Small bowel adenocarcinoma in Crohn’s disease: a systematic review and meta-analysis of the prevalence, manifestation, histopathology, and outcomes

Autor: Sneha Rajiv Jain, Yip Han Chin, Fung Joon Foo, Webber Chan, Cheng Han Ng, Snow Yunni Lin, Ming Hui Lee, David E. Ong, Aaron Shengting Mai, Raghav Sundar, Mark D. Muthiah, Wei Qiang Leow, Rupert W. Leong
Rok vydání: 2021
Předmět:
Zdroj: International Journal of Colorectal Disease. 37:239-250
ISSN: 1432-1262
0179-1958
DOI: 10.1007/s00384-021-04050-1
Popis: Small bowel adenocarcinoma (SBA) is a rare neoplasm that is associated with Crohn’s disease (CD). This study aims to quantify the prevalence of CD-SBA, review the current evidence of histopathology and molecular analysis findings, and identify the clinical presentation and outcomes of CD-SBA. Electronic databases Medline and Embase were searched for articles describing SBA in inflammatory bowel disease patients. The histopathology, molecular analysis findings, clinical presentation, prevalence, and outcomes of CD-SBA were extracted, and results were pooled with random effects. In total, 33 articles were included in the analysis. Prevalence of SBA was 1.15 (CI: 0.31–2.33) per 1000 CD patients. Only 11% (CI: 0.04–0.21) of CD-SBA patients had observable radiological features. CD-SBA was most commonly found in the ileum (84%), diagnosed at stage 2 (36%), with main presenting complaints including obstruction, weight loss, and abdominal pain. Significant histopathological findings included adjacent epithelial dysplasia, and an equal distribution of well-differentiated (49%) and poorly differentiated subtypes (46%). Most prevalent genetic mutation was KRAS mutation (18%), followed by mismatch repair deficiency (9.7%). The 5-year overall survival for CD-SBA patients was 29% (CI: 0.18–0.41), and 33% (CI: 0.26–0.41) for de novo SBA. No statistically significant increase in risk for CD-SBA was noted for treatment with thiopurines, steroids, and 5-ASA. Our meta-analysis found the prevalence of CD-SBA to be 1.15 per 1000 CD patients. The 5-year overall survival for CD-SBA was poor. The presenting symptoms were non-specific, and therefore the diagnosis requires a high index of suspicion.
Databáze: OpenAIRE
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