SNFGE SNFGE
 
Thématique :
- MICI
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Philippe SEKSIK
Coup de coeur :
 
 
Alimentary Pharmacology & Therapeutics (APT)
  2016/01  
 
  2016 Jan;43(2):252-61  
  doi: 10.1111/apt.13466. Epub 2015 Nov 9.  
 
  Excess risk of urinary tract cancers in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study  
 
  Bourrier A, Carrat F, Colombel JF, Bouvier AM, Abitbol V, Marteau P, Cosnes J, Simon T, Peyrin-Biroulet L, Beaugerie L; CESAME study group.  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=Excess+risk+of+urinary+tract+cancers+in+patients+receiving+thiopurines+for+in%EF%AC%82ammatory+bowel+disease%3A+a+prospective+observational+cohort+study  
 
 

BACKGROUND:

The risk of urinary tract cancers, including kidney and bladder cancers, was increased in transplant recipients receiving thiopurines.

AIM:

To assess the risk of urinary tract cancers in patients with inflammatory bowel disease (IBD) receiving thiopurines in the CESAME observational cohort.

METHODS:

Between May 2004 and June 2005, 19 486 patients with IBD, 30.1% of whom were receiving thiopurines, were enrolled. Median follow-up was 35 months (IQR: 29-40).

RESULTS:

Ten and six patients developed respectively kidney and bladder cancer. The incidence rates of urinary tract cancer were 0.48/1000 patient-years in patients receiving thiopurines (95% CI: 0.21-0.95), 0.10/1000 patient-years in patients who discontinued thiopurines (95% CI: 0.00-0.56) and 0.30/1000 patient-years in patients never treated with thiopurines (95% CI: 0.12-0.62) at entry. The standardised incidence ratio of urinary tract cancer was 3.40 (95% CI: 1.47-6.71, P = 0.006) in patients receiving thiopurines, 0.64 (95% CI: 0.01-3.56, P = 0.92) in patients previously exposed to thiopurines and 1.17 (95% CI: 0.47-12.42, P = 0.78) in patients never treated with thiopurines. The multivariate-adjusted hazard ratio (HR) of urinary tract cancer between patients receiving thiopurines and those not receiving thiopurines was 2.82 (95% CI: 1.04-7.68, P = 0.04). Other significant risk factors were male gender (HR: 3.98, 95% CI: 1.12-14.10, P = 0.03) and increasing age (HR after 65 years (ref <50): 13.26, 95% CI: 3.52-50.03, P = 0.0001).

CONCLUSION:

Patients with IBD receiving thiopurines have an increased risk of urinary tract cancers. Clinically relevant excess risk is observed in older men.

 
Question posée
 
L’utilisation des thiopurines au cours des MICI expose-t-elle à un risque de cancer des voies urinaires ?
 
Question posée
 
Oui surtout chez les hommes au-delà de 65 ans.
 
Commentaires

Une étude de la cohorte CESAME qui nous livre une fois de plus des données intéressantes sur le sur-risque de cancer chez les patients recevant des thiopurines. Il s’agit ici du sur-risque de cancer des voies urinaires (rein, vessie). Il n’est sur-risque n’est observé que dans le groupe exposé aux thiopurines pendant la période de recueil prospectif des cas incident de cancer. Les résultats conduisent à faire changer notre pratique chez les hommes de plus de 65 ans. En effet, on estime d’après ce travail, que dans cette population un homme sur 12 aura un cancer des voies urinaires s’il est exposé à un traitement par thiopurines pendant 10 ans. La limite essentielle reste l’absence de recueil prospectif de la consommation tabagique, facteur de risque bien validé pour ce type de cancer.

 
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