Introduction: The risk of new or recurrent cancer in inflammatory bowel disease (IBD) patients with a history of cancer treated with immunomodulators (IMMs), including conventional immunosuppressors (ISSs), biologics or small molecules is undefined. The primary aim was to assess the frequency of new or recurrent cancer in IBD patients treated with IMMs after first cancer. The secondary aim was to evaluate risk factors for new/recurrent cancer in the same IBD population.Methods: In a retrospective multicenter study, all IBD patients using any IMM after first (index) cancer were enrolled. Inclusion criteria: Crohn’s disease (CD) or ulcerative colitis (UC), history of any cancer, detailed clinical history, and follow-up after cancer of ≥6 months. Exclusion criteria: IMM use for ≤3 months.Results: In total, 122 IBD patients (84 CD, 38 UC) treated with IMMs after first cancer were enrolled (age 59.5 [26–89] years). Index cancer included (n= [%]) genitourinary tract cancer (18 [14.8]), non-melanotic skin cancer (NMSC) (17 [13.9]), breast cancer (15 [12.3]), thyroid cancer (13 [10.7]), melanoma (14 [11.4]), colorectal cancer (CRC) (11 [9.0]), hematopoietic cancer (9 [7.4]), prostatic cancer (8 [6.6]), neuroendocrine cancer (4 [3.3]), head and neck cancer (3 [2.5]), liver cancer (3 [2.5]), endometrium cancer (2 [1.6]), lung cancer (1 [0.8]) and others (3 [2.5]). ISSs after cancer included (n= [%]) thiopurines (10 [37]), methotrexate (MTX) (14 [51.9]) and others (3 [11.1]) Biologics included (n= [%]) TNF-inhibitors (36 [32.4]), vedolizumab (60 [53.6]), ustekinumab (45 [40.2]), small molecules (9 [7.3]) and others (6 [5.4]). In a median follow-up of 8 [1–45] years after index cancer, 12/122 (9.8%) patients using IMMs after cancer developed new or recurrent cancer. No risk factors for new/recurrent cancer (i.e., age at diagnosis of cancer, smoke, gender, IBD type, IMM use, duration before or after cancer) were identified.Conclusions: In a multicenter study, ISSs or biologics after cancer were not identified as risk factors for new or recurrent cancer in IBD. However, IMMs were used after a long-term interval from index cancer.
引言：对于有癌症病史的炎症性肠病（IBD）患者，使用免疫调节剂（包括传统免疫抑制剂、生物制剂或小分子药物）治疗是否会增加新发或复发癌症的风险尚不明确。本研究主要目的是评估IBD患者在首次患癌后接受免疫调节剂治疗时新发或复发癌症的发生频率，次要目的是评估该IBD人群中新发/复发癌症的风险因素。 方法：在一项回顾性多中心研究中，纳入所有首次患癌后使用任何免疫调节剂的IBD患者。纳入标准包括：克罗恩病或溃疡性结肠炎、任何癌症病史、详细的临床病史以及癌症后随访时间≥6个月。排除标准为：免疫调节剂使用时间≤3个月。 结果：共纳入122例首次患癌后接受免疫调节剂治疗的IBD患者（84例克罗恩病，38例溃疡性结肠炎），年龄59.5岁（范围26-89岁）。首次癌症类型包括（例数[百分比]）：泌尿生殖系统癌（18例[14.8%]）、非黑色素瘤皮肤癌（17例[13.9%]）、乳腺癌（15例[12.3%]）、甲状腺癌（13例[10.7%]）、黑色素瘤（14例[11.4%]）、结直肠癌（11例[9.0%]）、造血系统癌（9例[7.4%]）、前列腺癌（8例[6.6%]）、神经内分泌癌（4例[3.3%]）、头颈癌（3例[2.5%]）、肝癌（3例[2.5%]）、子宫内膜癌（2例[1.6%]）、肺癌（1例[0.8%]）及其他类型（3例[2.5%]）。癌症后使用的免疫抑制剂包括（例数[百分比]）：硫嘌呤类药物（10例[37%]）、甲氨蝶呤（14例[51.9%]）及其他（3例[11.1%]）；生物制剂包括（例数[百分比]）：肿瘤坏死因子抑制剂（36例[32.4%]）、维多珠单抗（60例[53.6%]）、乌司奴单抗（45例[40.2%]）；小分子药物（9例[7.3%]）及其他（6例[5.4%]）。在首次癌症后中位随访8年（范围1-45年）期间，122例患者中有12例（9.8%）在癌症后使用免疫调节剂期间出现新发或复发癌症。未发现与新发/复发癌症相关的风险因素（包括癌症诊断年龄、吸烟史、性别、IBD类型、免疫调节剂使用情况、癌症前后用药时长等）。 结论：在这项多中心研究中，癌症后使用免疫抑制剂或生物制剂未被确定为IBD患者新发或复发癌症的风险因素。但需注意，免疫调节剂的使用通常始于首次癌症后较长时间间隔。
肿瘤(癌症)患者之家