Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
Eur J Epidemiol. 2013 Jun;28(6):475-83. doi: 10.1007/s10654-013-9789-8. Epub 2013 Mar 5.
Celiac disease (CD) is associated with both lymphoproliferative malignancy (LPM) and increased death from LPM. Research suggests that co-existing autoimmune disease may influence survival in LPM. Through Cox regression we examined overall and cause-specific mortality in 316 individuals with CD+LPM versus 689 individuals with LPM only. CD was defined as having villous atrophy according to biopsy reports at any of Sweden's 28 pathology departments, and LPM as having a relevant disease code in the Swedish Cancer Register. During follow-up, there were 551 deaths (CD: n = 200; non-CD: n = 351). Individuals with CD+LPM were at an increased risk of death compared with LPM-only individuals [adjusted hazard ratio (aHR) = 1.23; 95% confidence interval (CI) = 1.02-1.48]. However, this excess risk was only seen in the first year after LPM diagnosis (aHR = 1.76), with HRs decreasing to 1.09 in years 2-5 after LPM diagnosis and to 0.90 thereafter. Individuals with CD and non-Hodgkin lymphoma (NHL) were at a higher risk of any death as compared with NHL-only individuals (aHR = 1.23; 95% CI = 0.97-1.56). This excess risk was due to a higher proportion of T cell lymphoma in CD patients. Stratifying for T- and B cell status, the HR for death in individuals with CD+NHL was 0.77 (95% CI = 0.46-1.31). In conclusion, we found no evidence that co-existing CD influences survival in individuals with LPM. The increased mortality in the first year after LPM diagnosis is related to the predominance of T-NHL in CD individuals. Individuals with CD+LPM should be informed that their prognosis is similar to that of individuals with LPM only. However, this study had low statistical power to rule our excess mortality in patients with CD and certain LPM subtypes.
乳糜泻（CD）与淋巴增生性恶性肿瘤（LPM）和 LPM 相关死亡率增加有关。研究表明，共存的自身免疫性疾病可能会影响 LPM 患者的生存。通过 Cox 回归分析，我们比较了 316 例 CD+LPM 患者和 689 例仅 LPM 患者的总体和特定原因死亡率。CD 是根据瑞典 28 个病理科任何一个部位的活检报告来定义的，LPM 是指在瑞典癌症登记处有相关疾病代码。随访期间，共有 551 人死亡（CD：n = 200；非-CD：n = 351）。与仅 LPM 患者相比，CD+LPM 患者的死亡风险增加[校正后的危险比（aHR）= 1.23；95%置信区间（CI）= 1.02-1.48]。然而，这种超额风险仅在 LPM 诊断后的第一年观察到（aHR = 1.76），在 LPM 诊断后的第 2-5 年 HR 降至 1.09，此后降至 0.90。与仅 NHL 患者相比，CD 患者患有非霍奇金淋巴瘤（NHL）的任何死亡风险均更高（aHR = 1.23；95% CI = 0.97-1.56）。这种超额风险归因于 CD 患者中 T 细胞淋巴瘤的比例更高。按 T 细胞和 B 细胞状态分层，CD+NHL 患者的死亡 HR 为 0.77（95% CI = 0.46-1.31）。总之，我们没有发现证据表明共存的 CD 会影响 LPM 患者的生存。LPM 诊断后第一年死亡率的增加与 CD 患者中 T-NHL 的优势有关。应告知 CD+LPM 患者，他们的预后与仅患有 LPM 的患者相似。然而，本研究的统计效能较低，无法排除 CD 患者和某些 LPM 亚型的死亡率过高的可能性。
