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Anorectal Cancer in Crohn’s Disease Has a Poor Prognosis Due to its Advanced Stage and Aggressive Histological Features: a Systematic Literature Review of Japanese Patients

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Abstract

Background

Patients with Crohn’s disease (CD) are generally known to be at an increased risk of cancer. The anorectal area is the most frequent cancer site in Japanese CD patients. However, the risks are not well defined. The aim of this study was to clarify the clinicopathological characteristics of Japanese CD-associated anorectal carcinoma patients and to explore screening methods for the detection of cancer at earlier stages.

Methods

A systematic review of case series and reports of Japanese CD-associated anorectal cancer patients published between 1983 and 2016 was conducted.

Result

There were 144 cases of cancer arising from anorectal lesions of CD. The median duration from the onset of CD to the cancer diagnosis was approximately 17 (0–39) years. The most prevalent histological type of cancer was mucinous carcinoma (49.3%), and 82.1% of patients were over T3 invasion. There were only 15.6% cases with early stage disease. A total of 82% patients had enhanced symptoms, whereas 56.3% of the early cancer cases had no symptomatic changes. Approximately 90% of cases were diagnosed preoperatively, and almost all early cancer patients were diagnosed with colonoscopy. The 5-year overall survival rate was 35.8%.

Conclusion

CD-associated anorectal carcinoma had a poor prognosis due to the advanced stage of the cases and aggressive histological features. As earlier-stage cancer is associated with a better prognosis than advanced stage disease, and it is also typically diagnosed by colonoscopy, surveillance colonoscopy may therefore help to improve the prognosis in cases without any symptomatic changes.

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Authors and Affiliations

  1. Department of Surgery, Minami-Nara General Medical Center, 8-1 Fukugami, Oyodo, Yoshino, Nara, 638-8551, Japan

    Takeshi Ueda

  2. Department of Surgery, Nara Medical University, Kashihara, Nara, Japan

    Takeshi Ueda, Takashi Inoue, Takayuki Nakamoto, Naoto Nishigori, Hiroyuki Kuge, Yoshiyuki Sasaki & Fumikazu Koyama

  3. Department of Endoscopy, Nara Medical University Hospital, Kashihara, Nara, Japan

    Takashi Inoue, Hisao Fujii & Fumikazu Koyama

  4. Nishigori Hospital, Kashihara, Nara, Japan

    Naoto Nishigori

  5. Gastrointestinal Endoscopy and IBD Center, Yoshida Hospital, Nara, Japan

    Hisao Fujii

Authors
  1. Takeshi Ueda
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  2. Takashi Inoue
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  3. Takayuki Nakamoto
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  5. Hiroyuki Kuge
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Contributions

T.U: study concept and design, data collection, analysis and interpretation of data; T.I., T.N., N.N., and Y.S.: decision to publish, or preparation of the manuscript; H.F. and F.K.: study supervision.

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Correspondence to Takeshi Ueda.

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Ueda, T., Inoue, T., Nakamoto, T. et al. Anorectal Cancer in Crohn’s Disease Has a Poor Prognosis Due to its Advanced Stage and Aggressive Histological Features: a Systematic Literature Review of Japanese Patients. J Gastrointest Canc 51, 1–9 (2020). https://doi.org/10.1007/s12029-018-0180-6

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  • DOI: https://doi.org/10.1007/s12029-018-0180-6

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