Increased Risk of Cancer and Mortality in a Large French Population-Based Paediatric-Onset Inflammatory Bowel Disease Retrospective Cohort

Abstract 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 Al...

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Published in:Journal of Crohn's and colitis 2023-04, Vol.17 (4), p.524-534
Main Authors: Dupont-Lucas, Claire, Leroyer, Ariane, Ley, Delphine, Spyckerelle, Claire, Bertrand, Valérie, Turck, Dominique, Savoye, Guillaume, Maunoury, Vincent, Guillon, Nathalie, Fumery, Mathurin, Sarter, Hélène, Gower-Rousseau, Corinne
Format: Article
Language:English
Subjects:
Adolescent
Adult
Child
Colitis, Ulcerative - drug therapy
Colitis, Ulcerative - epidemiology
Colorectal Neoplasms - epidemiology
Colorectal Neoplasms - etiology
Crohn Disease - drug therapy
Crohn Disease - epidemiology
Female
Human health and pathology
Humans
Incidence
Inflammatory Bowel Diseases - drug therapy
Inflammatory Bowel Diseases - epidemiology
Life Sciences
Male
Retrospective Studies
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Summary:Abstract 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. Graphical Abstract Graphical Abstract
ISSN:1873-9946
1876-4479
DOI:10.1093/ecco-jcc/jjac166