Subjects

Abstract

Background

Malignancy may occur as long-term complication of inflammatory bowel disease (IBD) due to different risk factors. We assessed prevalence and incidence of malignancy, and predictive factors in the Swiss IBD Cohort Study (SIBDCS).

Methods

All IBD patients in the SIBDCS were analyzed from a cross-sectional and longitudinal perspective. Patients with malignancies were compared to controls. Standardized incidence ratios (SIR) were calculated based on age-specific and sex-specific background rates.

Results

Malignancies were identified in 122 of 3119 patients (3.9%). In a logistic regression model, age (OR 1.04 per year), intestinal surgery (OR 3.34), and treatment with steroids (OR 2.10) were the main predictors for the presence of malignancy, while treatment with 5-ASA (OR 0.57) and biologics (OR 0.38) were protective. From a longitudinal perspective, 67 out of 2580 patients (2.6%) were newly diagnosed with malignancy during a follow-up of 12,420.8 years (median 4.9 years). While there was no increased risk for malignancy overall (SIR 0.93, 95% CI 0.72–1.18) and colorectal cancer (SIR 1.55, 95% CI 0.71–2.95), IBD patients had an increased risk for lymphoma (SIR 2.98, 95% CI 1.36–5.66) and biliary cancer (SIR 6.3, 95% CI 1.27–18.41). In a Cox regression model, age and recent use of immunomodulators were the main predictors for development of malignancies, while 5-ASA, biologics were protective.

Conclusion

IBD patients showed increased risk for lymphoma and biliary cancer, but not colorectal cancer and cancer overall. Age and recent use of immunomodulators were the main risk factors for malignancy, while aminosalicylates and biologics appear to be protective.

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Additional information

Members of the Swiss IBD Cohort Study Group are listed below the Acknowledgements.

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Acknowledgements

We would like to thank all patients and members of the Swiss IBD cohort study.

