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P144 Characterisation of incident cases of cancer in Inflammatory Bowel Disease: A prospective multicenter nested case-control IG-IBD study

L. Biancone*1, M.L. Scribano2, A. Armuzzi3, R. D'Incà4, C. Papi5, L. Spina6, A. Ruffa1, C. Petruzziello1, L. Guidi3, A. Kohn2, E. Calabrese1, F. Mocciaro7, P. Alvisi8, E. Angelucci1, R. Monterubbiansei2, W. Fries9, G. Riegler10, F. Castiglione11, I. Frankovic4, G. Margagnoni5, S. Renna12, R. Di Mitri7, G. Meucci13, F. Rogai14, S. Ardizzone15, A. Rossi1, A. Orlando12, F. Pallone1

1Università di Roma Tor Vergata, Medicina dei sistemi, cattedra di Gastroenterologia, Roma, Italy, 2AO S. Camillo Forlanini ~ Roma ~ Italy, GI Unit, Rome, Italy, 3Università Cattolica, CIC, Roma, 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, Department of Pediatric, Bologna, Italy, 9Università di Messina ~ , GI Unit, Messina, Italy, 10Seconda Università Napoli, SUN, Napoli, Italy, 11Università Federico II , GI Unit, Rome, Italy, 12Ospedale Cervello, Medicina Interna, Palermo, Italy, 13S. Giuseppe Hospital, Gastroenterology, Milano, Italy, 14AOU Careggi, Largo Brambilla,, Department of Gastroenterology, Firenze, Italy, 15Fatebenefratelli Hospital, Fatebenefratelli Hospital, Milano, Italy

Background

In a prospective, multicenter, nested case-control study, we aimed to characterize incident cases of cancer in IBD. The role of characteristics of IBD versus immunosuppressants (IS) and/or anti-TNFs use in determining the frequency and histotype of cancer was also investigated.

Methods

From January 2012 to October 2014, all incident cases of cancer in IBD patients (pts.) referring to 15 IBD Units were prospectively recorded. Each IBD pt. with cancer (IBD-K) was matched with 2 IBD controls with no cancer (IBD-C) for: IBD type (CD/UC), gender, age (±5yrs). Statistical analysis: data expressed as median (range), Student T test, chi-square test, multivariate logistic regression analysis, OR.

Results

Incident cases of cancer were observed in 130 IBD pts.: 77 CD (CD-K), 53 UC (UC-K). The frequency of cancer was higher in CD (59%) than in UC (41%)(p=0.004). Gender, age, IBD duration were comparable between the 130 IBD-K and 260 IBD-C (p=ns). Cancer incidence was 3.5/1000 pts., mortality rate 0.4/1000 pts. Among the 130 IBD-K pts., cancer involved: the gastrointestinal (GI) (41%;n=53) or genitourinary tract (21%;n=27;urinary n=17),lung (9.2%;n=12),skin (9.2%;n=12: 4 NMSC, 6 melanoma, 2 Kaposi), breast (6.1%;n=8), lymphoma (4.6%,n=6 only in CD: 4 NHL, IS in 4/6, IS+anti-TNFs 1/6), others (8.4%; n=11). The 53 GI tract cancers included: 35 (66%) colorectal (CRC),6 ileal (11%), 11(23%) others. GI and genitourinary tract cancers were the first and, respectively, the second more frequent cancer in IBD (p<0.0001 vs others). Cancer sites were comparable in UC vs CD: GI (51% vs 34%), genitourinary tract (17% vs 23%), skin (7% vs 10%), lung (11% vs 8%), breast (6% vs 6%), lymphoma (0 vs 10%;p=ns all), respectively. CRC, including 35/53 (66%) GI cancers,were more frequent in UC vs CD (63% vs 37%;p<0.0001). In CD, the percentage of pts. with perforating CD was higher in those developing any cancer (CD-K vs CD-C:29% vs 16%;p=0.01). In UC, the percentage of pts. with pancolitis was higher in those developing any cancer (UC-K vs UC-C: 60% vs 34%;p=0.006). Risk factors for any cancer included perforating behavior in CD (OR 2.94; 95% CI 1.25-7.11), pancolitis in UC (2.95;95% CI 1.35-6.71), but not IS and/or anti-TNFs use (CD:OR 1.77;95% CI 0.95-3.36;UC:OR 0.91; 95% CI 0.31-2.80). Age, active smoking, IBD duration, IS and/or anti-TNFs use did not increase the overall cancer risk.

Conclusion

In a prospective multicenter study, clinical characteristics, severity and phenotype of IBD (but not IS and/or anti-TNFs use) appeared to influence the overall cancer risk in IBD. CD phenotype, pancolitis in UC and penetrating behavior in CD were significant risk factors for any cancer.