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Risk of lymphoid neoplasms in a Swedish population-based cohort of 337,437 patients undergoing appendectomy
Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Unit of Biostatistics, Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0002-3552-9153
Department of Medicine, Clinical Epidemiology Unit, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
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2016 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 51, no 5, 583-589 p.Article in journal (Refereed) Published
Abstract [en]

Objective: Appendectomy remains one of the most common surgical procedures, but possible long-term consequences for health and disease are incompletely investigated. The appendix forms part of the secondary lymphoid system and appendectomy has been associated with increased risks of hematolymphoproliferative malignancies in some studies.

Materials and methods: We examined the risk of lymphoid neoplasms in a large cohort of 337,437 appendectomised patients <60 years of age in Sweden 1975-2009. We estimated relative risks of non-Hodgkin lymphoma (NHL) and major subtypes, Hodgkin lymphoma (HL), chronic lymphocytic leukaemia (CLL), myeloma, and acute lymphoblastic leukaemia (ALL) versus the general population using standardised incidence ratios (SIRs) with 95% confidence intervals (CIs).

Results: There was no increased risk of NHL (SIR = 0.97, 95%CI 0.88-1.06), major NHL subtypes, CLL (SIR = 0.87, 95%CI 0.70-1.06), myeloma (SIR = 1.14, 95%CI 0.96-1.33) or ALL (SIR = 1.10, 95%CI 0.80-1.47) following appendectomy. An increased risk of HL was observed among patients diagnosed with appendicitis (SIR = 1.29, 95%CI 1.07-1.54, p=0.007), especially individuals aged <20 years at surgery (SIR = 1.43, 95%CI 1.11-1.82), and for the nodular sclerosis subtype of HL (SIR = 1.55, 95%CI 1.01-2.27). A marginally increased risk of myeloma was noted among men, but the association was limited to the first few years of follow-up.

Conclusion: Appendectomy is not associated with any notable increase in risk of lymphoid neoplasms. A small increased risk of HL following appendicitis (rather than appendectomy per se) could reflect a true association, or shared susceptibility to infection/inflammation among individuals prone to develop HL. The association observed for myeloma may be explained by chance or surveillance bias.

Place, publisher, year, edition, pages
Oxon, United Kingdom: Taylor & Francis, 2016. Vol. 51, no 5, 583-589 p.
Keyword [en]
Adult Appendectomy/*adverse effects Female Follow-Up Studies Humans Incidence Lymphoma/epidemiology/*etiology Male Middle Aged *Population Surveillance Retrospective Studies Risk Assessment/*methods, Risk Factors Sweden/epidemiology, Young Adult, Acute lymphoblastic leukaemia, Hodgkin lymphoma, appendectomy appendicitis, chronic lymphocytic leukaemia, myeloma, non-Hodgkin lymphoma
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Medical and Health Sciences Public Health, Global Health, Social Medicine and Epidemiology
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URN: urn:nbn:se:oru:diva-54067DOI: 10.3109/00365521.2015.1124450ISI: 000369846300009PubMedID: 26652908ScopusID: 2-s2.0-84956783582OAI: oai:DiVA.org:oru-54067DiVA: diva2:1057807
Available from: 2016-12-19 Created: 2016-12-19 Last updated: 2016-12-20Bibliographically approved

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