P412 Time trend in clinicopathological features and prognosis of Ulcerative Colitis associated neoplasia: A nationwide cohort in Japan

Komatsu, K.(1)*;Shinagawa, T.(1);Noguchi, T.(1);Uchino, M.(2);Ikeuchi, H.(2);Okabayashi, K.(3);Tanaka, S.(4);Futami, K.(5);Itabashi, M.(6);Watanabe, K.(7);Nagahara, H.(8);Okita, Y.(9);Shimada, Y.(10);Mizuuchi, Y.(11);Okamoto, K.(12);Yamada, K.(13);Sato, Y.(14);Mizushima, T.(15);Kimura, H.(16);Takahashi, K.(17);Hida, K.(18);Kinugasa, Y.(19);Ishida, F.(20);Okuda, J.(21);Daito, K.(22);Yamamoto, T.(23);Yamamoto, S.(24);Koyama, F.(25);Hanai, T.(26);Komori, K.(27);Shida, D.(28);Arakaki, J.(29);Akagi, Y.(30);Yamaguchi, S.(31);Ueno, H.(32);Matsuda, K.(33);Ajioka, Y.(34);Sugihara, K.(35);Ishihara, S.(1);

(1)The University of Tokyo, Department of Surgical Oncology, Tokyo, Japan;(2)Hyogo College of Medicine, Department of Inflammatory Bowel Disease Surgery, Nishinomiya, Japan;(3)Keio University School of Medicine, Department of Surgery, Tokyo, Japan;(4)Hiroshima University Hospital, Department of Endoscopy, Hiroshima, Japan;(5)Fukuoka University Chikushi Hospital, Department of Surgery, Chikushino, Japan;(6)Tokyo Women’s Medical University, Department of Surgery- Division of Inflammatory Bowel Disease Surgery, Tokyo, Japan;(7)Tohoku University Graduate School of Medicine, Department of Surgery, Sendai, Japan;(8)Osaka City University Graduate School of Medicine, Department of Gastroenterological Surgery, Osaka, Japan;(9)Mie University Graduate School of Medicine, Department of Gastrointestinal and Pediatric Surgery- Institute of Life Sciences, Mie, Japan;(10)Niigata University, Division of Digestive and General Surgery- Graduate School of Medical and Dental Sciences, Niigata, Japan;(11)Kyushu University, Department of Surgery and Oncology- Graduate School of Medical Sciences, Fukuoka, Japan;(12)Tokyo Yamate Medical Center, Department of Coloproctology, Tokyo, Japan;(13)Coloproctology Center Takano Hospital, Department of Surgery, Kumamoto, Japan;(14)Toho University Sakura Medical Center, Department of Surgery, Chiba, Japan;(15)Osaka University, Department of Gastroenterological Surgery- Graduate School of Medical, Osaka, Japan;(16)Yokohama City University Medical Center, Inflammatory Bowel Disease Center, Yokohama, Japan;(17)Tohoku Rosai Hospital, Department of Colorectal Surgery, Sendai, Japan;(18)Kyoto University Hospital, Department of Surgery-, Kyoto, Japan;(19)Tokyo Medical and Dental University, Department of Gastrointestinal Surgery, Tokyo, Japan;(20)Showa University Northern Yokohama Hospital, Digestive disease center, Kanagawa, Japan;(21)Osaka Medical and Pharmaceutical University, Department of General and Gastroenterological Surgery, Takatsuki, Japan;(22)Kindai University, Department of Surgery- Faculty of Medicine, Osaka, Japan;(23)Yokkaichi Hazu Medical Center, Inflammatory Bowel Disease Center, Yokkaichi, Japan;(24)Tokai University School of Medicine, Department of Gastroenterological Surgery, Tokyo, Japan;(25)Nara Medical University, Department of Surgery, Nara, Japan;(26)Fujita Health University- School of Medicine, Department of Surgery, Mie, Japan;(27)Aichi Cancer Center Hospital, Department of Gastroenterological Surgery, Aichi, Japan;(28)IMSUT Hospital- The Institute of Medical Science- The University of Tokyo, Department of Surgery, Tokyo, Japan;(29)Urasoe General Hospital, Center for Gastroenterology- Department of Surgery, Okinawa, Japan;(30)Kurume University Hospital, Department of Surgery, Kurume, Japan;(31)Saitama Medical University International Medical Center-, Department of Gastroenterological Surgery, Saitama, Japan;(32)National Defense Medical College, Department of Surgery, Tokorozawa, Japan;(33)Teikyo University School of Medicine, Department of Surgery, Tokyo, Japan;(34)Niigata University, Department of Pathology, Niigata, Japan;(35)Tokyo Medical and Dental University, Honorary Director, Tokyo, Japan; The Study Group for Inflammatory Bowel Disease Associated Intestinal Cancers by the Japanese Society for Cancer of the Colon and Rectum

Background

With an increase in the number of Ulcerative Colitis (UC) patients in Japan, UC associated neoplasia (UCAN) cases have been accumulated. Laparoscopic surgery for sporadic advanced colorectal cancer was approved in 2002 and biologic agents have been approved for UC from 2010 in Japan. However, few reports have ever examined the time trend using a large patient cohort. We aimed to clarify time trend in clinicopathological features and prognosis of UCAN with a nationwide cohort. This study was conducted as a sub-analysis of the nationwide retrospective study across 47 institutions from the Japanese Society for Cancer of the Colon and Rectum.

Methods

A total of 1,139 UCAN patients were identified in the nationwide cohort from 1983 to 2020. Clinicopathological features, 5-year cancer specific survival (CSS) and overall survival (OS) were compared among the following three groups by the period of UCAN diagnosis, before 2000, 2001-2010 and 2011-2020 (the results are shown in this order).

Results

The number of UCAN patients registered in the database were 59, 340 and 740 in each period. Age at UCAN diagnosis (47, 51, 54, median, p<0.01) and the disease duration from UC diagnosis to UCAN diagnosis (14.3, 16.0, 17.5 years, mean, p<0.01) increased through the study periods. The rate of a surveillance colonoscopy as a diagnostic procedure (36.2%, 58.6%, 72.8%, p<0.01) increased without a change in the ratios of early (pathological stage 0-I) neoplasia (60.7%, 59.5%, 62.2%, p=0.72). Laparoscopic surgery became a dominant surgical procedure in the recent cases (1.7%, 33.2%, 47.7%, p<0.01) without an increase in postoperative complication rate (39.7%, 29.2%, 29.8%, p=0.26). Improvement in 5-year CSS (77.2%, 87.5%, 90.7%, p<0.05) and OS (77.2%, 84.3%, 88.5%, p<0.05) was observed. Among pathological stage III patients, better curative resection rate (66.7%, 92.6%, 97.1%, p<0.01) and the more use of adjuvant chemotherapy in the last decade (50.0%, 58.5%, 76.6%, p<0.05) were observed.

Conclusion

Longer duration of UC before the diagnosis of UCAN was observed in recent cases, which might be due to the improvement of medical therapy, including biologic agents. Minimally invasive surgery prevailed without an increase in postoperative complications. Curative resection and adjuvant chemotherapy might play a role in improvement of 5-year CSS and OS.