Incidence, Management, and Course of Cancer in Patients with Inflammatory Bowel Disease

Algaba, Alicia; Guerra, Iván; Marín-Jiménez, Ignacio; Quintanilla, E.; López-Serrano, Pilar; García-Sánchez, María Concepción; Casís, Begoña; Taxonera, Carlos; Moral, I.; Chaparro, María; Martín-Rodríguez, Daniel; Martín-Arranz, María Dolores; Manceñido, Noemí; Menchén, Luís; López-Sanromán, Antonio; Castaño, Ángel; Bermejo, Fernando

doi:10.1093/ecco-jcc/jjv032

Cited by 40 publications

(47 citation statements)

References 34 publications

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“…We estimated an incidence of 21.7/100,000, which is lower than the incidence in the general Swiss population (NICER, 47.7 for males, 29.5/100,000 for females). Similar results were achieved by a recent Spanish cohort study [23] . This paradoxical result is most likely caused by the fact that the median age of the investigated population was quite low and the incidence of CRC increases with age.…”

Section: Discussionsupporting

confidence: 90%

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Malignancies in Patients with Inflammatory Bowel Disease: A Single-Centre Experience

Madanchi¹,

Zeitz²,

Barthel³

et al. 2016

Digestion

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Background: Gastrointestinal and extraintestinal malignancies are long-term complications in patients with inflammatory bowel disease (IBD), likely as a result of chronic inflammation and the use of immunosuppressive medications used to control inflammation. Here, we assessed the frequency of malignancies in a large tertiary IBD centre at the University Hospital Zurich. Methods: We performed a retrospective analysis of data from 1,026 patients from our IBD clinic treated between 2007 and 2014. Results: Twenty two of the 1,026 patients developed 28 cases of malignancies, 14 patients were male and 8 patients female. The median latency between IBD diagnosis and first malignancy was 13 years (range 2-27 years). Most common malignancies were non-Hodgkin lymphoma, colorectal cancer (CRC), urothelial carcinoma, cholangiocellular carcinoma (CCC) and prostate cancer. The most common tumour type in Crohn's disease patients (13/22) was lymphoma (5 cases), in ulcerative colitis patients (9/22) CCC (2 cases) and CRC (2 cases). The observed incidence of lymphoma (32.5/100,000), bladder carcinoma (21.7/100,000) and CCC (10.8/100,000) was higher than expected and known from general population. All of the patients that developed a malignancy had received immunosuppressive therapy. Compared to a cohort of 927 IBD patients without malignancies there were no statistical differences regarding gender, antibodies targeting tumour necrosis factor and thiopurine use. Conclusion: Our data support the assumption that a long-standing disease course and immunosuppressive therapy increase the risk for developing malignancies in IBD patients.

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Section: Discussionsupporting

confidence: 90%

“…However, the CESAME cohort study found an incidence similar to the general population [31] . Algaba et al [23] also confirmed this new trend. The suggested regular skin cancer screening in IBD patients may be the reason for this finding.…”

Section: Discussionmentioning

confidence: 68%

Malignancies in Patients with Inflammatory Bowel Disease: A Single-Centre Experience

Madanchi¹,

Zeitz²,

Barthel³

et al. 2016

Digestion

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“…Eleven articles represented duplicate data 47–52 and we were unable to obtain sufficient information for analysis from 5 studies 53–57 resulting in a final cohort of 16 unique studies 34–43, 46, 58–62 (Table 1). There was an equal number of studies in IBD 35, 39–42, 46, 58 and RA 34, 36, 37, 43, 60–62 , with 1 study combining both populations 59 and 1 study in psoriasis 62 . Ten studies were population-based 34–38, 43, 46, 59, 60, 62 and 12 studies adopted a cohort design 34–38, 40, 41, 43, 46, 59, 60, 62 .…”

Section: Resultsmentioning

confidence: 99%

“…Ten studies were population-based 34–38, 43, 46, 59, 60, 62 and 12 studies adopted a cohort design 34–38, 40, 41, 43, 46, 59, 60, 62 . Three were from North America 40, 58, 59 , twelve from Europe 34–39, 41–43, 46, 60, 62 , and one from Asia 61 . The included studies investigated a spectrum of prior cancers (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…A few observational cohorts and registry-based studies suggested no increase in risk of cancer recurrence; however, the event rates were low, limiting statistical power to identify a true effect 34–38 . In addition, few prior studies have been able to compare the rate of recurrence of prior cancer or development of a new primary cancer between the different types of immunosuppressive therapy 34–36, 39–43 . Given the growing availability of different therapeutic targets, comparative safety studies are critical to appropriately position these therapies.…”

Section: Introductionmentioning

confidence: 99%

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Cancer Recurrence Following Immune-Suppressive Therapies in Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis

et al. 2016

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Background & Aims Physicians frequently encounter patients with immune-mediated diseases and a history of malignancy. There are limited data on the safety of immunosuppressive therapy for these patients. Published studies have been small with few events, precluding robust estimates of risk. Methods We searched Medline, EMBASE, and conference proceedings for terms related to immune mediated disease, immune-suppressive therapy, and cancer recurrence from inception to April 2015. We included 16 studies (9 of patients with rheumatoid arthritis, 8 of patients with inflammatory bowel disease, and of patients with psoriasis) and stratified studies by type of immune-suppressive therapy (monoclonal antibodies to tumor necrosis factor [anti-TNF], conventional immune-modulatory agents, or no immune suppression). A random effects meta-analysis was performed to calculate pooled incidence rates as well as risk differences between the various treatments. Results Our analysis included 11,702 persons contributing 31,258 person-years (p-y) of follow up after a prior diagnosis of cancer. Rates of cancer recurrence were similar among individuals receiving anti-TNF therapy (33.8/1000 p-y), immune-modulator therapy (36.2/1000 p-y), or no immunosuppression (37.5/1000 p-y), but were numerically higher among patients receiving combination immune suppression (54.5/1000 p-y) (P>.1 for all). Subgroup analysis of new and recurrent cancers separately, type of immune-modulator therapy, or immune-mediated disease revealed similar results, with no increase in risk. We found similar pooled incidence values for new or primary cancers when immunosuppression was initiated within 6 years (33.6/1000 p-y for immune-modulatory agents and 43.7/1000 p-y for anti-TNF agents) vs more 6 years after the index cancer (32.9/1000 p-y for immune-modulatory agents; P=.86 and 21.0/1000 p-y for anti-TNF agents; P=.43) Conclusion In a meta-analysis of 16 studies, we observed similar rates of cancer recurrence among individuals with prior cancer who received no immunosuppression, anti-TNF therapy, immune-modulator therapy, or combination treatments. Prospective studies are needed to ascertain optimal intervals for re-initiation of immune suppressive therapies for individuals with specific cancers.

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Female-Specific Cancer Risks and Screening in Inflammatory Bowel Disease

Felice

Kane

2019

Cancer Screening in Inflammatory Bowel Disease

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Incidence, Management, and Course of Cancer in Patients with Inflammatory Bowel Disease

Abstract: Patients with IBD have an increased risk for non-melanoma skin cancer and small bowel cancer. Immunosuppresive therapy is not related to a higher overall risk for cancer or worse tumor evolution in patients who maintain these drugs after cancer diagnosis.

Cited by 40 publications

References 34 publications

Malignancies in Patients with Inflammatory Bowel Disease: A Single-Centre Experience

Malignancies in Patients with Inflammatory Bowel Disease: A Single-Centre Experience

Cancer Recurrence Following Immune-Suppressive Therapies in Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis

Female-Specific Cancer Risks and Screening in Inflammatory Bowel Disease

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