Incidence of intestinal & extra-intestinal cancers among individuals with Crohn's disease in northern India.

in The Indian journal of medical research by Parth Sharma, Varad Putambekar, Peeyush Kumar, David Mathew Thomas, Sudheer K Vuyyuru, Bhaskar Kante, Sandeep Kumar Mundhra, Raju Sharma, Nihar Ranjan Dash, Govind Makharia, Saurabh Kedia, Vineet Ahuja

TLDR

  • This study looked at people with Crohn's disease (CD) and found that they have a higher risk of getting cancer. The study also found that the risk of getting cancer increases with age and the length of time someone has CD. The most common types of cancer found in people with CD were bowel cancer and cancer in other parts of the body. The study highlights the importance of monitoring people with CD for cancer and finding ways to reduce the risk of cancer in this group.

Abstract

Background & objectives Crohn's disease (CD) is associated with a higher risk of malignancy, which is attributed to disease behaviour and the usage of immunosuppressants. The burden of malignancy in CD is scarcely reported from Asia. We report real-world data on CD-related malignancy from a northern Indian cohort. Methods This retrospective analysis included individuals with CD who were followed up at the All India Institute of Medical Sciences, New Delhi, from 2005 to 2021. The standardized incidence ratio (SIR) was used to calculate the relative risk of malignancy in CD affected individuals compared to the general population. Results In this study, 952 study participants were included, with a mean age at diagnosis of 36.9±15.11 yr; 61.1 per cent were male. The median follow-up duration was 34 months [IQR (interquartile range): 19-73]. Most study participants received steroids (76.7%), immunomodulators (68.7%), or anti-TNF therapy (10.8%). The overall incidence of malignancy was 1.05 per cent, indicating a 10.45 times higher risk in CD [SIR: 10.45; 95% Confidence interval (CI):4.98-17.96]. Eight out of 826, 1 of 106 and 1 of 25 study participants developed malignancy in the first, second and third decades, respectively. The cumulative risk of malignancy was 2.7, 5.5, and 13.4 per cent in the first, second, and third decades, respectively. Regarding bowel malignancies, one study participant each developed ileocaecal adenocarcinoma, anorectal adenocarcinoma, malignant rectal fibrous histiocytoma, and gastric adenocarcinoma. Extraintestinal malignancies included single cases each of follicular neoplasia of the thyroid, neuroendocrine tumour of the pancreatic tail, breast cancer, hepatocellular cancer, oral cancer, and prostate cancer. No cases of lymphoma or skin malignancy were reported. Interpretation & conclusions At 30 yr, the cumulative risk of malignancy among Indian CD-affected individuals was 13.4 per cent, with a SIR of 10.45 (95% CI: 4.98- 17.96). The risk increased with increasing age at disease onset and duration.

Overview

  • The study aims to report real-world data on CD-related malignancy from a northern Indian cohort. The methodology used for the experiment includes a retrospective analysis of individuals with CD followed up at the All India Institute of Medical Sciences, New Delhi, from 2005 to 2021. The standardized incidence ratio (SIR) was used to calculate the relative risk of malignancy in CD affected individuals compared to the general population. The primary objective of the study is to determine the incidence and risk of malignancy in CD-affected individuals in India.

Comparative Analysis & Findings

  • The study found that the overall incidence of malignancy in CD-affected individuals was 1.05%, indicating a 10.45 times higher risk compared to the general population. The cumulative risk of malignancy was 2.7, 5.5, and 13.4% in the first, second, and third decades, respectively. The risk increased with increasing age at disease onset and duration. The study also identified the most common types of malignancies in CD-affected individuals, including bowel malignancies (ileocaecal adenocarcinoma, anorectal adenocarcinoma, malignant rectal fibrous histiocytoma, and gastric adenocarcinoma) and extraintestinal malignancies (follicular neoplasia of the thyroid, neuroendocrine tumour of the pancreatic tail, breast cancer, hepatocellular cancer, oral cancer, and prostate cancer). No cases of lymphoma or skin malignancy were reported.

Implications and Future Directions

  • The study's findings highlight the higher risk of malignancy in CD-affected individuals, which is attributed to disease behaviour and the usage of immunosuppressants. The burden of malignancy in CD is scarcely reported from Asia, and this study provides valuable real-world data on CD-related malignancy from a northern Indian cohort. The study's findings also suggest that the risk of malignancy increases with increasing age at disease onset and duration. Future research should focus on identifying the specific risk factors for malignancy in CD-affected individuals and developing targeted interventions to reduce the risk of malignancy. Additionally, further studies are needed to investigate the long-term outcomes of malignancy in CD-affected individuals and the effectiveness of different treatment options.
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