Characteristics, clinical outcomes, and prognostic factors of colorectal cancer in patients with Crohn's disease: American versus Korean tertiary referral center perspectives

Tanita Suttichaimongkol; Sung Wook Hwang; Nayantara Coelho-Prabhu; John B Kisiel; Byong Duk Ye; Suk-Kyun Yang; Edward V Loftus Jr; Sang Hyoung Park

doi:10.1177/17562848241275342

Characteristics, clinical outcomes, and prognostic factors of colorectal cancer in patients with Crohn's disease: American versus Korean tertiary referral center perspectives

Therap Adv Gastroenterol. 2024 Sep 18:17:17562848241275342. doi: 10.1177/17562848241275342. eCollection 2024.

Authors

Tanita Suttichaimongkol^{1

2}, Sung Wook Hwang³, Nayantara Coelho-Prabhu^{1

2}, John B Kisiel^{1

2}, Byong Duk Ye³, Suk-Kyun Yang³, Edward V Loftus Jr⁴, Sang Hyoung Park⁵

Affiliations

¹ Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
² Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
³ Department of Gastroenterology and Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁴ Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN 55905, USA.
⁵ Department of Gastroenterology and Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.

Abstract

Background: Crohn's disease (CD) exhibits variability in colorectal cancer (CRC) incidence and prognostic factors due to diverse clinical and behavioral characteristics, presenting inconsistencies between Western and Eastern patients.

Objectives: This study compared clinical characteristics between CD patients with CRC from the US and Korean tertiary referral centers and defined the prognostic factors related to mortality.

Design: Retrospective study.

Methods: We reviewed the electronic medical records of 236 adult CD patients with colorectal adenocarcinoma evaluated at Mayo Clinic Rochester, Florida, or Arizona (N = 200) and Asan Medical Center in Korea (N = 36) between January 1989 and August 2022.

Results: Asan patients had a younger age, shorter CD duration, more colonic involvement (L2 plus L3), penetrating behavior, perianal fistula, and shorter biological treatment duration before CRC diagnosis than Mayo patients. Furthermore, despite significant differences in body mass index, smoking status, primary sclerosing cholangitis, immunomodulators, CRC diagnosis period, clinical presentation, CRC location, surgery, and some histopathological details between the two groups, overall survival was not statistically different (p value, 0.29, log-rank test). Advanced age (adjusted hazard ratio (aHR), 1.03 per year; 95% confidence interval (CI), 1.01-1.04; p value, <0.01), unresectable CRC (aHR, 5.02; 95% CI, 2.49-10.12; p value, <0.01), and advanced CRC stage (aHR, 1.45 per stage; 95% CI, 1.07-1.97; p value, 0.02) were significantly associated with increased risk of death. CD remission at CRC diagnosis (aHR, 0.26; 95% CI, 0.08-0.91; p value, 0.04), CRC diagnosis period of 2011-2022 (aHR relative to 1989-2000, 0.46; 95% CI, 0.25-0.87; p value, 0.02), and CRC diagnosis by surveillance (aHR, 0.56; 95% CI, 0.32-0.98; p value, 0.04) were significantly associated with decreased risk of death.

Conclusion: Notably, some clinical features of CD with CRC differed between Asan and Mayo patients; however, overall survival was not different. CD remission, CRC surveillance, and more recent diagnosis of CRC were associated with a reduced risk of death.

Keywords: Crohn’s disease; colorectal adenocarcinoma; colorectal cancer; survival.