Predictors of time to surgical recurrence after ileal or ileocolonic resection in Crohn's disease: role of integrin αvβ6 and development of a predictive nomogram.

Surgical recurrence, defined as the need for reoperation at the anastomotic site, remains a critical challenge in Crohn's disease (CD) management. This study aimed to identify clinical and molecular risk factors associated with time to surgical recurrence and develop a validated nomogram for individualized risk stratification. 280 patients were included in this study. Integrin αvβ6 expression was quantified via immunohistochemistry in resection specimens using a validated semiquantitative scoring system. Univariate and multivariable Cox regression analysis were used to identify the variables associated with time to surgical recurrence. A nomogram was then constructed based on the above risk factors. Over a median post-resection follow-up of 71.4 months, surgical recurrence occurred in 32 patients (11.4%) at a median of 52.8 months. Multivariable Cox analysis identified active smoking (HR = 3.749, 95% CI: 1.823-7.710; P < 0.001) and high integrin αvβ6 expression (immunohistochemistry score > 3; HR = 3.738, 95% CI: 1.381-10.117; P = 0.009) as independent predictors of earlier recurrence. Conversely, B1 or B2 phenotype of CD (HR = 0.431, 95% CI: 0.212-0.880; P = 0.021) and postoperative biologic therapy (HR = 0.444, 95% CI: 0.210-0.938; P = 0.033) were associated with delayed recurrence. The nomogram incorporating these factors demonstrated good discriminative ability and calibration for 5 year recurrence prediction. High integrin αvβ6 expression, active smoking, penetrating phenotype, and absence of postoperative biologics drive earlier surgical recurrence of CD. The developed nomogram offers a clinically actionable tool for precise risk stratification, enabling personalized prophylactic strategies to mitigate reoperation and improve long-term outcomes.