P289 Extracolonic neoplasias in Inflammatory Bowel Disease patients: Data from the GETECCU ENEIDA registry
M. Chaparro*1, J.M. Benítez-Cantero2, A. López-García3, A. Juan4, J. Guardiola5, M. Mínguez6, X. Calvet7, L. Márquez8, L. Fernández-Salazar9, L. Bujanda10, A. López-San Román11, Y. Zabana12, R. Lorente13, J. Barrio14, M.D. Hinojosa15, M. Iborra16, M. Domínguez-Cajal17, M. Van Domselaar18, M.F. García-Sepulcre19, F. Gomollón20, M. Piqueras21, G. Alcaín22, M. Ramas1, V. García-Sánchez2, J. Panés3, E. Domènech4, J.P. Gisbert1
1Hospital Universitario de La Princesa, IIS-IP and CIBERehd, Gastroenterology Unit, Madrid, Spain, 2Hospital Universitario Reina Sofía, Gastroenterology Unit, Córdoba, Spain, 3Hospital Clínic de Barcelona and CIBERehd, Gastroenterology Unit, Barcelona, Spain, 4Hospital Universitari Germans Trias i Pujol and CIBERehd, Gastroenterology Unit, Badalona, Spain, 5Hospital de Bellvitge, Gastroenterology unit, Barcelona, Spain, 6Hospital Clínico Universitario de Valencia, Gastroenterology Unit, Valencia, Spain, 7Hospital de Sabadell. Corporació Sanitària Universitària Parc Taulí and CIBERehd, Gastroenterology Unit, Sabadell, Spain, 8Hospital del Mar, Gastroenterology Unit, Barcelona, Spain, 9Hospital Clínico Universitario de Valladolid, Gastroenterology Unit, Valladolid, Spain, 10Hospital de Donostia, Instituto Biodonostia, UPV/EHU and CIBEREHD, Gastroenterology Unit, Guipuzcoa, Spain, 11Hospital Universitario Ramón y Cajal, Gastroenterology Unit, Madrid, Spain, 12Hospital Universitario Mutua de Terrassa and CIBERehd, Gastroenterology Unit, Terrasa, Spain, 13Hospital General Universitario de Ciudad Real , Gastroenterology Unit, Ciudad Real, Spain, 14Hospital Universitario Rio Hortega, Gastroenterology Unit, Valladolid, Spain, 15Hospital de Manises, Gastroenterology Unit, Valencia, Spain, 16Hospital Universitario La Fe and CIBERehd, Gastroenterology Unit, Valencia, Spain, 17Hospital General San Jorge, Gastroenterology Unit, Huesca, Spain, 18Hospital de Torrejón, Gastroenterology Unit, Madrid, Spain, 19Hospital General Universitario de Elche, Gastroenterology Unit, Alicante, Spain, 20Hospital Clínico Universitario Lozano Blesa and CIBERehd, Gastroenterology Unit, Zaragoza, Spain, 21Hospital Universitari Mutua de Terrasa, Gastroenterology Unit, Barcelona, Spain, 22Hospital Clínico Universitario Virgen de la Victoria , Gastroenterology Unit, Málaga, Spain
BackgroundAims: a) To know the prevalence and distribution of ECNs in IBD patients; b) To estimate the incidence rate of ECNs; c) To evaluate the association between ECNs and the treatment with IMM and anti-TNF agents
Cohort, observational study. Inclusion criteria: IBD patients included in ENEIDA Project (a prospectively maintained registry) from GETECCU. Exclusion criteria: Patients with ECM before the diagnosis of IBD, lack of relevant information for this study (gender, date-of-birth, information about IMM and anti-TNF treatment, history of neoplasia) and patients that had received IMM other than steroids, thiopurines, methotrexate or anti-TNFs. To estimate the incidence rate of ECNs, only patients diagnosed with IBD after the implementation of ENEIDA in each center (2007 in most of them) were considered (inception cohort).
11,076 patients met the inclusion criteria (53% male, 50% Crohn's disease, median age 44 years) with a median follow-up of 99 months. 48% of patients had been exposed to IMM or anti-TNFs (46% thiopurines, 5% methotrexate, 20% anti-TNFs). The prevalence of ECN was 4.3% The prevalence of non-melanoma skin cancer and lymphoma was similar among patients exposed and non-exposed to thiopurines. The prevalence of cervical cancer was higher (but without reaching statistical significance) among women exposed to IMM (0.8 vs. 0.4%, p=0.1). In the multivariate analysis, age was the only variable associated with the risk of ECN (OR=1.03, 95%CI 1.02-1.03). 3,497 patients comprised the inception cohort, with a median follow-up of 27 months (52% male, 49% Crohn's disease, median age 38 years). 44% of patients had been exposed to IMM or anti-TNFs at any time during follow-up (42% thiopurines, 4% methotrexate, 20% anti-TNFs). 42 patients developed ECNs (1.2%), with an incidence rate of 478 and a standardized incidence rate (SIR) of 402 cases/100,000 patient-year (incidence rate in Spanish population=215 cases/100,000 inhabitants/year). Per-tumor incidence rate is shown in table 1. In the multivariate analysis, age was the only variable associated with a higher risk of ECN (HR=1.04, 95%CI 1.02-1.05). The treatment with IMM or anti-TNFs was not associated with a higher risk of ECN.
“Incidence rate of extracolonic cancers in the inception cohort”
The standardized incidence rate of ECNs in IBD patients was two-fold the incidence described for the Spanish general population. Older age was the only variable associated with a higher prevalence and incidence of ECNs. Neither thiopurines nor anti-TNF drugs seem to increase the risk of ECNs.