Adjuvant chemotherapy impact on the overall survival of completely resected small bowel adenocarcinoma: An updated meta-analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16806-e16806
Author(s):  
Philip A. Haddad ◽  
Dalia A. Hammoud ◽  
Kevin M. Gallagher
Keyword(s):  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Small Bowel ◽  
Survival Benefit ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Adjuvant Chemoradiotherapy ◽  
Small Bowel Adenocarcinoma ◽  
The Impact ◽  
Resected Small Bowel

e16806 Background: While the small intestine represents around 75% of the length and more than 90% of the gastrointestinal tract mucosal surface, it contributes around 2% of gastrointestinal tumors. Adenocarcinoma which constitutes 40% of all small bowel tumors is the most common histology. Complete surgical resection of early-stage small bowel adenocarcinoma (SBAC) is the only proven potentially curative therapy. Due to the rarity of this disease and the absence of randomized trials, the benefit of postoperative adjuvant chemotherapy (ACT) in patients with completely resected localized SBAC has been controversial. A meta-analysis conducted in 2018 found no survival benefit for adjuvant therapies in SBAC. However, this meta-analysis combined studies that used adjuvant chemotherapy and chemoradiotherapy and included studies contaminated by other less chemosensitive histologies and more advanced and sometimes metastatic disease. The purpose of this meta-analysis is to evaluate the impact of ACT on the overall survival (OS) of patients with completely resected SBAC incorporating more recent studies. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of resected small bowel adenocarcinoma, English language, publications from 2000 to the present, and comparative studies reporting OS with hazard ratios (HR) or Kaplan-Meier curves of patients that underwent ACT versus those that did not. Adjuvant chemoradiotherapy studies and those that reported aggregate OS for a cohort with mixed histologies were excluded. A meta-analysis was conducted using an inverse variance method with a random-effects model. Results: Nine retrospective series which included 2082 patients were selected and analyzed. The majority of SBAC patients that received ACT belonged to stages II & III. ACT was found to be significantly associated with better OS in patients with completely resected SBAC (HR 0.66, 95%CI: 0.56-0.78, p < 0.001). Conclusions: This is the first meta-analysis to show that adjuvant chemotherapy is associated with a survival benefit in patients with completely resected small bowel adenocarcinoma. In the absence of randomized clinical trials, this meta-analysis represents the most compelling data supporting the use of ACT in this patient population.

Adjuvant chemoradiotherapy impact on the overall survival of completely resected ampullary and periampullary carcinoma: An updated meta-analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4645-4645
Author(s):  
Philip A. Haddad ◽  
Kevin M. Gallagher ◽  
Dalia A. Hammoud
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Survival Benefit ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Adjuvant Chemoradiotherapy ◽  
Periampullary Carcinoma ◽  
Adjuvant Therapies ◽  
The Impact

4645 Background: Ampullary and Periampullary carcinomas (APAC) are uncommon gastrointestinal cancers that are often amenable to surgical resection. The benefit of postoperative adjuvant chemoradiotherapy (ACRT) in patients with completely resected localized AC has been controversial. A meta-analysis which was conducted in 2017 found no associated survival benefit for adjuvant therapies in APAC. However, this meta-analysis was methodologically flawed and combined studies that used adjuvant chemotherapy alone with those that used ACRT. The purpose of this meta-analysis is to evaluate the impact of ACRT on the overall survival (OS) of patients with completely resected APAC incorporating more recent studies. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of resected Ampullary and Periampullary carcinoma, English language, publications from 1999 to the present, comparative studies reporting OS with hazard ratios (HR) or Kaplan-Meier curves of patients that underwent ACRT versus those that did not, and studies that reported the aggregate OS data of adjuvant therapies where the preponderance of the cohort received ACRT. Adjuvant chemotherapy studies and those that reported aggregate OS for a cohort with preponderance of adjuvant chemotherapy were excluded. A meta-analysis was conducted using an inverse variance method with a random-effects model. Results: Sixteen retrospective series with a total of 1122 patients were included and analyzed. The majority of APAC patients that received ACRT tended to have high risk features. Four of these studies analyzed their OS data for the high risk APAC patients in addition to the cohort as a whole. Intra-arterial chemotherapy and concomitant radiotherapy was used in one study. ACRT was found to be significantly associated with better OS in patients with completely resected APAC (HR 0.76, 95%CI: 0.65-0.88, p < 0.001). Conclusions: This is the first meta-analysis to show that adjuvant chemoradiotherapy is associated with a survival benefit in patients with completely resected high risk Ampullary and Periampullary carcinoma. In the absence of randomized clinical trials, this meta-analysis represents the most compelling data supporting the use of ACRT in this patient population.

