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Increased Risk of Cancer and Mortality in a Large French Population-Based Paediatric-Onset Inflammatory Bowel Disease
Claire Dupont-Lucas1,2, Ariane Leroyer3,4, Delphine Ley4,5
1Department of Paediatrics, Caen University Hospital, F-14000 Caen, France.
Insights
Patients with paediatric-onset inflammatory bowel disease (IBD) face higher risks of cancer and mortality in adulthood. Factors like smoking and anti-TNF therapy increase cancer risk, while extraintestinal manifestations are linked to mortality.
Area of Science:
- Gastroenterology and Hepatology
- Oncology
- Epidemiology
Background:
- Paediatric-onset inflammatory bowel disease (pIBD) is linked to significant long-term health risks, including cancer and mortality.
- Understanding these risks is crucial for proactive management and improved patient outcomes.
Purpose of the Study:
- To quantify the incidence of cancer and mortality in adults with a history of pIBD.
- To identify specific factors associated with increased mortality and cancer risk in this cohort.
Main Methods:
- Retrospective cohort study of patients diagnosed with Crohn's disease or ulcerative colitis before age 17.
- Follow-up for cancer and mortality data, with standardized incidence and mortality ratios calculated against the general population.
- Cox regression analysis to determine risk factors for cancer and mortality.
Main Results:
- The study included 1344 patients, with 14 cancer cases and 15 deaths observed.
- pIBD patients showed a 2.7-fold increased cancer risk and a 1.7-fold increased mortality risk compared to the general population.
- Colorectal cancer risk was significantly elevated (SIR 41.2, SMR 70.4). Active smoking, anti-TNF therapy, and combination therapy were associated with increased cancer risk.
Conclusions:
- Individuals with pIBD have a substantially elevated risk of developing cancer and experiencing mortality.
- Specific therapeutic exposures and lifestyle factors like smoking significantly influence cancer risk in pIBD patients.
- Early identification and management of risk factors are essential for improving long-term outcomes in pIBD survivors.
Background And Aims:
Paediatric-onset IBD [pIBD] is associated with an increased risk of cancer and mortality in adulthood. The aims of this study were to measure the incidence of cancer and mortality in patients with pIBD and identify factors associated with mortality and cancer.
Methods:
All patients diagnosed with Crohn's disease [CD] or ulcerative colitis [UC] before the age of 17 years between 1988 and 2011 in the EPIMAD registry were retrospectively followed until 2013 for cancer and 2015 for mortality. Standardized incidence [SIR] and mortality ratios [SMR] were estimated compared to the general population. Cox regression was used to compare the effect of exposures on cancer and mortality among IBD patients.
Results:
We included 1344 patients [52% males, 75% CD], totalling 12 957 patient-years for cancer incidence and 18 817 patient-years for mortality. There were 14 cases of cancer [median age 27.8 years] and 15 deaths [median age 28.8 years]. The incidence of cancer and of mortality were increased compared to the general population: all-cancer SIR = 2.7 (95% confidence interval [CI]: 1.5-4.8), SMR = 1.7 [95% CI: 1.0-2.8]. Colorectal cancer had the highest SIR and SMR: SIR = 41.2 [95% CI: 17.2-99.0], SMR = 70.4 [95% CI 22.7-218.2]. Cancer was associated with (hazard ratio [HR], 95% CI): active smoking at diagnosis [5.5, 1.8-16.5], p = 0.002; any exposure to anti-tumour necrosis factor [6.1, 1.7-22.3], p = 0.0065; and exposure to combination therapy [7.4, 1.8-29.7], p = 0.0047. Mortality was associated with extraintestinal manifestations (HR 4.9 [95% CI: 1.7-13.8], p = 0.003).
Conclusions:
In this large population-based cohort, patients with pIBD had an increased risk of both cancer [2.7-fold] and mortality [1.7-fold], particularly for colorectal cancer.
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