TY - JOUR
T1 - Risk Factors and Clinical Outcomes of Head and Neck Cancer in Inflammatory Bowel Disease: A Nationwide Cohort Study
AU - Nissen, Loes H. C.
AU - Derikx, Lauranne A. A. P.
AU - Jacobs, Anouk M. E.
AU - van Herpen, Carla M.
AU - Kievit, Wietske
AU - Verhoeven, Rob
AU - van den Broek, Esther
AU - Bekers, Elise
AU - van den Heuvel, Tim
AU - Pierik, Marieke
AU - Rahamat-Langendoen, Janette
AU - Takes, Robert P.
AU - Melchers, Willem J. G.
AU - Nagtegaal, Iris D.
AU - Hoentjen, Frank
AU - Dutch Initiative Crohn Colitis ICC; Dutch Head Neck Soc; PALGA Grp; IBD HNC Grp
PY - 2018/9/1
Y1 - 2018/9/1
N2 - 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.
AB - 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.
KW - inflammatory bowel diseases
KW - head and neck cancer
KW - pharyngeal carcinoma
KW - oral cavity carcinoma
KW - immunosuppressive therapy
KW - EVIDENCE-BASED CONSENSUS
KW - ORGAN TRANSPLANT RECIPIENTS
KW - SQUAMOUS-CELL CARCINOMAS
KW - HUMAN-PAPILLOMAVIRUS
KW - OROPHARYNGEAL CANCER
KW - CROHNS-DISEASE
KW - IMMUNOSUPPRESSIVE THERAPY
KW - DIAGNOSIS
KW - AZATHIOPRINE
KW - METAANALYSIS
U2 - 10.1093/ibd/izy096
DO - 10.1093/ibd/izy096
M3 - Article
C2 - 30759216
SN - 1078-0998
VL - 24
SP - 2015
EP - 2026
JO - Inflammatory Bowel Diseases
JF - Inflammatory Bowel Diseases
IS - 9
ER -