Lymphocyte-to-monocyte ratio and neutrophil-to-lymphocyte ratio independently predict survival in resected small bowel adenocarcinoma.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 426-426
Author(s):  
Brandon M. Huffman ◽  
Shruti Patel ◽  
Siddhartha Yadav ◽  
Zhaohui Jin ◽  
Amit Mahipal
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Small Bowel ◽  
Tumor Size ◽  
Neutrophil To Lymphocyte Ratio ◽  
Stage I ◽  
Small Bowel Adenocarcinoma ◽  
Lymphocyte Ratio ◽  
Lymphocyte To Monocyte Ratio ◽  
Resected Small Bowel

426 Background: Small bowel adenocarcinoma is a rare malignancy affecting approximately 2,000 patients per year. There is a paucity of evidence prognosticating patients with small bowel adenocarcinoma. We aimed to evaluate multiple factors in patients with resected small bowel adenocarcinoma to determine any association with survival outcomes. Methods: Ninety three patients who underwent resection for stage I-III small bowel adenocarcinoma were retrospectively identified utilizing the pathology database at a single tertiary referral institution. All patients had complete follow up data and were included in the survival analysis. JMP software was used for statistical analysis. Overall survival was performed utilizing Kaplan-Meier method, and log-rank tests were used for statistical comparisons. Cox proportional hazards were performed to control for age, gender, location of tumor, tumor size, tumor stage, and adjuvant therapy. Sensitivity analysis was performed to establish best cutoff points for continuous variables. All tests were two sided and a P value of < 0.05 was considered significant. Results: The median age at diagnosis was 65 years (range 32-90). 61% were male. Median tumor size was 4.5 cm. There were 20, 36, and 37 patients with stage I, stage II, and stage III disease, respectively. Median overall survival (OS) was 151 months, 104 months, and 44 months for stages I, II, and III disease. In a multivariate analysis, independent predictor factors included presurgical lymphocyte to monocyte ratio (LMR) > 4.0, with a Hazard Ratio (HR) 0.13 (95% CI 0.007-0.69, p = 0.01), presurgical neutrophil to lymphocyte ratio (NLR) < 8.0, HR 0.39 (95% CI 0.17-0.96, p = 0.04), and tumor size < 7.5 cm, HR 0.22 (95% CI 0.07-0.85, p = 0.03). Stage, age, T stage, and N stage influenced overall survival in univariate analysis, but were not statistically significant on multivariate analysis. Conclusions: LMR and NLR independently predict survival in patients with resected small bowel adenocarcinoma.

Meta-analyses of randomized trials assessing the influence of chemotherapy and prognostic factor in advanced/recurrent gastric cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 4550-4550
Author(s):  
C. Pozzo ◽  
Y. Ohashi ◽  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Randomized Clinical Trials ◽  
Cox Regression ◽  
Meta Analysis ◽  
Performance Status ◽  
Small Sample ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
The Impact

