Department of Health Sciences, University of York, York, UK.
Department of Health Sciences, University of York, York, UK.
Cancer Epidemiol. 2019 Apr;59:236-243. doi: 10.1016/j.canep.2019.02.014. Epub 2019 Mar 4.
Autoimmune inflammatory disease increases the risk of diffuse large B-cell lymphoma (DLBCL) and marginal zone lymphoma (MZL), but findings for other mature B-cell malignancies are equivocal. Furthermore, it has been suggested that the increase in DLBCL is due to the activated B-cell (ABC) subtype; but data on this, and the impact of inflammatory co-morbidities on survival, are sparse and contradictory.
Data are from an established UK population-based cohort. Patients (n = 6834) diagnosed between 01/2009 and 08/2015 are included; DLBCL (n = 1771), myeloma (n = 1760), chronic lymphocytic leukaemia (CLL, n = 1580), MZL (n = 936), and follicular lymphoma (FL, n = 787). Information on rheumatological disorders and deaths was obtained by record-linkage to nationally compiled Hospital Episode Statistics, with age-and sex-matched individuals (n = 68,340) from the same catchment population (˜4 million people) providing the comparator.
Significantly increased risks for DLBCL (OR = 2.3, 95% CI 1.8-2.8) and MZL (OR = 2.0, 95% CI 1.5-2.7) were found for those with rheumatological disorders; the site distribution of those with/without rheumatological conditions differing for DLBCL (p = 0.007) and MZL (p = 0.002). No increases in risk were observed for the remaining mature B-cell malignancies, and no associations with survival were detected for DLBCL (age-adjusted HR = 1.2, 95% CI 0.9-1.6) or MZL (age-adjusted HR = 1.0, 95% CI 0.6-1.9). Furthermore, whilst our findings provide evidence for an association with rheumatological disease severity for DLBCL, they offer little support for the notion that the association is driven by an increase in the incidence of the ABC subtype.
Our findings support the hypothesis that the chronic activation and proliferation of specific B-cell populations which characterize autoimmune disease increase the potential for the lymphomagenic events that lead to DLBCL and MZL in both males and females; but have no impact on the development of CLL, FL or MM, or on survival.
自身免疫性炎症疾病会增加弥漫性大 B 细胞淋巴瘤（DLBCL）和边缘区淋巴瘤（MZL）的风险，但其他成熟 B 细胞恶性肿瘤的发现结果尚无定论。此外，有人认为 DLBCL 的增加是由于激活 B 细胞（ABC）亚型所致；但关于这一点，以及炎症合并症对生存的影响的数据很少且相互矛盾。
数据来自一个已建立的英国基于人群的队列。纳入了 2009 年 1 月至 2015 年 8 月期间诊断的患者（n=6834）；包括 DLBCL（n=1771）、骨髓瘤（n=1760）、慢性淋巴细胞白血病（CLL，n=1580）、MZL（n=936）和滤泡性淋巴瘤（FL，n=787）。通过与全国性的住院患者统计数据进行记录链接，获取了风湿性疾病的信息，而来自同一流域人群（˜400 万人）的年龄和性别匹配的个体（n=68340）作为对照组。
发现患有风湿性疾病的患者患 DLBCL（OR=2.3，95%CI 1.8-2.8）和 MZL（OR=2.0，95%CI 1.5-2.7）的风险显著增加；DLBCL（p=0.007）和 MZL（p=0.002）的病变部位分布在有/无风湿性疾病的患者中不同。其余成熟 B 细胞恶性肿瘤的风险未见增加，且未发现 DLBCL（年龄调整 HR=1.2，95%CI 0.9-1.6）或 MZL（年龄调整 HR=1.0，95%CI 0.6-1.9）与生存相关。此外，尽管我们的研究结果为 DLBCL 与风湿性疾病严重程度相关提供了证据，但对于这种关联是由 ABC 亚型发病率增加引起的观点，并没有提供太多支持。
我们的研究结果支持这样一种假设，即自身免疫性疾病特征性的特定 B 细胞群体的慢性激活和增殖增加了导致 DLBCL 和 MZL 的潜在淋巴肿瘤事件的可能性，这在男性和女性中均如此；但对 CLL、FL 或 MM 的发展或生存没有影响。
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