Does Colorectal Cancer in Ulcerative Colitis Patients Constitute a Risk for Chemotherapy Refractoriness? A Systemic Approach by Detailed Analysis via the Electronic Tumor Base Documentation System

Abstract

Background: Ulcerative colitis (UC) patients may develop colorectal cancer (CRC), especially with pancolitis and longer UC duration. The question whether CRC with underlying UC has a dismal prognosis remains unsettled. Patients and Methods: We performed an electronic tumor base documentation (eTBD) search of CRC and UC patients at our department to address whether (1) CRC prognosis is impaired and (2) defined risks can be determined. Results: With the inclusion of an index patient with UC and unresponsive CRC, 20 additional patients were identified via eTBD. Chemotherapy response was less substantial, with complete response or stable disease in 3 patients each, but rapidly progressing or refractory disease in 15/21 patients. 12 out of the 21 patients died. Our hazard ratio analysis revealed International Union against Cancer (UICC) stage IV and III disease, grade 3 tumors, longer latency from UC to CRC and age >60 years as potential risks. Median progression-free survival and overall survival were 48 and 82 months, respectively. Time from tumor dissemination to death was 10 months. Conclusions: The prognosis of CRC in UC patients is not necessarily impaired, albeit chemotherapy response with disseminated disease may be unfavorable. Our data should be enlarged by subsequent analyses to better elucidate whether response in UC and CRC is more challenging and defined risks can be confirmed.

Cancer Stem Cells in Ulcerative Colitis

“…[42] have reported that colon cancer following ulcerative colitis hasasimilaroverallsurvivalasregularCRC,buthasaworse response to chemotherapy, suggesting enhanced resistance or enhanced proportion of CSCs. Studies investigating the statusofCSCsatdifferentstagesofUCarescanty.However, asstatedabove,studiesbyCarpentinoetal.…”