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Risk of new or recurrent cancer under immunosuppressive therapy in patients with IBD and previous cancer
  1. Laurent Beaugerie1,
  2. Fabrice Carrat2,
  3. Jean-Frédéric Colombel3,
  4. Anne-Marie Bouvier4,
  5. Harry Sokol1,
  6. Abdenour Babouri5,
  7. Franck Carbonnel6,
  8. David Laharie7,
  9. Jean-Luc Faucheron8,
  10. Tabassome Simon9,
  11. Aimery de Gramont10,
  12. Laurent Peyrin-Biroulet5,
  13. for the CESAME Study Group
  1. 1Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine F-75012; ERL 1057 INSERM/UMRS 7203; GRC-UPMC 03, UPMC Univ Paris 06 F-75012, Paris, France
  2. 2Department of Public Health, Hôpital Saint-Antoine, AP-HP, F-75012 and UMR-S 707, INSERM & UPMC Univ Paris 06 F-75012, Paris, France
  3. 3Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  4. 4Registre Bourguignon des Cancers Digestifs F-21079; Inserm U866; CHRU Dijon; Université de Bourgogne, Dijon, France
  5. 5Inserm U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Université Henri Poincaré 1, Vandoeuvre-lès-Nancy, Nancy, France
  6. 6Department of Gastroenterology, Assistance Publique-Hôpitaux de Paris (AP-HP), University hospitals Paris-Sud, Site de Bicêtre, Paris Sud University, Paris XI, Le Kremlin Bicêtre, Villejuif, France
  7. 7CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie—Univ. Bordeaux, Laboratoire de bactériologie, F-33000 Bordeaux, Pessac, France
  8. 8Colorectal Unit, Department of Surgery, Grenoble University Hospital, CS 10217, 38043 Grenoble cedex, Grenoble, France
  9. 9Clinical Pharmacology Unit, Unité de Recherche clinique de l'Est Parisien, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, F-75012; UPMC Univ Paris 06, Paris, France
  10. 10Department of Oncology, AP-HP, Hôpital Saint-Antoine F-75012, Paris, France
  1. Correspondence to Professor Laurent Beaugerie, Service de Gastroentérologie et Nutrition, Hôpital Saint-Antoine 184 rue du faubourg Saint-Antoine, 75571 Paris, Cedex 12, France; laurent.beaugerie{at}sat.aphp.fr

Abstract

Objective To explore the risk of new or recurrent cancer among patients with IBD and previous cancer, exposed or not to immunosuppressants.

Design Among the 17 047 patients of the CESAME prospective observational cohort who were enrolled from May 2004 to June 2005, and followed-up until December 2007, we identified 405 patients with cancer diagnosed previous to study entry. We calculated the rates of incident cancer in patients with or without previous cancer, and we assessed by survival analysis and nested case-control study the impact of immunosuppressants on the risk of incident new or recurrent cancer in patients with previous cancer.

Results The rate of incident cancer was 21.1/1000 patient-years (PY) and 6.1/1000 PY in patients with and without previous cancer, respectively. The multivariate-adjusted HR of incident cancer between patients with and without previous cancer was 1.9 (95% CI 1.2 to 3.0, p=0.003). Among patients with previous cancer, the rates of new and recurrent cancers were, respectively, 13.2/1000 PY and 6.0/1000 PY in the 312 patients who were not taking immunosuppressant at the time of study entry, and 23.1/1000 PY and 3.9/1000 PY in the 93 patients treated with immunosuppressants at study entry. There was no significant association between the exposure to immunosuppressants and the risk of new or recurrent cancer.

Conclusions Patients with IBD with a history of cancer are at increased risk of developing any (new or recurrent) cancer, with a predominant incidence of new cancers. Treatment with immunosuppressants has no overall major impact per se on this risk.

  • Cancer Epidemiology
  • Crohn's Disease
  • Ulcerative Colitis
  • Azathioprine

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