4550 Background: Advanced or recurrent stomach cancer remains an incurable disease. Several drugs and different combinations of chemotherapy have been investigated but very often with small sample sizes making definitive conclusions difficult. The GASTRIC project is an individual-patient-data (IPD) based meta-analysis in the advanced disease setting to quantify the potential benefit of various chemotherapies. We used this large database to study the role of various prognostic factors and potential interactions with chemotherapy. Methods: All randomized clinical trials (RCT) closed to patient accrual at the end of 2004 were eligible. Radiotherapy, intraperitoneal chemotherapy, or immunotherapy was excluded. The primary endpoint was overall survival (OS). Baseline variables included sex, age, performance status (PS), diseases status at entry, prior surgery, number of organs involved at entry, location of metastasis, TNM stages, histology, operative procedures, and geographic area. The hazard ratio (HR) and 95% confidence interval (CI) was calculated by the multivariate Cox analysis to assess of the prognostic factors for their relationship to OS. Results: Fourty-nine eligible RCTs (7,120 patients) were identified. As of December 2008, IPD from 21 trials (3,619 patients) with a median follow- up of 7.3 months were available for OS. There was no statistically significant difference between 5FU-based, anthracycline-based, platinum-based, taxane-based, or irinotecan-based regimens versus any other CT. In the multivariate Cox regression analysis stratified by trial and treatment arm, PS of 2 (HR, 2.43; 95%CI, 2.02 to 2.94) compared to PS of 0, metastatic (HR, 1.29; 95%CI, 1.01 to 1.64) compared to local advanced, many number of organs, and location of metastasis (especially with peritorium; HR, 1.75; 95%CI, 1.23 to 2.48) compared to none were strongly associated with lower survival. Conclusions: Our interim results could not show an overall survival benefit in favour of 5FU-, anthracycline-, platinum-, taxane-, or irinotecan-based regimens compared with a regimen without the specific chemotherapy. We confirm the impact of PS, diseases status at entry, number of organs involved, and location of metastasis on OS. No significant financial relationships to disclose.

Effect of adjuvant chemotherapy on survival in FNCLCC grade 3 soft tissue sarcomas: A multivariate analysis of the French Sarcoma Group database

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 10504-10504
Author(s):  
A. Italiano ◽  
F. Delva ◽  
V. Brouste ◽  
P. Terrier ◽  
M. Trassard ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Adjuvant Chemotherapy ◽  
Soft Tissue ◽  
Meta Analysis ◽  
Soft Tissue Sarcomas ◽  
Tumor Grade ◽  
Grade 3 ◽  
The Impact

10504 Background: The SMAC meta-analysis failed to demonstrate that adjuvant chemotherapy (AC) significantly improves overall survival (OS) in adult patients with localised resectable soft-tissue sarcoma (STS). We report here the analysis of the impact of AC in the population of STS patients included in the prospective database of the French Sarcoma Group. Methods: Between 1980 and 1999, 2,029 pts with STS were admitted to one of the 20 tertiary cancer centers of the GSF for the management of a first tumoral event and were included prospectively in a comprehensive database. 152 pts were excluded from the study because of metastatic disease at diagnosis. All the cases were reviewed by the pathology subcommittee of the GSF. Tumor grade was assessed according to the FNCLCC system based on tumor differentiation, mitotic count, and necrosis. Results: 283 pts (14.5%) had grade 1, 736 (39.5%) grade 2 and 858 (46%) grade 3 tumors. 1,102 pts (59%) had extremity tumors. The commonest pathological subtypes were MFH 22.5%, liposarcoma 18%, leiomyosarcoma 13%, and synovial sarcoma 10%. 1,122 pts (60%) received adjuvant radiotherapy. AC was delivered in 16 grade 1 pts (6%), 167 grade 2 pts (23%) and 323 grade 3 pts (38%). The majority of patients who received AC had tumors with a deep topography (91%) and/or > 5 cm (75%) and/or located in the limbs (61%). The median follow-up was 9 years. The 5 year-OS was 90% for grade 1 pts, 63% for grade 2 pts and 46% for grade 3 pts. On multivariate analysis ( table 1 ), AC was strongly associated with improved metastasis-free survival (MFS) (5 year MFS: 53% vs 47%, HR 0.7 [0.5–0.9], p=0.003) and overall survival (OS) (5 year OS: 56% vs 44%, HR 0.7 [0.5–0.8], p=0.004) in grade 3 pts. This association was not observed in grade 2 pts (5 year MFS: 73% vs 72%, HR 0.9 [0.6–1.4], p=0.9; 5 year OS: 73% vs 65%, HR 0.7 [0.5–1.1]). Conclusions: This large cohort-based analysis with long-term follow-up indicates that FNCLCC grade 3 pts are likely to benefit from AC. [Table: see text] [Table: see text]

