Malignancies in Inflammatory Bowel Disease: Frequency, Incidence and Risk Factors—Results from the Swiss IBD Cohort Study

Abstract

BACKGROUND: Malignancy may occur as long-term complication of inflammatory bowel disease (IBD) due to different risk factors. We assessed prevalence and incidence of malignancy, and predictive factors in the Swiss IBD Cohort Study (SIBDCS). METHODS: All IBD patients in the SIBDCS were analyzed from a cross-sectional and longitudinal perspective. Patients with malignancies were compared to controls. Standardized incidence ratios (SIR) were calculated based on age-specific and sex-specific background rates. RESULTS: Malignancies were identified in 122 of 3119 patients (3.9%). In a logistic regression model, age (OR 1.04 per year), intestinal surgery (OR 3.34), and treatment with steroids (OR 2.10) were the main predictors for the presence of malignancy, while treatment with 5-ASA (OR 0.57) and biologics (OR 0.38) were protective. From a longitudinal perspective, 67 out of 2580 patients (2.6%) were newly diagnosed with malignancy during a follow-up of 12,420.8 years (median 4.9 years). While there was no increased risk for malignancy overall (SIR 0.93, 95% CI 0.72–1.18) and colorectal cancer (SIR 1.55, 95% CI 0.71–2.95), IBD patients had an increased risk for lymphoma (SIR 2.98, 95% CI 1.36–5.66) and biliary cancer (SIR 6.3, 95% CI 1.27–18.41). In a Cox regression model, age and recent use of immunomodulators were the main predictors for development of malignancies, while 5-ASA, biologics were protective. CONCLUSIONS: IBD patients showed increased risk for lymphoma and biliary cancer, but not colorectal cancer and cancer overall. Age and recent use of immunomodulators were the main risk factors for malignancy, while aminosalicylates and biologics appear to be protective.

Safety of Ustekinumab in Inflammatory Bowel Disease: Pooled Safety Analysis of Results from Phase 2/3 Studies

“…These rates are also similar to those observed in a Swiss IBD population (SIR, 0.93, [95% CI, 0.72–1.18]). 19 A small number of NMSCs were reported in this data set and comparable between ustekinumab and placebo. A reversal of BCC:SCC ratio (4:1), 20 a marker of immunosuppression impact, was not observed.…”

Roles of Macrophages in the Development and Treatment of Gut Inflammation

“…Despite the low mortality rate of IBD, the incidence rate is still a serious problem. Moreover, IBD is incurable and increases the risk of lymphoma, cholangiocarcinoma, and colorectal cancer (Samadder et al, 2019;Scharl et al, 2019). Many patients with IBD have to undergo surgery multiple times to relieve symptoms, which may lead to postoperative complications and infections, adversely affecting their quality of life (Torres et al, 2017;Ungaro et al, 2017;Liang et al, 2018).…”

Human Intestinal Mononuclear Phagocytes in Health and Inflammatory Bowel Disease

“…However, despite very low mortality from IBD, morbidity remains a significant problem, and conventional medication involves escalating drug regimens with concomitant side effects. Moreover, IBD is not curable and increases the risk for lymphoma, biliary cancer, and colorectal cancer (20,21). A significant number of IBD patients do not respond to treatments and must instead undergo surgery to relieve symptoms, often multiple times.…”