Development of Cancer Among Patients With Pediatric-Onset Inflammatory Bowel Disease

医学 炎症性肠病 硫嘌呤甲基转移酶 人口 癌症 溃疡性结肠炎 内科学 相对风险 荟萃分析 入射(几何) 小儿癌症 结直肠癌 队列研究 疾病 儿科 置信区间 环境卫生 物理 光学
作者
Rahma Elmahdi,Camilla Engel Lemser,Sandra Bohn Thomsen,Kristine H. Allin,Manasi Agrawal,Tine Jess
出处
期刊:JAMA network open [American Medical Association]
卷期号:5 (3): e220595-e220595 被引量:17
标识
DOI:10.1001/jamanetworkopen.2022.0595
摘要

Importance

Because the incidence of pediatric-onset inflammatory bowel disease (IBD) is increasing, knowledge of the long-term risk of cancer in this patient population is required.

Objective

To evaluate the relative rate of cancer among patients with pediatric-onset IBD.

Data Sources

A comprehensive systematic search was performed of MEDLINE and Embase from the date of database inception to October 31, 2021.

Study Selection

All unselected, population-based cohort studies of pediatric-onset IBD assessing the risk of cancer were included. Tertiary center referrals and insurance database studies were excluded. All articles were assessed by 2 independent reviewers.

Data Extraction and Synthesis

The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline for data extraction and used the Newcastle-Ottawa Scale for assessment of the risk of bias and the quality of included articles.

Main Outcomes and Measures

A random-effects model meta-analysis was conducted of included studies using the inverse-variance method to assess the relative rate of cancer overall and by IBD subtype (Crohn disease or ulcerative colitis), sex, and thiopurine exposure among patients with pediatric-onset IBD. Pooled relative rates (pRRs) along with 95% CIs were calculated for combined studies.

Results

Of 4628 articles screened, 5 population-based studies from North America and Europe were eligible for inclusion. These studies comprised 19 812 individuals with pediatric-onset IBD followed up for 283 540 person-years in which 715 cases of cancer were identified. Meta-analysis of pRR estimates showed a 2.4-fold increased rate of cancer among patients with pediatric-onset IBD (pRR, 2.46; 95% CI, 2.06-2.93), seen among patients with Crohn disease (pRR, 2.03; 95% CI, 1.67-2.46) and those with ulcerative colitis (pRR, 2.61; 95% CI, 2.00-3.40). This increased rate is primarily due to an increased rate of liver (pRR, 55.45; 95% CI, 19.59-156.99), colorectal (pRR, 20.29; 95% CI, 15.90-25.90), and small bowel (pRR, 16.20; 95% CI, 3.52-74.66) cancers. The incidence rate of cancer among patients with pediatric-onset IBD was reported by 4 studies and ranged from 1.0 to 3.3 cases per 1000 person-years.

Conclusions and Relevance

This meta-analysis of unselected, population-based studies showed a greater than 2-fold increased rate of cancer among patients with pediatric-onset IBD compared with the general pediatric populations, primarily owing to an increased rate of gastrointestinal cancers.

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