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Abstract
Immunosuppressive therapy may impact cancer risk in inflammatory bowel disease (IBD). Cancer specific data regarding risk and outcome are scarce and data for renal cell carcinoma (RCC) are lacking. We aimed(1) to identify risk factors for RCC development in IBD patients (2) to compare RCC characteristics, outcome and survival between IBD patients and the general population. A PALGA (Dutch Pathology Registry) search was performed to establish a case group consisting of all IBD patients with incident RCC in The Netherlands (1991-2013). Cases were compared with two separate control groups: (A) with a population-based IBD cohort for identification of risk factors (B) with a RCC cohort from the general population to compare RCC characteristics and outcomes. 180 IBD patients with RCC were identified. Pancolitis (OR 1.8-2.5), penetrating Crohn's disease (OR 2.8), IBD related surgery (OR 3.7-4.5), male gender (OR 3.2-5.0) and older age at IBD onset (OR 1.0-1.1) were identified as independent risk factors for RCC development. IBD patients had a significantly lower age at RCC diagnosis (p < 0.001), lower N-stage (p = 0.025), lower M-stage (p = 0.020) and underwent more frequently surgical treatment for RCC (p < 0.001) compared to the general population. This translated into a better survival (p = 0.026; HR 0.7) independent of immunosuppression. IBD patients with a complex phenotype are at increased risk to develop RCC. They are diagnosed with RCC at a younger age and at an earlier disease stage compared to the general population. This translates into a better survival independent of immunosuppressive or anti-TNFα therapy.
Highlights
Inflammatory bowel disease (IBD), including ulcerative colitis (UC), Crohn’s disease (CD) and indeterminate colitis is a chronic inflammatory disorder of the gastrointestinal tract
Only limited evidence is available, it has been suggested that immunosuppression in inflammatory bowel disease (IBD) patients may increase the risk for a variety of solid malignancies, such as renal cell carcinoma (RCC)
To identify risk factors for RCC development we established a control group of 1800 IBD patients randomly selected from the IBD South Limburg Cohort (IBDSL; Case control study A)
Summary
Inflammatory bowel disease (IBD), including ulcerative colitis (UC), Crohn’s disease (CD) and indeterminate colitis is a chronic inflammatory disorder of the gastrointestinal tract. Patients with this disease have an increased risk for both intestinal and various extraintestinal malignancies [1, 2]. This risk is mainly attributed to two drivers: chronic inflammation and drug-induced immunosuppression [3] Immunosuppressive medication such as thiopurines and methotrexate may play a role in the development of extra-intestinal malignancies by impairing immunosurveillance of tumor cells or inducing DNA damage [4,5,6,7]. We aimed(1) to identify risk factors for RCC development in IBD patients (2) to compare RCC characteristics, outcome and survival between IBD patients and the general population
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