title: Better survival of renal cell carcinoma in patients with inflammatory bowel disease.
abstract: BACKGROUND
  Immunosuppressive therapy may impact cancer risk in inflammatory bowel disease (IBD). Cancer specific data regarding risk and outcome are scarce and data for renal cell carcinoma (RCC) are lacking. We aimed(1) to identify risk factors for RCC development in IBD patients (2) to compare RCC characteristics, outcome and survival between IBD patients and the general population.
  
  
  METHODS
  A PALGA (Dutch Pathology Registry) search was performed to establish a case group consisting of all IBD patients with incident RCC in The Netherlands (1991-2013). Cases were compared with two separate control groups: (A) with a population-based IBD cohort for identification of risk factors (B) with a RCC cohort from the general population to compare RCC characteristics and outcomes.
  
  
  RESULTS
  180 IBD patients with RCC were identified. Pancolitis (OR 1.8-2.5), penetrating Crohn's disease (OR 2.8), IBD related surgery (OR 3.7-4.5), male gender (OR 3.2-5.0) and older age at IBD onset (OR 1.0-1.1) were identified as independent risk factors for RCC development. IBD patients had a significantly lower age at RCC diagnosis (p < 0.001), lower N-stage (p = 0.025), lower M-stage (p = 0.020) and underwent more frequently surgical treatment for RCC (p < 0.001) compared to the general population. This translated into a better survival (p = 0.026; HR 0.7) independent of immunosuppression.
  
  
  CONCLUSIONS
  IBD patients with a complex phenotype are at increased risk to develop RCC. They are diagnosed with RCC at a younger age and at an earlier disease stage compared to the general population. This translates into a better survival independent of immunosuppressive or anti-TNFα therapy.
authors.affiliation: Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Lauranne A A P
authors.initials: LA
authors.lastname: Derikx
authors.affiliation: Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Loes H C
authors.initials: LH
authors.lastname: Nissen
authors.affiliation: Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Joost P H
authors.initials: JP
authors.lastname: Drenth
authors.affiliation: Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Carla M
authors.initials: CM
authors.lastname: van Herpen
authors.affiliation: Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Wietske
authors.initials: W
authors.lastname: Kievit
authors.affiliation: Netherlands Comprehensive Cancer Organization / Netherlands Cancer Registry.
authors.forename: Rob H A
authors.initials: RH
authors.lastname: Verhoeven
authors.affiliation: Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Peter F A
authors.initials: PF
authors.lastname: Mulders
authors.affiliation: Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Hulsbergen-van de Kaa
authors.affiliation: Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Marye J
authors.initials: MJ
authors.lastname: Boers-Sonderen
authors.affiliation: Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Tim R A
authors.initials: TR
authors.lastname: van den Heuvel
authors.affiliation: Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Marieke
authors.initials: M
authors.lastname: Pierik
authors.affiliation: Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Iris D
authors.initials: ID
authors.lastname: Nagtegaal
authors.affiliation: Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Hoentjen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000401:mortality / Q000628:therapy; D016009:Chi-Square Distribution; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology / Q000401:mortality; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology / Q000401:mortality; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000276:immunology
chemical_list: D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha
keywords: immunosuppressive therapy; inflammatory bowel disease; renal cell carcinoma