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P802 Perforating Crohn's Disease and pancolitis as risk factors for incident cancer: a prospective multi-centre nested case–control IG-IBD study at 6 years

C. Petruzziello1, A. Armuzzi2, M. L. Scribano3, F. Castiglione4, R. D'incà5, M. Daperno6, C. Papi7, M. Vecchi8, W. Fries9, G. Riegler10, P. Alvisi11, F. Mocciaro12, B. Neri13, S. Festa7, A. Testa14, E. Calabrese15, R. Di Mitri16, E. De Crstofaro1, C. Gesuale1, L. Spina17, F. Rogai18, S. Renna19, G. Meucci20, L. Guidi21, A. Rossi15, A. Orlando19, L. Biancone*15

1University "Tor Vergata" of Rome, Department of Systems Medicine, Rome, Italy, 2Internal Medicine and Gastroenterology - Complesso Integrato Columbus Catholic University, Complesso Integrato Columbus, Internal Medicine and Gastroenterology, Rome, Italy, 3Azienda Ospedaliera S.Camillo-Forlanini, Gastroenterology Unit, Rome, Italy, 4Federico II University, Gastroenterologia AOU, Gastroenterologia AOU, Naples, Naples, Italy, 5University of Padua, Department of Surgical, Oncological and Gastroenterological Sciences, Padua, Italy, 6A.O. Mauriziano, Gastroenterology Unit, Turin, Italy, 7S. Filippo Neri Hospital, Gastroenterology Unit, Rome, Italy, 8IRCCS ca' Granda, Ospedale Maggiore Policlinico Foundation University of Milan della Carita, Gastroenterology and Endoscopy Unit, Milan, Italy, 9University of Messina, Department of Clinical and Experimental Medicine, Clinical Unit for Chroric Bowel Disorders, Messina, Italy, 10University della Campania ‘Luigi Vanvitelli’, U.O. of Gastroenterology C.S., Naples, Italy, 11Ospedale Maggiore, Unit PEDIATRIA, Bologna, Italy, 12Hospital Civico, Gastroenterology, Palermo, Italy, 13University "Tor Vergata" of Rome, GI Unit, Department of Systems Medicine, Rome, Italy, 14Federico II University, Gastroenterologia AOU, Naples, Italy, 15University, Department of Systems Medicine, Rome, Italy, 16Hospital Civico, Gastroenterology Unit, Palermo, Italy, 17IRCCS Policlinico S. Donato, San Donato Milanese, Gi Unit, Milan, Italy, 18AOU Careggi Univesrity Hospital, Gi Unit, Florence, Italy, 19Hospital ‘Riuniti Villa Sofia-Cervello’, Di.Bi.Mis., C.O.U. Of Internal Medicine, Palermo, Italy, 20SOFAR Ospedale San Giuseppe, Gi Unit, Milan, Italy, 21Complesso Integrato Columbus Catholic University, Complesso Integrato Columbus, Internal Medicine and Gastroenterology, Rome, Italy


In a prospective, multi-centre, nested case–control study at 6 years (years), we aimed to characterise incident cases of cancer in inflammatory bowel disease (IBD). Secondary end point was to evaluate risk factors for cancerc in IBD.


From 31 December 2011 to 31 December 2017, all incident cases of cancer in IBD patients referring to 16 IG-IBD Units (≥2 visits/year) were recorded. Each IBD patient with incident cancer was matched with 2 IBD patients with no cancer for: IBD type (Crohn’s disease, CD; ulcerative colitis, UC), gender, age (±5 years). Data expressed as median (range). Wilcoxon, χ2, Fisher exact test, multi-variate logistic regression analysis (OR [95% CI]).


Incident cancer occurred in 403 IBD patients: 204 CD (CD-K),199 UC (UC-K). Overall, 1209 IBD patients were considered (403 IBD-K; 806 IBD-C). In IBD, cancer (n = 403) involved (n = [%]): digestive system (129 [32%]), skin (60 [14.9%]: 27 NMSC, 31 melanoma, 2 others),urinary tract (39 [9.7%]), lung (28 [6.9%]), breast (22 [5.5%]), genital tract (26 [6.5%]), thyroid (8 [1.98%]), lymphoma (11 [2.72%] all in CD), small bowel cancers (16 [3.9%];15 CD [7.3%], 1 UC ileal pouch [0.5%]), others (64[15.9%]). Cancer frequency was comparable between CD and UC considering (n = [%]):digestive system (61[30%] vs. 6 [34%]);skin (33[16%] vs. 27[13.5%]);lung (14[6.8%] vs. 14 [7.0%]);breast (22[10.7%] vs. 24[12.1%]);genital tract (15[7.3%] vs. 11 [5.5%];p>0.05). Colorectal and urinary tract cancers were more frequent in UC vs. CD (58[29%] vs. 35[17%],p < 0.005;26[13%] vs. 13[6.3%], p = 0.039). Extracolonic cancers were more frequent in CD vs. UC (35/204 [17%] vs. 58/199 [29%]; p < 0.005). Risk factors considered: age (<40 vs. ≥40 years), IBD duration (< 10 vs. ≥10 years), smoking (Yes/No), ISS and/or anti-TNFα (Y/N),IBD-related surgery, UC extent, CD pattern, perianal CD risk factors for any cancer identified in UC: UC-related surgery (4.63 [2.62–8.42]), extensive vs. distal UC (1.73 [1.10–2.75]). The other risk factors were not significant (OR 1.30 [0.74–2.39]; 0.92 [0.63–1.35]; 0.92 [0.55–1.52]; 0.84 [0.51–1.38]; 1.54 [0.95–2.51], respectively). In CD, perforating pattern was the only significant risk factor (OR 2.33 [1.33–4.11]) (other risk factors: OR 0.93 [0.59–1.48]; 0.98 [0.67–1.43]; 0.74 [0.51–1.07]; 1.31 [0.90–1.92]; 0.97 [0.62–1.51]; 1.25 [0.79–2.01]; 1.02 [0.65–1.60]).In CD, the frequency of B3 pattern was higher in CD-K vs. CD-C (26% [54/204] vs. 15% [63/408]; p = 0.0033).The frequency of extensive UC was higher in UC-K vs. UC-C (51% [101/199] vs. 38% [152/398]; p = 0.0045).


In a prospective, multi-centre, nested-case–control study at 6 years, penetrating CD, extensive UC and UC-related surgery were significant risk factors for any incident cancer. Clinical characteristics of severity of IBD may increase the overall cancer risk. Lymphoma and SBC were associated with CD.