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OP04. Mortality and cancer in paediatric inflammatory bowel disease: A population-based study

C. Gower-Rousseau1, G. Savoye2, D. Turck3, M. Fumery4, J. Salleron5, A. Cortot6, E. Lerebours7, K. Ligier8, J.‑L. Dupas9, O. Mouterde10, C. Spyckerelle11, D. Djeddi12, L. Dauchet1, L. Peyrin-Biroulet13, J.‑F. Colombel14

1Lille University Hospital, Epidemiology Unit, EPIMAD Registry, Lille, France; 2Hôpital Charles Nicolle, Department of Gastroenterology, Rouen, France; 3Lille University Hospital, Paediatric Unit, Lille, France; 4Amiens University and Hospital, Gastroenterology, Amiens, France; 5Lille University Hospital, Epidemiology Unit, Lille, France; 6Lille University Hospital, Lille, France; 7Hôpital Charles Nicolle, Rouen, France; 8Registre général des cancers de Lille et sa région, Lille, France; 9Amiens University Hospital North Hospital, Dept. of Hepagastroenterology, Amiens, France; 10Rouen University and Hospital, Paediatric Unit, Rouen, France; 11St Vincent Hospital, Paediatric Unit, Lille, France; 12Amiens University and Hospital, Paediatric Unit, Amiens, France; 13University Hospital of Nancy, Hepato-Gastroenterology, Vandoeuvre-Lès-Nancy, France; 14Centre Hospitalier Universitaire de Lille, Hôpital Claude Huriez, Lille, France

Background: Although the incidence of paediatric Inflammatory Bowel Disease (IBD) continues to increase in Northern France [1], the risks of death and cancer in this population remain poorly characterized.

Methods: All patients under the age of 17 years, registered in the EPIMAD registry, and diagnosed between 1988 and 2004 with Crohn's disease (CD) or ulcerative colitis (UC) were included. The observed incidences of death and cancer were compared to those expected in the regional general population obtained by French Statistical Institute (INSEE) and the Register of cancers of Lille. Comparisons were performed using Fisher's exact test adjusted for gender and age and a Poisson specific law for rare events. Results were expressed using the standardized ratios of mortality and incidence (SMR and SIR).

Results: 698 patients (538 with CD and 160 with UC) were identified. 360 (52%) were male, the median age at IBD diagnosis was 14 years [12–16] and the median follow-up time was 11.5 years [7–15]. During the follow-up period the overall mortality was of 0.84% (6/698); this did not differ from that of the reference population (SMR=1.4 [0.5–3.0]; p = 0.27). After a median follow-up of 15 years [10–17], 1.3% of the population (nine patients) had a diagnosis of cancer: colonic (n = 2), biliary tract (cholangiocarcinoma) (n = 1), uterine cervix (n = 1), prepuce (n = 1), skin (basal cell carcinoma (n = 2), haematological (acute leukemia) (n = 1), and small bowel carcinoid (n = 1). One patient died of colon cancer. Compared to the general population, there was a significantly higher risk of cancer regardless of gender and age (SIR=2.7 [1.1–5.6]; p < 0.02). Six/9 patients (67%) who developed a cancer had received immunosuppressors or anti‑TNF therapy including combination therapy in 5 (55%).

Conclusions: In this large paediatric population-based IBD cohort, mortality did not differ from that of the general population but there was a significant 2.7-fold increased risk of neoplasia. Among the patients that developed cancer 55% had been exposed to combination therapy.

1. Chouraki V (2011), The changing pattern of Crohn's disease incidence in northern France: a continuing increase in the 10- to 19-year-old age bracket (1988–2007). Aliment Pharmacol Ther.