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Development of Cancer Among Patients With Pediatric-Onset Inflammatory Bowel Disease: A Meta-analysis of
Rahma Elmahdi1, Camilla E Lemser1, Sandra B Thomsen1
1Center for Molecular Prediction of Inflammatory Bowel Disease, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark.
Insights
Children with inflammatory bowel disease (IBD) face a significantly higher cancer risk, more than double that of the general pediatric population. This increased risk is mainly due to gastrointestinal cancers.
Area of Science:
- Gastroenterology
- Pediatric Oncology
- Epidemiology
Background:
- The incidence of pediatric-onset inflammatory bowel disease (IBD) is rising globally.
- Understanding the long-term cancer risk in this population is crucial for patient management and surveillance.
Purpose of the Study:
- To evaluate the relative cancer rate in individuals diagnosed with IBD during childhood.
- To identify specific cancer types and subtypes associated with pediatric IBD.
Main Methods:
- A systematic literature search was conducted across MEDLINE and Embase databases up to October 2021.
- Population-based cohort studies of pediatric IBD assessing cancer risk were included; tertiary center and insurance database studies were excluded.
- A random-effects model meta-analysis was performed on 5 eligible studies, comprising 19,812 patients and 283,540 person-years of follow-up.
Main Results:
- The meta-analysis revealed a 2.46-fold increased cancer rate in pediatric IBD patients compared to the general population.
- This elevated risk was observed for both Crohn disease (2.03-fold) and ulcerative colitis (2.61-fold).
- Key drivers of this increase include significantly higher rates of liver, colorectal, and small bowel cancers.
Conclusions:
- Patients with pediatric-onset IBD exhibit a more than twofold increased risk of cancer.
- The heightened risk is predominantly linked to gastrointestinal malignancies.
- Findings underscore the need for vigilant cancer screening and management strategies in pediatric IBD patients.
Importance:
Because the incidence of pediatric-onset inflammatory bowel disease (IBD) is increasing, knowledge of the long-term risk of cancer in this patient population is required.
Objective:
To evaluate the relative rate of cancer among patients with pediatric-onset IBD.
Data Sources:
A comprehensive systematic search was performed of MEDLINE and Embase from the date of database inception to October 31, 2021.
Study Selection:
All unselected, population-based cohort studies of pediatric-onset IBD assessing the risk of cancer were included. Tertiary center referrals and insurance database studies were excluded. All articles were assessed by 2 independent reviewers.
Data Extraction And Synthesis:
The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline for data extraction and used the Newcastle-Ottawa Scale for assessment of the risk of bias and the quality of included articles.
Main Outcomes And Measures:
A random-effects model meta-analysis was conducted of included studies using the inverse-variance method to assess the relative rate of cancer overall and by IBD subtype (Crohn disease or ulcerative colitis), sex, and thiopurine exposure among patients with pediatric-onset IBD. Pooled relative rates (pRRs) along with 95% CIs were calculated for combined studies.
Results:
Of 4628 articles screened, 5 population-based studies from North America and Europe were eligible for inclusion. These studies comprised 19 812 individuals with pediatric-onset IBD followed up for 283 540 person-years in which 715 cases of cancer were identified. Meta-analysis of pRR estimates showed a 2.4-fold increased rate of cancer among patients with pediatric-onset IBD (pRR, 2.46; 95% CI, 2.06-2.93), seen among patients with Crohn disease (pRR, 2.03; 95% CI, 1.67-2.46) and those with ulcerative colitis (pRR, 2.61; 95% CI, 2.00-3.40). This increased rate is primarily due to an increased rate of liver (pRR, 55.45; 95% CI, 19.59-156.99), colorectal (pRR, 20.29; 95% CI, 15.90-25.90), and small bowel (pRR, 16.20; 95% CI, 3.52-74.66) cancers. The incidence rate of cancer among patients with pediatric-onset IBD was reported by 4 studies and ranged from 1.0 to 3.3 cases per 1000 person-years.
Conclusions And Relevance:
This meta-analysis of unselected, population-based studies showed a greater than 2-fold increased rate of cancer among patients with pediatric-onset IBD compared with the general pediatric populations, primarily owing to an increased rate of gastrointestinal cancers.
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