Survival outcome of small bowel adenocarcinoma (SBA) in the last 12 years: Meta-analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14667-e14667
Author(s):  
Tannaz Armaghany ◽  
Runhua Shi ◽  
Joseph Ryan Shows ◽  
Glenn Morris Mills
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Treatment ◽  
Lymph Node Ratio ◽  
Meta Analysis ◽  
Positive Lymph Node ◽  
Low Grade ◽  
Small Bowel Adenocarcinoma ◽  
Node Ratio

e14667 Background: Due to rarity, management of SBA is currently controversial. Despite results from several single institutional studies showing no survival benefit with adjuvant chemotherapy, data extrapolated from established colorectal cancer studies are commonly used to manage this cancer. Here we report results of a meta-analysis on data from 14 retrospective studies published in English between years 2000 and 2011. Methods: PubMed database was searched using relevant keywords. Patients with SBA were included. Studies involving ampulary, periampulary and ileocecal valve tumors were excluded. The combined location and stage distribution were adjusted by sample size of each study. Primary outcome for the magnitude of benefit analysis were OS. Hazard ratios (HRs) with 95% confidence intervals (CIs) were extracted. A random-effect model according to the method of DerSimonian and Laird was used; a heterogeneity test was used. The effect of adjuvant chemotherapy and/or radiation treatment after curative surgery was evaluated. Effect of stage, grade, and positive lymph node ratio was also evaluated. Results: With available information within 14 studies, mean age of patients was 59.3(95% CI: 56.4 and 62.1). Duodenum was the most common site of primary tumor followed by the jejunum, ileum and not specified sites (59.27%, 23.49%, 11.42%, and 3.03%), respectively. Overall median survival was 17.2 months (95% CI: 13.9 and 20.5). Adjuvant treatment vs. non adjuvant treatment showed a HR of 1.17 (95% CI: 0.71-1.93) that was not statistically significant. HR for low grade vs. high grade tumors was 3.90 (95% CI: 2.15- 7.06). HR for stage was 3.09 (95% CI: 0.89-10.67, p=0.07) comparing high stage with low stage which suggested a marginally statistically significant effect. HR for positive lymph node ratio (LNR) was 4.63 (95% CI: 2.67-8.03). Conclusions: Our meta-analysis suggests adjuvant treatment after cancer directed curative intent surgery does not improve overall survival compared to observation in SBA. Grade of tumor and positive LNR are significant predicators of overall survival whereas stage has marginally significant effect on survival. Future trials investigating new or innovative adjuvant therapy in SBA are needed.

Validation of lymphocyte to monocyte ratio in resected small bowel adenocarcinoma as a predictor of survival.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15799-e15799
Author(s):  
Brandon M. Huffman ◽  
Zhaohui Jin ◽  
Siddhartha Yadav ◽  
Shruti Patel ◽  
Amit Mahipal ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factor ◽  
Small Bowel ◽  
Predictive Value ◽  
P Value ◽  
Small Bowel Adenocarcinoma ◽  
Training Set ◽  
Lymphocyte To Monocyte Ratio ◽  
Negative Prognostic Factor ◽  
Resected Small Bowel

