Engels Eric A, Parsons Ruth, Besson Caroline, Morton Lindsay M, Enewold Lindsey, Ricker Winnie, Yanik Elizabeth L, Arem Hannah, Austin April A, Pfeiffer Ruth M
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
Information Management Services, Inc., Rockville, Maryland.
Cancer Epidemiol Biomarkers Prev. 2016 Jul;25(7):1105-13. doi: 10.1158/1055-9965.EPI-16-0212. Epub 2016 Apr 26.
Certain medical conditions affect risk of non-Hodgkin lymphoma (NHL), but the full range of associations is unknown. We implemented a novel method ("medical condition-wide association study," MedWAS) to comprehensively evaluate medical risk factors for NHL documented in administrative health claims.
Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we conducted a case-control study comparing NHL cases [N = 52,691, age 66+ years, with five subtypes: chronic lymphocytic leukemia/small lymphocytic lymphoma, diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, marginal zone lymphoma (MZL), T-cell lymphoma (TCL)] to controls (N = 200,000). We systematically screened for associations with 5,926 medical conditions documented in Medicare claims more than 1 year before selection.
Fifty-five conditions were variously associated with NHL. Examples include well-established associations of human immunodeficiency virus, solid organ transplantation, and hepatitis C virus with increased DLBCL risk (ORs 3.83, 4.27, and 1.74, respectively), and autoimmune conditions with DLBCL and MZL (e.g., ORs of 2.10 and 4.74, respectively, for Sjögren syndrome). Risks for all NHL subtypes were increased after diagnoses of nonmelanoma skin cancer (ORs 1.19-1.55), actinic keratosis (1.12-1.25), or hemolytic anemia (1.64-4.07). Nine additional skin conditions increased only TCL risk (ORs 2.20-4.12). Diabetes mellitus was associated with increased DLBCL risk (OR 1.09). Associations varied significantly across NHL subtypes for 49 conditions (89%).
Using an exploratory method, we found numerous medical conditions associated with NHL risk, and many associations varied across NHL subtypes.
These results point to etiologic heterogeneity among NHL subtypes. MedWAS is a new method for assessing the etiology of cancer and other diseases. Cancer Epidemiol Biomarkers Prev; 25(7); 1105-13. ©2016 AACR.
某些医疗状况会影响非霍奇金淋巴瘤（NHL）的发病风险，但其中的全部关联尚不清楚。我们采用了一种新方法（“医疗状况全关联研究”，MedWAS）来全面评估行政健康索赔记录中的NHL医疗风险因素。
利用监测、流行病学和最终结果（SEER）-医疗保险数据，我们开展了一项病例对照研究，将NHL病例[共52,691例，年龄66岁及以上，包括五种亚型：慢性淋巴细胞白血病/小淋巴细胞淋巴瘤、弥漫性大B细胞淋巴瘤（DLBCL）、滤泡性淋巴瘤、边缘区淋巴瘤（MZL）、T细胞淋巴瘤（TCL）]与对照（共200,000例）进行比较。我们系统筛查了与入选前1年多医疗保险索赔记录中记载的5926种医疗状况的关联。
55种状况与NHL存在不同程度的关联。例如，包括已充分证实的人类免疫缺陷病毒、实体器官移植和丙型肝炎病毒与DLBCL风险增加相关（比值比分别为3.83、4.27和1.74），以及自身免疫性疾病与DLBCL和MZL相关（例如，干燥综合征的比值比分别为2.10和4.74）。非黑色素瘤皮肤癌、光化性角化病或溶血性贫血确诊后，所有NHL亚型的风险均增加（比值比为1.19 - 1.55、1.12 - 1.25或1.64 - 4.07）。另外九种皮肤状况仅增加TCL风险（比值比为2.20 - 4.12）。糖尿病与DLBCL风险增加相关（比值比为1.09）。49种状况（89%）在不同NHL亚型中的关联存在显著差异。
通过一种探索性方法，我们发现了众多与NHL风险相关的医疗状况，且许多关联在不同NHL亚型中存在差异。
这些结果表明NHL亚型之间存在病因异质性。MedWAS是一种评估癌症和其他疾病病因的新方法。《癌症流行病学、生物标志物与预防》；25(7)；1105 - 13。©2016美国癌症研究协会。
