Characteristics and Prognosis of Colorectal Cancer Associated With Rheumatic Disease

Abstract

It is well known that host immunity plays an important role in the defense against colorectal cancer (CRC) progression. The effects of autoimmune diseases, such as rheumatic disease (RD) in which the immune system is deregulated, on this immunity have not been fully investigated. The medical records of 1299 consecutive patients diagnosed with primary colorectal cancer who underwent surgical resection were retrospectively reviewed. The clinicopathologic factors of 28 subjects with RD (RD group) were compared with those of 1271 patients without RD (non-RD group). Compared to the non-RD group, the RD group was typified by a predominance of females (P , 0.01), older age (P , 0.01), and a lower incidence of rectal cancer (P ¼ 0.02). Although no difference was observed between the groups in terms of TNM classification, disease-free and overall survival were significantly poorer in the RD group in both univariate and multivariate analyses. Subjects who had RD for more than 10 years tended to have a higher frequency of lymph node metastasis (P ¼ 0.06) and a significantly higher incidence of synchronous distant metastasis (P ¼ 0.035) at the time of cancer diagnosis. RD was associated with a significantly poorer prognosis of colorectal cancer, suggesting that deregulation of the immune system by autoimmune diseases may adversely affect the host immune defense against colorectal cancer progression.Key words: Colorectal cancer -Rheumatic disease -Host immunity -Prognosis I t is well known that host immunity plays an important role in defenses against the development and progression of cancer. The degree of lymphocyte infiltration into tumors has been reported to correlate with improvements of patient survival.1 In carcinogen-induced mouse models of cancer, primary tumor susceptibility has been found to be enhanced in immunocompromised mice;Corresponding author: Junko Kishikawa, MD, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. In autoimmune diseases represented by rheumatic disease (RD), the immune system loses the ability to distinguish nonself from self, eliciting an immune response against self-antigens; in this process, there is a possibility that immune defenses against nonnormal cells are lost or impaired, facilitating the development and progression of cancer. In addition, the development of RD associated with cancer has been reported, and as its development is dependent on the production of substances such as hormones, peptides, autocrine and paracrine mediators, and antibodies or the stimulation of cytotoxic lymphocytes, the condition is known as paraneoplastic rheumatic syndrome. In such cases, RD tends to be less responsive to therapy than its nonparaneoplastic equivalents, and instead, treatment of the underlying cancer usually results in regression of RD.4,5 Thus, it is postulated that RD and cancer are closely associated. However, only a few reports on the incidence and risk of cancer among patients with RD exist,6,7 and the characteristics and prognosis of colorectal cancer (CRC) in these patients remain to ...

Association of HLA-B27 Gene and Rheumatoid Arthritis: Analysis of Potential Role as a Predictive Biomarker

“…A higher incidence rate of developing cardiovascular disease was reported among RA patients [47] which may explain the high expression level of HLA-B27 gene detected in both RA and heart tumor tissue. Patients with rheumatic disease show elevated rates of colorectal cancer recurrence [48]. A study showed that some cancer biomarkers such as CEA, CA 15-3, CA 125, and CA 19-9 had been elevated in individuals suffering from RA [49].…”

Long-Term Outcomes of Radical Surgery for Transverse Colon Cancer Staged from I to IIIC

“…The incidence of transverse colon cancer is relatively low, accounting for only about 10% of all colorectal cancer cases. 14,15 Although colorectal cancer has been well studied, [16][17][18][19] there are few studies on specifically transverse colon cancer, and there are even fewer studies on the long-term outcomes of transverse colon cancer patients who underwent radical surgery. To our best knowledge, this is the first study to analyze the risk factors for the long-term prognosis of transverse colon cancer.…”