Pediatric patients with IBD may face higher cancer, mortality risks
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Patients with pediatric onset inflammatory bowel disease may have a higher risk for cancer and death, according to a presentation at UEG Week Virtual 2021.
“As you know, the incidence of pediatric-onset IBD has been dramatically increasing over the past decades,” Claire Dupont-Lucas, MD, PhD, MPH, of the pediatrics department at Caen University Hospital in France, said. “Pediatric-onset IBD has the characteristic of having a more severe course in adults with IBD. Although cancer and mortality are dreaded complications of IBD, they’re rarely observed during the pediatric follow-up of the disease. Hence, the risk for cancer and mortality in pediatric-onset IBD are poorly known.”
To investigate the prevalence of cancer and mortality in patients with pediatric-onset IBD and to identify the factors associated with cancer and mortality, researchers used the EPIMAD registry to assess data from pediatric patients diagnosed with IBD before age 17 years from 1988 to 2011. Incident cancer data were collected through Dec. 31, 2013. The final cohort consisted of 1,344 patients with either Crohn’s disease (75%; median age, 14.5 years; 55.2% boys) or ulcerative colitis (25%; median age, 13.9 years; 42.7% boys). Data from the French population served as a reference group.
Median follow-up time was 13.1 years. Researchers recorded 14 cases of cancer (median delay after IBD diagnosis, 15 years; median age at cancer diagnosis, 27.8 years) across the cohort; 11 cases occurred in patients with CD, and three in patients with UC. There was a significantly higher incidence of cancer compared with the general population (standardized cancer incidence ratio [SIR] = 2.66; 95% CI, 1.47-4.8). Colorectal cancer (SIR = 41.2; 95% CI, 17.55-98.98), followed by skin cancer (basal cell carcinoma and melanoma), were the leading causes of death, according to Dupont-Lucas.
“If we look at colorectal cancer, the risk was increased by 41 times compared to the general population and 76 times for UC patients. The risk for melanoma was also increased by five times compared to the general population,” Dupont-Lucas said.
Researchers recorded 15 deaths (median delay after IBD diagnosis, 15.9 years; median age at death, 28.8 years), 14 of which occurred in patients with CD and all in patients diagnosed with IBD before 2004. Overall mortality rate was higher than the reference population (standardized mortality ratio [SMR] = 1.69; 95% CI, 1.02-2.8). Four deaths were attributed to cancer.
While the risk for death from CRC was 70 times greater compared with the general population (SMR = 70.37; 95% CI, 22.7-218.19), Dupont-Lucas noted no association between duration of immunosuppressant treatment or anti-tumor necrosis factor therapy and cancer occurrence.
“Mortality and risk of cancer are increased in young adults with pediatric onset IBD by 2.7-fold for cancer and 1.7-fold for death,” Dupont-Lucas concluded. “The main cause of cancer mortality being colorectal cancer, we recommend implementing cancer programs starting from adolescence. Although we did not find an association between exposure to treatments and cancer or mortality, a longer follow-up of the most recently diagnosed group will be necessary to confirm these results.”
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Dupont-Lucas C, et al. Abstract OP098. Presented at: UEG Week; Oct. 3-5, 2021 (virtual meeting).
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