title: Impaired Gastric Cancer Survival in Patients with Inflammatory Bowel Disease.
abstract: OBJECTIVE
  Both chronic inflammation and reduced immunosurveillance contribute to malignancy development in inflammatory bowel disease (IBD). Previous literature suggests that especially Crohn's disease patients are at an increased risk for developing gastric cancer (GC). This study aimed to identify risk factors for GC development in IBD and to compare the clinical characteristics of GC in IBD to those in the general population.
  
  
  METHODS
  We retrospectively searched the Dutch Pathology Database to identify all Dutch IBD patients with GC between January 2004 and December 2008. Two case-control studies were performed. I: to identify risk factors for GC in IBD, with controls from the IBD South Limburg (IBDSL) population-based cohort; and II: to compare GC disease course in IBD patients with the general population. General population data were obtained from the Eindhoven Cancer Registry (ECR).
  
  
  RESULTS
  We included 59 patients with IBD and GC (cases). Cases were significantly older at IBD diagnosis than IBDSL controls (median age 61 years versus 40; p<0.01), and ulcerative colitis (UC) was more frequent in the case group (69.5% versus 51.4%; p<0.01). We found no difference in age at diagnosis, gender, tumor location and tumor differentiation between IBD GC patients and ECR controls. When corrected for confounders and TNM-stage, IBD patients showed impaired survival (p=0.035; HR 1.385).
  
  
  CONCLUSIONS
  Survival is significantly reduced in IBD patients compared to the general population in the multivariate analysis of our study, but age at GC diagnosis and TNM-stage were comparable between IBD cases and controls. Elderly onset IBD emerged as a risk factor for GC development in IBD patients, particularly in UC.
authors.affiliation: Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands. loes.nissen@radboudumc.nl.
authors.forename: Loes H C
authors.initials: LH
authors.lastname: Nissen
authors.affiliation: Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Eemke L
authors.initials: EL
authors.lastname: Assendorp
authors.affiliation: Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Rachel S
authors.initials: RS
authors.lastname: van der Post
authors.affiliation: Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Lauranne A A P
authors.initials: LA
authors.lastname: Derikx
authors.affiliation: Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: de Jong
authors.affiliation: Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Wietske
authors.initials: W
authors.lastname: Kievit
authors.affiliation: Department of Gastroenterology and Hepatology, Maastricht University Medical Center, The Netherlands.
authors.forename: Marieke
authors.initials: M
authors.lastname: Pierik
authors.affiliation: Department of Gastroenterology and Hepatology, Maastricht University Medical Center, The Netherlands.
authors.forename: Tim
authors.initials: T
authors.lastname: van den Heuvel
authors.affiliation: Netherlands Cancer Registry / Netherlands comprehensive cancer organization, The Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: Verhoeven
authors.affiliation: Stichting PALGA, The Netherlands.
authors.forename: Lucy I H
authors.initials: LI
authors.lastname: Overbeek
authors.affiliation: Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Hoentjen
authors.affiliation: Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Iris D
authors.initials: ID
authors.lastname: Nagtegaal
mesh_terms: D000328:Adult; D017668:Age of Onset; D001706:Biopsy; D016009:Chi-Square Distribution; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents