S. Patil2, R. Chamberlain1 1Banner MD Anderson Cancer Center,Surgery,Gilbert, AZ, USA 2South Central Regional Medical Center,Surgery,Laurel, MS, USA
Introduction: Cancer is a deadly sequelae of chronic inflammation in Crohn's disease (CD) patients, which follows the inflammation-dysplasia-carcinoma sequence. The inflammatory milieu increase the risk of colorectal cancer by 2-3 fold and small bowel cancer by up to 60 fold in CD patients compared to general population. The incidence of other cancer types in CD patients is poorly studied. This is the first population based study to estimate risk of GI and Extra-GI cancer in CD patients.
Methods: National Inpatient Database (NIS 1998-2010) was used to identify patient with CD and demographic data including age, gender, race, mortality and type of malignancy were abstracted. Two groups were formed (CD patients with and without malignancies). The observed events for 13 randomly selected cancers were abstracted and converted to events/year/100,000 and compared against corresponding national incidence rate obtained from Surveillance Epidemiology and End Results (SEER) database. The Standardized Incidence Ratio (SIR) for each individual malignancy was calculated to assess the true risk.
Results: 373,199 patients with CD were indentified in NIS database, of whom 29,971 (8.0%) suffered from at least one cancer. The mean age of CD patients with cancer was 62.3±16.0 years compared to those without cancer 46.8±19.0, p <0.001. More females compared to males developed CD (1.5: 1) and associated cancer (1.3: 1), p <0.001. CD and associated cancer was highest in Caucasians compared to other ethnic groups, p <0.001. The mortality was higher in CD patients with cancer compared to those without cancer, p <.001. Patients with CD are at higher risk of developing gallbladder cancer (SIR = 7364.3), anal canal cancer (SIR = 4772.6), extrahepatic biliary cancer (SIR = 4628.5), small bowel cancer (SIR = 3465.9), sarcoma (SIR = 2562.9), liver cancer (SIR = 979.9) , pancreas cancer (SIR = 654.7), rectal cancer (SIR = 649.2), colon cancer (SIR = 219.7), and lung cancer (SIR= 132.6), compared to general population. The risk for breast, stomach and esophageal cancer was lower in CD patients compared to general population.
Conclusion: Patients with CD are at increased risk of developing GI and extra-GI cancers compared to general population, except for breast, stomach and esophageal cancers. The risk is higher in elderly, female and Caucasians. The mortality is higher in CD patients with cancer compared to those without cancer.
