炎症性肠病患者在近期患有恶性肿瘤时开始抗TNF治疗后发生癌症的风险
Risk of Incident Cancer in Inflammatory Bowel Disease Patients Starting Anti-TNF Therapy While Having Recent Malignancy.
作者信息
Poullenot Florian, Seksik Philippe, Beaugerie Laurent, Amiot Aurélien, Nachury Maria, Abitbol Vered, Stefanescu Carmen, Reenaers Catherine, Fumery Mathurin, Pelletier Anne-Laure, Nancey Stephane, Peyrin-Biroulet Laurent, Bourreille Arnaud, Hébuterne Xavier, Brixi Hedia, Savoye Guillaume, Lourenço Nelson, Altwegg Romain, Buisson Anthony, Cazelles-Boudier Christine, Racine Antoine, Vergniol Julien, Laharie David
机构信息
1CHU de Bordeaux, Hôpital Haut-Le[Combining Acute Accent]vêque, Service d'He[Combining Acute Accent]pato-gastroente[Combining Acute Accent]rologie, University of Bordeaux, Bordeaux, Pessac, France; 2Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, ERL 1157 INSERM/UMRS 7203, DHU 12B, UPMC, Paris, France; 3Department of Gastroenterology, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Paris Est Creteil University, Paris, France; 4CHRU de Lille, Hôpital Claude Huriez, Service des Maladies de l'Appareil Digestif-Endoscopie Digestive, Lille, France; 5Department of Gastroenterology, Cochin Hospital, Assistance Publique Hôpitaux de Paris and Paris V University, Paris, France; 6Hôpital Beaujon, Gastroente[Combining Acute Accent]rologie, Maladies Inflammatoires Chroniques de l'Intestin et Assistance Nutritive, AP-HP, Universite[Combining Acute Accent] Paris VII, Clichy, France; 7Department of Gastroenterology, CHU of Liège, University of Liège, Belgium; 8GIGA Research, University of Liege, Belgium; 9Service d'He[Combining Acute Accent]pato-Gastroente[Combining Acute Accent]rologie, CHU Amiens, Université de Picardie Jules Verne, Amiens, France; 10Department of Gastroenterology, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; 11Department of Gastroenterology, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre Benite, France; 12INSERM U1111, CIRI, Lyon, France; 13INSERM U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Université Henri Poincaré 1, Vandoeuvre-lès-Nancy, France; 14Inserm CIC 1114 and Institut des Maladies de l'Appareil Digestif, University Hospital, Nantes, France; 15CHU de Nice, Hôpital de l'Archet 2, Service de Gastroente[Combining Acute Accent]rologie et Nutrition Clinique, Nice, France; 16Department of Hepato-Gastroenterology and Digestive Oncology Hôpital Robert Debré, Reims, France; 17CHU de Rouen, Hôpital Charles Nicolle, Service de Gastroente[Combining Acute A
出版信息
Inflamm Bowel Dis. 2016 Jun;22(6):1362-9. doi: 10.1097/MIB.0000000000000741.
BACKGROUND
Patients with inflammatory bowel disease (IBD) and history of malignancy within the last 5 years are usually contraindicated for receiving anti-tumor necrosis factor (anti-TNF) agents. The aim of this study is to assess survival without incident cancer in a cohort of IBD patients exposed to anti-TNF while having previous malignancy within past 5 years.
METHODS
Data from IBD patients with previous malignancy diagnosed within the last 5 years before starting an anti-TNF agent were collected through a Groupe d'Etude Thérapeutiques des Affections Inflammatoires du tube Digestif multicenter survey. Inclusion date corresponded to the first anti-TNF administration after cancer diagnosis.
RESULTS
Twenty centers identified 79 cases of IBD patients with previous malignancy diagnosed 17 months (median; range: 1-65) before inclusion. The most frequent cancer locations were breast (n = 17) and skin (n = 15). After a median follow-up of 21 (range: 1-119) months, 15 (19%) patients developed incident cancer (8 recurrent and 7 new cancers), including 5 basal-cell carcinomas. Survival without incident cancer was 96%, 86%, and 66% at 1, 2, and 5 years, respectively. Crude incidence rate of cancer was 84.5 (95% CI, 83.1-85.8) per 1000 patient-years.
CONCLUSIONS
In a population of refractory IBD patients with recent malignancy, anti-TNF could be used taking into account a mild risk of incident cancer. Pending prospective and larger studies, a case-by-case joint decision taken with the oncologist is recommended for managing these patients in daily practice.
背景
患有炎症性肠病（IBD）且在过去5年内有恶性肿瘤病史的患者通常禁忌使用抗肿瘤坏死因子（抗TNF）药物。本研究的目的是评估一组过去5年内有恶性肿瘤病史但接受抗TNF治疗的IBD患者无新发癌症的生存率。
方法
通过炎症性肠病治疗研究组多中心调查收集在开始使用抗TNF药物前5年内被诊断为患有恶性肿瘤的IBD患者的数据。纳入日期对应于癌症诊断后的首次抗TNF给药。
结果
20个中心确定了79例IBD患者，这些患者在纳入前17个月（中位数；范围：1 - 65个月）被诊断为患有恶性肿瘤。最常见的癌症部位是乳腺（n = 17）和皮肤（n = 15）。中位随访21个月（范围：1 - 119个月）后，15例（19%）患者发生了新发癌症（8例复发癌和7例新发癌），其中包括5例基底细胞癌。1年、2年和5年无新发癌症的生存率分别为96%、86%和66%。癌症的粗发病率为每1000患者年84.5（95% CI，83.1 - 85.8）。
结论
在近期患有恶性肿瘤的难治性IBD患者群体中，考虑到有轻度的新发癌症风险，可以使用抗TNF药物。在进行前瞻性的大规模研究之前，建议在日常实践中与肿瘤学家逐案共同做出决策来管理这些患者。
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