title: Excess risk of urinary tract cancers in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study.
abstract: BACKGROUND
  The risk of urinary tract cancers, including kidney and bladder cancers, was increased in transplant recipients receiving thiopurines.
  
  
  OBJECTIVE
  To assess the risk of urinary tract cancers in patients with inflammatory bowel disease (IBD) receiving thiopurines in the CESAME observational cohort.
  
  
  METHODS
  Between May 2004 and June 2005, 19 486 patients with IBD, 30.1% of whom were receiving thiopurines, were enrolled. Median follow-up was 35 months (IQR: 29-40).
  
  
  RESULTS
  Ten and six patients developed respectively kidney and bladder cancer. The incidence rates of urinary tract cancer were 0.48/1000 patient-years in patients receiving thiopurines (95% CI: 0.21-0.95), 0.10/1000 patient-years in patients who discontinued thiopurines (95% CI: 0.00-0.56) and 0.30/1000 patient-years in patients never treated with thiopurines (95% CI: 0.12-0.62) at entry. The standardised incidence ratio of urinary tract cancer was 3.40 (95% CI: 1.47-6.71, P = 0.006) in patients receiving thiopurines, 0.64 (95% CI: 0.01-3.56, P = 0.92) in patients previously exposed to thiopurines and 1.17 (95% CI: 0.47-12.42, P = 0.78) in patients never treated with thiopurines. The multivariate-adjusted hazard ratio (HR) of urinary tract cancer between patients receiving thiopurines and those not receiving thiopurines was 2.82 (95% CI: 1.04-7.68, P = 0.04). Other significant risk factors were male gender (HR: 3.98, 95% CI: 1.12-14.10, P = 0.03) and increasing age (HR after 65 years (ref <50): 13.26, 95% CI: 3.52-50.03, P = 0.0001).
  
  
  CONCLUSIONS
  Patients with IBD receiving thiopurines have an increased risk of urinary tract cancers. Clinically relevant excess risk is observed in older men.
authors.affiliation: Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, Paris, France.|ERL 1057 INSERM/UMRS 7203 and GRC-UPMC 03, UPMC Univ Paris 06, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Bourrier
authors.affiliation: Department of Public Health, AP-HP, Hôpital Saint-Antoine, Paris, France.|UMR-S 1136, INSERM & UPMC Univ Paris 06, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Carrat
authors.affiliation: The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: J-F
authors.initials: JF
authors.lastname: Colombel
authors.affiliation: Registre Bourguignon des Cancers Digestifs, Inserm U866, CHRU Dijon, FRANCIM, Dijon, France.
authors.forename: A-M
authors.initials: AM
authors.lastname: Bouvier
authors.affiliation: Department of Gastroenterology, AP-HP, Hôpital Cochin-Port Royal, Paris, France.|University Paris Descartes 05, Paris, France.
authors.forename: V
authors.initials: V
authors.lastname: Abitbol
authors.affiliation: Department of gastroenterology, AP-HP, Hôpital Lariboisière, Paris, France.|University Paris Diderot Paris 7, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Marteau
authors.affiliation: Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, Paris, France.|ERL 1057 INSERM/UMRS 7203 and GRC-UPMC 03, UPMC Univ Paris 06, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Cosnes
authors.affiliation: Clinical Pharmacology Unit, Unité de Recherche clinique de l'Est Parisien, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Paris, France.|UPMC Univ Paris 06, Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Simon
authors.affiliation: Inserm U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France.
authors.forename: L
authors.initials: L
authors.lastname: Peyrin-Biroulet
authors.affiliation: Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, Paris, France.|ERL 1057 INSERM/UMRS 7203 and GRC-UPMC 03, UPMC Univ Paris 06, Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Beaugerie
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D014571:Urologic Neoplasms / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult