Abstract
Background
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.
Aims
To compare the characteristics of CAC and SN within the previously or currently inflamed
mucosa.
Methods
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.
Results
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.
Conclusion
Recognizing differences in the characteristics of CAC and SN within the inflamed mucosa
is critical to avoid unnecessary total colectomy in patients with SN.
Keywords
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Article info
Publication history
Published online: May 28, 2019
Accepted:
May 2,
2019
Received:
October 31,
2018
Identification
Copyright
© 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
