Department of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Kalk, University of Cologne, Buchforststrasse, Cologne, Germany.
Department of General and Visceral Surgery, Evangelisches Krankenhaus Kalk, University of Cologne, Buchforststrasse, Cologne, Germany.
J Crohns Colitis. 2021 Oct 7;15(10):1686-1693. doi: 10.1093/ecco-jcc/jjab057.
Carcinoma associated with perianal fistula in Crohn's disease is a pending threat for patients. This study aimed to improve understanding and facilitate development of diagnostic and therapeutic strategies.
A retrospective case-control study was conducted at four German hospitals. The analysis included 40 patients with proven malignancy associated with perianal Crohn's fistulas and 40 randomly selected controls with fistulizing perianal Crohn's disease. Differences between groups were analysed and multivariate calculations were performed to describe risk factors for oncological outcomes.
Histology revealed adenocarcinoma in 33/40 patients and squamous cell carcinoma in 7/40 patients. Compared to fistula patients without carcinoma, patients with malignancies associated with fistula had a diagnosis of Crohn's disease at younger age. Crohn's disease lasted longer in patients with malignancy [25.8 ± 9.0 vs 19.6 ± 10.4; p = 0.006]. Fistula-related findings differed significantly between the two groups. Signs of complicated and severe fistulation including complex anatomy and chronic activity occurred significantly more often in patients with malignancy associated with fistula. Significant multivariate hazard ratios for overall mortality and progression-free survival were shown for histological type of cancer, metastatic disease and R1 resection. Overall survival was 45.1 ± 28.6 months and the 5-year survival rate was 65%.
In patients with adenocarcinoma or squamous cell carcinoma associated with perianal fistula in Crohn's disease, fistula characteristics determine the risk of malignancy. Early diagnosis influences outcomes, while treatment of chronic fistula activity may be key to preventing malignancy. Expert multimodal therapy is paramount for successful treatment of perianal fistula-associated malignancies.
克罗恩病相关的肛周瘘管癌对患者来说是一个潜在的威胁。本研究旨在提高认识，并为诊断和治疗策略的制定提供帮助。
在德国的四家医院进行了一项回顾性病例对照研究。分析纳入了 40 例经证实的与肛周克罗恩病瘘管相关的恶性肿瘤患者和 40 例随机选择的具有瘘管性肛周克罗恩病的对照患者。对两组之间的差异进行分析，并进行多变量计算以描述肿瘤学结果的危险因素。
组织学检查显示 33/40 例患者为腺癌，7/40 例患者为鳞状细胞癌。与无癌性瘘管的瘘管患者相比，具有瘘管相关恶性肿瘤的患者克罗恩病的诊断年龄更小。恶性肿瘤患者的克罗恩病持续时间更长[25.8±9.0 比 19.6±10.4；p=0.006]。两组之间的瘘管相关表现存在显著差异。在具有瘘管相关恶性肿瘤的患者中，复杂解剖和慢性活动等复杂和严重的瘘管表现更为常见。癌症的组织学类型、转移性疾病和 R1 切除是总体死亡率和无进展生存率的显著多变量危险比。总生存期为 45.1±28.6 个月，5 年生存率为 65%。
在克罗恩病相关的肛周瘘管腺癌或鳞状细胞癌患者中，瘘管特征决定了恶性肿瘤的风险。早期诊断影响结局，而慢性瘘管活动的治疗可能是预防恶性肿瘤的关键。多模式治疗是成功治疗肛周瘘管相关恶性肿瘤的关键。
