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P108. Fistulizing pattern is associated with a higher frequency and incidence of cancer in Crohn's disease: A single-center cohort study involving 1288 patients with inflammatory bowel disease

L. Biancone, M. Ranieri, S. Onali, S. Zuzzi, G. Condino, C. Petruzziello, F. Zorzi, M. Ascolani, F. Pallone

Policlinico Tor Vergata, Rome, Italy

Aim: In a single-center, cohort study we assessed whether in Crohn's Disease (CD) and Ulcerative Colitis (UC) not only immunosuppressors (ISS) and anti-TNFs, but also the pattern and extent of IBD may influence the frequency and histotype of cancer.

Materials and Methods: In a monocentric study, clinical records of all Inflammatory Bowel Disease (IBD) patients followed up for at least 1 year from 1984–2010 were reviewed. Data recorded: IBD type/site/duration, surgery, smoking habits, follow up length, ISS and/or anti-TNFs use. Cases of cancer after the diagnosis of IBD were reported. Statistical analysis: Wilcoxon test (median ages), Kaplan-Meyer survival analysis (IBD duration), Log rank (UC vs CD duration), chi square and z test (percentages comparison), Miettinen test-based (differences in rates).

Results: Study population: 1288 IBD (621F): 663 CD (346F), 625 UC (275F) patients. The age at IBD diagnosis was higher in CD vs UC (median 35 vs 30 yrs; p < 0.01), while IBD duration was comparable. The percentage of patients with ISS and/or anti-TNFs use was higher in CD vs UC (ISS 19.4% vs 12%; anti-TNFs 7.8% vs 3.2%; ISS and anti-TNFs 18.5% vs 5.1%; p < 0.01). Cancer was diagnosed in 57/1288 (4.4%) IBD patients. The frequency and incidence of cancer was higher in CD vs UC (40/633, 6.4% vs 17/625; 2.7%; 5 vs 2.8/1000 pt/yrs; p < 0.01). No specific histotype of cancer appeared associated with IBD type, although lymphoma was diagnosed only in CD (n = 3). The percentage of smokers was higher in CD vs UC (49.3% vs 35%; p < 0.01). Among non-smokers, the frequency of cancer was higher in CD vs UC (7.4% vs 2%; p = 0.012). In CD, the frequency of any cancer in patients with perianal disease was higher than in patients with no perianal disease (10.9% vs 4.3%; p < 0.01), while the incidence was comparable (5.5/1000 pt/yrs vs 3.5/1000 pt/yrs). Patients with fistulizing CD (luminal or perianal) showed a higher frequency and incidence of cancer than patients with stricturing or inflammatory CD (13.8% vs 4.8% and 3.2%; p < 0.01; incidence 8.6/1000 pt/yrs vs 3.3/1000 pt/yrs vs 3.6/1000 pt/yrs; p < 0.01). IBD site/extent did not influence the frequency of cancer (UC distal 2.1%, subtotal 2.8%, total 6.9%;CD ileum 5.6%, colon 5.3%, ileum-colon 7.9%; p = n.s.). There was a not statistically significant different incidence of cancer in patients treated with ISS and/or anti-TNFs in the 3 groups, although difference in time of administration may influence the cancer incidence.

Conclusions: In our cohort, a high incidence of cancer was observed, being higher in CD vs UC. Fistulizing pattern appeared to significantly increase the incidence of cancer in CD. This issue should be considered when using ISS and biologics in this subgroup of patients.