Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Université du Québec, Laval, QC, Canada.
Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
J Intern Med. 2019 Nov;286(5):583-595. doi: 10.1111/joim.12965. Epub 2019 Sep 9.
Most risk factors for lymphoma identified so far relate to immunosuppression, but its aetiology remains unclear.
We investigated whether Bacillus Calmette-Guérin (BCG) vaccination is associated with lymphoma, overall and separately for Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL).
A cohort of 400 611 subjects born in the province of Québec, Canada, between 1970 and 1974 was used. Information on BCG vaccination was extracted from the Quebec BCG Vaccination Registry. Lymphomas cases were individuals who had ≥2 health encounters, medical visits or hospitalizations, for lymphoma within 2 months or who were identified through the Quebec Tumor Registry. Cox proportional hazard regression was used to estimate hazard ratios (HRs) and 95% confidence interval (CI), adjusting for potential confounders.
A total of 178 335 (46.0%) subjects were BCG-vaccinated, and 1478 (0.38%) cases of lymphomas were ascertained. Amongst them, 922 were identified as NHL and 421 as HL. After adjustment, no association was observed between BCG vaccination and either lymphoma (any type) (HR = 1.03, 95% CI: 0.96-1.11) or NHL (HR = 0.99, 95% CI: 0.86-1.13). For HL, nonproportional hazards were observed. Before the age of 18, the risk of HL was elevated amongst vaccinated individuals (HR = 2.26, 95% CI: 1.39-3.69). However after 18 years of age, no association was found (HR = 0.93, 95% CI: 0.75-1.15).
Bacillus Calmette-Guérin vaccination may increase the risk of HL before 18 years of age, but residual confounding cannot entirely be excluded. Given the benefits of BCG vaccination, these results need to be reproduced in other populations before firm conclusions can be drawn.
迄今为止，大多数已确定的淋巴瘤风险因素都与免疫抑制有关，但病因仍不清楚。
我们研究了卡介苗（BCG）疫苗接种是否与淋巴瘤相关，包括总体情况以及霍奇金淋巴瘤（HL）和非霍奇金淋巴瘤（NHL）的情况。
使用了一个出生于加拿大魁北克省、1970 年至 1974 年期间的 400611 名受试者的队列。BCG 疫苗接种信息从魁北克 BCG 疫苗接种登记处提取。淋巴瘤病例是指在 2 个月内至少有 2 次健康就诊、医疗访视或住院治疗，或通过魁北克肿瘤登记处确定的患有淋巴瘤的个体。使用 Cox 比例风险回归来估计风险比（HR）和 95%置信区间（CI），并调整潜在的混杂因素。
共有 178335 名（46.0%）受试者接受了 BCG 疫苗接种，共确定了 1478 例（0.38%）淋巴瘤病例。其中，922 例被确定为 NHL，421 例为 HL。调整后，BCG 疫苗接种与任何类型的淋巴瘤（HR=1.03，95%CI：0.96-1.11）或 NHL（HR=0.99，95%CI：0.86-1.13）之间均无关联。对于 HL，观察到非比例风险。在 18 岁之前，接种疫苗的个体发生 HL 的风险增加（HR=2.26，95%CI：1.39-3.69）。然而，18 岁以后，未发现关联（HR=0.93，95%CI：0.75-1.15）。
BCG 疫苗接种可能会在 18 岁之前增加 HL 的风险，但不能完全排除残余混杂因素。鉴于 BCG 疫苗接种的益处，在得出明确结论之前，这些结果需要在其他人群中得到复制。
