Kopylov Uri, Vutcovici Maria, Kezouh Abbas, Seidman Ernest, Bitton Alain, Afif Waqqas
*Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada; †Faculty of Medicine, McGill University, Montreal, QC, Canada; and ‡Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, QC, Canada.
Inflamm Bowel Dis. 2015 Aug;21(8):1847-53. doi: 10.1097/MIB.0000000000000457.
Immunomodulatory medications in patients with inflammatory bowel disease (IBD) have been associated with an increased risk of developing certain malignancies. The aim of this study was to evaluate the risk of melanoma, nonmelanoma skin cancer, colorectal cancer and lymphoma associated with immunomodulators and biologics in patients with IBD.
A nested case-control study was carried out using the provincial health insurance database of Québec, Canada (RAMQ/MedECHO).
A total of 41,176 patients with IBD were identified of whom 19,582 patients were eligible for inclusion in the study. Treatment with thiopurine for more than 5 years was associated with a significantly increased risk of nonmelanoma skin cancer (odds ratio: 1.78; 95% confidence interval, 1.25-2.54). Immunomodulator treatment was not associated with an increased risk of non-Hodgkin's lymphoma (odds ratio: 0.87; 95% confidence interval, 0.53-1.41). Neither immunomodulators nor anti-TNF-α agents were associated with an increased risk of melanoma or colorectal cancer.
In a large provincial IBD cohort, treatment with immunomodulators for more than 5 years was associated with an increased risk of non-melanoma skin cancer, whereas the risk of lymphoma, melanoma, and colorectal cancer was not increased. No association was found between the risk of the evaluated malignancies and anti-TNF-α medications.
炎症性肠病（IBD）患者使用免疫调节药物与患某些恶性肿瘤的风险增加有关。本研究的目的是评估IBD患者使用免疫调节剂和生物制剂后发生黑色素瘤、非黑色素瘤皮肤癌、结直肠癌和淋巴瘤的风险。
利用加拿大魁北克省的省级医疗保险数据库（RAMQ/MedECHO）进行了一项巢式病例对照研究。
共识别出41176例IBD患者，其中19582例符合纳入本研究的条件。硫唑嘌呤治疗超过5年与非黑色素瘤皮肤癌风险显著增加相关（比值比：1.78；95%置信区间，1.25 - 2.54）。免疫调节剂治疗与非霍奇金淋巴瘤风险增加无关（比值比：0.87；95%置信区间，0.53 - 1.41）。免疫调节剂和抗TNF-α药物均与黑色素瘤或结直肠癌风险增加无关。
在一个大型省级IBD队列中，免疫调节剂治疗超过5年与非黑色素瘤皮肤癌风险增加相关，而淋巴瘤、黑色素瘤和结直肠癌风险未增加。在所评估的恶性肿瘤风险与抗TNF-α药物之间未发现关联。
