María Chaparro1, M Ramas1, J M Benítez2, A López-García3, A Juan4, J Guardiola5, M Mínguez6, X Calvet7, L Márquez8, L I Fernández Salazar9, L Bujanda10, C García11, Y Zabana12, R Lorente13, J Barrio14, E Hinojosa15, M Iborra16, M Domínguez Cajal17, M Van Domselaar18, M F García-Sepulcre19, F Gomollón20, M Piqueras21, G Alcaín22, V García-Sánchez2, J Panés3, E Domènech4, E García-Esquinas23, F Rodríguez-Artalejo23, J P Gisbert1. 1. Hospital de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain. 2. Hospital Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain. 3. Hospital Clinic (CIBERehd), Barcelona, Spain. 4. Hospital Germans Trias i Pujol (CIBERehd), Badalona, Spain. 5. Badalona, Hospital Bellvitge, Barcelona, Spain. 6. Hospital Clínico de Valencia, Valencia, Spain. 7. Hospital Parc Taulí, Barcelona, Spain. 8. Hospital del Mar, Barcelona, Spain. 9. Hospital Clínico Universitario de Valladolid, Valladolid, Spain. 10. Hospital Donostia (CIBERehd), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain. 11. Hospital Ramón y Cajal, Madrid, Spain. 12. Hospital Mutua de Terrassa (CIBERehd), Terrassa, Spain. 13. Hospital General Universitario de Ciudad Real, Ciudad Real, Spain. 14. Hospital Universitario Río Hortega, Valladolid, Spain. 15. Hospital de Manises, Valencia, Spain. 16. Hospital La Fe (CIBERehd), Valencia, Spain. 17. Hospital General San Jorge, Huesca, Spain. 18. Hospital de Torrejón, Madrid, Spain. 19. Hospital General Universitario de Elche, Alicante, Spain. 20. ISS Aragón, Hospital Clínico "Lozano Blesa" (CIBERehd), Zaragoza, Spain. 21. Consorci de Terrassa, Terrassa, Spain. 22. Hospital Clínico Universitario de Málaga, Málaga, Spain. 23. Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPaz and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
Abstract
OBJECTIVES: The objective of this study was (a) To know the prevalence and distribution of extracolonic cancer (EC) in patients with inflammatory bowel disease (IBD); (b) To estimate the incidence rate of EC; (c) To evaluate the association between EC and treatment with immunosuppressants and anti-tumor necrosis factor (TNF) agents. METHODS: This was an observational cohort study. INCLUSION CRITERIA: IBD and inclusion in the ENEIDA Project (a prospectively maintained registry) from GETECCU. EXCLUSION CRITERIA: Patients with EC before the diagnosis of IBD, lack of relevant data for this study, and previous treatment with immunosuppressants other than corticosteroids, thiopurines, methotrexate, or anti-TNF agents. The Kaplan-Meier method was used to evaluate the impact of several variables on the risk of EC, and any differences between survival curves were evaluated using the log-rank test. Stepwise multivariate Cox regression analysis was used to investigate factors potentially associated with the development of EC, including drugs for the treatment of IBD, during follow-up. RESULTS: A total of 11,011 patients met the inclusion criteria and were followed for a median of 98 months. Forty-eight percent of patients (5,303) had been exposed to immunosuppressants or anti-TNF drugs, 45.8% had been exposed to thiopurines, 4.7% to methotrexate, and 21.6% to anti-TNF drugs. The prevalence of EC was 3.6%. In the multivariate analysis, age (HR=1.05, 95% CI=1.04-1.06) and having smoked (hazards ratio (HR)=1.47, 95% confidence interval (CI)=1.10-1.80) were the only variables associated with a higher risk of EC. CONCLUSIONS: Neither immunosuppressants nor anti-TNF drugs seem to increase the risk of EC. Older age and smoking were associated with a higher prevalence of EC.
OBJECTIVES: The objective of this study was (a) To know the prevalence and distribution of extracolonic cancer (EC) in patients with inflammatory bowel disease (IBD); (b) To estimate the incidence rate of EC; (c) To evaluate the association between EC and treatment with immunosuppressants and anti-tumor necrosis factor (TNF) agents. METHODS: This was an observational cohort study. INCLUSION CRITERIA: IBD and inclusion in the ENEIDA Project (a prospectively maintained registry) from GETECCU. EXCLUSION CRITERIA: Patients with EC before the diagnosis of IBD, lack of relevant data for this study, and previous treatment with immunosuppressants other than corticosteroids, thiopurines, methotrexate, or anti-TNF agents. The Kaplan-Meier method was used to evaluate the impact of several variables on the risk of EC, and any differences between survival curves were evaluated using the log-rank test. Stepwise multivariate Cox regression analysis was used to investigate factors potentially associated with the development of EC, including drugs for the treatment of IBD, during follow-up. RESULTS: A total of 11,011 patients met the inclusion criteria and were followed for a median of 98 months. Forty-eight percent of patients (5,303) had been exposed to immunosuppressants or anti-TNF drugs, 45.8% had been exposed to thiopurines, 4.7% to methotrexate, and 21.6% to anti-TNF drugs. The prevalence of EC was 3.6%. In the multivariate analysis, age (HR=1.05, 95% CI=1.04-1.06) and having smoked (hazards ratio (HR)=1.47, 95% confidence interval (CI)=1.10-1.80) were the only variables associated with a higher risk of EC. CONCLUSIONS: Neither immunosuppressants nor anti-TNF drugs seem to increase the risk of EC. Older age and smoking were associated with a higher prevalence of EC.
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