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P638. Impact of extra-intestinal cancer diagnosis and treament on inflammatory bowel disease outcome

S. Rajca1, A. Bourrier1, H. Sokol1, L. Beaugerie1, I. Nion-Larmurier1, P. Seksik1, J. Cosnes1, 1St Antoine hospital, Gastroenterology, Paris, France

Background

The occurrence of extra-intestinal cancer in a patient with inflammatory bowel disease (IBD) may worsen the course of IBD due to a modification of IBD treatment, gastrointestinal side effects of chemotherapy or radiotherapy, or a pro-inflammatory effect of malignant lesions. The aim of our study was to evaluate the impact of cancer and its management on IBD outcome.

Methods

80 IBD patients (51 Crohn's disease, 29 ulcerative colitis, 33 men, mean age at diagnosis 40 yrs) diagnosed with extra-intestinal cancer were selected in the MICISTA database, including 7500 cases of IBD. IBD activity (a year was considered as active if at least one flare occurred), medical treatment and surgery, collected prospectively, were compared before and after cancer diagnosis. Moreover, patients with cancer were compared to control patients without cancer matched (1 on 3) on age, sex, disease phenotype (CD or UC) and age at IBD diagnosis. Results were expressed as median and interquartile range (IQR). Comparisons were performed using non parametric tests.

Results

During the 3 years following cancer diagnosis, IBD was active in 41 patients (51%), immunosupressants were started or continued in 18 patients (22%; thiopurines n = 9, methotrexate n = 8, anti-TNF n = 2), and surgery was required in 13 patients (16%; 9 CD, 4 UC). In the 55 patients who had a prospective follow up, percentage of active years was 27% (IQR 0–50) before, and 19% (IQR 0–53) after cancer diagnosis (NS). Comparison of these two consecutive periods did not show significant changes in the number of patients who received immunosuppressants (20 vs. 24, NS) and required surgery (8 vs. 15, NS). Patients treated with chemotherapy (n = 27) had the same percentage of active years than those who did not receive chemotherapy (33 vs. 32.5%, NS). Compared to controls (2121 patient-years), evolution after cancer diagnosis (629 patient-years) was characterized by a lesser use of immunossupressants (19% vs. 25%, p < 0.001), and increased rate of surgery (4% vs. 2.5%, p < 0.05), but percentage of active years was similar (30.7 vs. 30.4%). Individual variations in IBD activity after cancer diagnosis were not statistically different in patients with cancer and their matched controls.

Conclusion

Occurrence of extra-intestinal cancer impacts IBD therapeutic management, with less use of immunosuppressants and more surgery. However in the long-term, cancer diagnosis does not seem to influence IBD activity.