Prognosis and molecular characteristics of IBD-associated colorectal cancer: Experience from a French tertiary-care center

Published:March 04, 2023DOI:



      Little is known about the prognosis of colorectal cancer associated with inflammatory bowel disease (CRC-IBD) in a real-world cohort in France.


      We conducted a retrospective observational study including all patients presenting CRC-IBD in a French tertiary center.


      Among 6510 patients, the rate of CRC was 0.8% with a median delay of 19.5 years after IBD diagnosis (median age 46 years, ulcerative colitis 59%, initially localized tumor 69%). There was a previous exposure to immunosuppressants (IS) in 57% and anti-TNF in 29% of the cases. A RAS mutation was observed in only 13% of metastatic patients. OS of the whole cohort was 45 months. OS and PFS of synchronous metastatic patients was 20.4 months and 8.5 months respectively. Among the patients with localized tumor those previously exposed to IS had a better PFS (39 months vs 23 months; p = 0.05) and OS (74 vs 44 months; p = 0.03). The IBD relapse rate was 4%. No unexpected chemotherapy side-effect was observed


      OS of CRC-IBD is poor in metastatic patients although IBD is not associated with under-exposure or increased toxicity to chemotherapy. Previous IS exposure may be associated with a better prognosis.

      Key words

      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 to Digestive and Liver Disease
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Fumery M.
        • et al.
        Incidence, risk factors, and outcomes of colorectal cancer in patients with ulcerative colitis with low-grade dysplasia: a systematic review and meta-analysis.
        Clin Gastroenterol Hepatol. 2017; 15: 665
        • Kappelman M.D.
        • et al.
        Evaluation of the patient-reported outcomes measurement information system in a large cohort of patients with inflammatory bowel diseases.
        Clin Gastroenterol Hepatol. 2014; 12
        • Lutgens M.W.M.D.
        • et al.
        Declining risk of colorectal cancer in inflammatory bowel disease: an updated meta-analysis of population-based cohort studies.
        Inflamm Bowel Dis. 2013; 19: 789-799
        • Ullman T.A.
        • Itzkowitz S.H.
        Intestinal inflammation and cancer.
        Gastroenterology. 2011; 140 (1807-1816.e1)
        • Longo D.L.
        • Beaugerie L.
        • Itzkowitz S.H.
        Cancers complicating inflammatory bowel disease.
        New Engl J Med. 2015; 372: 1441-1452
        • Bye W.A.
        • et al.
        Strategies for detecting colorectal cancer in patients with inflammatory bowel disease: a cochrane systematic review and meta-analysis.
        Am J Gastroenterol. 2018; 113: 1801-1809
        • Wijnands A.M.
        • et al.
        Prognostic factors for advanced colorectal neoplasia in inflammatory bowel disease: systematic review and meta-analysis.
        Gastroenterology. 2021; 160: 1584-1598
        • Muller M.
        • et al.
        Genomic and molecular alterations in human inflammatory bowel disease-associated colorectal cancer.
        United Eur Gastroenterol J. 2020; 8: 675-684
        • Yaeger R.
        • et al.
        Systemic chemotherapy for metastatic colitis-associated cancer has a worse outcome than sporadic colorectal cancer: matched case cohort analysis.
        Clin Colorectal Cancer. 2020; 19: e151-e156
        • Peyrin-Biroulet L.
        • et al.
        Colorectal cancer in inflammatory bowel diseases: a population-based study (1976-2008).
        Inflamm Bowel Dis. 2012; 18: 2247-2251
        • Raja Ali R.A.
        • Dooley C.
        • Comber H.
        • Newell J.
        • Egan L.J
        Clinical features, treatment, and survival of patients with colorectal cancer with or without inflammatory bowel disease.
        Clin Gastroenterol Hepatol. 2011; 9: 584-589.e2
        • Amelot A.
        • et al.
        IDH-Mutation is a weak predictor of long-term survival in glioblastoma patients.
        PLoS ONE. 2015; 10
        • Buhard O.
        • et al.
        Multipopulation analysis of polymorphisms in five mononucleotide repeats used to determine the microsatellite instability status of human tumors.
        J Clinic Oncol. 2006; 24: 241-251
        • Beaugerie L.
        • et al.
        Risk of colorectal high-grade dysplasia and cancer in a prospective observational cohort of patients with inflammatory bowel disease.
        Gastroenterology. 2013; 145
        • Waljee A.K.
        • et al.
        Anti-tumour necrosis factor-α therapy and recurrent or new primary cancers in patients with inflammatory bowel disease, rheumatoid arthritis, or psoriasis and previous cancer in Denmark: a nationwide, population-based cohort study.
        Lancet Gastroenterol Hepatol. 2020; 5: 276-284
        • Axelrad J.
        • et al.
        Risk of new or recurrent cancer in patients with inflammatory bowel disease and previous cancer exposed to immunosuppressive and anti-tumor necrosis factor agents.
