects or fix-effects models. The study is registered with PROSPERO, CRD42021261513. Results: Of 12,768 records identified, twenty-five studies with 8034 IBD-CRC and 810,526 non-IBD CRC patients were included in the analysis. IBD-CRC patients have a significant worse overall survival (OS) with the hazard ratio (HR) of 1.33 [95% confidence interval (CI): 1.20–1.47] than those without IBD. Pooled estimates of cancer-specific survival demonstrated that IBD-CRC patients had a poorer cancer-specific survival than those without IBD with fixed-effect model (HR, 2.17; 95% CI: 1.68–2.78; P < 0.0001). Moreover, ulcerative colitis-associated CRC patients have favorable OS than Crohn’s disease-associated CRC (HR 0.79,95% CI: 0.72–0.87). Compared to non-IBD-CRC, patients with IBD-associated CRC are characterized by an increased rate of poor differentiation (OR 2.02, 95% CI: 1.57–2.61), mucinous or signet ring cell carcinoma (OR 2.43, 95% CI: 1.34–4.42), synchronous tumors (OR 3.18, 95% CI: 2.26–4.47), right-sided CRC (OR 1.62, 95%CI: 1.05–2.05), male patients (OR 1.10, 95% CI: 1.05–1.16), and a reduced rate of R0 resections (OR 0.60, 95% CI: 0.44–0.82). Conclusions: IBD-CRC patients have a significant worse OS than patients with non-IBD CRC, which may be attributed to more aggressive histological characteristics and a lower rate of R0 resections at the primary tumor site. Optimized therapeutic standards and tailored follow-up strategies might improve the prognosis of IBD-CRC patients.

Colitis-Associated Colorectal Cancer in Patients with Inflammatory Bowel Diseases in a Tertiary Referral Center: A Propensity Score Matching Analysis

“…Five-year survivability was lower in patients with IBD in relation to 5-year survivability in patients with sporadic CRC. Lower survivability of patients with CAC was also observed in other studies and most recent meta-analysis [19,28,29,[35][36][37]. Klos et al observed significantly lower overall 3-year survivability for patients with IBD.…”

Research hotspot and trend analysis in the diagnosis of inflammatory bowel disease: A machine learning bibliometric analysis from 2012 to 2021

“…More importantly, increased the risk of colorectal cancer (CRC) in IBD patients has been attributed to long-standing chronic inflammation, with the contribution of genetic alterations and environmental factors such as the microbiota ( 49 ), but the detailed mechanism is still elusive ( 50 ). IBD-associated CRC (IBD-CRC) might appear through different tumorigenesis pathways, because tumors occur in the inflamed area of the colon and have characteristic clinicopathological features ( 51 , 52 ).…”

Inflammatory Bowel Disease-Associated Colorectal Cancer Epidemiology and Outcomes: An English Population-Based Study

“…Here, IBD-CRCs diagnosed up to 2006 were in younger patients, were in more early stage and had worse cancer-specific survival (mean, 32.9 vs 42.4 months) (5). Single-center studies from IBD specialist centers in America (29) and recently England (30) have shown reduced or equivalent early death, respectively, for IBD-CRC compared with controls without IBD (31), but pooled results from a recent meta-analysis report worse overall survival (32). Our contemporary English results show that little progress has been made to reduce these differences with worse stage-specific survival after 2 years, which is of concern.…”