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Non-Hodgkin's lymphoma and other nonhepatic malignancies in Swedish patients with hepatitis C virus infection
Örebro University, Department of Clinical Medicine.ORCID iD: 0000-0001-7248-0910
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2005 (English)In: Hepatology, ISSN 0270-9139, E-ISSN 1527-3350, Vol. 41, no 3, p. 652-659Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to evaluate the association between hepatitis C virus (HCV) infection and non-Hodgkin's lymphoma (NHL), multiple myeloma (MM), thyroid cancer (TC), chronic lymphatic leukemia (CLL), acute lymphatic leukemia (ALL), and Hodgkin's lymphoma (HL). A Swedish cohort of 27,150 HCV-infected persons notified during 1990-2000 was included in the study. The database was linked to other national registers to calculate the observation time, expressed as person-years, and to identify all incident malignancies in the cohort. The patients were stratified according to assumed time of previous HCV infection. The relative risk of malignancy was expressed as a standardized incidence ratio (SIR)-the observed number compared to the expected number. During 1990-2000 there were 50 NHL, 15 MM, 14 ALL, 8 TC, 6 CLL, and 4 HL diagnoses in the cohort. Altogether, 20 NHL, 7 MM, 5 TC, 4 CLL, 1 ALL, and 1 HL patient fulfilled the criteria to be included in the statistical analysis. The observation time was 122,272 person-years. The risk of NHL and MM was significantly increased in the stratum with more than 15 years of infection (SIR 1.89 [95% CI, 1.10-3.03] and 2.54 [95% CI, 1.11-5.69], respectively). The association was not significant in TC or CLL. In conclusion, we report the incidence of several malignancies in a nationwide cohort of HCV-infected persons. Although the delayed diagnosis of HCV probably has resulted in an underestimation of the risk, this study showed a significantly increased risk of NHL and MM.

Place, publisher, year, edition, pages
2005. Vol. 41, no 3, p. 652-659
Keywords [en]
Hepatitis C/*complications, Humans, Leukemia; Lymphocytic; Chronic; B-Cell/etiology, Lymphoma; Non-Hodgkin/*etiology, Male, Middle Aged, Multiple Myeloma/etiology, Neoplasms, Precursor Cell Lymphoblastic Leukemia-Lymphoma/etiology, RNA; Viral/analysis, Risk Factors, Thyroid Neoplasms/etiology
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-4743DOI: 10.1002/hep.20608PubMedID: 15723449OAI: oai:DiVA.org:oru-4743DiVA, id: diva2:139042
Available from: 2008-11-24 Created: 2008-11-24 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Hepatitis C virus infection: a nationwide study of associated morbidity and mortality
Open this publication in new window or tab >>Hepatitis C virus infection: a nationwide study of associated morbidity and mortality
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The hepatitis C virus (HCV) was characterised in 1989. HCV was transmitted through transfusion of blood/blood products, but injection drug use is now the most common route of transmission. The infection is usually asymptomatic but becomes chronic in about 75%, and in 20 years 15-25% develops liver cirrhosis, with a risk for liver failure and liver cancer. HCV has also been associated with lymphoproliferative disorders. The aim of this thesis was to study morbidity and mortality in a national, population-based cohort of HCV-infected individuals. The study population consisted of all persons with a diagnosed HCV-infection recorded in the national surveillance database. This file was linked to other national registers to obtain information of emigration, deaths, cancers, and inpatient care. All personal identifiers were removed before analysis.

In Paper I the standardized incidence ratios (SIR) for Hodgkin’s and non-Hodgkin’s lymphoma (NHL), multiple myeloma, acute and chronic lymphatic leukaemia, and thyroid cancer were studied. In the HCV-cohort (n: 27,150) there was a doubled risk for NHL and multiple myeloma in patients infected for more than 15 years, compared with the general population (age-, sex- and calendar-year specific incidence rates). The results strengthened these earlier controversial associations.

The SIR and also the absolute risk for primary liver cancer were estimated in Paper II. In the HCV-cohort (n: 36,126) the individuals infected for more than 25 years had a more than 40 times increased risk for liver cancer compared with the general population. The absolute risk of primary liver cancer was 7% within 40 years of HCV-infection.

Mortality and cause of death were studied in Paper III. The standardized mortality ratio (SMR) demonstrated a 5.8 times excess mortality in the HCV-cohort (n: 34,235) compared with the general population, and a 35.5 times excess mortality from liver disease. Deaths from illicit drugs and external reasons were common in young adults.

Paper IV presents a study of inpatient care. The HCV-cohort (n: 43,000) was compared with a matched reference population (n: 215,000). Cox regression was used to estimate the likelihood, a hazard ratio, for admission to hospital, and frequencies and rates to estimate the total burden. In the HCV-cohort inpatient care was high and about 50% was psychiatric, often drug-related care. The likelihood for liver-related admissions was very high, and serious liver complications increased in the 2000s, indicating that HCV-associated liver disease will increase the next decade. In the 2000s, about 1000 individuals per year were treated with HCV-combination therapy.

To conclude, the risk for NHL and multiple myeloma was doubled, and liver- and drug-related morbidity and mortality was very high in the HCV-cohort. Serious liver complications increased in the 2000s and will probably increase the coming decade.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2009. p. 66
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 34
Keywords
HCV, hepatitis C, epidemiology, non-Hodgkin's lymphoma, NHL, multiple myeloma, primary liver cancer, HCC, mortality, inpatient care, hospitalization
National Category
Medical and Health Sciences
Research subject
Infectious Diseases; Epidemiology; Medicine
Identifiers
urn:nbn:se:oru:diva-7835 (URN)978-91-7668-681-2 (ISBN)
Public defence
2009-10-09, Wilandersalen, Universitetssjukhuset, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-09-14 Created: 2009-09-07 Last updated: 2017-10-18Bibliographically approved

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Duberg, Ann-SofiBäck, Erik

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