Risk of extraintestinal cancer in patients with inflammatory bowel disease: a multicenter retrospective cohort study in Japan.
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BACKGROUND: Studies investigating the incidence of extra-intestinal cancer (EIC) in Asian inflammatory bowel disease (IBD) patients are limited. The impact of thiopurines and anti-tumor necrosis factor (anti-TNF) antibodies on the development of EIC remains unclear. METHODS: In this multicenter retrospective cohort study, we analyzed data from 4604 IBD patients (1864 with Crohn's disease [CD] and 2740 with ulcerative colitis [UC]) with a history of hospital visits between 2008 and 2020. The standardized incidence ratio (SIR) of EIC was calculated. To identify predictors of the presence of EIC, clinical characteristics and medication were evaluated. The cumulative probability of EIC was compared based on exposure to thiopurines and anti-TNF antibodies. RESULTS: EIC was identified in 65 CD patients and 97 UC patients. A higher incidence of leukemia was observed in CD patients (SIR 5.21). Gallbladder/bile duct cancer was more prevalent in UC patients (SIR 2.65), while gastric cancer was less common (SIR 0.46). Independent predictors of EIC in CD patients included female sex, age, disease duration, and complicated disease behavior, while in UC patients, predictors included age, primary sclerosing cholangitis, and current steroid use. Use of thiopurines in CD patients and anti-TNF antibodies in UC patients appeared protective against the presence of EIC. However, the duration of exposure to thiopurines and anti-TNF antibodies did not affect the development of EIC. CONCLUSIONS: Japanese CD and UC patients seem to have a higher incidence of leukemia and gallbladder/bile duct cancer, respectively. Thiopurines and anti-TNF antibodies were not associated with an increased risk of EIC.