Long-term CRC surveillance recommended for IBD patients
MedWire News: Patients with inflammatory bowel disease (IBD) should undergo long-term surveillance, suggest study findings showing that colorectal carcinoma (CRC) is frequently diagnosed at advanced stages in these patients.
The findings are of importance, given that CRC is a serious complication of IBD that accounts for approximately of 15% deaths in this group of patients.
"Several authors have reported that IBD-related CRC is frequently diagnosed at an advanced stage. Our study confirmed these data," say Hagit Tulchinsky (Tel Aviv Sourasky Medical Center, Israel) and colleagues.
For the study, the team reviewed the medical records of 53 patients with ulcerative colitis (UC) or Crohn's disease (CD) who underwent surgery for CRC between 1992 and 2009.
Study findings showed that patients had an average 21.5-year duration of IBD before diagnosis of CRC. Colon and rectal cancer were diagnosed in 53% and 43% of patients, respectively, with all malignancies located in segments with colitis.
"It is biologically plausible that an increased cancer risk is secondary to chronic inflammation, which is also supported by the fact that duration of disease is an important risk factor for CRC," comment the authors.
The patients' mean age at operation, gender, tumor location, and time of cancer diagnosis were comparable between both groups, although mean disease duration before CRC was significantly longer among UC patients compared with CD patients, at 22.7 versus 16.6 years.
On average, the pathological tumor stage for all patients was 6%, 23%, 19%, 36%, and 17% for stage 0, I, II, III, and IV disease, respectively. However, the distribution of tumor stage differed significantly between patients, with 84% of CD patients diagnosed with a locally advanced or metastatic disease compared with 42.5% of UC patients.
Neoadjuvant chemoradiation was given to eight patients with locally advanced rectal cancer. After a mean follow-up of 56 months, 54% of patients were alive and disease-free, 6% were alive with disease, and 40% had died from cancer-related causes.
Analysis of survival by IBD stage revealed survival rates of 100%, 89%, 83%, 37%, and 0% for stages 0, I, II, III, and IV, respectively. Overall, 5-year survival was 61% for UC patients and 37% for CD patients.
"We recommend close long-term surveillance of patients with long-standing IBD, and that the follow-up protocol should be the same UC and CC patients," conclude the authors in the journal Colorectal Disease.
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By Ingrid Grasmo