Clinical Research Papers:
Better survival of renal cell carcinoma in patients with inflammatory bowel disease
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Lauranne A.A.P. Derikx1, Loes H.C. Nissen1, Joost P.H. Drenth1, Carla M. van Herpen2, Wietske Kievit3, Rob H.A. Verhoeven4, Peter F.A. Mulders5, Christina A. Hulsbergen-van de Kaa6, Marye J. Boers-Sonderen2, Tim R.A. van den Heuvel7, Marieke Pierik7, Iris D. Nagtegaal6, Frank Hoentjen1, On behalf of the Dutch Initiative on Crohn and Colitis (ICC), PALGA group and IBD/RCC group
1Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Radboud university medical centre, Nijmegen, The Netherlands
2Department of Medical Oncology, Radboud university medical centre, Nijmegen, The Netherlands
3Radboud Institute for Health Sciences, Radboud university medical centre, Nijmegen, The Netherlands
4Netherlands comprehensive cancer organization / Netherlands Cancer Registry, Utrecht, The Netherlands
5Department of Urology, Radboud university medical centre, Nijmegen, The Netherlands
6Department of Pathology, Radboud university medical centre, Nijmegen, The Netherlands
7Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands
Lauranne A.A.P. Derikx, e-mail: Lauranne.Derikx@radboudumc.nl
Keywords: inflammatory bowel disease, renal cell carcinoma, immunosuppressive therapy
Received: June 30, 2015 Accepted: September 24, 2015 Published: October 05, 2015
Background: Immunosuppressive therapy may impact cancer risk in inflammatory bowel disease (IBD). Cancer specific data regarding risk and outcome are scarce and data for renal cell carcinoma (RCC) are lacking. We aimed(1) to identify risk factors for RCC development in IBD patients (2) to compare RCC characteristics, outcome and survival between IBD patients and the general population.
Methods: A PALGA (Dutch Pathology Registry) search was performed to establish a case group consisting of all IBD patients with incident RCC in The Netherlands (1991–2013). Cases were compared with two separate control groups: (A) with a population-based IBD cohort for identification of risk factors (B) with a RCC cohort from the general population to compare RCC characteristics and outcomes.
Results: 180 IBD patients with RCC were identified. Pancolitis (OR 1.8–2.5), penetrating Crohn’s disease (OR 2.8), IBD related surgery (OR 3.7–4.5), male gender (OR 3.2–5.0) and older age at IBD onset (OR 1.0–1.1) were identified as independent risk factors for RCC development. IBD patients had a significantly lower age at RCC diagnosis (p < 0.001), lower N-stage (p = 0.025), lower M-stage (p = 0.020) and underwent more frequently surgical treatment for RCC (p < 0.001) compared to the general population. This translated into a better survival (p = 0.026; HR 0.7) independent of immunosuppression.
Conclusions: IBD patients with a complex phenotype are at increased risk to develop RCC. They are diagnosed with RCC at a younger age and at an earlier disease stage compared to the general population. This translates into a better survival independent of immunosuppressive or anti-TNFα therapy.
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