DOP093. Characterisation of incident cases of cancer in inflammatory bowel disease: A prospective multicenter matched-pair IG-IBD study
L. Biancone1, C. Petruzziello1, A. Armuzzi2, M.L. Scribano3, R. D'Incà4, C. Papi5, L. Spina6, L. Guidi2, A. Kohn3, E. Calabrese1, G. Condino1, S. Onali1, F. Mocciaro7, R. Monterubbianesi3, P. Alvisi8, W. Fries9, G. Riegler10, F. Castiglione11, I. Frankovic4, G. Margagnoni5, R. Di Mitri7, G. Meucci12, F. Rogai13, S. Ardizzone14, A. Orlando15, F. Pallone1, 1Università di Roma Tor Vergata, Medicina dei sistemi, cattedra di Gastroenterologia, Roma, Italy, 2Università Cattolica, CIC, Roma, Italy, 3A.O.San Camillo Forlanini, Gastroenterology Unit, Rome, Italy, 4University of Padova, Gastroenterology Department, Padova, Italy, 5AO S. Filippo Neri, UOC GE/Hep, Roma, Italy, 6Università S. Donato, Gastroenterologia, Milano, Italy, 7ARNAS Civico-Di Cristina-Benfratelli Hospital, Gastroenterology and Endoscopy Unit, Palermo, Italy, 8Ospedale Maggiore, Pediatria, Bologna, Italy, 9Università di Messina, Medicina Interna, Messina, Italy, 10Seconda Università Napoli, SUN, Napoli, Italy, 11Università “Federico II” di Napoli, Gastroenterologia, Napoli, Italy, 12S. Giuseppe Hospital, Gastroenterology, Milano, Italy, 13AOU Careggi, Largo Brambilla, Gastroenterologia, Firenze, Italy, 14Luigi Sacco University Hospital, Gastroenterology Department, Milano, Italy, 15Ospedale Cervello, Medicina Interna, Palermo, Italy
Concern still exists about the cancer risk using thiopurines (IMM) and/or anti-TNFs in Inflammatory Bowel Disease (IBD). In a prospective, multicenter case–control study, we aimed to characterize incident cases of cancer in IBD. The possible role of characteristics of IBD vs IMM and/or anti-TNFs use in determining the frequency of any cancer was also investigated.
From January 2012 to October 2013, characteristics of all incident cases of cancer in IBD patients (pts) referring to 15 IBD centers were recorded in a common database. In each center, each IBD pt with a new diagnosis of cancer (IBD-K) was matched with 2 IBD pts with no cancer (IBD-C) for: IBD type (CD/UC), gender, age (±5 yrs). Statistical analysis: Data reported as median (range); Chi-squared, T test, univariate analysis used as appropriate.
Incident cases of cancer were reported in 89 IBD pts (43 M), age 59 yrs (16–85). The frequency of cancer was higher in CD (CD-K) (n = 53; 60%) than in UC (UC-K) (n = 36; 40%; p = 0.007). Controls included 178 IBD-C with no cancer (86 M, age 58 yrs, 15–83). IBD duration was comparable between the 89 IBD-K pts and their matched 178 IBD-C (12 yrs, 0–50 vs 11 yrs, 0–50; p = ns). Among the 89 IBD-K pts, cancer more frequently involved the GI tract (35%), followed by the genitourinary tract (21%), skin (9%), breast (8%), lung (7%), lymphoma (5%) (others 14%). In particular, cancer involved: the GI tract (n = 34; 14 CD, 20 UC), genitourinary tract (n = 20; 11 CD; 9 UC), skin (n = 9; 7 CD, 2 UC; in CD 3 melanoma: 2 no IMM no anti-TNFs; 1 IMM, no anti-TNFs; 4 NMSC: 3 IMM + anti-TNFs, 1 IMM, no anti-TNFs; in UC 1 melanoma, 1 Kaposi: both no IMM, no anti-TNFs); lung (n = 7; 4 CD, 3 UC), breast (n = 8; 6 CD, 2 UC), lymphoma (n = 5; 5 CD, 5 M, 2 IMM + anti-TNFs, 1 IMM, 2 no IMM/no anti-TNFs), others (n = 14; 10 CD; 4 UC). GI cancers were more frequent in UC (55%) than in CD (26%; p < 0.001), while lymphoma and skin cancers were more frequent in CD vs UC (9% vs 0%; p = 0.006; 13% vs 5%; p = 0.084). Incidence of any cancer in UC was higher in pancolitis (n = 20;55%) vs distal (n = 12; 33%; p = 0.003) or subtotal UC (n = 4;11%; p < 0.0001). In CD, there were no differences between stricturing (36%), fistulizing (28%) or inflammatory CD (36%; p = ns). IMM and anti-TNFs use was observed in a comparable proportion of IBD pts (CD, UC) developing or not cancer (IBD: IMM: IBD-K vs IBD-C: 35% vs 39%; Anti-TNFs: IBD-K vs IBD-C 31% vs 39%; p = ns).
In a prospective multicenter match-pair study, incident cases of cancer were more frequent in CD than in UC. GI cancer was more frequent in UC, while skin cancer and lymphoma in CD. IBD phenotype (CD) and UC extent appeared to influence the frequency of any cancer, while IMM and/or anti-TNFs use the frequency of specific cancer histotypes (lymphoma, skin cancer).