e15799 Background: Lymphocyte to monocyte ratio (LMR) has been described as a prognostic factor in many solid tumors including colorectal adenocarcinoma. LMR has not been investigated as a prognostic factor in small bowel cancers. In this study, we aimed to evaluate prognostic factors in resected small bowel adenocarcinoma including LMR. Methods: Two hundred forty-one patients who underwent resection for stage I-III small bowel adenocarcinoma were retrospectively identified utilizing the pathology database at a single tertiary referral institution from 1994 to 2015. All patients had complete follow up data and were included in the survival analysis. One hundred sixty-nine patients had preoperative peripheral blood counts available for analysis. Plot of martingale residuals against LMR were used to establish best cutoff points for LMR. A training set for LMR included consecutively identified patients from 2006 to 2015, and a validation cohort including patients identified from 1994 to 2005 was used. Overall survival was performed utilizing Kaplan-Meier method, and Wilcoxon tests were used for statistical comparisons. Cox proportional hazards were performed and all tests were two sided. P value of < 0.05 was considered significant. Results: Median overall survival for the entire group was 54.5 months (95% CI: 37.2-81.2 months) with 5- and 10-year overall survival of 48% and 35%. The training set for LMR included 81 patients, and the validation set included 88 patients. The cutoff of 1.56 was chosen based on most significant p value (p = 0.002). When combined, the overall area under the curve (AUC) for LMR was 0.63, p < 0.01, (specificity 37.3%, sensitivity 90.1%, positive predictive value 33.1%, and negative predictive value 92.2%). There were 126 patients with LMR > 1.56 and 43 patients with LMR < 1.56 in the entire cohort. In multivariate analysis, LMR under 1.56 was a negative prognostic factor, HR = 2.20 (95% CI: 1.27-3.84, p < 0.01). In addition to LMR, age > 60 years and advanced T stage were independently negative predictors of overall survival in all patients. Conclusions: Lymphocyte-to-monocyte ratio < 1.56 is a validated negative prognostic factor in resected small bowel adenocarcinoma.

scholarly journals Association between Transfusion Status and Overall Survival in Patients with Myelodysplastic Syndromes: A Systematic Literature Review and Meta-Analysis

2016 ◽  
Vol 136 (1) ◽  
pp. 23-42 ◽  
Author(s):  
Sue Harnan ◽  
Shiji Ren ◽  
Tim Gomersall ◽  
Emma S. Everson-Hock ◽  
Anthea Sutton ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Benefit ◽  
Positive Impact ◽  
Meta Analysis ◽  
Credible Interval ◽  
Interaction Coefficient ◽  
Bibliographic Databases ◽  
Risk Of Death ◽  
Transfusion Independence ◽  
The Impact

Introduction: Multiple studies show that transfusion independence (TI) in myelodysplastic syndrome (MDS) has a positive impact on overall survival (OS). To assess this, a systematic review and meta-analysis of the association between TI and OS in patients with MDS was conducted (PROSPERO ID: CRD42014007264). Methods: Comprehensive searches of 5 key bibliographic databases were conducted and supplemented with additional search techniques. Included were studies that had recruited adults aged >18 years with MDS and had examined the impact of transfusion status on OS. Results: Fifty-five studies (89 citations) were included. The vast majority reported a statistically significant hazard ratio (HR) for OS in favor of TI patients or in patients who acquired TI after treatment. A random-effects meta-analysis was conducted. Patients classed as TI at baseline showed a 59% decrease in the risk of death compared with transfusion-dependent (TD) patients [HR 0.41; 95% credible interval (CrI) 0.29-0.56], and this effect did not appear to interact significantly with illness severity (interaction coefficient HR 1.38; 95% CrI 0.62-3.41). A meta-analysis of studies where patients acquired TI was not possible, but those studies consistently reported a survival benefit for those who acquired TI. Conclusion: The findings revealed a 59% pooled reduction in mortality among TI patients when compared with TD patients.

Association of adjuvant chemoradiotherapy with survival in patients with resected gallbladder carcinoma: A systematic review and meta-analysis.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 477-477 ◽  
Author(s):  
Eui Kyu Chie ◽  
Byoung Hyuck Kim ◽  
Jeanny Kwon ◽  
Kyubo Kim
Keyword(s):  
Systematic Review ◽  
Lymph Node ◽  
Gallbladder Carcinoma ◽  
Survival Benefit ◽  
Meta Analysis ◽  
Convincing Evidence ◽  
Adjuvant Chemoradiotherapy ◽  
Curative Surgery ◽  
Risk Of Death ◽  
The Impact

