Long-term efficacy of infliximab maintenance therapy for perianal Crohn’s disease

AIM:To assess the long-term efficacy of seton drainage with infliximab maintenance therapy in treatment of stricture for perianal Crohn’s disease(CD). METHODS:Sixty-two patients with perianal CD who required surgical treatment with or without infliximab between September 2000 and April 2010 were identified from our clinic’s database.The activities of the perianal lesions were evaluated using the modified perianal CD activity index(mPDAI)score.The primary endpoint was a clinical response at 12-15 wk after surgery as a shortterm efficacy.Secondary endpoints were recurrence as reflected in the mPDAI score,defined as increased points in every major element.The clinical responses were classified as completely healed(mPDAI=0),partially improved(mPDAI score decreased more than 4 points),and failure or recurrence(mPDAI score increased or decreased less than 3 points). RESULTS:There were 43 males and 19 females,of whom 26 were consecutively treated with infliximab after surgery as maintenance therapy.Complete healing was not seen.Failure was seen in 10/36(27.8%) patients without infliximab and 4/26(15.4%)patients with infliximab(P=0.25).Partial improvement was seen in 26/36(72.2%)patients without infliximab and 22/26(88.5%)patients with infliximab(P=0.25). Short-term improvement was achieved in 48/62(77.4%) patients.Although the mPDAI score improved significantly with surgery regardless of infliximab,it decreased more from baseline in patients with infliximab(50.0%) than in those without infliximab(28.6%),(P=0.003). In the long-term,recurrence rates were low regardless of infliximab in patients without anorectal stricture.In patients with anorectal stricture,cumulative recurrence incidences increased gradually and exceeded 40%at 5 years regardless of infliximab.No efficacy of infliximab treatment was found(P=0.97).Although the cumulative rate of ostomy creation was also low in patients without stricture and high in patients with stricture,no protective efficacy was found with infliximab treatment(P =0.6 without stricture,P=0.22 with stricture). CONCLUSION:Infliximab treatment was demonstrated to have short-term efficacy for perianal lesions.Longterm benefit with infliximab was not proven,at least in patients with anorectal stricture.

Impact of preoperative chemoradiotherapy using concurrent S-1 and CPT-11 on long-term clinical outcomes in locally advanced rectal cancer

BACKGROUND Preoperative chemoradiotherapy regimens using a second drug for locally advanced rectal cancer are still under clinical investigation.AIM To investigate the clinical outcomes of patients with locally advanced rectal cancer treated with preoperative chemoradiotherapy using tegafur/gimeracil/oteracil(S-1)plus irinotecan(CPT-11).METHODS This was a single-center retrospective study of 82 patients who underwent radical surgery for rectal cancer after chemoradiotherapy with S-1(80 mg/m2/d),CPT-11(60 mg/m2/d),and radiation(total 45 Gy)between 2009 and 2016.The median follow-up was 51 mo(range:17–116 mo).RESULTS Twenty-nine patients(35.4%)had T3 or T4 rectal cancer with mesorectal fascia invasion,36(43.9%)had extramural vascular invasion,24(29.8%)had N2 rectal cancer and eight(9.8%)had lateral lymph node swelling.The relative dose intensity was 90.1%for S-1 and 92.9%for CPT-11.Seventy-nine patients(96.3%)underwent R0 resection.With regard to pathological response,13 patients(15.9%)had a pathological complete response and 52(63.4%)a good response(tumor regression grade 2/3).The 5-year local recurrence-free survival,relapsefree survival and overall survival rates were 90.1%,72.5%and 91.3%,respectively.We analyzed the risk factors for local recurrence-free survival by Cox regression analysis and none were detected.Previously described risk factors such as T4 stage,mesorectal fascia invasion or lateral lymph node swelling were not detected as negative factors for local recurrence-free survival.CONCLUSION We demonstrated good compliance and favorable tumor regression in patients with locally advanced rectal cancer treated with preoperative S-1 and CPT-11.