Issue 01

Clinical Question

Does anti-TNF therapy for IBD alter the incidence of renal cell carcinoma (RCC)?

Editor’s Bottom Line

There is no increased risk of renal cell carcinoma in patients with IBD and on anti-TNF therapy.

Reference

Wauters L, Billiet T, Papamichael K, et al. Incidence of renal cell carcinoma in inflammatory bowel disease patients with and without anti-TNF treatment. Eur J Gastroenterol Hepatol. 2017 Jan;29(1):84–90.
https://www.ncbi.nlm.nih.gov/pubmed/27603297

Synopsis

Patients with IBD and renal cell carcinoma were identified between 1990 and 2014 at the University Hospitals Leuven. A control cohort of patients with rheumatic disease (RD) was used for comparison.

The IBD-RCC cohort comprised 7 anti-TNF exposed patients and 21 anti-TNF naïve patients. In comparison, the RD-RCC cohort comprised 1 patient exposed to anti-TNF and 26 who were anti-TNF naïve. Within the IBD-RCC cohort, anti-TNF therapy was associated with younger age at time of RCC diagnosis (46 vs. 63 years), immunosuppressive therapy (100% vs. 24%), partial nephrectomy (86% vs. 33%), and surgery within 1 month of diagnosis (71% vs. 14%). In comparison with the IBD-RCC cohort, RD-RCC patients were older at time of diagnosis (70 vs. 59 years), had less nephron-sparing surgery (26% vs. 54%), had more symptoms (44% vs. 14%) and advanced tumours (30% vs. 7%). Standardized incident ratios (SIRs) by gender and anti-TNF exposure are presented in Table 1 for IBD-RCC patients.

No statistically significant increase in risk for RCC relative to the Belgian population was found in patients with IBD who received anti-TNF therapy. Frequent abdominal imaging as standard of care for IBD facilitated the discovery of asymptomatic, early stage RCC in the patients with IBD.

Table 1

Details

Study Design: Retrospective observational study
Funding: Hellenic Society of Gastroenterology
Allocation: n/a
Setting: Belgium
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.