Small Bowel Adenocarcinoma: Is there a difference in survival for Crohn’s versus Sporadic cases?
J Crohns Colitis. 2019 Sep 21;:
Authors: Fields AC, Hu FY, Lu P, Irani J, Bleday R, Goldberg JE, Melnitchouk N
BACKGROUND AND AIMS: It is well known that Crohn’s disease is a risk factor for the development of small bowel adenocarcinoma. However, the association between Crohn’s disease-associated small bowel adenocarcinoma and survival is less understood. The goal of this study is to determine the impact of Crohn’s disease on survival in small bowel adenocarcinoma.
METHODS: Patients with small bowel adenocarcinoma, either associated with Crohn’s disease or diagnosed sporadic, were identified in the National Cancer Database from 2004-2016. The primary outcome is overall survival.
RESULTS: Of 2,668 patients, 493 had Crohn’s disease-associated small bowel adenocarcinoma and 2,175 had sporadic small bowel adenocarcinoma. Crohn’s disease patients were more likely to present at a younger age (62 vs 65, p<0.001), have tumors located in the ileum (62.7% vs 25.0%, p<0.001), and have poorly differentiated tumors (47.0% vs 31.7%, p<0.001) compared to sporadic small bowel adenocarcinoma. Factors associated with significantly decreased survival included older age (HR:1.02, 95%CI:1.02-1.03, p<0.001), higher Charlson score (HR:1.39, 95%CI:1.13-1.72, p=0.002), higher tumor grade (HR:1.09, 95%CI:1.04-1.14, p<0.001), positive surgical margins (HR:1.60, 95%CI:1.39-1.84, p<0.001), and higher stage of disease (HR:1.90, 3.75, 8.13, 95%CI:1.37-2.64, 2.68-5.24, 5.77-11.47, for II, III, IV, respectively, compared to I, all p<0.001) (Table 3). Receipt of chemotherapy was associated with significantly improved survival (HR:0.61, 95%CI:0.53-0.70, p<0.001). CD (HR:1.01, 95%CI: 0.99-1.02, p=0.39), was not significantly associated with survival.
CONCLUSION: Compared to sporadic patients, Crohn’s disease patients have similar overall survival and Crohn’s disease is not an independent risk factor for mortality.
PMID: 31541248 [PubMed – as supplied by publisher]