背景:这项研究描述了临床特征,结果,三级转诊中心的克罗恩病(CD)患者肛门癌的预后。
方法:35例成人CD患者的电子病历,包括袋子的CD,在罗切斯特梅奥诊所评估的肛门癌,佛罗里达,或亚利桑那州在1989年1月至2022年8月之间进行了回顾性审查。
结果:在癌症诊断之前,与肛门癌患者相比,囊袋相关癌患者的炎症性肠病中位病程较短(10年vs26年).26例患者(74%)有肛周疾病或直肠阴道瘘,35%有人乳头瘤病毒感染史。21例患者(60%)在麻醉(EUA)下通过肛门检查被诊断为癌症。超过一半的腺癌是粘液性的。16例患者(47%)为美国癌症联合委员会(AJCC)肿瘤淋巴结转移(TNM)3期,83%通过手术治疗。在最后的随访中,57%的患者活着,没有癌症。1-,3年和5年总生存率为93.8%(95%置信区间[CI],85.7%-100%),71.5%(95%CI,56.4%-90.7%),和67.7%(95%CI,51.2%-87.7%),分别。高级AJCCTNM阶段(危险比,每个阶段3.20;95%CI,1.05-9.72;P=0.040)与死亡风险增加显着相关,而2011-2022年的癌症诊断期(HR,相对于1989-2000年,0.16;95%CI,0.04-0.72;P=0.017)与死亡风险降低显着相关。
结论:肛门和袋相关性癌是CD的罕见并发症,长期的肛周疾病是一个重要的危险因素。肛门EUA提高了诊断率。较新的癌症治疗策略和手术与优异的生存结果相关。
这项研究描述了鳞状细胞癌和肛门腺癌的罕见克罗恩病(CD)并发症,并以回肠袋-肛门吻合术(IPAA)CD患者的袋相关性癌为特征。5年总生存率为68%。
BACKGROUND: This study described the clinical characteristics, outcomes, and prognosis of Crohn\'s disease (CD) patients with anal cancer in a tertiary referral center.
METHODS: The electronic medical records of 35 adult CD patients, including CD of the pouch, with anal carcinoma evaluated at Mayo Clinic Rochester, Florida, or Arizona between January 1989 and August 2022 were retrospectively reviewed.
RESULTS: Before cancer diagnosis, patients with pouch-related carcinoma had a shorter median duration of inflammatory bowel disease than those with anal carcinoma (10 vs 26 years). Twenty-six patients (74%) had perianal diseases or rectovaginal fistula, and 35% had a history of human papillomavirus infection. Twenty-one patients (60%) were diagnosed with cancer by anal examination under anesthesia (EUA). More than half of adenocarcinomas were mucinous. Sixteen patients (47%) were American Joint Committee on Cancer (AJCC) Tumor Nodes Metastasis (TNM) stage 3, and 83% were treated by surgery. At last follow-up, 57% of patients were alive without cancer. The 1-, 3- and 5-year overall survival rates were 93.8% (95% confidence interval [CI], 85.7%-100%), 71.5% (95% CI, 56.4%-90.7%), and 67.7% (95% CI, 51.2%-87.7%), respectively. Advanced AJCC TNM stage (hazard ratio, 3.20 per stage; 95% CI, 1.05-9.72; P = .040) was significantly associated with increased risk of death, whereas the period of cancer diagnosis in 2011-2022 (HR, relative to 1989-2000, 0.16; 95% CI, 0.04-0.72; P = .017) was significantly related to decreased risk of death.
CONCLUSIONS: Anal and pouch-related carcinomas were rare complications of CD, and long-standing perianal diseases were an important risk factor. Anal EUA improved the diagnostic yield. Newer cancer treatment strategies and surgery were associated with excellent survival outcome.
This study described the uncommon Crohn’s disease (CD) complications of squamous cell carcinoma and adenocarcinoma of the anus and was characterized pouch-related carcinoma in patients with CD of the ileal pouch-anal anastomosis (IPAA). The 5-year overall survival rate was 68%.