Mortality and Cancer in Pediatric-Onset Inflammatory Bowel Disease: A Population-Based Study
Mortality and Cancer in Pediatric-Onset Inflammatory Bowel Disease: A Population-Based Study
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DOI：
10.1038/ajg.2013.242
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发表时间：
2013-10-01
影响因子：
9.8
通讯作者：
Gower-Rousseau, Corinne
中科院分区：
文献类型：
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作者：
Peneau, Anais;Savoye, Guillaume;Gower-Rousseau, Corinne
目的：尽管法国北部儿童炎症性肠病（IBD）的发病率持续上升，但该人群的死亡和癌症风险尚未确定。方法：纳入所有在EPIMAD登记处记录的年龄< 17岁，并在1988年至2004年间诊断为克罗恩病（CD）或溃疡性结肠炎（UC）的患者。观察到的死亡和癌症发病率与法国统计局（INSEE）和里尔癌症登记处获得的区域一般人口的预期发病率进行了比较。采用Fisher精确检验进行比较，并使用标准化死亡率（SMRs）和标准化发病率比率表示比较。结果：共发现698例患者（538例CD， 160例UC）；360例（52%）为男性，IBD诊断时的中位年龄为14岁（12-16岁），中位随访时间为11.5年（7-15年）。随访期间，死亡率为0.84%(6/698)，与参考人群无差异(SMR = 1.4 (0.5-3.0)；P = 0.27)。在中位随访15年（10-17年）后，1.3%的患者（9/698）患有癌症：结肠癌（n = 2）、胆道癌（n = 1）、子宫颈癌（n = 1）、包皮癌（n = 1）、皮肤癌(基底细胞癌（n = 2）、血液病（急性白血病）和类小肠癌（n = 1）。不论性别和年龄，患癌风险均显著增加(标准化发病率= 3.0 (1.3 -5.9)；P < 0.02)。9名癌症患者中有4名接受了免疫抑制剂或抗肿瘤坏死因子治疗（包括3名患者的联合治疗）。结论：在这个以儿童人群为基础的IBD队列中，死亡率与一般人群没有差异，但肿瘤形成的风险显著增加了三倍。
OBJECTIVES: Although the incidence of pediatric inflammatory bowel disease (IBD) continues to rise in Northern France, the risks of death and cancer in this population have not been characterized.METHODS: All patients < 17 years, recorded in EPIMAD registry, and diagnosed between 1988 and 2004 with Crohn's disease (CD) or ulcerative colitis (UC) were included. The observed incidences of death and cancer were compared with those expected in the regional general population obtained by French Statistical Institute (INSEE) and the cancer Registry from Lille. Comparisons were performed using Fisher's exact test and were expressed using the standardized mortality ratios (SMRs) and standardized incidence ratios.RESULTS: A total of 698 patients (538 with CD and 160 with UC) were identified; 360 (52%) were men, the median age at IBD diagnosis was 14 years (12-16) and the median follow-up time was 11.5 years (7-15). During follow-up, the mortality rate was 0.84% (6/698) and did not differ from that in the reference population (SMR = 1.4 (0.5-3.0); P = 0.27). After a median follow-up of 15 years (10-17), 1.3% of patients (9/698) had a cancer: colon (n = 2), biliary tract (cholangiocarcinoma; n = 1), uterine cervix (n = 1), prepuce (n = 1), skin (basal cell carcinoma (n = 2), hematological (acute leukemia; n = 1), and small bowel carcinoid (n = 1). There was a significantly increased risk of cancer regardless of gender and age (standardized incidence ratio = 3.0 (1.3 -5.9); P < 0.02). Four out of nine patients who developed a cancer had received immunosuppressants or anti-tumor necrosis factor-alpha therapy (including combination therapy in three patients).CONCLUSIONS: In this large pediatric population-based IBD cohort, mortality did not differ from that of the general population but there was a significant threefold increased risk of neoplasia.