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Biancone L, Armuzzi A, Scribano ML, Castiglione F, D'Incà R, Orlando A, Papi C, Daperno M, Vecchi M, Riegler G, Fries W, Alvisi P, Meucci G, Mocciaro F, Rogai F, Festa S, Guidi L, Testa A, Spina L, Renna S, Viola A, Patturelli M, Di Mitri R, Frankovic I, Calabrese E, Petruzziello C, De Cristofaro E, Sena G, Ruffa A, Neri B, Rossi A. Cancer Risk in Inflammatory Bowel Disease: A 6-Year Prospective Multicenter Nested Case-Control IG-IBD Study. Inflamm Bowel Dis 2020; 26:450-459. [PMID: 31498388 DOI: 10.1093/ibd/izz155] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND In a 6-year, multicenter, prospective nested case-control study, we aimed to evaluate risk factors for incident cancer in inflammatory bowel disease (IBD), when considering clinical characteristics of IBD and immunomodulator use. The secondary end point was to provide characterization of incident cancer types. METHODS All incident cases of cancer occurring in IBD patients from December 2011-2017 were prospectively recorded in 16 Italian Group for the Study of Inflammatory Bowel Disease units. Each of the IBD patients with a new diagnosis of cancer was matched with 2 IBD patients without cancer, according to IBD phenotype (ulcerative colitis [UC] vs Crohn's disease [CD]), age (±5 years), sex. Risk factors were assessed by multivariate logistic regression analysis. RESULTS Cancer occurred in 403 IBD patients: 204 CD (CD cases), 199 UC (UC cases). The study population included 1209 patients (403 IBD cases, 806 IBD controls). Cancer (n = 403) more frequently involved the digestive system (DS; 32%), followed by skin (14.9%), urinary tract (9.7%), lung (6.9%), genital tract (6.5%), breast (5.5%), thyroid (1.9%), lymphoma (2.7%, only in CD), adenocarcinoma of the small bowel (SBA; 3.9%, 15 CD, 1 pouch in UC), other cancers (15.9%). Among cancers of the DS, colorectal cancer (CRC) more frequently occurred in UC (29% vs 17%; P < 0.005), whereas SBA more frequently occurred in CD (13% vs 6.3% P = 0.039). In CD, perforating (B3) vs non-stricturing non-perforating (B1) behavior represented the only risk factor for any cancer (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.33-4.11). In CD, risk factors for extracolonic cancer (ECC) were a B3 vs B1 and a stricturing (B2) vs B1 behavior (OR, 2.95; 95% CI, 1.62-5.43; OR, 1.79; 95% CI, 1.09-2.98). In UC, risk factors for ECC and for overall cancer were abdominal surgery for UC (OR, 4.63; 95% CI, 2.62-8.42; OR, 3.34; 95% CI, 1.88-5.92) and extensive vs distal UC (OR, 1.73; 95% CI, 1.10-2.75; OR, 1.99; 95% CI, 1.16-3.47). Another risk factor for ECC was left-sided vs distal UC (OR, 1.68; 95% CI, 1.00-2.86). Inflammatory bowel disease duration was a risk factor for skin and urinary tract cancers. CONCLUSIONS Perforating CD, extensive UC, and abdominal surgery for UC were identified as risk factors for overall incident cancer and for ECC. The clinical characteristics associated with severe IBD may increase cancer risk.
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Affiliation(s)
- Livia Biancone
- Department of Systems Medicine, GI Unit, Università degli Studi di Roma "Tor Vergata", Rome, Italy
| | - Alessandro Armuzzi
- IBD Unit, Presidio Columbus Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Renata D'Incà
- IBD Unit, Gastroenterology, Azienda-Università of Padova, Padua, Italy
| | | | | | - Marco Daperno
- AO Ordine Mauriziano, SC Gastroenterologia, Turin, Italy
| | - Maurizio Vecchi
- University of Milan, IRCCS Ca' Granda, Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Gabriele Riegler
- Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - Walter Fries
- IBD Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | | | - Filippo Mocciaro
- GI and Endoscopy Unit, ARNAS Civico Di Cristina-Benfratelli, Palermo, Italy
| | | | | | - Luisa Guidi
- IBD Unit, Presidio Columbus Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Sara Renna
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Anna Viola
- IBD Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Marta Patturelli
- Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - Roberto Di Mitri
- GI and Endoscopy Unit, ARNAS Civico Di Cristina-Benfratelli, Palermo, Italy
| | - Iris Frankovic
- IBD Unit, Gastroenterology, Azienda-Università of Padova, Padua, Italy
| | - Emma Calabrese
- Department of Systems Medicine, GI Unit, Università degli Studi di Roma "Tor Vergata", Rome, Italy
| | - Carmelina Petruzziello
- Department of Systems Medicine, GI Unit, Università degli Studi di Roma "Tor Vergata", Rome, Italy
| | - Elena De Cristofaro
- Department of Systems Medicine, GI Unit, Università degli Studi di Roma "Tor Vergata", Rome, Italy
| | - Giorgia Sena
- Department of Systems Medicine, GI Unit, Università degli Studi di Roma "Tor Vergata", Rome, Italy
| | - Alessandra Ruffa
- Department of Systems Medicine, GI Unit, Università degli Studi di Roma "Tor Vergata", Rome, Italy
