Effect of Biologics on the Risk of Advanced-Stage Inflammatory Bowel Disease-Associated Intestinal Cancer: A Nationwide Study-猫眼课题宝

DOI：

10.14309/ajg.0000000000002149

发表时间：

2022-12

期刊：

The American Journal of Gastroenterology

影响因子：

通讯作者：

中科院分区：

其他

文献类型：

作者：

R. Seishima;K. Okabayashi;H. Ikeuchi;M. Uchino;K. Futami;T. Noguchi;Hiroki Ohge;Yasuhito Iseki;Kazuhiro Watanabe;M. Itabashi;Kinya Okamoto;Y. Toiyama;T. Ogino;Masafumi Nakamura;Kazutaka Yamada;T. Wakai;Yuji Sato;H. Kimura;Kenichi P. Takahashi;K. Hida;Y. Kinugasa;F. Ishida;J. Okuda;K. Daito;F. Koyama;H. Ueno;Takayuki Yamamoto;Seiichiro Yamamoto;T. Hanai;A. Maemoto;J. Arakaki;K. Komori;Yoshito Akagi;D. Shida;S. Yamaguchi;K. Matsuda;Kiyoshi Maeda;T. Noake;R. Nezu;Shin-ichi Sasaki;J. Hasegawa;E. Sunami;Y. Kanemitsu;K. Katsumata;K. Uehara;T. Kiyomatsu;T. Suto;S. Kazama;Takeshi Yamada;T. Goi;S. Ishihara;Y. Ajioka;K. Sugihara

简介：本研究的目的是通过全国多中心数据集评估生物制剂对晚期炎症性肠病 (IBD) 相关肠癌风险的影响。方法：本研究纳入了 1983 年至 2020 年诊断为 IBD 相关肠道肿瘤（发育不良或癌症）的克罗恩病 (CD) 和溃疡性结肠炎 (UC) 患者的病历。治疗药物分为3类：生物制剂、5-氨基水杨酸和免疫调节剂。根据 CD 和 UC 患者使用的药物比较病理癌症分期。结果：总共纳入 1,042 名患者（214 名 CD 患者和 828 名 UC 患者）。没有一种药物与 CD 患者的癌症分期显着相关。在 UC 患者中，晚期癌症分期与生物制剂（早期：7.7% vs 晚期：2.0%，P < 0.001）、5-氨基水杨酸和免疫调节剂的使用较少显着相关。在定期监测诊断的患者中，生物制剂的使用与较低的晚期癌症发生率相关（生物制剂 [−] 24.5% vs [+] 9.1%，P = 0.043），但其他药物的情况并非如此。多变量分析显示，生物制剂的使用与较低的晚期疾病风险显着相关（比值比 = 0.111 [95% 置信区间，0.034–0.356]，P < 0.001）。讨论：生物制剂的使用与 UC 患者晚期 IBD 相关癌症的较低风险相关，但与 CD 患者无关。 UC和CD之间的癌症进展机制可能不同，需要进一步研究。

INTRODUCTION: The aim of this study was to evaluate the effect of biologics on the risk of advanced-stage inflammatory bowel disease (IBD)-associated intestinal cancer from a nationwide multicenter data set. METHODS: The medical records of patients with Crohn's disease (CD) and ulcerative colitis (UC) diagnosed with IBD-associated intestinal neoplasia (dysplasia or cancer) from 1983 to 2020 were included in this study. Therapeutic agents were classified into 3 types: biologics, 5-aminosalicylic acid, and immunomodulators. The pathological cancer stage was compared based on the drug used in both patients with CD and UC. RESULTS: In total, 1,042 patients (214 CD and 828 UC patients) were included. None of the drugs were significantly associated with cancer stage in the patients with CD. In the patients with UC, an advanced cancer stage was significantly associated with less use of biologics (early stage: 7.7% vs advanced stage: 2.0%, P < 0.001), 5-aminosalicylic acid, and immunomodulators. Biologic use was associated with a lower incidence of advanced-stage cancer in patients diagnosed by regular surveillance (biologics [−] 24.5% vs [+] 9.1%, P = 0.043), but this was not the case for the other drugs. Multivariate analysis showed that biologic use was significantly associated with a lower risk of advanced-stage disease (odds ratio = 0.111 [95% confidence interval, 0.034–0.356], P < 0.001). DISCUSSION: Biologic use was associated with a lower risk of advanced IBD-associated cancer in patients with UC but not with CD. The mechanism of cancer progression between UC and CD may be different and needs to be further investigated.

Effect of Biologics on the Risk of Advanced-Stage Inflammatory Bowel Disease-Associated Intestinal Cancer: A Nationwide Study

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