Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Department of Infectious Diseases, Karolinska University Hospital, 171 76, Stockholm, Sweden.
BMC Med. 2020 Oct 30;18(1):296. doi: 10.1186/s12916-020-01759-8.
Malaria is associated with Burkitt lymphoma among children in Sub-Saharan Africa. No longitudinal studies have assessed the long-term risk of other lymphoma or cancer overall. Here, we investigated the risk of lymphoid neoplasms and other cancer after malaria.
We included 4125 patients diagnosed with malaria in Sweden in 1987-2015, identified either through the National Surveillance Database at the Public Health Agency of Sweden, the National Inpatient and Outpatient Register, or by reports from microbiology departments. A comparator cohort (N = 66,997) matched on sex, age and birth region was retrieved from the general population and an additional cohort with all individuals born in Sub-Saharan Africa registered in the Total Population Register in 1987-2015 (N = 171,756). Incident lymphomas and other cancers were identified through linkage with the Swedish Cancer Register. Hazard ratios (HRs) were assessed using Cox regression with attained age as the timescale.
A total of 20 lymphoid neoplasms and 202 non-haematological cancers were identified among malaria patients during a mean follow-up of 13.3 and 13.7 years, respectively. The overall risk of lymphoid neoplasms was not significantly increased (hazard ratio [HR] 1.24, 95% confidence interval [CI] 0.79-1.94), neither did we find any association with all-site non-haematological cancer (HR 0.89, 95% CI 0.77-1.02). However, in the Sub-Saharan Africa cohort, we observed an increased risk of lymphoid neoplasms after malaria diagnosis (HR 2.39, 95% CI 1.06-5.40), but no difference in the risk of other cancer (HR 1.01, 95% CI 0.70-1.45). The association could not be explained by co-infection with HIV or chronic hepatitis B or C, since the risk estimate was largely unchanged after excluding patients with these comorbidities (HR 2.63, 95% CI 1.08-6.42). The risk became more pronounced when restricting analyses to only including non-Hodgkin and Hodgkin lymphomas (HR 3.49, 95% CI 1.42-8.56).
Individuals born in malaria-endemic areas and diagnosed with malaria in Sweden had an increased risk of lymphoid neoplasms, especially B cell lymphoma. There was no association with cancer overall nor did single malaria episodes confer an increased risk in travellers.
在撒哈拉以南非洲地区，疟疾与伯基特淋巴瘤在儿童中有关。尚无纵向研究评估其他淋巴瘤或总体癌症的长期风险。在这里，我们研究了疟疾后发生淋巴样肿瘤和其他癌症的风险。
我们纳入了 1987 年至 2015 年间在瑞典被诊断患有疟疾的 4125 名患者，这些患者通过瑞典公共卫生局的国家监测数据库、国家住院和门诊登记处或微生物学部门的报告确定。通过与一般人群中性别、年龄和出生地区相匹配，获得了一个对照组队列（n=66997），并通过在 1987 年至 2015 年期间登记在总人口登记册中的所有撒哈拉以南非洲出生的个体获得了一个额外的队列（n=171756）。通过与瑞典癌症登记处的链接确定了淋巴瘤和其他癌症的发病情况。使用 Cox 回归评估风险比（HR），以达到的年龄为时间尺度。
在平均随访 13.3 年和 13.7 年期间，疟疾患者共发生 20 例淋巴样肿瘤和 202 例非血液系统癌症。淋巴样肿瘤的总体风险没有显著增加（风险比 [HR] 1.24，95%置信区间 [CI] 0.79-1.94），也没有发现与所有部位非血液系统癌症的任何关联（HR 0.89，95% CI 0.77-1.02）。然而，在撒哈拉以南非洲队列中，我们观察到疟疾诊断后发生淋巴样肿瘤的风险增加（HR 2.39，95% CI 1.06-5.40），但其他癌症的风险没有差异（HR 1.01，95% CI 0.70-1.45）。排除患有这些合并症的患者后，风险估计值基本不变（HR 2.63，95% CI 1.08-6.42），这表明这种关联不能用合并感染 HIV 或慢性乙型肝炎或丙型肝炎来解释。当仅包括非霍奇金和霍奇金淋巴瘤的分析时，风险变得更加明显（HR 3.49，95% CI 1.42-8.56）。
在疟疾流行地区出生并在瑞典被诊断患有疟疾的个体发生淋巴样肿瘤的风险增加，尤其是 B 细胞淋巴瘤。总体癌症无关联，单次疟疾发作也不会增加旅行者的风险。
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