title: Risk of new or recurrent cancer under immunosuppressive therapy in patients with IBD and previous cancer.
abstract: OBJECTIVE
  To explore the risk of new or recurrent cancer among patients with IBD and previous cancer, exposed or not to immunosuppressants.
  
  
  METHODS
  Among the 17 047 patients of the CESAME prospective observational cohort who were enrolled from May 2004 to June 2005, and followed-up until December 2007, we identified 405 patients with cancer diagnosed previous to study entry. We calculated the rates of incident cancer in patients with or without previous cancer, and we assessed by survival analysis and nested case-control study the impact of immunosuppressants on the risk of incident new or recurrent cancer in patients with previous cancer.
  
  
  RESULTS
  The rate of incident cancer was 21.1/1000 patient-years (PY) and 6.1/1000 PY in patients with and without previous cancer, respectively. The multivariate-adjusted HR of incident cancer between patients with and without previous cancer was 1.9 (95% CI 1.2 to 3.0, p=0.003). Among patients with previous cancer, the rates of new and recurrent cancers were, respectively, 13.2/1000 PY and 6.0/1000 PY in the 312 patients who were not taking immunosuppressant at the time of study entry, and 23.1/1000 PY and 3.9/1000 PY in the 93 patients treated with immunosuppressants at study entry. There was no significant association between the exposure to immunosuppressants and the risk of new or recurrent cancer.
  
  
  CONCLUSIONS
  Patients with IBD with a history of cancer are at increased risk of developing any (new or recurrent) cancer, with a predominant incidence of new cancers. Treatment with immunosuppressants has no overall major impact per se on this risk.
authors.affiliation: Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine F-75012; ERL 1057 INSERM/UMRS 7203; GRC-UPMC 03, UPMC Univ Paris 06 F-75012, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Beaugerie
authors.affiliation: Department of Public Health, Hôpital Saint-Antoine, AP-HP, F-75012 and UMR-S 707, INSERM & UPMC Univ Paris 06 F-75012, Paris, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Carrat
authors.affiliation: Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Colombel
authors.affiliation: Registre Bourguignon des Cancers Digestifs F-21079; Inserm U866; CHRU Dijon; Université de Bourgogne, Dijon, France.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Bouvier
authors.affiliation: Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine F-75012; ERL 1057 INSERM/UMRS 7203; GRC-UPMC 03, UPMC Univ Paris 06 F-75012, Paris, France.
authors.forename: Harry
authors.initials: H
authors.lastname: Sokol
authors.affiliation: Inserm U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Université Henri Poincaré 1, Vandoeuvre-lès-Nancy, Nancy, France.
authors.forename: Abdenour
authors.initials: A
authors.lastname: Babouri
authors.affiliation: Department of Gastroenterology, Assistance Publique-Hôpitaux de Paris (AP-HP), University hospitals Paris-Sud, Site de Bicêtre, Paris Sud University, Paris XI, Le Kremlin Bicêtre, Villejuif, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Carbonnel
authors.affiliation: CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie-Univ. Bordeaux, Laboratoire de bactériologie, F-33000 Bordeaux, Pessac, France.
authors.forename: David
authors.initials: D
authors.lastname: Laharie
authors.affiliation: Colorectal Unit, Department of Surgery, Grenoble University Hospital, CS 10217, 38043 Grenoble cedex, Grenoble, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Faucheron
authors.affiliation: Clinical Pharmacology Unit, Unité de Recherche clinique de l'Est Parisien, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, F-75012; UPMC Univ Paris 06, Paris, France.
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.affiliation: Department of Oncology, AP-HP, Hôpital Saint-Antoine F-75012, Paris, France.
authors.forename: Aimery
authors.initials: A
authors.lastname: de Gramont
authors.affiliation: Inserm U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Université Henri Poincaré 1, Vandoeuvre-lès-Nancy, Nancy, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy*; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology; D009369:Neoplasms / Q000139:chemically induced* / Q000453:epidemiology / Q000209:etiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D007166:Immunosuppressive Agents
keywords: Azathioprine; Cancer Epidemiology; Crohn's Disease; Ulcerative Colitis