Hepatobiliary Cancer Risk in Patients with Inflammatory Bowel Disease: A Scandinavian Population-Based Cohort StudyShow others and affiliations
2021 (English)In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 30, no 5, p. 886-894Article in journal (Refereed) Published
Abstract [en]
Background: Inflammatory bowel disease (IBD) has been associated with hepatobiliary cancer, but existing evidence is poor. We evaluated risk of death from hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and extrahepatic cholangiocarcinoma (ECC) among patients with IBD.
Methods: This Swedish/Danish population-based cohort study (1969-2017) followed patients with IBD and 1:10 matched population comparators from their diagnosis/match date until death, emigration, or end of follow-up.
Results: Among the 97,496 patients with ulcerative colitis/963,026 comparators, we found 66/390 HCC-deaths, 120/173 ICC-deaths, and 91/220 ECC-deaths (median follow-up 10 years); the 10-year-mortality was 0.5% (per mille) for HCC, 0.6% for ICC, and 0.4% for ECC, which decreased to 0.3%, 0.4%, and 0.2%, respectively, in 2003-2017. Overall hazard ratios (HR) were 1.83 [95% confidence interval (CI), 1.41-2.38] for HCC-, 7.33 (95% CI, 5.81-9.25) for ICC-, and 4.46 (95% CI, 3.49-5.70) for ECC-deaths. A total of 22/66 HCC-deaths, 87/120 ICC-deaths, and 55/91 ECC-deaths occurred among patients with ulcerative colitis with primary sclerosing cholangitis (PSC), corresponding to 10-year-mortality of 6.7%, 26.2%, and 17.2%, respectively. Among 47,399 patients with Crohn's disease (median follow-up 11 years), 10-year-mortality from HCC (n = 28), ICC (n = 28), and ECC (n = 24) were 0.3%, 0.1%, and 0.3%, respectively, and corresponding HRs were 1.96 (95% CI, 1.31-2.93), 3.33 (95% CI, 2.19-5.09), and 3.10 (95% CI, 1.97-4.87). One of 28 HCC-deaths, 14/28 ICC-deaths (10-year-mortality 19%), and 12/24 ECC-deaths (10-year-mortality 14%) occurred after PSC.
Conclusions: Risk of HCC-, ICC-, and ECC-deaths was low in patients with IBD and decreased over time. However, a large proportion of deaths occurred after PSC.
Impact: Guidelines on specific surveillance strategies for patients with IBD with PSC, but not those without PSC, are needed.
Place, publisher, year, edition, pages
American Association for Cancer Research , 2021. Vol. 30, no 5, p. 886-894
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:oru:diva-93679DOI: 10.1158/1055-9965.EPI-20-1241ISI: 000675843800007PubMedID: 33627380Scopus ID: 2-s2.0-85105501461OAI: oai:DiVA.org:oru-93679DiVA, id: diva2:1585265
Funder
Novo Nordisk, NNF19OC0058609Swedish Society of Medicine, SLS-789611Stockholm County Council, 2017072020190638The Karolinska Institutet's Research Foundation, 20170720Swedish Research Council, 2020-02002Swedish Heart Lung FoundationForte, Swedish Research Council for Health, Working Life and Welfare, 2016-00424Swedish Cancer Society, PjF 20 0752
Note
Funding agencies:
Independent Research Fund Denmark 8020-00153B
Young Scholar Award from the Strategic Research Area Epidemiology Program at Karolinska Institutet
2021-08-162021-08-162021-08-16Bibliographically approved