Risk Factors and Clinical Outcomes of Head and Neck Cancer in Inflammatory Bowel Disease: A Nationwide Cohort Study

Loes H. C. Nissen*, Lauranne A. A. P. Derikx, Anouk M. E. Jacobs, Carla M. van Herpen, Wietske Kievit, Rob Verhoeven, Esther van den Broek, Elise Bekers, Tim van den Heuvel, Marieke Pierik, Janette Rahamat-Langendoen, Robert P. Takes, Willem J. G. Melchers, Iris D. Nagtegaal, Frank Hoentjen, Dutch Initiative Crohn Colitis ICC; Dutch Head Neck Soc; PALGA Grp; IBD HNC Grp

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Web of Science)

Abstract

Background: Immunosuppressed inflammatory bowel disease (IBD) patients are at increased risk to develop extra-intestinal malignancies. Immunosuppressed transplant patients show increased incidence of head and neck cancer with impaired survival. This study aims to identify risk factors for oral cavity (OCC) and pharyngeal carcinoma (PC) development in IBD, to compare clinical characteristics in IBD with the general population, and to assess the influence of immunosuppressive medication on survival. Methods: We retrospectively searched the Dutch Pathology Database to identify all IBD patients with OCC and PC between 1993 and 2011. Two case-control studies were performed: We compared cases with the general IBD population to identify risk factors, and we compared cases with non-IBD cancer patients for outcome analyses. Results: We included 66 IBD patients and 2141 controls with OCC, 31 IBD patients and 1552 controls with PC, and 1800 IBD controls. Age at IBD diagnosis was a risk factor for OCC development, Crohn's disease (CD; odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.07), and ulcerative colitis (UC; OR, 1.03; 95% CI, 1.01-1.06). For PC, this applied to UC (OR, 1.05; 95% CI, 1.01-1.06). IBD OCC cases showed impaired survival (P = 0.018); in PC, survival was similar. There was no effect of immunosuppression on survival. Human papillomavirus (HPV) testing of IBD cases revealed 52.2% (12/23) HPV-positive oropharyngeal carcinomas (OPCs). Conclusion: This study shows that IBD is associated with impaired OCC survival. Higher age at IBD diagnosis is a risk factor for OCC development. We found no influence of immunosuppression on survival; 52.2% of OPC in IBD contained HPV.
Original languageEnglish
Pages (from-to)2015-2026
Number of pages12
JournalInflammatory Bowel Diseases
Volume24
Issue number9
DOIs
Publication statusPublished - 1 Sep 2018

Keywords

  • inflammatory bowel diseases
  • head and neck cancer
  • pharyngeal carcinoma
  • oral cavity carcinoma
  • immunosuppressive therapy
  • EVIDENCE-BASED CONSENSUS
  • ORGAN TRANSPLANT RECIPIENTS
  • SQUAMOUS-CELL CARCINOMAS
  • HUMAN-PAPILLOMAVIRUS
  • OROPHARYNGEAL CANCER
  • CROHNS-DISEASE
  • IMMUNOSUPPRESSIVE THERAPY
  • DIAGNOSIS
  • AZATHIOPRINE
  • METAANALYSIS

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