Incidence of renal cell carcinoma in inflammatory bowel disease patients with and without anti-TNF treatment. Issue 1 (January 2017)

• Record Type: Journal Article
• Authors: Wauters, Lucas; Billiet, Thomas; Papamichael, Konstantinos; Ballet, Vera; Joniau, Steven; Verschueren, Patrick; Silversmit, Geert; Van Assche, Gert; Vermeire, Séverine; Ferrante, Marc
• Is Part Of: European journal of gastroenterology & hepatology. Volume 29:Issue 1(2017:Jan.)
• Publication Date: 2017-01
• Subjects: anti-tumor necrosis factor -- inflammatory bowel disease -- renal cell carcinoma; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000000735
• Languages: English
• ISSNs: 0954-691X

Abstract

Abstract : Objective: We aimed to study the risk of renal cell carcinoma (RCC) with anti-tumor necrosis factor (anti-TNF) therapy in inflammatory bowel disease (IBD) and rheumatic diseases (RD) and calculate standardized incidence ratios (SIRs) in IBD. Materials and methods: This was a retrospective case–control and cohort study spanning 25 years, including IBD and RD patients with a diagnosis of RCC (1990–2014) identified through the electronic database of a tertiary referral center. Results: RCC was confirmed in seven anti-TNF-exposed (TNF+) and 21 anti-TNF-naive (TNF−) IBD and one TNF+ and 26 TNF− RD patients. In IBD-RCC, younger age at RCC diagnosis [median (interquartile range) 46 (42–58) vs. 63 (52–75) years; P =0.02], immunosuppressive therapy (100 vs. 24%; P <0.0004), partial nephrectomy (86 vs. 33%; P =0.02), and surgery less than 1 month after diagnosis of RCC (71 vs. 14%; P =0.004) were associated with anti-TNF. Compared with IBD, RD patients were older at RCC diagnosis [70 (60–77) vs. 59 (47–69) years; P =0.02] with less nephron-sparing surgery (26 vs. 54%; P =0.04) and more symptomatic (44 vs. 14%; P =0.02) and advanced tumors (30 vs. 7%; P =0.04). SIRs in IBD-RCC TNF− and TNF+ were 5.4 (95% confidence interval 2.9–9.2) and 7.1 (2.3–16.5) in male patients and 8.5 (3.7–16.8) and 4.8 (0.6–17.3) in female patients, respectively. The risk for RCC associated with anti-TNF in IBD was 0.8 (0.3–2.5) in men and 1.4 (0.2–5.5) in women. Conclusion: The favorable patient and tumor profiles in IBD with anti-TNF may suggest incidentally discovered RCC on abdominal imaging. SIRs for IBD-RCC were not increased after anti-TNF exposure.