title: Outcomes from IBD-associated and non-IBD-associated colorectal cancer: a Surveillance Epidemiology and End Results Medicare study.
abstract: BACKGROUND
  There is controversy as to whether the clinicopathological features of colorectal cancer in the setting of IBD are distinct from sporadic colorectal cancer.
  
  
  OBJECTIVE
  The aim of this study was to compare the characteristics and outcomes between IBD-associated and sporadic colorectal cancer.
  
  
  METHODS
  This retrospective population-based cohort study used the Surveillance, Epidemiology, and End Results Medicare-linked database.
  
  
  METHODS
  This study was conducted in 6 US metropolitan areas enrolled in Surveillance, Epidemiology, and End Results.
  
  
  METHODS
  Beneficiaries of Medicare parts A and B identified from the Surveillance, Epidemiology, and End Results database with a diagnosis of IBD-associated or sporadic colorectal cancer who underwent surgical resection were included in the study.
  
  
  METHODS
  The main outcome was death. The adjusted risk ratio for death compared patients with IBD-associated colorectal cancer with patients who had sporadic colorectal cancer.
  
  
  RESULTS
  Patients with IBD-associated colorectal cancer were more likely to present at an earlier stage, use immunosuppression, and have metachronous colorectal cancer. Although total proctocolectomy was more common among IBD patients with colorectal cancer, the majority (>75%) underwent a segmental resection. Cancer-specific survival was worse for IBD-associated colorectal cancer vs sporadic colorectal cancer (mean, 32.9 months vs 42.4 months). After adjusting for potential confounders, older age, male sex, higher stage, IBD, immunosuppression, neoadjuvant radiation, and metachronous tumor were associated with a higher risk of cancer-specific mortality. Among patients with IBD, there was no difference in cancer-specific survival for segmental colectomy vs proctocolectomy.
  
  
  CONCLUSIONS
  This is a retrospective cohort study utilizing insurance data dependent on the correct coding of patient claims.
  
  
  CONCLUSIONS
  Older patients with IBD-associated colorectal cancer appear to have a slightly worse outcome than those with sporadic colorectal cancer. The cause of this is multifactorial, but it does not appear to be associated with a more limited surgical resection.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. sdemees1@jhmi.edu
authors.forename: Susan L
authors.initials: SL
authors.lastname: Gearhart
authors.forename: Hari
authors.initials: H
authors.lastname: Nathan
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wick
authors.forename: Jonathan
authors.initials: J
authors.lastname: Efron
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Shore
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000401:mortality / Q000601:surgery; D000368:Aged; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D008297:Male; D016017:Odds Ratio; D018426:SEER Program; D015996:Survival Rate