P327 Colorectal cancer in IBD patients treated or untreated with anti-TNFs: A retrospective matched-pair study in a 14 years follow up
M. Ascolani*1, C. Petruzziello1, G. Sica2, A. Ruffa1, S. Onali1, E. Calabrese1, E. Lolli1, F. Pallone1, L. Biancone1
1Università di Roma Tor Vergata, Medicina dei sistemi, cattedra di Gastroenterologia, Roma, Italy, 2Università di Roma Tor Vergata, Chirurgia, Roma, Italy
In murine models, blocking TNF-alpha showed efficacy in colitis-associated colon cancer. Chronic inflammation in Inflammatory Bowel Disease (IBD) colitis has been associated with colorectal cancer (CRC). In a retrospective matched-pair study, the frequency of CRC was compared in a cohort of Inflammatory Bowel Disease (IBD) patients treated or not with anti-TNFs. In a matched-pair study, the role played by clinical characteristics of IBD in determining the frequency of CRC was evaluated.
Clinical records of all IBD patients followed up from 2000 to 2014 at our tertiary IBD center developing cancer of the lower GI tract (IBD-K)(small intestine, appendix, CRC, anal canal) were reviewed. Each IBD-K patient was matched with 2 IBD patients with no cancer of the lower GI tract (IBD-C) for IBD type (Crohn's Disease,CD/Ulcerative Colitis, UC), gender,age (±5yrs). Anti-TNFs (Infliximab or Adalimumab, at least 1 administration) and immunosuppressors (IS) use was reported. Statistical analysis: data were expressed as median (range), Student's T test, Chi square test.
IBD population included 2387 patients: 384(16%) used anti-TNFs. Cancer of the lower GI tract developed in 15/2387 (0.62%) IBD patients (9 CD,6 UC), including 12 CRC (6 UC,6 CD),1 ileal carcinoma (1CD),1 appendiceal carcinoid (1CD),1 anal canal carcinoma (1CD). In the 15 IBD-K patients, age at diagnosis of cancer was 51 yrs (28-73), IBD duration 19 yrs (1-47). IBD-K patients included; 9 CD of the ileum (I)(n=4), colon (C)(n=2), ileum-colon (IC)(n=3), 6 UC distal (n=3), left-sided (n=1), pancolitis (n=2). Among the 15 IBD-K patients, 3 (20%) received anti-TNFs and/or IS (combined in all 3). In these 3 IBD-K patients, cancer included CRC (n=2), carcinoid (n=1) in 2 CD (2F,age 40,54yrs, CD duration 28,26 yrs; I-C,fistulizing), 1UC (1F,CRC, age 30, duration 19yrs; pancolitis). Among the 384/2387 (16%) IBD treated with anti-TNFs, CRC developed in 3 (0.78%)(combined IS in 3).Among the 2003/2387 (84%) IBD patients anti-TNFs naïve, 12(0.6%) developed cancer of the lower GI tract: CRC in 10 (0.5%)(p=ns vs patients treated with anti-TNFs). IBD-C included 30 patients (18CD, 12UC;14 M,age 54 [37-75]), with CD (13 I;2 C;3 I-C) or UC (distal 11,left-sided 1). Anti-TNFs were used in a comparable proportion of matched IBD patients developing or not cancer (IBD-C n=6/30; 20% vs IBD-K n=3/15;20%). In IBD-C controls, IS were used in 10 (33%)(combined with anti-TNFs in 2; 6.7%).
In a retrospective matched-pair study, a comparable low frequency of colorectal cancer was observed in IBD patients treated or untreated with anti-TNFs.