P631 Long-term outcome of colorectal cancer in Crohn’s and ulcerative colitis: a comparative study
S. Scaringi*1, C. Di Martino1, F. Giudici1, D. Zambonin1, F. Tonelli2, F. Ficari1, P. Bechi1
1Careggi University Hospital, Surgery and Translational Medicine, Florence, Italy, 2University of Florence, Florence, Italy
Colorectal cancer is a main cause of inflammatory bowel disease-associated death. Patients with ulcerative colitis (UC) and Crohn’s colitis (CC) have an increased risk of developing colorectal cancer (CRC) as demonstrated by many studies. The risk for CRC is similar between CC and UC and is approximately 5.6-fold greater than in the general population. Few studies on the effect of UC and CC on the prognosis of CRC have been performed. In this retrospectively study, we examined CRC outcome in UC and CC patients.
In total, 901 patients affected by UC and CC underwent surgery at the Digestive Surgery Unit, Department of Surgery, and Translational Medicine of Careggi University Hospital, between March 1987 and September 2015. Only patients with disease-associated CRC have been included in our study. We evaluated overall survival at 3 and 5 years. Statistical analysis was performed using the SPSS (version 17.0) database.
In total, 901 patients (534 UC and 367 CC) underwent surgery. There were 57 (10.6%) patients with adenocarcinoma in UC groups, and 14 (3.8%) in CC patients. According to Dukes’ Classification we founded 15.7% of A (n = 9), 14% of B1 (n = 8), 28.1% of B2 (n = 16), 24.6% C (n = 14), and 14% of D (n = 8) in UC patients; 14.3% of A (n = 2), 14.3% of B1 (n = 2), 35.7% of B2 (n = 5), 28.6% of C (n = 4), and 7.1% of D (n = 1) in CC patients. 37 (64.9%) of UC patients had a preoperative histology, whereas incidental diagnosis was made post-operatively in 20 patients (35.1 %). Conversely, only 3 (21.4%) patients with CC had preoperative diagnosis of adenocarcinoma. Median survival was 59.9 months for UC patients, with a 3 and 5 years survival of 89% and 69% (mean follow-up: 80 months, range 4–253), while it was 37.8 months in CC, with a 3 and 5 years survival of 60% and 30% (mean follow-up: 52 months, range 2–82). Compared survival calculated with Kaplan–Meyer method showed a statistical difference amongst the 2 groups (UC vs CC, p = 0.002, RR = 2.3).
CC-CRC patients had a poorer survival rate than the UC-CRC patients. Most UC-CRC were diagnosed based on endoscopic findings with biopsy of suspicious lesions or of areas of active colitis, and an incidental finding in the resection specimen is rare, so they underwent surgery with oncological criteria. This is not of use in CC-CRC because CC patients often do not undergo routine surveillance, and they show a more advanced cancer stage. Moreover, they often have an incidental diagnosis of CRC in the resection specimen, so they frequently undergo segmental resections and are not treated with a more extensive UC-like surgical approach.