| | - Benedetto Neri
- Department of Systems Medicine, GI Unit, Università degli Studi di Roma "Tor Vergata", Rome, Italy
| | - Alessandra Rossi
- Department of Systems Medicine, GI Unit, Università degli Studi di Roma "Tor Vergata", Rome, Italy
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Fries W, Viola A, Manetti N, Frankovic I, Pugliese D, Monterubbianesi R, Scalisi G, Aratari A, Cantoro L, Cappello M, Samperi L, Saibeni S, Casella G, Mocci G, Rea M, Furfaro F, Contaldo A, Magarotto A, Calella F, Manguso F, Inserra G, Privitera AC, Principi M, Castiglione F, Caprioli F, Ardizzone S, Danese S, Papi C, Bossa F, Kohn A, Armuzzi A, D'Incà R, Annese V, Alibrandi A, Bonovas S, Fiorino G. Disease patterns in late-onset ulcerative colitis: Results from the IG-IBD "AGED study". Dig Liver Dis 2017; 49:17-23. [PMID: 27717794 DOI: 10.1016/j.dld.2016.09.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 08/13/2016] [Accepted: 09/11/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Late-onset UC represents an important issue for the near future, but its outcomes and relative therapeutic strategies are yet poorly studied. AIM To better define the natural history of late-onset ulcerative colitis. METHODS In a multicenter retrospective study, we investigated the disease presentation and course in the first 3 years in 1091 UC patients divided into 3 age-groups: diagnosis ≥65years, 40-64 years, and <40years. Disease patterns, medical and surgical therapies, and risk factors for disease outcomes were analyzed. RESULTS Chronic active or relapsing disease accounts for 44% of patients with late-onset UC. Across all age-groups, these disease patterns require 3-6 times more steroids than remitting disease, but immunomodulators and, to a lesser extent, biologics are less frequently prescribed in the elderly. Advanced age, concomitant diseases and related therapies were found to be inversely associated with the use of immunomodulators or biologics, but not with surgery. CONCLUSIONS The conclusion that late-onset UC follows a mild course may apply only to a subset of patients. an important percentage of elderly patients present with more aggressive disease. Since steroid use and surgery rates did not differ in this subgroup, lower use of immunosuppressive therapy and biologics may reflect concerns in prescribing these therapies in the elderly.
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Affiliation(s)
- Walter Fries
- Clinical Unit for Chronic Bowel Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Anna Viola
- Clinical Unit for Chronic Bowel Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Natalia Manetti
- Gastroenterology Unit, University Hospital Careggi, Florence, Italy
| | - Iris Frankovic
- Gastroenterology Unit, Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Daniela Pugliese
- IBD Unit Complesso Integrato Columbus, Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy
| | | | - Giuseppe Scalisi
- Div. of Gastroenterology, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | | | - Laura Cantoro
- Gastroenterology Unit, Campus BioMedico, University of Rome, Rome, Italy
| | - Maria Cappello
- UOC Gastroenterologia ed Epatologia, A.O.U. Policlinico, Palermo, Italy
| | - Leonardo Samperi
- Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Catania, Italy
| | - Simone Saibeni
- U.O. Gastroenterologia, Ospedale di Rho, ASST Rhodense, Italy
| | - Giovanni Casella
- Dipartimento di Medicina Ospedale Desio, Dipartimento di Medicina, Desio, MB, Italy
| | | | - Matilde Rea
- Gastroenterology, "Federico II" University, Naples, Italy
| | - Federica Furfaro
- Gastroenterology and IBD-Unit, Luigi Sacco University Hospital, Milan, Italy
| | | | - Andrea Magarotto
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Calella
- Gastroenterology, Ospedale San Giuseppe, Azienda USL11, Empoli, Firenze, Italy
| | - Francesco Manguso
- UOSC of Gastroenterology and Endoscopy, AORN "A. Cardarelli", Naples, Italy
| | - Gaetano Inserra
- Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Catania, Italy
| | | | | | | | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Sandro Ardizzone
- Gastroenterology and Digestive Endoscopy, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Claudio Papi
- Gastroenterology Unit, San Filippo Neri Hospital, Rome, Italy
| | - Fabrizio Bossa
- Div. of Gastroenterology, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Anna Kohn
- Gastroenterology Unit, A.O. San Camillo Forlanini, Rome, Italy
| | - Alessandro Armuzzi
- IBD Unit Complesso Integrato Columbus, Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy
| | - Renata D'Incà
- Gastroenterology Unit, Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Vito Annese
- Gastroenterology Unit, University Hospital Careggi, Florence, Italy
| | | | - Stefanos Bonovas
- IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
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