AGE OF ONSET OF INFLAMMATORY BOWEL DISEASE AND THE DEVELOPMENT OF COLORECTAL CANCER
Naomi M. Sell*, Yasmeen Z. Qwaider, Rocco Ricciardi, Christy E. Cauley, Liliana G. Bordeianou, David L. Berger, Hiroko Kunitake, Robert N. Goldstone
Surgery, Massachusetts General Hospital, Boston, MA
Background: Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer (CRC), accounting for 1-2% of all CRC in the United States. The risk of developing CRC secondary to IBD increases with disease extent, duration, and disease activity. This study aimed to evaluate the effect of age of diagnosis of IBD on CRC development and tumor characteristics.
Methods: Clinicopathologic data was retrospectively collected for all patients age 18 and older diagnosed with CRC who underwent operative resection at a single institution between 1/1/2004 through 12/31/2016. Patients were included if they had a prior diagnosis of either Crohn’s Disease (CD) or Ulcerative Colitis (UC). Patients with indeterminate colitis were excluded. The cohort was divided into patients diagnosed with IBD before or after age 50, when colon cancer screening in the general population begins.
Results: Of 2,042 patients with CRC that underwent surgery within the time frame, 45 (2.2%) had a prior history of IBD; 27 (60%) with CD and 18 (40%) with UC. Eighty-four percent of patients had colon cancer, while 16% had rectal cancer with no significant difference between CD or UC. Date of IBD diagnosis was available for 42 of the 45 patients, with 27 (64%) patients diagnosed before age 50, and 15 (36%) after age 50. The younger cohort had a significantly longer disease duration (median: 22 years) compared to the older cohort (median: 9 years; p<0.001). Only 44.4% of young-onset patients followed recommended IBD surveillance guidelines compared to 80% of the older group (p=0.03). Patients diagnosed with IBD before the age of 50 were more likely to have severely active IBD at the time of CRC diagnosis (51.2% vs. 13.3%, p<0.05) and were more likely to have multifocal dysplasia on final pathology (33.3% vs. 6.7%, p=0.05). There was no difference between groups in pathological stage of the tumor (p=0.44). While there was no difference in overall survival between the two groups, the older cohort was more likely to have locoregional or metastatic recurrence of their CRC (33.3% older vs. 7.7% younger, p=0.04).
Conclusions: Young-onset IBD patients are often diagnosed with CRC in the setting of active IBD disease and are more likely to have multiple sites of dysplasia on pathology when compared to patients diagnosed with IBD after the age of 50. However, late-onset IBD patients had greater CRC recurrence despite a shorter duration of IBD disease and stricter patient adherence to IBD endoscopic surveillance guidelines, suggesting a difference in CRC pathophysiology by age.
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