Wang Zheng, Zhang Huimin, Yang Hong, Zhang Mengmeng, Qian Jiaming
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Oncol. 2021 Dec 9;11:788980. doi: 10.3389/fonc.2021.788980. eCollection 2021.
Patients suffering from inflammatory bowel disease (IBD) have an increased risk of cancer. However, the risk of malignancy in patients with elderly-onset IBD (≥60 years) remains controversial. Hence, we aimed to identify and compare the dissimilarities in morbidity and related risk factors between patients with elderly-onset and adult-onset (18-59 years) IBD in a Chinese cohort.
Patients with confirmed IBD, diagnosed at age ≥18 years, between January 1998 and December 2020 at the Peking Union Medical College Hospital were enrolled. The yearly incidence rates (IRs) for cancer were calculated, and the characteristics were analyzed in these patients.
A total of 1,480 patients suffering from adult-onset IBD and 129 patients suffering from elderly-onset IBD with a median follow-up period of 4.9 years and 4.8 years, respectively, were included. Patients in the elderly-onset IBD group demonstrated an increased overall incidence of cancer than that demonstrated by patients in the adult-onset group (IR 26.9 versus 9.51, respectively, per 1,000 person-years; relative risk [RR], 2.83). Colorectal cancer was the most common malignancy in the two groups, and patients suffering from elderly-onset IBD demonstrated a higher incidence of the malignancy (IR, 7.07 versus 3.34, respectively, per 1,000 person-years; RR, 2.12). Among the extraintestinal cancers, hematological malignancies and urinary tract cancers (including renal and urinary bladder carcinoma) were common in the elderly-onset group (IR, 4.24 and 4.24 per 1,000 person-years, respectively), whereas thyroid cancer was more common in the adult-onset group (IR, 1.36 per 1,000 person-years). Analysis of clinical characteristics revealed that patients with elderly-onset IBD who developed cancer were more likely to have diabetes and urinary lithiasis ( = 0.041 and 0.035, respectively). In addition, patients in the elderly-onset group had a shorter course from IBD to cancer, less exposure to immunosuppressants, less extraintestinal manifestations, and higher cancer-related mortality. Cox proportional risk regression analysis in the elderly-onset IBD group revealed that diabetes was an independent risk factor for the progression to cancer (hazard ratio [HR], 12.53 [2.379-65.994], = 0.003).
The risk of malignancy in patients suffering from elderly-onset IBD increased significantly as compared with those with adult-onset disease. Therefore, cancer monitoring should be initiated earlier for patients in the elderly-onset group.
炎症性肠病（IBD）患者患癌风险增加。然而，老年发病型IBD（≥60岁）患者的恶性肿瘤风险仍存在争议。因此，我们旨在识别并比较中国队列中老年发病型和成年发病型（18 - 59岁）IBD患者在发病率及相关危险因素方面的差异。
纳入1998年1月至2020年12月在北京协和医院确诊、年龄≥18岁的IBD患者。计算癌症的年发病率（IRs），并分析这些患者的特征。
共纳入1480例成年发病型IBD患者和129例老年发病型IBD患者，中位随访时间分别为4.9年和4.8年。老年发病型IBD组患者的总体癌症发病率高于成年发病型组（每1000人年的IR分别为26.9和9.51；相对风险[RR]，2.83）。结直肠癌是两组中最常见的恶性肿瘤，老年发病型IBD患者的该恶性肿瘤发病率更高（每1000人年的IR分别为7.07和3.34；RR，2.12）。在肠外癌症中，血液系统恶性肿瘤和泌尿系统癌症（包括肾癌和膀胱癌）在老年发病型组中常见（每1000人年的IR分别为4.24和4.24），而甲状腺癌在成年发病型组中更常见（每1000人年的IR为1.36）。临床特征分析显示，患癌的老年发病型IBD患者更易患糖尿病和尿路结石（分别为 = 0.041和0.035）。此外，老年发病型组患者从IBD到癌症的病程较短，免疫抑制剂暴露较少，肠外表现较少，且癌症相关死亡率较高。老年发病型IBD组的Cox比例风险回归分析显示，糖尿病是癌症进展的独立危险因素（风险比[HR]，12.53[2.379 - 65.994]， = 0.003）。
与成年发病型IBD患者相比，老年发病型IBD患者的恶性肿瘤风险显著增加。因此，应更早地对老年发病型组患者启动癌症监测。
