Although various studies have been conducted on colitis-associated cancer (CAC), few have assessed the differences in the clinical and endoscopic features, treatment, and prognosis of CAC and sporadic neoplasia (SN) in the inflamed mucosa of ulcerative colitis (UC) patients.
To compare the characteristics of CAC and SN within the previously or currently inflamed mucosa.
Between 1997 and 2017, we retrospectively analyzed the endoscopic chart data of 348 colonic lesions from 266 UC patients. Non-dysplastic lesions and lesions located outside the inflamed mucosa were excluded. The diagnosis of CAC or SN was confirmed by conventional histopathological and immunohistochemical evaluation of p53 and Ki67.
In total, 74 patients with CAC (97 lesions) and 46 with SN (58) were enrolled. The proportions of patients with a younger age of onset of UC, with chronic persistent UC, and with severe inflamed mucosa were significantly higher in the CAC group. In the SN group, no flat lesions were found, whereas 26% of the lesions in the CAC group were flat. Sixteen patients died during a median follow-up of 6.1 years (interquartile range (IQR) 1.8–11.1)in the CAC group, whereas 1 patient died during a median follow-up 3.2 years(IQR 1.4–4.6) in the SN group. Mortality from colorectal cancer was significantly higher (P = 0.015) in the CAC group (12/68; 17.6%) than in the SN group (1/44; 2.3%). The 5-year survival rate was 100% in the SN group and 97% in the CAC group for lesions located in the mucosa or submucosa.
Recognizing differences in the characteristics of CAC and SN within the inflamed mucosa is critical to avoid unnecessary total colectomy in patients with SN.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Digestive and Liver Disease
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The risk of colorectal cancer in ulcerative colitis: a meta-analysis.Gut. 2001; 48: 526-535
- Risk of colorectal cancer in patients with ulcerative colitis: a meta-analysis of population-based cohort studies.Clin Gastroenterol Hepatol. 2012; 10: 639-645
- European evidence-based consensus: inflammatory bowel disease and malignancies.J Crohns Colitis. 2015; 9: 945-965
- More right-sided IBD-associated colorectal cancer in patients with primary sclerosing cholangitis.Inflamm Bowel Dis. 2009; 15: 1331-1336
- Risk factors for neoplasia in inflammatory bowel disease patients with pancolitis.Am J Gastroenterol. 2010; 105: 2405-2411
- Inflammation is an independent risk factor for colonic neoplasia in patients with ulcerative colitis: a case-control study.Clin Gastroenterol Hepatol. 2013; 11: 1601-1608
- Inflammatory bowel disease biopsies: updated British Society of Gastroenterology reporting guidelines.J Clin Pathol. 2013; 66: 1005-1026
- Forty-year analysis of colonoscopic surveillance program for neoplasia in ulcerative colitis: an updated overview.Am J Gastroenterol. 2015; 110: 1022-1034
- Sporadic adenoma in ulcerative colitis: endoscopic resection is an adequate treatment.Gut. 2006; 55: 1151-1155
- Outcome of sporadic adenomas and adenoma-like dysplasia in patients with ulcerative colitis undergoing polypectomy.Inflamm Bowel Dis. 2012; 18: 226-235
- Endoscopic morphologic features of ulcerative colitis-associated dysplasia classified according to the SCENIC consensus statement.Gastrointest Endosc. 2017; 85: 639-646
- SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease.Gastrointest Endosc. 2015; 81: 489-501
- Immunohistochemical assessment of a unique basal pattern of p53 expression in ulcerative-colitis-associated neoplasia using computer-assisted cytometry.Diagn Pathol. 2014; 9: 99
- Expression of survivin, YB-1, and KI-67 in sporadic adenomas and dysplasia-associated lesions or masses in ulcerative colitis.Appl Immunohistochem Mol Morphol. 2001; 9: 143-149
- Dysplastic lesions in inflammatory bowel disease: molecular pathogenesis to morphology.Arch Pathol Lab Med. 2013; 137: 338-350
- Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study.N Engl J Med. 1987; 317: 1625-1629
- European consensus on the histopathology of inflammatory bowel disease.J Crohns Colitis. 2013; 7: 827-851
- Dysplasia-associated lesion or mass (DALM) detected by colonoscopy in long-standing ulcerative colitis: an indication for colectomy.Gastroenterology. 1981; 80: 366-374
- K-ras mutations and p53 alterations in neoplastic and nonneoplastic lesions associated with longstanding ulcerative colitis.Am J Pathol. 1994; 144: 767-775
- p53 protein expression in ulcerative colitis-associated colorectal dysplasia and carcinoma.Hum Pathol. 1994; 25: 1069-1074
- Comparison of p53 immunoexpression with allelic loss of p53 in ulcerative colitis-associated dysplasia and carcinoma.Oncol Rep. 1998; 5: 477-480
- Increased p53 mutation load in noncancerous colon tissue from ulcerative colitis: a cancer-prone chronic inflammatory disease.Cancer Res. 2000; 60: 3333-3337
- Clonality, founder mutations, and field cancerization in human ulcerative colitis-associated neoplasia.Gastroenterology. 2009; 136: 542-550
- Immunohistochemical assessment of Ki67 and p53 expression assists the diagnosis and grading of ulcerative colitis-related dysplasia.Histopathology. 2000; 37: 108-114
- Whole-Exome Sequencing Analyses of Inflammatory Bowel Disease-Associated Colorectal Cancers.Gastroenterology. 2016; 150: 931-943
- Mucosa-associated microbiota dysbiosis in colitis associated cancer.Gut Microbes. 2018; 9: 131-142
- Polypectomy may be adequate treatment for adenoma-like dysplastic lesions in chronic ulcerative colitis.Gastroenterology. 1999; 117: 1288-1294
- Colonoscopic polypectomy in chronic colitis: conservative management after endoscopic resection of dysplastic polyps.Gastroenterology. 1999; 117: 1295-1300
- Long-term follow-up after polypectomy treatment for adenoma-like dysplastic lesions in ulcerative colitis.Clin Gastroenterol Hepatol. 2004; 2: 534-541
Published online: May 28, 2019
Accepted: May 2, 2019
Received: October 31, 2018
© 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.