Mortality and Cancer in Pediatric-Onset Inflammatory Bowel Disease: A Population-Based Study

被引:49
作者
Peneau, Anais [1 ,2 ]
Savoye, Guillaume [3 ]
Turck, Dominique [2 ,4 ]
Dauchet, Luc [2 ,5 ]
Fumery, Mathurin [6 ]
Salleron, Julia [2 ]
Lerebours, Eric [3 ]
Ligier, Karine [7 ,8 ]
Vasseur, Francis [2 ,5 ]
Dupas, Jean-Louis [6 ]
Mouterde, Olivier [9 ]
Spyckerelle, Claire [10 ]
Djeddi, Djamal [11 ]
Peyrin-Biroulet, Laurent [12 ]
Colombel, Jean-Frederic [1 ,2 ,13 ]
Gower-Rousseau, Corinne [5 ]
机构
[1] Lille Univ Nord France, CHU Lille, Gastroenterol Unit, Lille, France
[2] Univ Lille 2, Lille, France
[3] Rouen Univ & Hosp, Gastroenterol Unit, Rouen, France
[4] Lille Univ Nord France, CHU Lille, Pediat Unit, Lille, France
[5] Lille Univ Nord France, CHU Lille, Epidemiol Unit, Lille, France
[6] Amiens Univ & Hosp, Gastroenterol Unit, Amiens, France
[7] Lille Univ Nord France, CHU Lille, Biostat Unit, Lille, France
[8] Ctr Reference Reg Cancerolo, Loos, France
[9] Rouen Univ & Hosp, Pediat Unit, Rouen, France
[10] St Vincent Hosp, Pediat Unit, Lille, France
[11] Amiens Univ & Hosp, Pediat Unit, Amiens, France
[12] Nancy Univ & Hosp, INSERM U954, Gastroenterol Unit, Vandoeuvre Les Nancy, France
[13] Mt Sinai Sch Med, New York, NY USA
关键词
NORTHERN FRANCE 1988-1999; CROHNS-DISEASE; ULCERATIVE-COLITIS; EXTRAINTESTINAL CANCER; INCEPTION COHORT; RISING INCIDENCE; NATURAL-HISTORY; OLMSTED COUNTY; INCREASED RISK; FOLLOW-UP;
D O I
10.1038/ajg.2013.242
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
OBJECTIVES: Although the incidence of pediatric inflammatory bowel disease (IBD) continues to rise in Northern France, the risks of death and cancer in this population have not been characterized. METHODS: All patients < 17 years, recorded in EPIMAD registry, and diagnosed between 1988 and 2004 with Crohn's disease (CD) or ulcerative colitis (UC) were included. The observed incidences of death and cancer were compared with those expected in the regional general population obtained by French Statistical Institute (INSEE) and the cancer Registry from Lille. Comparisons were performed using Fisher's exact test and were expressed using the standardized mortality ratios (SMRs) and standardized incidence ratios. RESULTS: A total of 698 patients (538 with CD and 160 with UC) were identified; 360 (52%) were men, the median age at IBD diagnosis was 14 years (12-16) and the median follow-up time was 11.5 years (7-15). During follow-up, the mortality rate was 0.84% (6/698) and did not differ from that in the reference population (SMR = 1.4 (0.5-3.0); P = 0.27). After a median follow-up of 15 years (10-17), 1.3% of patients (9/698) had a cancer: colon (n = 2), biliary tract (cholangiocarcinoma; n = 1), uterine cervix (n = 1), prepuce (n = 1), skin (basal cell carcinoma (n = 2), hematological (acute leukemia; n = 1), and small bowel carcinoid (n = 1). There was a significantly increased risk of cancer regardless of gender and age (standardized incidence ratio = 3.0 (1.3 -5.9); P < 0.02). Four out of nine patients who developed a cancer had received immunosuppressants or anti-tumor necrosis factor-alpha therapy (including combination therapy in three patients). CONCLUSIONS: In this large pediatric population-based IBD cohort, mortality did not differ from that of the general population but there was a significant threefold increased risk of neoplasia.
引用
收藏
页码:1647 / 1653
页数:7
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