477 Background: The impact of adjuvant radiotherapy (ART) on survival in gallbladder carcinoma (GBC) remains underexplored, and conflicting results have been reported. We conducted a systematic review and meta-analysis to clarify the impact of ART in GBC. Methods: Systematic literature search was performed in the several databases following the PRISMA guidelines from inception to August 2016. We included the studies which reported survival outcome in the patients with or without ART following curative surgery. Results: Fourteen retrospective studies including 9364 analyzable patients met all inclusion criteria, but most of them had a moderate risk of bias. Generally, ART group had more patients with unfavorable characteristics than the surgery alone group. Nevertheless, pooled results showed that ART significantly reduced the risk of death (HR, 0.54; 95% CI, 0.44-0.67; p < 0.001) and recurrence (HR, 0.61; 95% CI, 0.38-0.98; p = 0.04) compared to the surgery alone group. Exploratory analyses demonstrated that subgroup of patients with lymph node positive disease (HR, 0.61; p < 0.001) and R1 resection (HR, 0.55; p < 0.001) had survival benefit from ART, while those with lymph node negative disease did not (HR 1.06; p = 0.78). No evidence of publication bias was found (p = 0.663). Conclusions: This work is the first meta-analysis evaluating the role of ART and provides convincing evidence that ART may offer survival benefit, especially in high risk patients. However, further confirmation with a randomized prospective study is needed to clarify the subgroup of GBC patients who would most benefit from ART.

Small Bowel Adenocarcinoma: Is There a Difference in Survival for Crohn's Versus Sporadic Cases?

2019 ◽  
Vol 14 (3) ◽  
pp. 303-308 ◽  
Author(s):  
Adam C Fields ◽  
Frances Y Hu ◽  
Pamela Lu ◽  
Jennifer Irani ◽  
Ronald Bleday ◽  
...  
Keyword(s):  
Overall Survival ◽  
Risk Factor ◽  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Small Bowel Adenocarcinoma ◽  
Younger Age ◽  
Sporadic Cases ◽  
Poorly Differentiated ◽  
The Impact

Abstract Background and Aims It is well known that Crohn's disease is a risk factor for the development of small bowel adenocarcinoma. However, the association between Crohn's disease-associated small bowel adenocarcinoma and survival is less understood. The goal of this study was to determine the impact of Crohn's disease on survival in small bowel adenocarcinoma. Methods Patients with small bowel adenocarcinoma, either associated with Crohn's disease or diagnosed sporadic, were identified in the National Cancer Database from 2004–2016. The primary outcome was overall survival. Results Of 2668 patients, 493 had Crohn's disease-associated small bowel adenocarcinoma and 2175 had sporadic small bowel adenocarcinoma. Crohn's disease patients were more likely to present at a younger age [62 vs 65, p &lt; 0.001], have tumours located in the ileum [62.7% vs 25.0%, p &lt; 0.001], and have poorly differentiated tumours [47.0% vs 31.7%, p &lt; 0.001] compared with sporadic small bowel adenocarcinoma. Factors associated with significantly decreased survival included older age (hazard ratio [HR]: 1.02, 95% confidence interval [CI]: 1.02–1.03, p &lt; 0.00)], higher Charlson score [HR: 1.39, 95% CI: 1.13–1.72, p = 0.002], higher tumour grade [HR: 1.09, 95% CI: 1.04–1.14, p &lt; 0.001], positive surgical margins [HR: 1.60, 95% CI: 1.39–1.84, p &lt; 0.001], and higher stage of disease [HR: 1.90, 3.75, 8.13, 95% CI: 1.37–2.64, 2.68–5.24, 5.77–11.47, for II, III, IV, respectively, compared with I, all p &lt; 0.001]. Receipt of chemotherapy was associated with significantly improved survival [HR: 0.61, 95% CI: 0.53–0.70, p &lt; 0.001]. Crohn's disease [HR: 1.01, 95% CI: 0.99–1.02, p = 0.39], was not significantly associated with survival. Conclusion Compared with sporadic patients, Crohn's disease patients have similar overall survival, and Crohn's disease is not an independent risk factor for mortality.

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