        Clin Gastroenterol Hepatol. 2016; 14: 58-64
        • Grivennikov S.I.
        Inflammation and colorectal cancer: colitis-associated neoplasia.
        Semin Immunopathol. 2013; 35: 229-244
        • Mutaguchi M.
        • et al.
        Difference in the clinical characteristic and prognosis of colitis-associated cancer and sporadic neoplasia in ulcerative colitis patients.
        Dig Liver Dis. 2019; 51: 1257-1264
        • Jensen A.B.
        • et al.
        Survival after colorectal cancer in patients with ulcerative colitis: a nationwide population-based Danish study.
        Am J Gastroenterol. 2006; 101: 1283-1287
        • Kvist N.
        • et al.
        Malignancy in ulcerative colitis.
        Scand J Gastroenterol. 1989; 24: 497-506
        • Wintjens D.S.J.
        • et al.
        Incidence and classification of postcolonoscopy colorectal cancers in inflammatory bowel disease: a Dutch population-based cohort study.
        J Crohns Colitis. 2018; 12: 777-783
        • Shah S.C.
        • Itzkowitz S.H.
        Colorectal cancer in inflammatory bowel disease: mechanisms and management.
        Gastroenterology. 2022; 162: 715-730.e3
        • Herrinton L.J.
        • et al.
        Incidence and mortality of colorectal adenocarcinoma in persons with inflammatory bowel disease from 1998 to 2010.
        Gastroenterology. 2012; 143: 382-389
        • Delaunoit T.
        • Limburg P.J.
        • Goldberg R.M.
        • Lymp J.F.
        • Loftus E.v.
        Colorectal cancer prognosis among patients with inflammatory bowel disease.
        Clin Gastroenterol Hepatol. 2006; 4: 335-342
        • Gearhart S.L.
        • et al.
        Outcomes from IBD-associated and non-IBD-associated colorectal cancer: a surveillance epidemiology and end results medicare study.
        Dis Colon Rectum. 2012; 55: 270-277
        • Larsen M.
        • et al.
        Survival after colorectal cancer in patients with Crohn's disease: a nationwide population-based Danish follow-up study.
        Am J Gastroenterol. 2007; 102: 163-167
        • Aparicio T.
        • et al.
        Colorectal cancer care in elderly patients: unsolved issues.
        Dig Liver Dis. 2016; 48: 1112-1118
        • Ghiringhelli F.
        • et al.
        Epidemiology and prognosis of synchronous and metachronous colon cancer metastases: a French population-based study.
        Dig Liver Dis. 2014; 46: 854-858
        • Brackmann S.
        • et al.
        Widespread but not localized neoplasia in inflammatory bowel disease worsens the prognosis of colorectal cancer.
        Inflamm Bowel Dis. 2010; 16: 474-481
        • Lepage C.
        • et al.
        Trends in net survival from rectal cancer in six European Latin countries: results from the SUDCAN population-based study.
        Eur J Cancer Prev. 2017; 26: S48-S55
        • Faivre J.
        • et al.
        Trends in net survival from colon cancer in six European Latin countries: results from the SUDCAN population-based study.
        Eur J Cancer Prev. 2017; 26: S40-S47
        • Rollot F.
        • et al.
        Long-term net survival in patients with colorectal cancer in France: an informative contribution of recent methodology.
        Dis Colon Rectum. 2013; 56: 1118-1124
        • André T.
        • et al.
        Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial.
        J Clin Oncol. 2009; 27: 3109-3116
        • Venook A.P.
        • et al.
        Effect of first-line chemotherapy combined with cetuximab or bevacizumab on overall survival in patients with KRAS wild-type advanced or metastatic colorectal cancer: a randomized clinical trial.
        JAMA. 2017; 317: 2392-2401
        • Heinemann V.
        • et al.
        FOLFIRI plus cetuximab or bevacizumab for advanced colorectal cancer: final survival and per-protocol analysis of FIRE-3, a randomised clinical trial.
        Br J Cancer. 2021; 124: 587-594
        • Alpert L.
        • et al.
        Targeted mutational analysis of inflammatory bowel disease-associated colorectal cancers.
        Hum Pathol. 2019; 89: 44-50
        • Robles A.I.
        • et al.
        Whole-exome sequencing analyses of inflammatory bowel disease−associated colorectal cancers.
        Gastroenterology. 2016; 150: 931-943
        • Yaeger R.
        • et al.
        Genomic alterations observed in colitis-associated cancers are distinct from those found in sporadic colorectal cancers and vary by type of inflammatory bowel disease.
        Gastroenterology. 2016; 151: 278-287.e6
        • Aparicio T.
        • et al.
        Panel gene profiling of small bowel adenocarcinoma: results from the NADEGE prospective cohort.
        Int J Cancer. 2021; 148: 1731-1742
        • Zaborowski A.M.
        • et al.
        Characteristics of early-onset vs late-onset colorectal cancer: a review.
        JAMA Surg. 2021; 156: 865-874