Reich J M, Mullooly J P, Johnson R E
Pulmonary Division, Bess Kaiser Medical Center, Portland, Ore.
Chest. 1995 Mar;107(3):605-13. doi: 10.1378/chest.107.3.605.
To determine whether a reported association between sarcoidosis and malignancy can be supported.
In this retrospective survey in a general community setting, we crossmatched the Kaiser Permanente Northwest Region (KPNW) Tumor Registry comprising 3 x 10(4) cases observed over 32 years against a sarcoidosis registry of 243 cases observed over 24 years. We used linkage criteria, eg, previously reported associated malignancies, late age onset of sarcoidosis, and close temporal proximity, to identify joint occurrences suggesting an etiologic relationship. We assessed the feasibility of detecting an association of sarcoidosis and Hodgkins disease (HD) by computing the required sample size based on incidence estimates of sarcoidosis and HD in this population. Medical records of 241 persons identified by the Tumor Registry as having HD were reviewed.
KPNW, a health maintenance organization.
We studied 6.8 x 10(6) KPNW member-years from 1960 to 1992 at risk for malignancy; 5.6 x 10(6) member-years from 1971 to 1992 at risk for sarcoidosis.
Six of the 11 (55%; 95% confidence interval, 26 to 84) correctly classified sarcoidosis and malignancy (S&M) cases met two or more linkage criteria. A seventh case, incorrectly classified as sarcoidosis, exhibited a necrotizing systemic granulomatous process, believed to represent a response to a fatal lymphoproliferative disorder. The mean age (40 years) of the 11 patients with S&M was 9 years higher than the mean age of the patients with sarcoidosis in the population from which they were drawn. The stage of sarcoidosis at diagnosis among the 11 S&M cases was exclusively 0 and I and thus divergent from expected values in this population. We found no instances of sarcoidosis accompanying HD.
Linkage analysis provides evidence that S&M may be etiologically related in at least a quarter of cases in which both are present.
确定结节病与恶性肿瘤之间已报道的关联是否能够得到证实。
在本次针对普通社区环境的回顾性调查中，我们将包含32年间观察到的3×10⁴例病例的凯撒永久西北区域（KPNW）肿瘤登记处与24年间观察到的243例结节病登记处进行了交叉匹配。我们使用关联标准，例如先前报道的相关恶性肿瘤、结节病的晚发年龄以及时间上的紧密接近度，来识别提示病因关系的共同发生情况。我们通过基于该人群中结节病和霍奇金病（HD）的发病率估计计算所需样本量，评估检测结节病与HD关联的可行性。对肿瘤登记处确定的241例患有HD的人员的病历进行了审查。
KPNW，一家健康维护组织。
我们研究了1960年至1992年间有患恶性肿瘤风险的6.8×10⁶KPNW成员年；1971年至1992年间有患结节病风险的5.6×10⁶成员年。
11例（55%；95%置信区间，26%至84%）正确分类的结节病与恶性肿瘤（S&M）病例中有6例符合两个或更多关联标准。第七例病例被错误分类为结节病，表现为坏死性全身性肉芽肿过程，被认为代表对致命性淋巴增殖性疾病的反应。11例S&M患者的平均年龄（40岁）比其所属人群中结节病患者的平均年龄高9岁。11例S&M病例在诊断时结节病的分期均为0期和I期，因此与该人群中的预期值不同。我们未发现结节病与HD同时存在的情况。
关联分析提供了证据，表明在至少四分之一同时存在S&M的病例中，两者可能存在病因学关系。
