Ulcerative colitis-associated neoplasms often harbor poor prognostic histologic components with low detection by biopsy.

IF 3.4 Q2 GASTROENTEROLOGY & HEPATOLOGY Intestinal Research Pub Date : 2024-10-01 Epub Date: 2024-05-07 DOI:10.5217/ir.2024.00006

Ryoya Sakakibara, Shinya Sugimoto, Kaoru Takabayashi, Hiroki Kiyohara, Yusuke Wakisaka, Yuta Kaieda, Miho Kawaida, Yusuke Yoshimatsu, Tomohisa Sujino, Naoki Hosoe, Motohiko Kato, Masayuki Shimoda, Yohei Mikami, Yasushi Iwao, Takanori Kanai

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Abstract

Background/aims: Poorly differentiated adenocarcinoma, signet-ring cell carcinoma, and mucinous adenocarcinoma (por/sig/muc), which are considered to be histologic subtypes with a poor prognosis, occur more frequently with colitis-associated cancer than with sporadic tumors. However, their invasiveness and manifestations are unclear. This study aimed to determine the prevalence of the por/sig/muc component in ulcerative colitis-associated neoplasms (UCANs) and its association with invasiveness and to clarify its clinicohistologic and endoscopic features.

Methods: This retrospective observational study included patients diagnosed with ulcerative colitis-associated high-grade dysplasia or adenocarcinoma from 1997 to 2022 who were divided according to the presence or absence of a por/sig/muc component.

Results: Thirty-five patients had UCAN with a por/sig/muc component and 66 had UCAN without this component. The 5-year survival rate was significantly lower in the por/sig/muc group than in the tub group (67% vs. 96%, P= 0.001), which was attributed to disease above stage III and depth to below the subserosa. Biopsy-based diagnosis before resection detected a por/sig/muc component in only 40% of lesions (14/35). Lesions with a por/sig/muc component were prevalent even in the early stages: stage 0 (4/36, 11%), I (8/20, 40%), II (7/12, 58%), III (10/14, 71%), and IV (6/8, 75%).

Conclusions: This is the first investigation that shows UCANs with a por/sig/muc component tended to be deeply invasive and were often not recognized preoperatively. Endoscopists should be aware that UCAN often has a por/sig/muc component that is not always recognized on biopsy, and the optimal treatment strategy needs to be carefully considered.

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溃疡性结肠炎相关肿瘤往往含有预后不良的组织学成分，而活检的检出率却很低。

背景/目的：分化不良的腺癌、印戒细胞癌和粘液腺癌（por/sig/muc）被认为是预后不良的组织学亚型，它们在结肠炎相关癌症中的发病率高于散发性肿瘤。然而，它们的侵袭性和表现尚不明确。本研究旨在确定por/sig/muc成分在溃疡性结肠炎相关肿瘤（UCANs）中的发病率及其与侵袭性的关系，并明确其临床组织学和内窥镜特征：这项回顾性观察研究纳入了1997年至2022年期间被诊断为溃疡性结肠炎相关性高级别发育不良或腺癌的患者，并根据是否存在por/sig/muc成分对这些患者进行了分类：结果：35 名患者的 UCAN 含有 por/sig/muc 成分，66 名患者的 UCAN 不含该成分。por/sig/muc组的5年存活率明显低于管状组（67% vs. 96%，P= 0.001），这归因于疾病在III期以上，深度在粘膜下以下。切除前的活检诊断仅在40%的病变（14/35）中检测到por/sig/muc成分。有por/sig/muc成分的病变甚至在早期阶段也很普遍：0期（4/36，11%）、I期（8/20，40%）、II期（7/12，58%）、III期（10/14，71%）和IV期（6/8，75%）：这是首次调查显示，带有por/sig/muc成分的UCAN往往具有深度侵袭性，而且术前往往无法识别。内镜医师应该意识到，UCAN通常具有por/sig/muc成分，但活检时并不总能发现，因此需要仔细考虑最佳治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Intestinal Research GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

7.40

自引率

10.20%

发文量

审稿时长

38 weeks

期刊介绍： Intestinal Research (Intest Res) is the joint official publication of the Asian Organization for Crohn''s and Colitis (AOCC), Chinese Society of IBD (CSIBD), Japanese Society for IBD (JSIBD), Korean Association for the Study of Intestinal Diseases (KASID), Taiwan Society of IBD (TSIBD) and Colitis Crohn''s Foundation (India) (CCF, india). The aim of the Journal is to provide broad and in-depth analysis of intestinal diseases, especially inflammatory bowel disease, which shows increasing tendency and significance. As a Journal specialized in clinical and translational research in gastroenterology, it encompasses multiple aspects of diseases originated from the small and large intestines. The Journal also seeks to propagate and exchange useful innovations, both in ideas and in practice, within the research community. As a mode of scholarly communication, it encourages scientific investigation through the rigorous peer-review system and constitutes a qualified and continual platform for sharing studies of researchers and practitioners. Specifically, the Journal presents up-to-date coverage of medical researches on the physiology, epidemiology, pathophysiology, clinical presentations, and therapeutic interventions of the intestinal diseases. General topics of interest include inflammatory bowel disease, colon and small intestine cancer or polyp, endoscopy, irritable bowel syndrome and other motility disorders, infectious enterocolitis, intestinal tuberculosis, and so forth. The Journal publishes diverse types of academic materials such as editorials, clinical and basic reviews, original articles, case reports, letters to the editor, brief communications, perspective, statement or commentary, and images that are useful to clinicians and researchers.