P126 IBD-related malignancies and mortalities observed in 2015: first results from the prospective nationwide Hungarian registry
T. Molnar*1, F. Nagy1, P. Fitz2, L. Lakatos3, P. Miheller4, T. Szamosi5, A. Vincze6, J. Banai5, A. Kovács7, J. Novák8, A. Salamon9, A. Szepes10, N. Szigeti11, M. Juhász4, K. Müllner4, O. Kadenczki12, M. Rutka1, A. Bálint1, R. Bor1, A. Milassin1, Z. Szepes1, K. Farkas1
1University of Szeged, First Department of Medicine, Szeged, Hungary, 2St. Francis Hospital, Kalocsa, Hungary, 3Csolnoky Ferenc Veszprém County Hospital, Veszprém, Hungary, 4Semmelweis University, 2nd Department of Medicine, Budapest, Hungary, 5State Health Centre, Department of Gastroenterology, Budapest, Hungary, 6University of Pécs, First Department of Internal Medicine, Pécs, Hungary, 7Péterfy Sándor Hospital and Trauma Centre, Budapest, Hungary, 8Bekes County Pandy Kalman Hospital, Gyula, Hungary, 9Tolna County Balassa Janos Hospital, Gastroenterology Department, Szekszárd, Hungary, 10Bács-Kiskun County University Teaching Hospital, Kecskemét, Hungary, 11University of Pécs, Second Department of Internal Medicine and Nephrology Centre, Pécs, Hungary, 12University of Debrecen, Debrecen, Hungary
Inflammatory bowel diseases (IBD-Crohn’s disease [CD]; ulcerative colitis [UC] are lifelong inflammatory conditions of the gastrointestinal tract. IBD-associated colorectal cancer (CRC) accounts for approximately 1%–2% of all cases of CRC. Although data on mortality rates in IBD patients are controversial, CRC has been shown to account for approximately 10%–15% of all deaths amongst IBD patients. The aim of our nationwide registry was to collect prospectively IBD-related mortalities and all types of malignancies diagnosed in the Hungarian IBD population.
Data on all death and malignancies developed from January 2015 in IBD patients were recorded. Each members of the Hungarian Society of Gastroenterology were prospectively interviewed 3 times monthly by personal e-mails to report both death and malignancies observed in their patient population. Demographic and clinical data including previous immunosuppressive and biological therapy were also collected.
In total, 14 newly diagnosed malignancies were reported (mean age 48.4 years old; mean disease duration was 20 years; male/female ratio was 10/4) 11 CRC (mean age 50.5 years; mean disease duration 20.2 years; and male/female ratio was 8/3), 1 pouch cancer previously colectomised because of sigmoid tumour, 1 with gallbladder, 1 with cervix, and 1 with tonsil cancer throughout the examined period. Further, 7 of the 11 CRC cases were associated with UC, 86% with pancolitis and chronic disease course. Eight of the eleven cases were located on the rectosigmoid region; one had multiple localisation (5 cancers simultaneously). Thirteen patients with treated IBD died during the examined period. Seven cases were related to IBD (5 males, 2 females; 1 CD patient with rectal cancer, 1 patient with pouch cancer, 1 CD patient with interstitial pneumonia, 1 UC and 1 CD patients with septic complications, 1 UC patient with meningitis, 1 UC patient with haemorrhagic shock). Age of death was significantly lower in case of IBD-related mortality compared with the other patients and general population (44 vs 65 vs 73.4 [data from Central Statistical Office 2013, Hungary] years, p = 0.02). Biological therapy was administered for 4 patients with IBD-related mortality throughout the disease course.
The most frequently observed IBD-related malignancy is CRC, which can be multifocal and mainly involved the distal part of the colorectum typically in UC patients with pancolitis and chronic activity. Malignancy and septic complications were the leading causes of IBD-related mortality characterised by earlier death than in the rest and in the non-IBD population.