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Ogino T, Mizushima T, Fujii M, Sekido Y, Eguchi H, Nezu R, Ikeuchi H, Motoi U, Futami K, Okamoto K, Nagahara H, Watanabe K, Okabayashi K, Yamada K, Ohge H, Tanaka S, Mizuuchi Y, Ohkita Y, Sato Y, Ueno H, Kono T, Itabashi M, Kimura H, Hida K, Kinugasa Y, Takahashi K, Koyama F, Hanai T, Maeda K, Noake T, Shimada Y, Yamamoto T, Arakaki J, Mastuda K, Okuda J, Sunami E, Akagi Y, Kastumata K, Uehara K, Yamada T, Sasaki S, Ishihara S, Ajioka Y, Sugihara K. Crohn's Disease-Associated Anorectal Cancer Has a Poor Prognosis With High Local Recurrence: A Subanalysis of the Nationwide Japanese Study. Am J Gastroenterol 2023; 118:1626-1637. [PMID: 36988310 PMCID: PMC10453357 DOI: 10.14309/ajg.0000000000002269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) is one of the major life-threatening complications in patients with Crohn's disease (CD). Previous studies of CD-associated CRC (CD-CRC) have involved only small numbers of patients, and no large series have been reported from Asia. The aim of this study was to clarify the prognosis and clinicopathological features of CD-CRC compared with sporadic CRC. METHODS A large nationwide database was used to identify patients with CD-CRC (n = 233) and sporadic CRC (n = 129,783) over a 40-year period, from 1980 to 2020. Five-year overall survival (OS), recurrence-free survival (RFS), and clinicopathological characteristics were investigated. The prognosis of CD-CRC was further evaluated in groups divided by colon cancer and anorectal cancer (RC). Multivariable Cox regression analysis was used to adjust for confounding by unbalanced covariables. RESULTS Compared with sporadic cases, patients with CD-CRC were younger; more often had RC, multiple lesions, and mucinous adenocarcinoma; and had lower R0 resection rates. Five-year OS was worse for CD-CRC than for sporadic CRC (53.99% vs 71.17%, P < 0.001). Multivariable Cox regression analysis revealed that CD was associated with significantly poorer survival (hazard ratio 2.36, 95% confidence interval: 1.54-3.62, P < 0.0001). Evaluation by tumor location showed significantly worse 5-year OS and RFS of CD-RC compared with sporadic RC. Recurrence was identified in 39.57% of CD-RC cases and was mostly local. DISCUSSION Poor prognosis of CD-CRC is attributable primarily to RC and high local recurrence. Local control is indispensable to improving prognosis.
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Affiliation(s)
- Takayuki Ogino
- Department of Gastroenterological Surgery, Graduate School of Medical, Osaka University, Osaka, Japan
- Department of Therapeutics for Inflammatory Bowel Diseases, Graduate School of Medical, Osaka University, Osaka, Japan
| | - Tsunekazu Mizushima
- Department of Therapeutics for Inflammatory Bowel Diseases, Graduate School of Medical, Osaka University, Osaka, Japan
| | - Makoto Fujii
- Division of Health Sciences, Graduate School of Medical, Osaka University, Osaka, Japan
| | - Yuki Sekido
- Department of Gastroenterological Surgery, Graduate School of Medical, Osaka University, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medical, Osaka University, Osaka, Japan
| | - Riichiro Nezu
- Department of Surgery, Osaka Central Hospital, Osaka, Japan
| | - Hiroki Ikeuchi
- Department of Inflammatory Bowel Disease Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Uchino Motoi
- Department of Inflammatory Bowel Disease Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kitaro Futami
- Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Kinya Okamoto
- Department of Coloproctology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Hisashi Nagahara
- Department of Surgery, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Kazuhiro Watanabe
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Kazutaka Yamada
- Department of Surgery, Coloproctology Center Takano Hospital, Kumamoto, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Yusuke Mizuuchi
- Department of Surgery and Oncology, Kyusyu University, Fukuoka, Japan
| | - Yoshiki Ohkita
- Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yu Sato
- Department of Surgery, Toho University Sakura Medical Center, Chiba, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Toru Kono
- Advanced Surgery Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Michio Itabashi
- Department of Surgery, Division of Inflammatory Bowel Disease Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideaki Kimura
- Inflammatory Bowel Disease Center, Yokohama City University Medical Centre, Yokohama, Japan
| | - Koya Hida
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenichi Takahashi
- Department of Colorectal Surgery, Tohoku Rosai Hospital, Sendai, Japan
