Higashiura Rei, Sakakibara Yuko, Ishida Hisashi, Hasegawa Hiroko, Tanaka Satoshi, Fukutake Nobuyasu, Yamamoto Shunsuke, Sakamori Ryotaro, Mori Kiyoshi, Mita Eiji
Department of Gastroenterology and Hepatology, National Hospital Organization Osaka National Hospital.
Department of Gastroenterology and Hepatology, Ikeda City Hospital.
Nihon Shokakibyo Gakkai Zasshi. 2023;120(8):671-679. doi: 10.11405/nisshoshi.120.671.
In recent years, with the rising incidence of patients having long-term Crohn's disease, there has been an increase in the number of reports of carcinogenesis from dysplasia with chronic inflammation as the primary pathogenic factor. We hereby report a case of multiple metastases that appeared 5 years after surgery, in a patient with rectal cancer who had Crohn's disease. A man in his 50s was diagnosed with Crohn's disease which affected his small and large intestines 21 years back. The patient was being treated with oral steroids, 5-aminosalicylic acid, and modified nutrition. Infliximab was added to the treatment after it was introduced 11 years ago. He also had a history of rectal cancer and had undergone surgery for the same 5 years back. He was diagnosed with stage II cancer, and had not received any adjuvant chemotherapy. However, 5 years after surgery, multiple metastases recurred, and chemotherapy with mFOLFOX6 was administered. Additionally, for treating his Crohn's disease, which was also active, infliximab was changed to vedolizumab;however, the patient died a year later. Colorectal cancer accompanied with Crohn's disease has a higher risk of developing metastasis and is associated with poorer prognosis as compared to the noncomplicated colorectal cancer. Regarding treatment modalities, while searching for multidisciplinary treatment methods centered on surgical treatment in collaboration with medical oncologists and radiologists, the safety of treatment for Crohn's disease in patients with cancer must be borne in mind. The rising prevalence of cases of colorectal cancer with Crohn's disease is expected to lead to the formulation of specialized diagnostic and treatment strategies for these patients.
近年来，随着长期患有克罗恩病的患者发病率上升，以慢性炎症为主要致病因素的发育异常致癌的报道数量有所增加。我们在此报告一例患有克罗恩病的直肠癌患者术后5年出现多处转移的病例。一名50多岁的男性在21年前被诊断出患有累及小肠和大肠的克罗恩病。该患者接受口服类固醇、5-氨基水杨酸和改良营养治疗。11年前英夫利昔单抗上市后被添加到治疗方案中。他还有直肠癌病史，5年前接受了直肠癌手术。他被诊断为II期癌症，未接受任何辅助化疗。然而，术后5年，多处转移复发，遂给予mFOLFOX6化疗。此外，为治疗其同样处于活动期的克罗恩病，将英夫利昔单抗换为维多珠单抗；然而，患者一年后死亡。与非复杂性结直肠癌相比，伴有克罗恩病的结直肠癌发生转移的风险更高，预后更差。关于治疗方式，在与医学肿瘤学家和放射科医生合作寻找以手术治疗为中心的多学科治疗方法时，必须牢记癌症患者克罗恩病治疗的安全性。预计伴有克罗恩病的结直肠癌病例的患病率上升将促使为这些患者制定专门的诊断和治疗策略。
