P532. Colon cancer in IBD patients treated or untreated with anti-TNFs: A retrospective matched-pair study in a 13 years follow up
M. Ascolani, G. Condino, C. Petruzziello, S. Onali, E. Calabrese, E. Lolli, A. Ruffa, F. Pallone, L. Biancone, Università di Roma Tor Vergata, Medicina dei sistemi, cattedra di Gastroenterologia, Roma, Italy
Blocking TNF-α showed efficacy in colitis-associated colon cancer in murine models. Chronic inflammation in Inflammatory Bowel Disease (IBD) colitis has been associated with colon cancer. In a monocentric retrospective matched-pair study in a cohort of IBD patients in follow up, we compared the frequency of colon cancer in patients treated or untreated with anti-TNFs. The role played by clinical characteristics of IBD in determining the frequency of colon cancer was also evaluated.
Clinical records of all IBD patients in follow up from 2000 to 2013 developing cancer of the lower GI tract (IBD-K) (small intestine, appendix, colon or anal canal) were reviewed. Each IBD-K patient was retrospectively matched with 2 IBD patients with no cancer (IBD-C), for IBD type (MDC/RCU), gender, age (±5 yrs). Anti-TNFs (Infliximab or Adalimumab ≥1 dose) and IMM (≥6 mos) use was reported. Statistical analysis: data expressed as median (range); Student's T test, Chi squared test.
During the study period, 2387 IBD patients were in follow up: 384 (16%) received anti-TNFs. From 2000 to 2013, 15 IBD patients (9 CD, 6 UC) developed cancer of the lower GI tract (0.62%), including 12 colon cancers (6 UC, 6 CD), 1 ileal adenocarcinoma (1 CD), 1 carcinoid of the appendix (1 CD), 1 anal canal squamous carcinoma (1 CD). Among the 15 IBD-K (7 M), median age at diagnosis of cancer was 51 (28–73) yrs, IBD duration 19 yrs (1–47). CD involved the ileum (I) in 4 patients, the colon (C) in 2 patients and the ileum–colon (IC) in 3 patients; UC was distal in 3, left-sided in 1 and total in 2 patients. Among the 15 IBD-K patients, 3 (20%) received anti-TNFs and/or IMM (all 3 received both). These 3 patients developed cancer (2 colon, 1 carcinoid): 2 CD (2 F, age 40 and 54 yrs, CD duration 28 and 26 yrs; fistulizing IC) and 1 UC (1 F, age 30, duration 19 yrs; pancolitis). Among the 384/2387 (16%) IBD patients treated with anti-TNFs during the 13 years follow up, colon cancer developed in 3 (0.78%) (all 3 patients also treated with IMM). Among the 2003/2387 patients never treated with anti-TNFs during the follow up, 12 (0.6%) developed cancer of the lower GI tract, 10 (0.5%) colon cancer (p = ns vs patients treated with anti-TNFs). IBD-C included 30 patients (18 CD, 12 UC; 14 M/16 F, age 54 yrs, range 37–75; CD of the I (n = 13), C (n = 2), IC (n = 3); UC was distal (n = 11), left-sided (n = 1) or total (n = 0). Anti-TNFs were used by a comparable number of IBD patients developing or not cancer (IBD-C n = 6/30; 20% vs IBD-K n = 3/15; 20%). In IBD-C, IMM use was reported in 10 (33%) (combined with anti-TNFs in 2; 6.7%).
In a retrospective matched-pair study, a comparable low frequency of colon cancer was observed in IBD patients treated or untreated with anti-TNFs.