Prognosis of small bowel adenocarcinoma in Crohn's disease compares favourably with de novo small bowel adenocarcinoma

N. Wieghard, S. Mongoue-Tchokote, J. I. Young, Brett Sheppard, Vassiliki Tsikitis

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Aim: Limited data exist on Crohn's disease (CD)-associated small bowel adenocarcinoma (SBA). A large-scale retrospective cohort study was conducted comparing the clinical features and outcome of CD-associated SBA and de novo SBA. Method: Data for patients with small bowel adenocarcinoma were gathered from the 1992–2010 United States Surveillance, Epidemiology and End Results cancer registry–Medicare linked database. We identified 2123 patients, of whom 179 had CD-associated and 1944 de novo SBA. The main outcome measures were overall survival (OS) and cancer-specific survival (CSS). Results: CD-associated SBA was most commonly located in the ileum (62% vs 31%, P < 0.0001). CD patients were diagnosed at an earlier stage (I/II), compared with de novo SBA (55% vs 32%, P < 0.0001), and were more likely to undergo surgery (81% vs 72%, P = 0.0016). Chemotherapy use was similar (25% vs 21%, P = 0.1886). Patients with CD-associated SBA had better 5-year OS (43% vs 34%, P = 0.0121) but a similar CSS (65% vs 64%, P = 0.77). There was no difference in the OS between the cohorts when stratified by stage. On multivariate analysis, CD was not significantly related to OS [hazard ratio (HR) 0.97, 95% CI: 0.79–1.20, P = 0.7889]. Surgery and the extent of lymphadenectomy improved OS for all SBA patients (HR 0.73, 95% CI: 0.60–0.88, P = 0.001), whereas chemotherapy did not (HR 1.13, 95% CI: 0.99–1.28, P = 0.0665). Conclusion: Patients with CD-associated SBA present at an earlier stage than patients with de novo SBA, they receive more surgery but similar rates of chemotherapy, and have similar OS and CSS. The presence of CD does not worsen survival after treatment of SBA.

Original languageEnglish (US)
Pages (from-to)446-455
Number of pages10
JournalColorectal Disease
Volume19
Issue number5
DOIs
StatePublished - May 1 2017

Fingerprint

Crohn Disease
Adenocarcinoma
Survival
Drug Therapy
Neoplasms
Lymph Node Excision
Ileum
Epidemiology
Cohort Studies
Multivariate Analysis
Retrospective Studies
Outcome Assessment (Health Care)
Databases

Keywords

  • adjuvant chemotherapy
  • Crohn's disease
  • SEER–Medicare database
  • Small bowel adenocarcinoma

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Prognosis of small bowel adenocarcinoma in Crohn's disease compares favourably with de novo small bowel adenocarcinoma. / Wieghard, N.; Mongoue-Tchokote, S.; Young, J. I.; Sheppard, Brett; Tsikitis, Vassiliki.

In: Colorectal Disease, Vol. 19, No. 5, 01.05.2017, p. 446-455.

Research output: Contribution to journalArticle

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title = "Prognosis of small bowel adenocarcinoma in Crohn's disease compares favourably with de novo small bowel adenocarcinoma",
abstract = "Aim: Limited data exist on Crohn's disease (CD)-associated small bowel adenocarcinoma (SBA). A large-scale retrospective cohort study was conducted comparing the clinical features and outcome of CD-associated SBA and de novo SBA. Method: Data for patients with small bowel adenocarcinoma were gathered from the 1992–2010 United States Surveillance, Epidemiology and End Results cancer registry–Medicare linked database. We identified 2123 patients, of whom 179 had CD-associated and 1944 de novo SBA. The main outcome measures were overall survival (OS) and cancer-specific survival (CSS). Results: CD-associated SBA was most commonly located in the ileum (62{\%} vs 31{\%}, P < 0.0001). CD patients were diagnosed at an earlier stage (I/II), compared with de novo SBA (55{\%} vs 32{\%}, P < 0.0001), and were more likely to undergo surgery (81{\%} vs 72{\%}, P = 0.0016). Chemotherapy use was similar (25{\%} vs 21{\%}, P = 0.1886). Patients with CD-associated SBA had better 5-year OS (43{\%} vs 34{\%}, P = 0.0121) but a similar CSS (65{\%} vs 64{\%}, P = 0.77). There was no difference in the OS between the cohorts when stratified by stage. On multivariate analysis, CD was not significantly related to OS [hazard ratio (HR) 0.97, 95{\%} CI: 0.79–1.20, P = 0.7889]. Surgery and the extent of lymphadenectomy improved OS for all SBA patients (HR 0.73, 95{\%} CI: 0.60–0.88, P = 0.001), whereas chemotherapy did not (HR 1.13, 95{\%} CI: 0.99–1.28, P = 0.0665). Conclusion: Patients with CD-associated SBA present at an earlier stage than patients with de novo SBA, they receive more surgery but similar rates of chemotherapy, and have similar OS and CSS. The presence of CD does not worsen survival after treatment of SBA.",
keywords = "adjuvant chemotherapy, Crohn's disease, SEER–Medicare database, Small bowel adenocarcinoma",
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T1 - Prognosis of small bowel adenocarcinoma in Crohn's disease compares favourably with de novo small bowel adenocarcinoma

