University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada.
Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Inflamm Bowel Dis. 2023 Jul 5;29(7):1047-1056. doi: 10.1093/ibd/izac171.
We compared risks of nonmelanoma skin cancers (NMSCs) and melanoma preceding and following a diagnosis of inflammatory bowel disease (IBD) and to evaluate the effect of thiopurines and anti-tumor necrosis factor α (anti-TNF-α) on skin cancer risk in IBD.
This was a retrospective, historical cohort study using the population-based University of Manitoba IBD Epidemiology Database (11 228 IBD cases and 104 725 matched controls) linked to the Manitoba Cancer Registry. Logistic and Cox regression analyses were performed to calculate skin cancer risks prior to and after IBD diagnosis.
Persons with ulcerative colitis (UC) were more likely to have basal cell carcinoma (BCC) predating their UC diagnosis (odds ratio, 1.32; 95% confidence interval [CI], 1.08-1.60). Risks of squamous cell carcinoma (SCC), other NMSCs, or melanoma prior to IBD diagnosis were not significantly increased. Post-IBD diagnosis, risks of BCC (hazard ratio, 1.53; 95% CI, 1.37-1.70) and SCC (hazard ratio, 1.61; 95% CI, 1.29-2.01) were significantly increased across all IBD groups except for SCC in UC. There was no significant association between melanoma and IBD post-IBD diagnosis. The risks of BCC and melanoma were increased in thiopurine and anti-TNF users, and risk of SCC was increased in only thiopurine users. Nested cohort analysis of persons with IBD with censoring at both thiopurines and anti-TNF use confirmed a higher baseline risk of BCC and no effect on SCC, comparable to pre-IBD diagnosis findings.
The risk of BCC preceding a diagnosis of UC is higher than in non-UC controls, compared with a generally increased risk of all NMSCs post-IBD diagnosis. Thiopurine and anti-TNF therapy increase the risks for skin cancers in persons with IBD after their diagnoses.
我们比较了非黑色素瘤皮肤癌（NMSC）和黑色素瘤在炎症性肠病（IBD）诊断前后的风险，并评估了巯嘌呤和抗肿瘤坏死因子-α（抗-TNF-α）对 IBD 患者皮肤癌风险的影响。
这是一项基于人群的回顾性历史队列研究，使用曼尼托巴大学 IBD 流行病学数据库（11228 例 IBD 病例和 104725 例匹配对照）与曼尼托巴癌症登记处进行了链接。使用逻辑回归和 Cox 回归分析来计算 IBD 诊断前后的皮肤癌风险。
溃疡性结肠炎（UC）患者在 UC 诊断前更有可能患有基底细胞癌（BCC）（比值比，1.32；95%置信区间[CI]，1.08-1.60）。IBD 诊断前，鳞状细胞癌（SCC）、其他 NMSC 或黑色素瘤的风险并未显著增加。IBD 诊断后，BCC（风险比，1.53；95%CI，1.37-1.70）和 SCC（风险比，1.61；95%CI，1.29-2.01）的风险在除 UC 中的 SCC 以外的所有 IBD 组中均显著增加。IBD 诊断后，黑色素瘤与 IBD 之间无显著关联。在使用巯嘌呤和抗-TNF 的患者中，BCC 和黑色素瘤的风险增加，而 SCC 的风险仅在使用巯嘌呤的患者中增加。在同时使用巯嘌呤和抗-TNF 进行 censoring 的 IBD 患者的嵌套队列分析中，确认了 BCC 的基线风险较高，与 IBD 诊断前的发现相比，SCC 没有影响。
与 IBD 诊断后所有 NMSC 的总体风险增加相比，UC 诊断前 BCC 的风险高于非 UC 对照。巯嘌呤和抗-TNF 治疗增加了 IBD 患者诊断后的皮肤癌风险。
