*Department of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center, Radboud University Medical Center, Nijmegen, the Netherlands; †Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, the Netherlands; ‡Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands; §Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; ‖Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands; ¶Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands; **Department of Gastroenterology and Hepatology, Maasstad Ziekenhuis, Rotterdam, the Netherlands; ††Department of Gastroenterology and Hepatology, Maria-Middelares Ziekenhuis, Gent, Belgium; ‡‡Netherlands Cancer Registry/Netherlands Comprehensive Cancer Organization, Eindhoven, the Netherlands; §§Stichting PALGA, Houten, the Netherlands; and ‖‖Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands.
Inflamm Bowel Dis. 2017 Nov;23(11):2018-2026. doi: 10.1097/MIB.0000000000001191.
Patients with inflammatory bowel disease (IBD) are at increased risk to develop malignant melanoma and this risk may increase with use of anti-tumor necrosis factor (TNF) therapy. Impaired survival of immunosuppressed melanoma patients is reported in transplant and rheumatology patients. This study aims to (1) identify risk factors for melanoma development in patients with IBD, (2) compare clinical characteristics of melanoma in patients with IBD to the general population, and (3) assess the influence of immunosuppressive medication on survival.
We retrospectively searched the Dutch Pathology Database to identify all Dutch patients with IBD with cutaneous melanoma between January 1991 and December 2011. We then performed 2 case-control studies. To identify risk factors for melanoma development in IBD, we compared patients with IBD with melanoma to the general IBD population. To compare outcome and survival after melanoma diagnosis, we compared cases with non-IBD melanoma patients.
We included 304 patients with IBD with melanoma, 1800 IBD controls, and 8177 melanoma controls. IBD cases had more extensive IBD (ulcerative colitis: pancolitis: cases 44.5% versus IBD controls without melanoma 28.1%; P < 0.01; Crohn's disease: ileal and colonic disease: cases 57.9% versus controls 48.9%; P = 0.02). Despite a lower Nodes (N)-stage in patients with IBD (N1+ 8.3% versus 18.2%; P < 0.01) with comparable Tumor (T) and Metastasis (M) stages, survival was similar between groups, regardless of immunosuppressive or anti-TNF therapy.
This study showed that IBD extent is a risk factor for melanoma development. Despite the lower N-stage in patients with IBD, we could not confirm impaired survival after melanoma in patients with IBD, regardless of anti-TNF and/or thiopurine use.
炎症性肠病（IBD）患者发生恶性黑色素瘤的风险增加，这种风险可能随着抗肿瘤坏死因子（TNF）治疗而增加。在移植和风湿病患者中，报道了免疫抑制黑色素瘤患者生存受损的情况。本研究旨在：（1）确定 IBD 患者黑色素瘤发展的危险因素，（2）比较 IBD 患者黑色素瘤的临床特征与普通人群，（3）评估免疫抑制药物对生存的影响。
我们回顾性地搜索了荷兰病理学数据库，以确定 1991 年 1 月至 2011 年 12 月期间所有患有 IBD 伴皮肤黑色素瘤的荷兰患者。然后我们进行了两项病例对照研究。为了确定 IBD 患者黑色素瘤发展的危险因素，我们将 IBD 伴黑色素瘤患者与普通 IBD 人群进行了比较。为了比较黑色素瘤诊断后的结局和生存，我们将病例与非 IBD 黑色素瘤患者进行了比较。
我们纳入了 304 例 IBD 伴黑色素瘤患者、1800 例 IBD 对照患者和 8177 例黑色素瘤对照患者。IBD 病例的 IBD 更广泛（溃疡性结肠炎：全结肠炎：病例为 44.5%，而无黑色素瘤的 IBD 对照为 28.1%；P < 0.01；克罗恩病：回肠和结肠疾病：病例为 57.9%，而对照为 48.9%；P = 0.02）。尽管 IBD 患者的 N 期（N+）较低（8.3%对 18.2%；P < 0.01），且肿瘤（T）和转移（M）分期相当，但无论是否使用免疫抑制剂或抗 TNF 治疗，两组之间的生存情况相似。
本研究表明，IBD 程度是黑色素瘤发展的危险因素。尽管 IBD 患者的 N 期较低，但我们无法证实 IBD 患者黑色素瘤后生存受损，无论是否使用抗 TNF 和/或硫嘌呤。
