Livia Biancone1, Alessandro Armuzzi2, Maria Lia Scribano3, Renata D'Inca4, Fabiana Castiglione5, Claudio Papi6, Erika Angelucci7, Marco Daperno8, Filippo Mocciaro9, Gabriele Riegler10, Walter Fries11, Gianmichele Meucci12, Patrizia Alvisi13, Luisa Spina14, Sandro Ardizzone15, Carmelina Petruzziello7, Alessandra Ruffa7, Anna Kohn3, Maurizio Vecchi14, Luisa Guidi2, Roberto Di Mitri9, Sara Renna16, Calabrese Emma7, Francesca Rogai17, Alessandra Rossi11, Ambrogio Orlando16, Francesco Pallone7. 1. Department of Systems Medicine, Gastroenterology Unit, University 'Tor Vergata', Rome, Italy biancone@med.uniroma2.it. 2. Department of Internal Medicine, Division of Gastroenterology, Columbus, Catholic University and IBD Unit, Rome, Italy. 3. GI Unit, A.O. San Camillo-Forlanini, IBD Unit, Rome, Italy. 4. Department of Gastroenterology, U.O. Gastroenterology, University of Padua, Padua, Italy. 5. Department of Gastroenterology, University 'Federico II', Naples, Italy. 6. IBD Unit, S. Filippo Neri Hospital, Rome, Italy. 7. Department of Systems Medicine, Gastroenterology Unit, University 'Tor Vergata', Rome, Italy. 8. GI Unit, A.O. Ordine Mauriziano di Torino, Turin, Italy. 9. GI Unit, ARNAS Civico-DI Cristina Benfratelli, Palermo, Italy. 10. GI Unit, SUN, II University of Naples, Naples, Italy. 11. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. 12. Department of Pediatry, GI Unit, `Maggiore Hospital', Bologna, Italy. 13. GI Unit, 'Maggiore Hospital', Bologna, Italy. 14. Department of Biomedical Sciences for Health, University of Milan, and GI Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. 15. GI Unit, Hospital 'Fatebenefratelli', Milan, Italy. 16. Division of Internal Medicine 'Villa Sofia-Cervello' Hospital, University of Palermo, Palermo, Italy. 17. Department of Medical and Surgical Specialties, Gastroenterology SOD2, A.O. Universitaria Careggi, Florence, Italy.
Abstract
BACKGROUND AND AIMS: Cancer risk in inflammatory bowel disease [IBD] is still debated. In a prospective, multicentre, nested case-control study, we aimed to characterise incident cases of cancer in IBD. The role of immunomodulators vs clinical characteristics of IBD as risk factors for cancer was also investigated. MATERIALS AND METHODS: From January 2012 to December 2014, each IBD patient with incident cancer was matched with two IBD patients without cancer for: IBD type, gender, and age. Risk factors were assessed by multivariate regression analysis. RESULTS: IBD patients considered numbered 44619: 21953 Crohn's disease [CD], 22666 ulcerative colitis [UC]. Cancer occurred in 174 patients: 99 CD [CD-K], 75 UC [UC-K]. Controls included 198 CD [CD-C], 150 UC [UC-C]. Cancer incidence in IBD was 3.9/1000, higher in CD (4.5/1000 [99/21,953]) than in UC (3.3/1000 [75/22,666]; p = 0.042). Cancers involved: digestive system [36.8%], skin [13.2%], urinary tract [12.1%], lung [8.6%], breast [8%], genital tract [6.9%], thyroid [4.6%], lymphoma [3.5%], others [6.3%]. In CD, penetrating behaviour and combined thiopurines and tumour necrosis factor alpha [TNFα] antagonists were risk factors for cancer overall: odds ratio [OR] (95% confidence interval [CI] 2.33 [1.01-5.47]); 1.97 [1.1-3.5]; and for extracolonic cancers 3.9 [1.56-10.1]; 2.15 [1.17-4.1], respectively. In UC, risk factors were pancolitis and disease-related surgery for cancer overall (OR: 2.52 [1.26-5.1]; 5.09 [1.73-17.1]); disease-related surgery for colorectal cancer [CRC] (OR 3.6 [1.0-12]); and extensive and left-sided vs distal UC for extracolonic cancers (OR: 2.55 [1.15-5.9]; 2.6 [1.04-6.6]), respectively. CONCLUSIONS: In a multicentre study, penetrating CD and extensive UC were risk factors for cancer overall. Cancer incidence was higher in CD than in UC.
BACKGROUND AND AIMS: Cancer risk in inflammatory bowel disease [IBD] is still debated. In a prospective, multicentre, nested case-control study, we aimed to characterise incident cases of cancer in IBD. The role of immunomodulators vs clinical characteristics of IBD as risk factors for cancer was also investigated. MATERIALS AND METHODS: From January 2012 to December 2014, each IBD patient with incident cancer was matched with two IBD patients without cancer for: IBD type, gender, and age. Risk factors were assessed by multivariate regression analysis. RESULTS: IBD patients considered numbered 44619: 21953 Crohn's disease [CD], 22666 ulcerative colitis [UC]. Cancer occurred in 174 patients: 99 CD [CD-K], 75 UC [UC-K]. Controls included 198 CD [CD-C], 150 UC [UC-C]. Cancer incidence in IBD was 3.9/1000, higher in CD (4.5/1000 [99/21,953]) than in UC (3.3/1000 [75/22,666]; p = 0.042). Cancers involved: digestive system [36.8%], skin [13.2%], urinary tract [12.1%], lung [8.6%], breast [8%], genital tract [6.9%], thyroid [4.6%], lymphoma [3.5%], others [6.3%]. In CD, penetrating behaviour and combined thiopurines and tumour necrosis factor alpha [TNFα] antagonists were risk factors for cancer overall: odds ratio [OR] (95% confidence interval [CI] 2.33 [1.01-5.47]); 1.97 [1.1-3.5]; and for extracolonic cancers 3.9 [1.56-10.1]; 2.15 [1.17-4.1], respectively. In UC, risk factors were pancolitis and disease-related surgery for cancer overall (OR: 2.52 [1.26-5.1]; 5.09 [1.73-17.1]); disease-related surgery for colorectal cancer [CRC] (OR 3.6 [1.0-12]); and extensive and left-sided vs distal UC for extracolonic cancers (OR: 2.55 [1.15-5.9]; 2.6 [1.04-6.6]), respectively. CONCLUSIONS: In a multicentre study, penetrating CD and extensive UC were risk factors for cancer overall. Cancer incidence was higher in CD than in UC.