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INTRODUCTION:
We explored the clinical characteristics, treatment, and outcomes of colitis-associated colorectal cancer (CAC) and compared with sporadic colorectal cancer in Taiwan.
METHODS:In this retrospective study spanning 1987–2022, CACs diagnosed according to endoscopic and pathological reports from 14 tertiary centers were reported to our cohort. Clinical demographics, endoscopic findings, histological results, treatment modalities, and outcomes were analyzed. Sporadic colorectal cancer data were retrieved from the Cancer Registry Annual Report, Ministry of Health and Welfare, Taiwan.
RESULTS:We enrolled 65 patients with CAC (median age: 56 years; male: 66.2%). Distal colon was the most common tumor location (41.5%). Of patients with ulcerative colitis, 77.2% had extensive colitis, and 76.5% had Mayo endoscopic subscores of ≥2. Moreover, 50% of lesions were nonpolypoid with indistinct borders in 66.7%. Signet-ring cell subtype consisted of 12.3%. Surveillance colonoscopy adherence was 78.4%, yet 51.3% interval cancers occurred. Disease stage 0–4 distribution was 15%, 20%, 13.3%, 20%, and 31.7%, respectively. Endoscopic resection was feasible for 14%, whereas 67.7% required surgery. During follow-up (median: 21.5 months), we recorded 23.2% recurrence and 34.5% mortality. Lesions with indistinct borders were associated with adverse outcomes (adjusted odds ratio = 11.5 [1.35–98.16]). Colitis-associated rectal cancers, diagnosed later (P < 0.001), had worse outcomes than sporadic rectal cancers.
DISCUSSION:This is the largest Asian CAC cohort study, emphasizing the need for stringent disease control, improving detection, and reducing interval cancers. Signet-ring cell subtype was prevalent. Rectal colitis-associated cancers were diagnosed later with poorer outcomes than sporadic rectal cancers.
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; Meng-Tzu, Weng 2 ; Jen-Wei, Chou 3 ; Hsu-Heng, Yen 4 ; Chun-Chi, Lin 5 ; Feng-Fan, Chiang 6 ; Chen-Shuan, Chung 7 ; Wei-Chen, Lin 8 ; Chen-Wang, Chang 8 ; Le Puo-Hsien 9 ; Chia-Jung, Kuo 9 ; Ching-Pin, Lin 10 ; Wen-Hung, Hsu 11 ; Chiao-Hsiung, Chuang 12 ; Tsai Tzung-Jiun 13 ; I-Che, Feng 14 ; Shu-Chen, Wei 15
; Tien-Yu, Huang 16 1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City,
2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei,
3 Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung,
4 Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, Changhua,
5 Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei,
6 Division of Colorectal Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung,
7 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City,
8 Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei,
9 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan,
10 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung,
11 Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung,
12 Department of Internal Medicine, National Cheng Kung University Hospital, National Cheng Kung University College of Medicine, Tainan,
13 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung,
14 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan,
15 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei,
16 Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei,