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Crohn’s Disease–like Reaction Predicts Favorable Prognosis in Colitis-associated Colorectal Cancer

Lewis, Brian BA*; Lin, Jingmei MD, PhD; Wu, Xianrui MD; Xie, Hao PhD*; Shen, Bo MD§; Lai, Keith MD; Manilich, Elena PhD; Liu, Xiuli MD, PhD

doi: 10.1097/MIB.0b013e31829e13e1
Original Clinical Articles

Background: Idiopathic inflammatory bowel disease is associated with an increased risk of developing colorectal cancer. Colitis-associated colorectal cancer (CAC) has unique histomorphology features; however, whether histomorphology is predictive of survival in CAC, independent of overall clinical tumor stage, remains unknown. The aim of this study is to determine if clinicodemographics and tumor histomorphologic features are prognostic in patients with CAC.

Methods: A cohort of CAC patients were identified from the Pathology Database at Cleveland Clinic; slides were reviewed and other relevant data were collected by retrospective review of medical records.

Results: Univariate analysis demonstrated that poor differentiation, N stage (N1/N2 versus N0), M stage (M1 versus M0), Tumor, Node, Metastasis (TNM) stage (III/IV versus I/II), positive margin, and Crohn's–like reaction were significantly associated with both overall survival (OS) and progression-free survival (PFS) in CAC. Additionally, the presence of >2 tumor-infiltrating lymphocytes/high-power field was found to be significantly associated with longer PFS. Multivariate analysis confirmed that high TNM stage (III/IV versus I/II) was associated with shorter OS and PFS (hazard ratio 2.7, 95% confidence interval [CI]: 1.1–6.7, P = 0.04; 4.84 [95% CI: 2.0–11.5], P < 0.001, respectively), and positive margin status was associated with shorter OS (hazard ratio 4.0 [95% CI: 1.0–15.7], P = 0.05), whereas the presence of Crohn’s–like reaction was associated with longer OS and PFS (hazard ratio 0.3 [95% CI: 0.12–0.79], P = 0.02; 0.25 [95% CI: 0.11–0.58], P = 0.001, respectively).

Conclusions: In CAC, high tumor clinical stage and positive margin predict worse survival but Crohn’s disease–like reaction is associated with longer OS and PFS.

Article first published online 2 August 2013Supplemental Digital Content is Available in the Text.

*Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio;

Department of Pathology and Laboratory Medicine, Indiana University School, of Medicine, Indianapolis, Indiana; and

Department of Colorectal Surgery,

§Department of Gastroenterology, Digestive Disease Institute, and

Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio.

Reprints: Xiuli Liu, MD, PhD, Department of Anatomic Pathology, Cleveland Clinic, L25 9500 Euclid Avenue, Cleveland, OH 44195 (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors have no conflicts of interest to disclose.

Brian Lewis and Jingmei Lin contributed equally to this work.

Received April 03, 2013

Accepted May 29, 2013

© Crohn's & Colitis Foundation of America, Inc.
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