Ulcerative colitis-associated neoplasms often harbor poor prognostic histologic components with low detection by biopsy
- Author:
Ryoya SAKAKIBARA
1
;
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
Author Information
- Publication Type:Original Article
- From:Intestinal Research 2024;22(4):428-438
- CountryRepublic of Korea
- Language:English
-
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.
