Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada.
J Crohns Colitis. 2019 Sep 27;13(10):1302-1310. doi: 10.1093/ecco-jcc/jjz058.
To explore the trends and the predictors of incident malignant cancer among patients with inflammatory bowel disease [IBD].
We identified a cohort of all patients with incident IBD in Quebec, Canada, from 1998 to 2015, using provincial administrative health-care databases [RAMQ and Med-Echo]. Annual incidence rates [IRs] of cancer were calculated using Poisson regression and were compared with those of the Quebec population using standardized incidence ratios [SIRs ]. Temporal trends in these rates were evaluated by fitting generalized linear models. Conditional logistic regression was used to estimate odds ratios [ORs] for predictors associated with cancer development.
The cohort included 35 985 patients with IBD, of which 2275 developed cancers over a mean follow-up of 8 years (IR 785.6 per 100 000 persons per year; 95% confidence interval [CI] 754.0-818.5). The rate of colorectal cancer decreased significantly from 1998 to 2015 [p < 0.05 for linear trend], but the incidence remained higher than expected, compared with the Quebec population [SIR 1.39; 95% CI 1.19-1.60]. Rates of extraintestinal cancers increased non-significantly over time [p = 0.11 for linear trend]. In the IBD cohort, chronic kidney disease [OR 1.29; 95% CI 1.17-1.43], respiratory diseases [OR 1.07; 95% CI 1.02-1.12], and diabetes mellitus [OR 1.06; 95% CI 1.01-1.11] were associated with an increase in the incidence of cancer.
The decreasing rates of colorectal cancer suggest improved management and care in IBD. Further studies are needed to explore the impact of comorbid conditions on the risk of cancer in IBD.
探讨炎症性肠病（IBD）患者新发恶性肿瘤的趋势和预测因素。
我们利用加拿大魁北克省的省级医疗保健数据库（RAMQ 和 Med-Echo），确定了 1998 年至 2015 年期间所有新发 IBD 患者的队列。采用泊松回归计算癌症的年发生率（IR），并使用标准化发病率比（SIR）与魁北克人群进行比较。通过拟合广义线性模型评估这些比率的时间趋势。采用条件逻辑回归估计与癌症发生相关的预测因素的比值比（OR）。
该队列包括 35985 例 IBD 患者，平均随访 8 年后有 2275 例发生癌症（IR 为 785.6/100000 人/年；95%置信区间[CI]为 754.0-818.5）。1998 年至 2015 年，结直肠癌的发病率显著下降（线性趋势 p<0.05），但与魁北克人群相比，发病率仍高于预期（SIR 为 1.39；95%CI 为 1.19-1.60）。随着时间的推移，非肠道癌症的发病率呈非显著性增加（线性趋势 p=0.11）。在 IBD 队列中，慢性肾脏病（OR 1.29；95%CI 1.17-1.43）、呼吸系统疾病（OR 1.07；95%CI 1.02-1.12）和糖尿病（OR 1.06；95%CI 1.01-1.11）与癌症发病率的增加相关。
结直肠癌发病率的下降表明 IBD 的管理和护理得到了改善。需要进一步研究来探讨合并症对 IBD 患者癌症风险的影响。
