Risk of Melanoma and Non-Melanoma Skin Cancer among Patients with Inflammatory Bowel Disease
A partir de données administratives américaines portant sur 108 518 patients ayant une maladie inflammatoire de l'intestin, cette étude rétrospective de cohorte évalue l'association entre diverses maladies inflammatoires et le risque de cancer de la peau (mélanome ou autre), puis analyse l'influence des traitements associés sur ce risque
Patients with inflammatory bowel disease (IBD) are at risk for certain malignancies. We aimed to determine the risk of melanoma and non-melanoma skin cancer (NMSC) in patients with IBD and how medications affect these risks. We performed retrospective cohort and nested case-control studies using administrative data from LifeLink™ Health Plan Claims Database from 1997 to 2009. The cohort comprised108,518 patients with IBD, were each matched to 4 individuals without IBD. Melanoma and NMSC risks were evaluated by incidence rate ratio (IRR) and by adjusted Cox proportional hazard ratio (HR) modeling. In nested case-control studies, patients with melanoma or NMSC were matched to 4 patients with IBD without melanoma or NMSC. Conditional logistic regression was used to determine associations between medications and both skin cancers. In the cohort, IBD was associated with an increased incidence of melanoma (IRR, 1.29; 95% confidence interval [CI], 1.09–1.53). Risk was greatest among individuals with Crohn’s disease (IRR, 1.45; 95% CI, 1.13–1.85; adjusted HR, 1.28; 95% CI, 1.00–1.64). The incidence of NMSC also increased among patients with IBD (IRR, 1.46; 95% CI, 1.40–1.53), and was greatest among those with CD (IRR, 1.64; 95%, CI 1.54–1.74). In the nested case-control studies, therapy with biologics increased the risk for melanoma (odds ratio [OR], 1.88; 95% CI, 1.08–3.29). Patients that had used thiopurines had increased risk for NMSC (OR, 1.85; 95% CI, 1.66–2.05). Immunosuppression increases the risk of melanoma and NMSC among patients with IBD. Melanoma risk is increased by biologic use and NMSC risk is increased by thiopurines. Patients with IBD should be counseled and monitored for skin cancer.
http://linkinghub.elsevier.com/retrieve/pii/S0016508512006853?showall=true 2012