Children and adolescents with an immune-mediated inflammatory disease (pIMID) have an almost double risk of cancer compared with those in whom pIMID is absent, suggested the results of a Danish study. This translated into 1.2 cases of cancer/1,000 patient-years in patients with a pIMID diagnosis and 0.6 cases/1,000 patient-years in controls.
In adults, an increased risk of cancer in patients with inflammatory bowel disease (IBD) has been described, but data regarding the riskof pIMID in children is still limited [1,2]. Therefore, a Danish, case-control study investigated the particular risk of malignancies in paediatric patients with pIMID. The pIMID diagnoses included IBD, autoimmune idiopathic liver disease (AILD), and rheumatic disease . Participants had to be under 18 years of age and have 2 diagnostic codes for pIMID within the National Patient Registry between 1980 and 2018, or 1 entry plus 1 disease-related treatment. Each case was matched with up to 10 controls from the general population.
The study cohort consisted of 13,216 participants with pIMID (5,811 IBD, 329 AILD, 7,241 rheumatic disease) and 114,502 controls. The median age at pIMID diagnosis ranged from 9.9 to 14.9 years and the median follow-up time from 9.0 to 11.6 years.
The researchers identified 207 cases of cancer among the participants with pIMID and 847 among the controls. “We found a 2-fold increased risk of cancer in patients with pIMID compared with the background population,” Ms Andrea Ehrström (Hvidovre Hospital, Denmark) commented on the hazard ratio (HR) of 2.1 (P<0.0001) that was determined by Cox regression. This significantly increased risk varied depending on the type of pIMID: HR 2.4 for IBD, 5.7 for AILD, and 1.6 for rheumatic disease. After stratification according to the cancer site, participants with paediatric IBD and AILD held a significantly increased risk of colorectal cancer, liver cancer, and non-melanoma skin cancer. Furthermore, an about 2-fold risk was seen for melanoma in IBD together with a nearly 5-fold risk for lymphoma (HR 4.8). For participants with rheumatic disease, the augmented hazard of cancer was significant for lymphoma (HR 2.7) and leukaemia (HR 5.7). The investigation also looked at the possible influence of more than 1 pIMID diagnosis on the overall cancer risk and established an HR of 2.8 compared with only 1 pIMID.
“The increased risk of cancer corresponds to 1.2 cancer cases per 1,000 patient-years for pIMID compared with 0.6 cancer cases per 1,000 patient-years among the controls,” Ms Ehrström added in her conclusion.
- Ehrström A. The risk of cancer in pediatric-onset immune-mediated inflammatory diseases – a nationwide Danish study from 1980-2018. OP22, ECCO 2023, 1–4 March, Copenhagen, Denmark.
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Table of Contents: ECCO 2023
Letter from the Editor
ECCO 2023 Highlights Podcast
What Is New in Biologic Therapy?
Beneficial effect of early, post-operative vedolizumab on endoscopic recurrence in CD
Long-term data supports the established efficacy and safety of ustekinumab in UC
Anti-TNF withdrawal may be a safe option in stable IBD
Intensified drug therapy leads to better stricture morphology in CD
Small Molecules in IBD: State of the Art
Continued efficacy of long-term ozanimod as UC treatment
Upadacitinib successful in the management of both CD and UC
Solid results for long-term therapy of UC with filgotinib
Paediatric IBD: What You Need To Know
Perinatal period is crucial for the risk of developing CD
Early-life antibiotic exposure: a risk factor for paediatric-onset IBD
Paediatric patients with immune-mediated inflammatory disease harbour a heightened cancer risk
Risk Factors and Complications of IBD
Checking kidney function is important during the course of IBD
Diabetes therapy with GLP-1-based drugs does not elevate the risk of IBD
Surgical Approaches: New Developments
Long-term resection potentially better than anti-TNF treatment in CD
Early, post-operative complications in CD reduced by pre-operative enteral nutrition, irrespective of biologic exposure
Pearls of the Posters
Drop in overall IBD procedures during the pandemic
Proton pump inhibitors associated with worse outcomes in CD
Poor sleep in CD linked to low levels of vitamin D
Novel AI tool assessing mucosal inflammation achieves high correlation with histopathologists