Hepato-pancreato-biliary malignancies in patients with crohn's disease: a United States population based study from national inpatient sample database (1998–2010)

Abstract

Background: Cancer is a deadly sequelae of chronic inflammation in Crohn's disease (CD) patients, which follows the inflammation-dysplasia-carcinoma sequence. Although the risk of colorectal and small bowel cancer has been documented, the incidence of other cancer types in CD is poorly studied. This is the first population-based study to estimate risk of Hepato-Pancreato-Biliary (HPB) cancer in CD patients. Methods: National Inpatient Database (NIS 1998–2010) was used to identify patients with CD and demographic data were abstracted. The observed events for gallbladder, extrahepatic biliary, liver and pancreatic cancers were abstracted and converted to events/year/100,000 and compared against corresponding national incidence rate obtained from Surveillance Epidemiology and End Results (SEER) database. The Standardized Incidence Ratio (SIR) for each individual malignancy was calculated to assess the true risk. Results: 373,199 patients with CD were identified in NIS database, of whom 722 (0.2%) suffered from at least one HPB cancer. The mean age of CD patients with cancer was 63.43 years, significantly higher than those without cancer (48.04). The male:female ratio of patients with CD and HPB cancer is 1.15:1. CD and associated HPB cancer was highest in Caucasians. The in- hospital mortality was higher in CD patients with HPB cancer(6.9%) compared to those without cancer(0.98%). Patients with CD are at higher risk of developing gallbladder cancer (SIR = 7364.3), extrahepatic biliary cancer (SIR = 4628.5), liver cancer (SIR = 979.9) and pancreatic cancer (SIR = 654.7) compared to the general population. Conclusion: Patients with CD are at increased risk of developing HPB cancers compared to the general population. The risk is higher in elderly, male and Caucasians. The in-hospital mortality is higher in CD patients with HPB cancer compared to those without HPB cancer.Table 1Comparison of demographic characters of patients with Crohn's disease (CD) with and without associated hepato-pancreato-biliary (HPB) malignanciesOverallCD with HPB MalignancyCD without HPB MalignancyN (%)373,199722 (0.2)372,477 (99,8)Age48.07 ± 19.2863.43 ± 13.1248.04±19.28Male: Female1:1.471.15:11:1.47Race Caucasian237,814 (63.7)536 (74.2)237,278 (63.7) African American27,453 (7.4)40 (5.5)27,413 (7.4) Hispanic10,766 (2.9)13 (1.8)10,753 (2.9) Others97,166 (26.0)133 (18.4)97,033 (26.1)Mortality50 (6.9)3655 (0.98)N; number of patients. Open table in a new tab Table 2Standardized Incidence Ratio (SIR) of hepato-pancreato-biliary (HPB) malignancies in patients with Crohn's diseaseObserved events/year/100,000Expected events/year/100,000SIRaSIR = Standardized Incidence Ratio (observed events/expected events × 100).Gallbladder cancer88.41.27364.3Extrahepatic biliary cancer87.91.94628.5Liver cancer84.38.6979.9Pancreas cancer81.812.5654.7a SIR = Standardized Incidence Ratio (observed events/expected events × 100). Open table in a new tab N; number of patients.