Division of Epidemiology and Public Health, School of Community Health Sciences, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham, UK.
Aliment Pharmacol Ther. 2012 Mar;35(6):730-9. doi: 10.1111/j.1365-2036.2012.04998.x. Epub 2012 Jan 30.
People with coeliac disease are known to be at increased risk of malignancy; however, long-term risks of malignancy beyond 10-15 years are largely unstudied.
To estimate how long an increased risk of malignancy among coeliac disease patients persists following diagnosis and treatment, using data from a cohort with an average follow-up of 25 years.
People with coeliac disease diagnosed in the Lothian region of Scotland, United Kingdom, were followed up from January 1970 or the date of coeliac disease diagnosis (whichever was later) until the first occurrence of death, emigration, cancer diagnosis or the end of 2004. Standardised incidence ratios were calculated to compare the cancer incidence rates among this group with those from the population of Scotland.
Overall, the risk of any malignancy in coeliac disease patients compared with the general population was increased 40% [standardised incidence ratio (SIR) = 1.41; 95% CI 1.09-1.78]. An increased risk for cancer overall persisted for up to 15 years, beyond which no overall increase in malignancy risk was observed, although the risk of non-Hodgkin's lymphoma remained raised beyond 15 years (SIR = 5.15; 95% CI 1.40-13.2). In total, there were 14 non-Hodgkin's lymphomas in the cohort, providing an overall incidence of 1.3 per 1000 person-years.
The overall risk of malignancy in coeliac patients declines with time after diagnosis and is not significantly increased after 15 years. Most of the increased risk can be attributed to the development of haematological malignancies, despite their very low absolute rate of occurrence.
已知乳糜泻患者的恶性肿瘤风险增加；然而，诊断和治疗后超过 10-15 年的恶性肿瘤长期风险在很大程度上尚未得到研究。
使用平均随访时间为 25 年的队列数据，估计乳糜泻患者在诊断和治疗后恶性肿瘤风险持续增加的时间。
在英国苏格兰洛锡安区诊断为乳糜泻的患者从 1970 年 1 月或乳糜泻诊断日期（以较晚者为准）开始进行随访，直到首次死亡、移民、癌症诊断或 2004 年底。计算标准化发病比以比较该组患者的癌症发病率与苏格兰人群的发病率。
总体而言，与普通人群相比，乳糜泻患者的任何恶性肿瘤风险增加了 40%（标准化发病比[SIR] = 1.41；95%CI 1.09-1.78）。在诊断后长达 15 年的时间里，整体癌症风险持续增加，此后未观察到恶性肿瘤风险增加，但非霍奇金淋巴瘤的风险在 15 年后仍升高（SIR = 5.15；95%CI 1.40-13.2）。在该队列中共有 14 例非霍奇金淋巴瘤，总发病率为每 1000 人年 1.3 例。
诊断后随着时间的推移，乳糜泻患者的恶性肿瘤总风险会下降，在 15 年后不会显著增加。尽管发生的绝对比率非常低，但大部分增加的风险可归因于血液系统恶性肿瘤的发展。
