The frequency of malignancy and risk factors associated with malignancies in inflammatory bowel disease patients at Çukurova University

Background and Aims: Inflammatory bowel disease (IBD) is a chronic inflammatory disorder that is not limited to gut. IBD patients have increased risk of devolopment of gastrointestinal and extraintestinal malignancies. This risk may be the result of chronic inflammation, or associated with immunosuppressive drugs that used to control inflammation. In this study, our aim was to find out which malignancies are common and possible risk factors associated with malignancies in patients with inflammatory bowel disease in our region Methods: The medical records were collected retrospectively from 376 patients whose diagnosis of IBD was confirmed clinically, endoscopically and histopathologically between 2011 and 2021 in the department of gastroenterology at Çukurova University. Demographic characteristics (age, gender), comorbidities, clinical characteristics of IBD (extent of colonic involvement, rectal disease, presence of fistulas or strictures, diagnosis time), results of biopsy materials taken, history of surgery, history of drugs and corticosteroid therapy of patients was assessed. The association between malignancy and these factors was analyzed. Results: Two hundred and twelve of patients were male and 164 patients female, the median age was 38,5 (range 17-80 years) at the time the study was performed. Sixteen patients (7 ulcerative colitis, 8 Crohn's disease, 1 indeterminate colitis) developed eighteen cases of malignancies. 13 of the patients with malignancy were male and 3 were female. The most common malignancies were colorektal cancer and skin cancers. Apart from these two, there have been cases of Kaposi's sarcoma, papillary urothelial carcinoma, gastric adenocarcinoma, adenocarcinoma of unknown primary, Hodgkin's lymphoma, thyroid papillary cancer, hepatocellular cancer, multiple myeloma and prostate cancer. The median elapsed time between diagnosis of disease and malignancies was 8 years. The median elapsed time until development of colorectal cancer was 13,5 years in ulcerative colitis and 8 years in patients with extensive colitis. There were 4 cases of malignancy whose thiopurine have been shown to increase the risk. In patients with TNF-α inhibitors use (median 3 years), the risk of malignancy was found to be less compared to those who had never used TNF-α inhibitors. In patients who have clinical/endoscopic active disease once a year or more the risk of cancer was found to be 5,8 times higher. Conclusions: In patients with IBD, the use of thiopurine may increase the risk of malignancy development and the use of TNF-α inhibitors is associated with a lower cancer risk. The risk of malignancy is greater in patients who have clinical/endoscopic active disease once a year or more. In order to confirm our results, prospective population-based studies with large patient groups must be disigned.