| | - Fumikazu Koyama
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Tsunekazu Hanai
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | | | - Yoshifumi Shimada
- Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Takayuki Yamamoto
- Inflammatory Bowel Disease Center, Yokkaichi Hazu Medical Center, Yokkaichi, Japan
| | - Junya Arakaki
- Center for Gastroenterology, Department of Surgery, Urasoe General Hospital, Urasoe, Japan
| | - Keiji Mastuda
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Junji Okuda
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan
| | - Eiji Sunami
- Department of Surgery, Kyorin University, Tokyo, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University Hospital, Kurume, Japan
| | - Kenji Kastumata
- Department of Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Kay Uehara
- Department of Gastroenterological Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Takeshi Yamada
- Department of Digestive Surgery, Nippon Medical School, Tokyo, Japan
| | - Shin Sasaki
- Department of Coloproctological Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Yoichi Ajioka
- Department of Pathology, Niigata University, Niigata, Japan
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El Homsi M, Golia Pernicka JS, Lall C, Nougaret S, Paspulati RM, Pickhardt PJ, Sheedy SP, Petkovska I. Beyond squamous cell carcinoma: MRI appearance of uncommon anal neoplasms and mimickers. Abdom Radiol (NY) 2023; 48:2898-2912. [PMID: 37027015 PMCID: PMC10775174 DOI: 10.1007/s00261-023-03891-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 04/08/2023]
Abstract
Anal cancer is an uncommon malignancy. In addition to squamous cell carcinoma, there are a variety of other less common malignancies and benign pathologies that may afflict the anal canal, with which abdominal radiologists should be familiar. Abdominal radiologists should be familiar with the imaging features that can help distinguish different rare anal tumors beyond squamous cell carcinoma and that can aid in diagnosis therefore help steer management. This review discusses these uncommon pathologies with a focus on their imaging appearance, management, and prognosis.
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Affiliation(s)
- Maria El Homsi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Jennifer S Golia Pernicka
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Stephanie Nougaret
- Department of Radiology, Montpellier Cancer Research Institute (IRCM), Montpellier, France
| | - Raj M Paspulati
- Department of Radiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | | | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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Abstract
Perianal Crohn's disease affects 25%-35% of patients with Crohn's disease and has proven to be one of the most difficult complications of the disease to treat. Patients with perianal Crohn's disease have lower health-related quality of life scores typically related to pain and fecal incontinence. In addition, patients with perianal Crohn's disease have higher rates of hospitalizations, surgeries, and overall healthcare costs. A multidisciplinary approach is necessary for the successful management of Crohn's disease with perianal fistula. Medical management is required to treat the underlying immune dysregulation to heal the luminal inflammation and the inflammation within the fistula tracts. Current options for medical therapy include biologics, dual therapy with thiopurines, therapeutic drug monitoring, and a close follow-up. Surgical management is critical to drain abscesses before immunosuppressive therapy and place setons when appropriate. Once the patient's inflammatory burden is well managed, definitive surgical therapies including fistulotomies, advancement flaps, and ligation of intersphincteric fistula tract procedures can be considered. Most recently, the use of stem cell therapy in the treatment of perianal fistula has given new hope to the cure of perianal fistula in Crohn's disease. This review will outline the most current data in the medical and surgical management of perianal Crohn's disease.
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Affiliation(s)
- Alyssa M Parian
- Division of Gastroenterology and Hepatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Megan Obi
- Department of General Surgery, Digestive Disease Surgical Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Phillip Fleshner
- Division of Colorectal Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - David A Schwartz
- Inflammatory Bowel Disease Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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