AU - Wieghard, N.

AU - Mongoue-Tchokote, S.

AU - Young, J. I.

AU - Sheppard, Brett

AU - Tsikitis, Vassiliki

PY - 2017/5/1

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N2 - Aim: Limited data exist on Crohn's disease (CD)-associated small bowel adenocarcinoma (SBA). A large-scale retrospective cohort study was conducted comparing the clinical features and outcome of CD-associated SBA and de novo SBA. Method: Data for patients with small bowel adenocarcinoma were gathered from the 1992–2010 United States Surveillance, Epidemiology and End Results cancer registry–Medicare linked database. We identified 2123 patients, of whom 179 had CD-associated and 1944 de novo SBA. The main outcome measures were overall survival (OS) and cancer-specific survival (CSS). Results: CD-associated SBA was most commonly located in the ileum (62% vs 31%, P < 0.0001). CD patients were diagnosed at an earlier stage (I/II), compared with de novo SBA (55% vs 32%, P < 0.0001), and were more likely to undergo surgery (81% vs 72%, P = 0.0016). Chemotherapy use was similar (25% vs 21%, P = 0.1886). Patients with CD-associated SBA had better 5-year OS (43% vs 34%, P = 0.0121) but a similar CSS (65% vs 64%, P = 0.77). There was no difference in the OS between the cohorts when stratified by stage. On multivariate analysis, CD was not significantly related to OS [hazard ratio (HR) 0.97, 95% CI: 0.79–1.20, P = 0.7889]. Surgery and the extent of lymphadenectomy improved OS for all SBA patients (HR 0.73, 95% CI: 0.60–0.88, P = 0.001), whereas chemotherapy did not (HR 1.13, 95% CI: 0.99–1.28, P = 0.0665). Conclusion: Patients with CD-associated SBA present at an earlier stage than patients with de novo SBA, they receive more surgery but similar rates of chemotherapy, and have similar OS and CSS. The presence of CD does not worsen survival after treatment of SBA.

AB - Aim: Limited data exist on Crohn's disease (CD)-associated small bowel adenocarcinoma (SBA). A large-scale retrospective cohort study was conducted comparing the clinical features and outcome of CD-associated SBA and de novo SBA. Method: Data for patients with small bowel adenocarcinoma were gathered from the 1992–2010 United States Surveillance, Epidemiology and End Results cancer registry–Medicare linked database. We identified 2123 patients, of whom 179 had CD-associated and 1944 de novo SBA. The main outcome measures were overall survival (OS) and cancer-specific survival (CSS). Results: CD-associated SBA was most commonly located in the ileum (62% vs 31%, P < 0.0001). CD patients were diagnosed at an earlier stage (I/II), compared with de novo SBA (55% vs 32%, P < 0.0001), and were more likely to undergo surgery (81% vs 72%, P = 0.0016). Chemotherapy use was similar (25% vs 21%, P = 0.1886). Patients with CD-associated SBA had better 5-year OS (43% vs 34%, P = 0.0121) but a similar CSS (65% vs 64%, P = 0.77). There was no difference in the OS between the cohorts when stratified by stage. On multivariate analysis, CD was not significantly related to OS [hazard ratio (HR) 0.97, 95% CI: 0.79–1.20, P = 0.7889]. Surgery and the extent of lymphadenectomy improved OS for all SBA patients (HR 0.73, 95% CI: 0.60–0.88, P = 0.001), whereas chemotherapy did not (HR 1.13, 95% CI: 0.99–1.28, P = 0.0665). Conclusion: Patients with CD-associated SBA present at an earlier stage than patients with de novo SBA, they receive more surgery but similar rates of chemotherapy, and have similar OS and CSS. The presence of CD does not worsen survival after treatment of SBA.

KW - adjuvant chemotherapy

KW - Crohn's disease

KW - SEER–Medicare database

KW - Small bowel adenocarcinoma

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