P628 Anti-TNF treatment and renal cell carcinoma in patients with inflammatory bowel disease, rheumatoid arthritis and spondyloarthropathy: trigger or cure?
L. Wauters*1, S. Joniau2, P. Verschueren3, G. Van Assche1, S. Vermeire1, M. Ferrante1
1University Hospital Leuven, Department of Gastroenterology, Leuven, Belgium, 2University Hospital Leuven, Department of Urology, Leuven, Belgium, 3University Hospital Leuven, Department of Rheumatology, Leuven, Belgium
There is limited evidence on the risk of solid cancers such as renal cell carcinoma (RCC) in chronic inflammatory conditions treated with anti-TNF therapy. We studied the occurrence of RCC in patients with inflammatory bowel disease (IBD), as well as rheumatoid arthritis and spondyloarthropathy (REU) at a tertiary referral centre.
In this retrospective cohort study using a supervised automatic search of our electronic clinical database, we included all IBD and REU patients who were diagnosed with RCC between January 1990 and September 2014. Medical records were reviewed for demographic and clinical variables, including type and duration of anti-TNF treatment. Age at diagnosis of RCC, tumour stage and surgical treatment were compared between groups.
The diagnosis of RCC was confirmed in 22/2538 (0.9%) anti-TNF naïve IBD patients and in 7/1847 (0.4%) IBD patients with anti-TNF exposure (p=0.049). IBD/RCC patients with anti-TNF had a significantly higher rate of prior immunosuppression (100% vs. 27%; p=0.001) and surgery (100% vs. 62%, p=0.042) compared to anti-TNF naïve IBD/RCC patients. In anti-TNF treated IBD patients, RCC was diagnosed at a younger age (median 46.0 (IQR 42.3-56.4) vs. 63.1 (51.6-71.8) years; p=0.034) and early surgery (within 1 month of diagnosis) (100% vs. 23%; p=0.0003) and partial nephrectomy (86% vs. 33%; p=0.013) were more common. In the REU group, 29 patients with RCC were identified with only one patient previously exposed to anti-TNF. Compared to IBD, symptomatic RCC was more common in REU patients (41% vs. 17%; p=0.043) and RCC was diagnosed at a significantly older age (70.0 (60.0-77.0) vs. 58.1 (46.0-67.3) years; p=0.008) and in advanced tumour stages (≥ T2 28% vs. 7%; p=0.037).
M, male; F, female; CD, Crohn’s disease; AS, ankylosing spondylitis; IFX, infliximab; ADA, adalimumab; ETA, etanercept; AZA, azathioprine; MTX, methotrexate; Cx, ciclosporine
|N||Sex||Age IBD/REU diagnosis||Type of IBD/REU||Age start anti-TNF||Use of anti-TNF||Time on anti-TNF (months)||Other immunosuppression||Age RCC diagnosis|
|3||F||22||CD||34||IFX, ADA||48, 41||AZA, MTX||43|
|4||M||23||CD||31||IFX, ADA||168, 3||AZA, MTX||46|
|5||M||30||CD||36||IFX, ADA||36, 48||AZA||42|
|8||M||24||AS||50||IFX, ETA||28, 38||55|
IBD/RCC patients with anti-TNF exposure were diagnosed at a younger age and undergoing early and nephron sparing surgery, inferring a better patient and tumour profile. Conversely, REU/RCC were diagnosed at a higher age and in more advanced stages with only one patient with anti-TNF. The higher rate of prior immunosuppression and surgery in IBD patients with anti-TNF indicates more active disease, requiring regular abdominal imaging which may lead to incidentally found low stage RCC. However, a potential treatment or disease related risk is not excluded and further long-term multicentre case-control studies are needed.