TY - JOUR

T1 - The Risk of Extraintestinal Cancer in Inflammatory Bowel Disease

T2 - A Systematic Review and Meta-analysis of Population-based Cohort Studies

AU - Lo, Bobby

AU - Zhao, Mirabella

AU - Vind, Ida

AU - Burisch, Johan

N1 - Publisher Copyright: © 2021 AGA Institute

PY - 2021

Y1 - 2021

N2 - Background & Aims: Patients with Crohn's disease (CD) and ulcerative colitis (UC) are at increased risk of developing intestinal cancer. However, less is known about the risk of extraintestinal cancers (EICs). The aim of this study was to conduct a systematic review and meta-analysis of population-based cohorts assessing the risk of EICs in inflammatory bowel disease (IBD) patients. Methods: Only population-based studies reporting on the prevalence or incidence of EICs were included. In total, 884 studies were screened and those included were assessed for quality. Eligible studies were pooled for length of follow-up evaluation, events in the IBD population, and events or expected events in a control population for the meta-analyses. Results: In total, 40 studies were included in the systematic review and 15 studies were included in the meta-analysis. The overall risk of EICs was found to be increased in both CD (incidence rate ratio [IRR]: 1.43 [CI, 1.26, 1.63]) and UC (IRR: 1.15 [1.02, 1.31]) patients. Both CD and UC patients presented with an increased risk of skin (IRR: CD, 2.22 [1.41–3.48]; UC, 1.38 [1.12–1.71]) and hepatobiliary (IRR: CD, 2.31 [1.25–4.28]; UC, 2.05 [1.52–2.76]) malignancies. Furthermore, CD patients showed an increased risk of hematologic (IRR, 2.40 [1.81–3.18]) and lung (IRR, 1.53 [1.23–1.91]) cancers. These increased risks were present despite treatment with immunosuppressives. Conclusions: This systematic review and meta-analysis shows that both CD and UC patients are at an increased risk of developing EICs, both overall and at specific sites. However, additional studies with longer follow-up evaluation are needed to assess the true risk of EICs posed by IBD.

AB - Background & Aims: Patients with Crohn's disease (CD) and ulcerative colitis (UC) are at increased risk of developing intestinal cancer. However, less is known about the risk of extraintestinal cancers (EICs). The aim of this study was to conduct a systematic review and meta-analysis of population-based cohorts assessing the risk of EICs in inflammatory bowel disease (IBD) patients. Methods: Only population-based studies reporting on the prevalence or incidence of EICs were included. In total, 884 studies were screened and those included were assessed for quality. Eligible studies were pooled for length of follow-up evaluation, events in the IBD population, and events or expected events in a control population for the meta-analyses. Results: In total, 40 studies were included in the systematic review and 15 studies were included in the meta-analysis. The overall risk of EICs was found to be increased in both CD (incidence rate ratio [IRR]: 1.43 [CI, 1.26, 1.63]) and UC (IRR: 1.15 [1.02, 1.31]) patients. Both CD and UC patients presented with an increased risk of skin (IRR: CD, 2.22 [1.41–3.48]; UC, 1.38 [1.12–1.71]) and hepatobiliary (IRR: CD, 2.31 [1.25–4.28]; UC, 2.05 [1.52–2.76]) malignancies. Furthermore, CD patients showed an increased risk of hematologic (IRR, 2.40 [1.81–3.18]) and lung (IRR, 1.53 [1.23–1.91]) cancers. These increased risks were present despite treatment with immunosuppressives. Conclusions: This systematic review and meta-analysis shows that both CD and UC patients are at an increased risk of developing EICs, both overall and at specific sites. However, additional studies with longer follow-up evaluation are needed to assess the true risk of EICs posed by IBD.

KW - Crohn's Disease

KW - Extraintestinal Cancer

KW - Inflammatory Bowel Disease

KW - Population-Based

KW - Ulcerative Colitis

U2 - 10.1016/j.cgh.2020.08.015

DO - 10.1016/j.cgh.2020.08.015

M3 - Review

C2 - 32801010

AN - SCOPUS:85095450425

VL - 19

SP - 1117-1138.e19

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

SN - 1542-3565

IS - 6

ER -