Journal
CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION
Volume 30, Issue 5, Pages 886-894Publisher
AMER ASSOC CANCER RESEARCH
DOI: 10.1158/1055-9965.EPI-20-1241
Keywords
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Funding
- Independent Research Fund Denmark [8020-00153B]
- Novo Nordisk Foundation [NNF19OC0058609]
- Swedish Society of Medicine [SLS-789611]
- Young Scholar Award from the Strategic Research Area Epidemiology Program at Karolinska Institutet
- Stockholm County Council [20170720, 20190638]
- Karolinska Institutet (ALF) [20170720, 20190638]
- Swedish Research Council [2020-02002]
- Swedish Cancer Society
- Stockholm County Council (ALF)
- Swedish Heart-Lung Foundation
- FORTE Foundation [2016-00424]
- Swedish Cancer Foundation [PjF 20 0752]
- Formas [2016-00424] Funding Source: Formas
- Forte [2016-00424] Funding Source: Forte
- Swedish Research Council [2020-02002] Funding Source: Swedish Research Council
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The risk of death from hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and extrahepatic cholangiocarcinoma is low in patients with ulcerative colitis, with a significant proportion of deaths occurring in those with primary sclerosing cholangitis.
Background: Inflammatory bowel disease (IBD) has been associated with hepatobiliary cancer, but existing evidence is poor. We evaluated risk of death from hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and extrahepatic cholangiocarcinoma (ECC) among patients with IBD. Methods: This Swedish/Danish population-based cohort study (1969-2017) followed patients with IBD and 1:10 matched population comparators from their diagnosis/match date until death, emigration, or end of follow-up. Results: Among the 97,496 patients with ulcerative colitis/963,026 comparators, we found 66/390 HCC-deaths, 120/173 ICC-deaths, and 91/220 ECC-deaths (median follow-up 10 years); the 10-year-mortality was 0.5% (per mille) for HCC, 0.6% for ICC, and 0.4% for ECC, which decreased to 0.3%, 0.4%, and 0.2%, respectively, in 2003-2017. Overall hazard ratios (HR) were 1.83 [95% confidence interval (CI), 1.41-2.38] for HCC-, 7.33 (95% CI, 5.81-9.25) for ICC-, and 4.46 (95% CI, 3.49-5.70) for ECC-deaths. A total of 22/66 HCC-deaths, 87/120 ICC-deaths, and 55/91 ECC-deaths occurred among patients with ulcerative colitis with primary sclerosing cholangitis (PSC), corresponding to 10-year-mortality of 6.7%, 26.2%, and 17.2%, respectively. Among 47,399 patients with Crohn's disease (median follow-up 11 years), 10-year-mortality from HCC (n = 28), ICC (n = 28), and ECC (n = 24) were 0.3%, 0.1%, and 0.3%, respectively, and corresponding HRs were 1.96 (95% CI, 1.31-2.93), 3.33 (95% CI, 2.19-5.09), and 3.10 (95% CI, 1.97-4.87). One of 28 HCC-deaths, 14/28 ICC-deaths (10-year-mortality 19%), and 12/24 ECC-deaths (10-year-mortality 14%) occurred after PSC. Conclusions: Risk of HCC-, ICC-, and ECC-deaths was low in patients with IBD and decreased over time. However, a large proportion of deaths occurred after PSC. Impact: Guidelines on specific surveillance strategies for patients with IBD with PSC, but not those without PSC, are needed.
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