Incidence of renal cell carcinoma in inflammatory bowel disease patients with and without anti-TNF treatment.
OBJECTIVE
We aimed to study the risk of renal cell carcinoma (RCC) with anti-tumor necrosis factor (anti-TNF) therapy in inflammatory bowel disease (IBD) and rheumatic diseases (RD) and calculate standardized incidence ratios (SIRs) in IBD.


METHODS
This was a retrospective case-control and cohort study spanning 25 years, including IBD and RD patients with a diagnosis of RCC (1990-2014) identified through the electronic database of a tertiary referral center.


RESULTS
RCC was confirmed in seven anti-TNF-exposed (TNF+) and 21 anti-TNF-naive (TNF-) IBD and one TNF+ and 26 TNF- RD patients. In IBD-RCC, younger age at RCC diagnosis [median (interquartile range) 46 (42-58) vs. 63 (52-75) years; P=0.02], immunosuppressive therapy (100 vs. 24%; P<0.0004), partial nephrectomy (86 vs. 33%; P=0.02), and surgery less than 1 month after diagnosis of RCC (71 vs. 14%; P=0.004) were associated with anti-TNF. Compared with IBD, RD patients were older at RCC diagnosis [70 (60-77) vs. 59 (47-69) years; P=0.02] with less nephron-sparing surgery (26 vs. 54%; P=0.04) and more symptomatic (44 vs. 14%; P=0.02) and advanced tumors (30 vs. 7%; P=0.04). SIRs in IBD-RCC TNF- and TNF+ were 5.4 (95% confidence interval 2.9-9.2) and 7.1 (2.3-16.5) in male patients and 8.5 (3.7-16.8) and 4.8 (0.6-17.3) in female patients, respectively. The risk for RCC associated with anti-TNF in IBD was 0.8 (0.3-2.5) in men and 1.4 (0.2-5.5) in women.


CONCLUSIONS
The favorable patient and tumor profiles in IBD with anti-TNF may suggest incidentally discovered RCC on abdominal imaging. SIRs for IBD-RCC were not increased after anti-TNF exposure.
Departments of aGastroenterology and Hepatology bUrology cRheumatology, University Hospitals Leuven, KU Leuven, Leuven dBelgian Cancer Registry, Brussels, Belgium.
Lucas
L
Wauters
Thomas
T
Billiet
Konstantinos
K
Papamichael
Vera
V
Ballet
Steven
S
Joniau
Patrick
P
Verschueren
Geert
G
Silversmit
Gert
G
Van Assche
Séverine
S
Vermeire
Marc
M
Ferrante
D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001530:Belgium / Q000453:epidemiology; D001688:Biological Products / Q000009:adverse effects*; D002292:Carcinoma, Renal Cell / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D007680:Kidney Neoplasms / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha