Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea; Department of Radiation Oncology, Seoul National University Hospital, Seoul, South Korea.
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea.
J Autoimmun. 2021 Jul;121:102647. doi: 10.1016/j.jaut.2021.102647. Epub 2021 May 12.
We aimed to evaluate the association between autoimmune disease (AID) and lymphoma incidence in the Korean population. We also aimed to compare the overall survival (OS) in patients with AID-associated lymphoma (AAL) with that in patients with lymphoma without AID.
We used National Sample Cohort 2002-2015 provided by National Health Insurance Service. Among 1,011,638 patients, 994,496 were recruited for the final cohort: 130,987 patients (13.2%) in the AID group and 863,509 (86.8%) in control. Lymphoma was diagnosed in 1162 patients and 322 patients with accompanying AID, irrespective of the time point of diagnosis, were defined as AAL. Of those, patients who experienced lymphoma development at least one year after AID diagnosis were defined as post-AID lymphoma (N = 155).
The median follow-up duration was 13.7 years. AAL accounted for 0.03% of total and 27.7% of lymphoma cases. AID patients experienced more Epstein-Barr virus (0.02 vs. 0.01%, P = 0.027) or Helicobacter pylori infection (63.9 vs. 41.4%, P < 0.001) than the control group did. AID was associated with a 1.45-fold increased risk of lymphoma. The median time interval from AID to AAL was 10.9 months. The risk of lymphoma increased in the order of: psoriasis (adjusted odds ratio [AOR] 1.61), systemic lupus erythematosus (AOR 3.99), multiple sclerosis (AOR 4.52), and sarcoidosis (AOR 26.37). Sjogren syndrome was not related to lymphoma in this cohort. The 5-year OS in AAL was not different from that in lymphoma patients without AID (60.9 vs. 61.5%, P = 0.970).
The association patterns in AAL in Korean population were different from those of Western countries. Further studies on lymphomatogenesis from distinct baseline characteristics (e.g. chronic infection status) would elucidate the difference based on race and ethnicity.
本研究旨在评估自身免疫性疾病（AID）与韩国人群淋巴瘤发病风险的相关性，并比较伴发 AID 的淋巴瘤（AAL）患者与无 AID 的淋巴瘤患者的总生存期（OS）。
我们使用了国家健康保险服务提供的 2002-2015 年全国抽样队列数据。在 1011638 名患者中，有 994496 名被纳入最终队列：AID 组 130987 名（13.2%），对照组 863509 名（86.8%）。1162 名患者被诊断为淋巴瘤，322 名伴发 AID 的患者无论诊断时间点如何均被定义为 AAL。其中，在 AID 诊断后至少 1 年发生淋巴瘤的患者被定义为 AID 后淋巴瘤（N=155）。
中位随访时间为 13.7 年。AAL 占所有淋巴瘤的 0.03%，占所有病例的 27.7%。与对照组相比，AID 患者更易发生 EBV（0.02% vs. 0.01%，P=0.027）或幽门螺杆菌感染（63.9% vs. 41.4%，P<0.001）。AID 使淋巴瘤发病风险增加 1.45 倍。从 AID 到 AAL 的中位时间间隔为 10.9 个月。发病风险依次为：银屑病（调整后的优势比[OR] 1.61）、系统性红斑狼疮（OR 3.99）、多发性硬化症（OR 4.52）和结节病（OR 26.37）。在本队列中，干燥综合征与淋巴瘤无关。AAL 患者的 5 年 OS 与无 AID 的淋巴瘤患者无差异（60.9% vs. 61.5%，P=0.970）。
韩国人群 AAL 的发病模式与西方国家不同。进一步研究不同基线特征（如慢性感染状态）下的淋巴瘤发生机制，将根据种族和民族差异阐明这一差异。
