Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing, 100050, China.
School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China.
Inflamm Bowel Dis. 2023 Mar 1;29(3):384-395. doi: 10.1093/ibd/izac096.
This study aims to examine the prospective association of inflammatory bowel disease (IBD) with long-term risk of overall, site-specific cancer and cancer-specific mortality in middle-aged and older people.
The study included participants free of any cancer at baseline from the UK Biobank, with IBD patients as an exposure group and non-IBD patients as a reference group. Primary outcome was the incidence of overall cancer and cancer-specific mortality. Secondary outcomes included site-specific cancers and types of digestive cancers. Cox proportional hazard model was used to investigate the associated risk of incident malignancies and related mortality.
Among 455 927 participants, 5142 were diagnosed with IBD (3258 ulcerative colitis [UC]; 1449 Crohn's disease [CD]; others unspecified). During a median of 12.2-year follow-up, 890 cases of incident cancer were identified in IBD patients (15.74 per 1000 person years) compared with 63 675 cases in reference individuals (12.46 per 1000 person years). Of these cases, 220 and 12 838 cancer-specific deaths occurred in IBD and non-IBD groups. Compared with non-IBD participants, the adjusted hazard ratio (AHR) for overall cancer and cancer-specific mortality was 1.17 (95% CI, 1.09-1.25) and 1.26 (95% CI, 1.18-1.35) among IBD patients, with an AHR of 1.15 (95% CI, 1.02-1.31) and 1.38 (95% CI, 1.08-1.75) in UC and 1.15 (95% CI, 1.06-1.25) and 1.25 (95% CI, 1.06-1.49) in CD, respectively. Specifically, increased risk of digestive (1.33; 95% CI, 1.12-1.57), nonmelanoma (1.25; 95% CI, 1.11-1.41), and male genital (1.29; 95% CI, 1.09-1.52) cancers was observed in IBD patients.
Compared with non-IBD, IBD may be associated with an increased risk of overall cancer and cancer-specific mortality, particularly digestive cancers, nonmelanoma and male genital cancers.
本研究旨在探讨炎症性肠病（IBD）与中老年人群总体和特定部位癌症以及癌症特异性死亡率的长期风险之间的前瞻性关联。
该研究纳入了英国生物银行中基线时无任何癌症的参与者，以 IBD 患者作为暴露组，非 IBD 患者作为参照组。主要结局为总体癌症和癌症特异性死亡率的发生情况。次要结局包括特定部位癌症和消化道癌症类型。采用 Cox 比例风险模型来研究恶性肿瘤发病相关风险和相关死亡率。
在 455927 名参与者中，有 5142 名被诊断为 IBD（溃疡性结肠炎[UC]3258 例；克罗恩病[CD]1449 例；其他未特指 436 例）。在中位随访 12.2 年后，IBD 患者中有 890 例发生了新发癌症（每 1000 人年 15.74 例），而参照个体中有 63675 例（每 1000 人年 12.46 例）。在这些病例中，IBD 组和非 IBD 组分别有 220 例和 12838 例癌症特异性死亡。与非 IBD 参与者相比，IBD 患者的总体癌症和癌症特异性死亡率的校正风险比（AHR）分别为 1.17（95%CI，1.09-1.25）和 1.26（95%CI，1.18-1.35），UC 患者的 AHR 分别为 1.15（95%CI，1.02-1.31）和 1.38（95%CI，1.08-1.75），CD 患者的 AHR 分别为 1.15（95%CI，1.06-1.25）和 1.25（95%CI，1.06-1.49）。具体而言，IBD 患者发生消化道（1.33；95%CI，1.12-1.57）、非黑素瘤（1.25；95%CI，1.11-1.41）和男性生殖器官（1.29；95%CI，1.09-1.52）癌症的风险增加。
与非 IBD 相比，IBD 可能与总体癌症和癌症特异性死亡率增加相关，尤其是消化道癌症、非黑素瘤和男性生殖器官癌症。
