Greater recurrence of CRC in late-onset vs early onset IBD
Patients with late-onset inflammatory bowel disease had a greater recurrence of colorectal cancer than patients with early-onset, despite a shorter disease duration and strictly following recommended endoscopic surveillance guidelines, according to data from Digestive Disease Week.
These findings suggest a difference in colorectal cancer pathophysiology by age, according to the researchers.
“Despite longer IBD disease duration at the time of colon or rectal cancer diagnosis, patients with early-onset IBD had significantly more advanced colitis at the time of diagnosis of colon and rectal cancer,” Robert Goldstone, MD, Massachusetts General Hospital general and GI surgeon, told Healio Gastroenterology. “Although there was no difference in staging of cancer between the two cohorts, those with early-onset IBD were far more likely to have multifocal dysplasia and those with late-onset IBD had significantly greater incidence of tumor recurrence. The increased risk for tumor recurrence among the late-onset IBD patients is unclear and will require further study as to tumor biology and operative management.”
Goldstone and colleagues retrospectively collected clinicopathologic data from 2,042 patients aged 18 years or older with colorectal cancer who underwent operative resection between January 1, 2004, and December 31, 2016. Forty-five patients had a prior history of IBD, 25 of whom had Crohn’s disease and 18 whohad ulcerative colitis. Researchers divided patients into two groups: patients diagnosed with IBD before age 50 years or after age 50 years.
Eighty-four percent of patients had colon cancer and 16% had rectal cancer. No significant difference was seen between CD or UC. Data regarding IBD diagnosis was available for 42 of the 45 patients with IBS. Twenty-seven patients received a diagnosis before age of 50 years and 15 patients received a diagnosis after age 50 years. Younger patients had significantly lower disease duration compared with older patients (median, 22 years vs. 9 years; P < .001). Date revealed that 44.4% of younger patients, vs. 80% of older patients, followed the recommended IBD surveillance guidelines (P = .03). The findings also showed that pPatients under 50 years diagnosed with IBD had a greater risk for severely active IBD at the time of CRC diagnosis (51.2% vs. 13.3%; P < .05). Additionally, these patients had a greater risk for multifocal dysplasia on final pathology (33.3% vs. 6.7%; P = .05). Investigators did not see any difference between groups regarding pathological state of the tumor (P = .44). While they did not see a difference in the overall survival between the groups, older patients were more likely to have locoregional or metastatic recurrence of their CRC (33.3% vs. 7.7%; P = .04).
“Further research is required to identify the main reason for greater tumor recurrence among the late-onset IBD patients,” Goldstone said. “This may be related to the more conservative operative approach employed for these patients (segmental colectomy) as opposed to the traditional total proctocolectomy.” – by Monica Jaramillo
- Sell NM, et al. Abstract 811. Presented at: Digestive Disease Week; May 2-5, 2020; Chicago (meeting canceled).