Members of the SIBDCS study group

Karim Abdelrahman, Gentiana Ademi, Patrick Aepli, Amman Thomas, Claudia Anderegg, Anca-Teodora Antonino, Eva Archanioti, Eviano Arrigoni, Diana Bakker de Jong, Bruno Balsiger, Polat Bastürk, Peter Bauerfeind, Andrea Becocci, Dominique Belli, José M. Bengoa, Luc Biedermann, Janek Binek, Mirjam Blattmann, Stephan Boehm, Tujana Boldanova, Jan Borovicka, Christian P. Braegger, Stephan Brand, Lukas Brügger, Simon Brunner, Patrick Bühr, Bernard Burnand, Sabine Burk, Emanuel Burri, Sophie Buyse, Dahlia-Thao Cao, Ove Carstens, Dominique H. Criblez, Sophie Cunningham, Fabrizia D’Angelo, Philippe de Saussure, Lukas Degen, Joakim Delarive, Christopher Doerig, Barbara Dora, Susan Drerup, Mara Egger, Ali El-Wafa, Matthias Engelmann, Jessica Ezri, Christian Felley, Markus Fliegner, Nicolas Fournier, Montserrat Fraga, Yannick Franc, Pascal Frei, Remus Frei, Michael Fried, Florian Froehlich, Raoul Ivano Furlano, Luca Garzoni, Martin Geyer, Laurent Girard, Marc Girardin, Delphine Golay, Ignaz Good, Ulrike Graf Bigler, Beat Gysi, Johannes Haarer, Marcel Halama, Janine Haldemann, Pius Heer, Benjamin Heimgartner, Beat Helbling, Peter Hengstler, Denise Herzog, Cyrill Hess, Roxane Hessler, Klaas Heyland, Thomas Hinterleitner, Claudia Hirschi, Petr Hruz, Pascal Juillerat, Carolina Khalid-de Bakker, Stephan Kayser, Céline Keller, (Christina Knellwolf (-Grieger)), Christoph Knoblauch, Henrik Köhler, Rebekka Koller, Claudia Krieger(-Grübel), Patrizia Künzler, Rachel Kusche, Frank Serge Lehmann, Andrew Macpherson, Michel H. Maillard, Michael Manz, Astrid Marot, Rémy Meier, Christa Meyenberger, Pamela Meyer, Pierre Michetti, Benjamin Misselwitz, Patrick Mosler, Christian Mottet, Christoph Müller, Beat Müllhaupt, Leilla Musso, Michaela Neagu, Cristina Nichita, Jan Niess, Andreas Nydegger, Nicole Obialo, Diana Ollo, Cassandra Oropesa, Ulrich Peter, Daniel Peternac, Laetitia Marie Petit, Valérie Pittet, Daniel Pohl, Marc Porzner, Claudia Preissler, Nadia Raschle, Ronald Rentsch, Alexandre Restellini, Sophie Restellini, Jean-Pierre Richterich, Frederic Ris, Branislav Risti, Marc Alain Ritz, Gerhard Rogler, Nina Röhrich, Jean-Benoît Rossel, Vanessa Rueger, Monica Rusticeanu, Markus Sagmeister, Gaby Saner, Bernhard Sauter, Mikael Sawatzki, Michael Scharl, Martin Schelling, Susanne Schibli, Hugo Schlauri, Dominique Schluckebier, Daniela Schmid, Sybille Schmid (-Uebelhart), Jean-François Schnegg, Alain Schoepfer, Vivianne Seematter, Frank Seibold, Mariam Seirafi, Gian-Marco Semadeni, Arne Senning, Christiane Sokollik, Joachim Sommer, Johannes Spalinger, Holger Spangenberger, Philippe Stadler, Peter Staub, Dominic Staudenmann, Volker Stenz, Michael Steuerwald, Alex Straumann, Bruno Strebel, Andreas Stulz, Michael Sulz, Aurora Tatu, Michela Tempia-Caliera, Joël Thorens, Kaspar Truninger, Radu Tutuian, Patrick Urfer, Stephan Vavricka, Francesco Viani, Jürg Vögtlin, Roland Von Känel, Dominique Vouillamoz, Rachel Vulliamy, Paul Wiesel, Reiner Wiest, Stefanie Wöhrle, Samuel Zamora, Silvan Zander, Tina Wylie, Jonas Zeitz, Dorothee Zimmermann

Author information

Author notes

  1. These authors contributed equally: Michael Scharl and Thomas Greuter.

Affiliations

  1. Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland

    • Sylvie Scharl MD
    • , Christiane Barthel MD
    • , Luc Biedermann MD
    • , Benjamin Misselwitz MD
    • , Alex Straumann MD
    • , Stephan R. Vavricka MD
    • , Gerhard Rogler MD, PhD
    • , Michael Scharl MD
    •  & Thomas Greuter MD
  2. Institute of Social and Preventive Medicine, University Hospital Lausanne—CHUV, Lausanne, Switzerland

    • Jean-Benoit Rossel PhD
  3. Division of Gastroenterology and Hepatology, University Hospital Lausanne—CHUV, Lausanne, Switzerland

    • Alain M. Schoepfer MD

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Consortia

  1. on behalf of the Swiss IBD Cohort Study Group

    Guarantor of the article

    Thomas Greuter.

    Specific author contributions

    Study concept and design: SS, SRV, MS, and TG; acquisition of data: SS, CB; statistical analysis: JBR, TG; interpretation of data: SS, AMS, AS, MS, and TG; drafting of manuscript: MS, TG; critical revision of the manuscript for important intellectual content: CB, JBR, LB, BM, AMS, AS, SRV, and GR; Supervision: MS, TG.

    Financial support

    This work was supported by research grants from the Swiss National Science Foundation to GR (grant No. 310030–120312), to MS (grant No. 314730_166381), to TG (grant No. P2ZHP3_168561) and to the Swiss IBD Cohort (grant no. 33CS30_148422).

    Potential competing interests

    None.

    Corresponding author

    Correspondence to Thomas Greuter MD.

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    DOI

    https://doi.org/10.1038/s41395-018-0360-9