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P292. Clinical characteristics of inflammatory bowel disease may influence the cancer risk when using immunomodulators: incident cases of cancer in a multicenter case-control study

C. Petruzziello1, A. Armuzzi2, A. Kohn3, R. D'Incà4, C. Papi5, L. Spina6, L. Guidi2, M.L. Scribano3, S. Onali1, G. Condino1, E. Calabrese1, R. Monterubbianesi3, P. Alvisi7, W. Fries8, G. Riegler9, F. Castiglione10, G. Margagnoni5, G. Meucci11, F. Rogai12, F. Pallone1, L. Biancone1, 1Università Tor Vergata, Roma, Italy, 2Med Int/GI CIC Università Cattolica, Roma, Italy, 3AO S. Camillo Forlanini, Roma, Italy, 4Università Padova, Padova, Italy, 5UOC GE/Hep, AO S. Filippo Neri, Roma, Italy, 6Università S. Donato, Milano, Milano, Italy, 7Ospedale Maggiore, Bologna, Bologna, Italy, 8Università Messina, Messina, Italy, 9SUN Seconda Università di Napoli, Napoli, Italy, 10Università Federico II, Napoli, Napoli, Italy, 11Ospedale S. Giuseppe, Milano, Milano, Italy, 12AOU Careggi, Firenze, Firenze, Italy

Background

The role of thiopurins (IMM) and anti-TNFs vs clinical characteristics of Inflammatory Bowel Disease (IBD) in determining the cancer risk is debated. In a multicenter, case-control prospective longitudinal study, we investigated the role of clinical characteristics of IBD vs the use of immunomodulators (IMM and/or anti-TNFs), in determining the incidence of cancer.

Methods

In an ongoing multicenter prospective longitudinal study, all incident cases of cancer in IBD patients in follow up from Jan. to Nov. 2012 in 12 Italian IBD referral centers were recorded. Each IBD patient developing cancer (IBD-K) was matched with 2 IBD patients with no cancer (IBD-C), matched for IBD type (CD/UC), gender, age (±5yrs). Demographic and clinical characteristics of IBD and cancer were recorded. Statistic was performed by using the T test or Chi-squared test.

Results

During the follow up, incident cases of cancer were observed in 31 IBD patients (IBD-K) (16M; median age 60yrs, range 16–82), including 21 CD (68%) (CD-K) and 10 UC (32%; p < 0.001 vs CD), with no relation with gender (UC: 7M; CD: 9M). The median age at time of diagnosis of cancer was comparable between the 21 CD-K and 10 UC-K (60yrs, range 16–80 vs 60, range 37–82; p = n.s.). For each of the 31 IBD-K, 2 matched IBD-C patients were enrolled (n = 62) (32M, median age 60yrs, range 15–81). IBD duration did not differ between patients with vs without cancer (median yrs, range: IBD-K vs IBD-C 10, range 1–50 vs 12, range 1–31;CD-K vs CD-C: 8.5, range 1.5–50 vs 12, range 1–30; UC-K vs UC-C: 10, range 1–37 vs 13, range 1–31; p = ns). Among the 31 IBD-K, cancer involved: the GI tract (n = 9; 5CD, 4UC), the breast (n = 4; 3CD, 1UC), 1 HL (1 CD), other sites (n = 17, including 4 skin cancers: 3CD, 1UC, 1 melanoma in 1 CD). IMM use was observed in a comparable proportion of IBD-K and IBD-C (IBD-K vs IBD-C: 10/31, 32% vs 34/62, 55%; p = 0.06; CD-K vs CD-C 8/21, 38% vs 27/42, 64%; p = 0.09; UC-K vs UC-C 2/10, 20% vs 7/20, 35%; p = n.s.). The same finding was observed for anti-TNFs (IBD-K vs IBD-C 8/31, 26% vs 21/62, 34%; p = ns; CD-K vs CD-C 7/21, 33% vs 18/42, 43%; p = n.s.; UC-K vs UC-C 1/10: 10% vs 3/20, 15%; p = n.s.).

Conclusion

In a multicenter case-control study including incident cases of cancer in IBD patients matched with IBD controls with no cancer, clinical features of IBD, including CD type, appear to play a role in the development of cancer. Clinical characteristics of IBD may influence the risk of cancer when using immunomodulators, including anti-TNFs, in IBD.