Ellen Leifer Shulman and Steven Shulman Digestive Disease, Cleveland Clinic Florida, Center, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt.
Updates Surg. 2024 Jan;76(1):119-126. doi: 10.1007/s13304-023-01660-y. Epub 2023 Oct 9.
The increased risk of colorectal cancer (CRC) in patients with inflammatory bowel disease (IBD) has been well documented in the literature. The present study aimed to assess the characteristics and outcomes of rectal cancer in patients with IBD. This study was a retrospective review of a prospectively maintained IRB-approved database at Cleveland Clinic Florida. Rectal cancer patients with or without IBD treated with curative surgery between 2016 and 2020 were compared for demographics, disease characteristics, and pathologic and oncologic outcomes. The primary outcomes were 3-year overall survival (OS) and disease-free survival (DFS). Secondary outcomes were clinicopathologic outcomes including disease stage, tumor histology and histologic features, and treatments received. 238 patients with rectal cancer were included, 15 (6.3%) of whom had IBD. IBD patients were significantly younger (52.9 vs 60.3 years, p = 0.033), presented more often with cT1-2 tumors (64.3% vs 30.4%, p = 0.008), and signet-ring cell pathology (14.3% vs 2%, p = 0.02). IBD patients received neoadjuvant chemoradiation less often (40% vs 72.6%, p = 0.029) and had shorter time between diagnosis and surgery (7.5 vs 25 weeks, p = 0.013) than did non-IBD patients. Both groups had similar OS (36 vs 34.7 months, p = 0.431) and DFS (36 vs 32.9 months, p = 0.121). IBD patients with rectal cancer tend to present at a younger age, with a less invasive disease, and signet-ring carcinomas, and receive neoadjuvant treatment less often than non-IBD patients. Based on low level of evidence, IBD and non-IBD rectal cancer patients might have similar survival.
炎症性肠病（IBD）患者结直肠癌（CRC）的风险增加在文献中已有充分记载。本研究旨在评估 IBD 患者直肠癌的特征和结局。本研究是对克利夫兰诊所佛罗里达州前瞻性维护的 IRB 批准的数据库进行的回顾性分析。比较了 2016 年至 2020 年间接受根治性手术治疗的伴有或不伴有 IBD 的直肠癌患者的人口统计学、疾病特征以及病理和肿瘤学结局。主要结局是 3 年总生存率（OS）和无病生存率（DFS）。次要结局是临床病理结局，包括疾病分期、肿瘤组织学和组织学特征以及所接受的治疗。共纳入 238 例直肠癌患者，其中 15 例（6.3%）患有 IBD。IBD 患者明显更年轻（52.9 岁 vs 60.3 岁，p=0.033），更常表现为 cT1-2 肿瘤（64.3% vs 30.4%，p=0.008）和印戒细胞病理（14.3% vs 2%，p=0.02）。IBD 患者接受新辅助放化疗的比例较低（40% vs 72.6%，p=0.029），且从诊断到手术的时间间隔较短（7.5 周 vs 25 周，p=0.013）。两组患者的 OS（36 个月 vs 34.7 个月，p=0.431）和 DFS（36 个月 vs 32.9 个月，p=0.121）相似。IBD 合并直肠癌患者的发病年龄更小，疾病侵袭性更低，印戒细胞癌更为常见，且接受新辅助治疗的比例低于非 IBD 患者。基于低水平证据，IBD 和非 IBD 直肠癌患者的生存情况可能相似。
