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Does celiac disease influence survival in lymphoproliferative malignancy?
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.ORCID iD: 0000-0003-1024-5602
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York NY, United States.
Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine, Rochester MN, United States.
Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine, Rochester MN, United States.
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2013 (English)In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 28, no 6, p. 475-483Article in journal (Refereed) Published
Abstract [en]

Celiac disease (CD) is associated with both lymphoproliferative malignancy (LPM) and increased death from LPM. Research suggests that co-existing autoimmune disease may influence survival in LPM. Through Cox regression we examined overall and cause-specific mortality in 316 individuals with CD+LPM versus 689 individuals with LPM only. CD was defined as having villous atrophy according to biopsy reports at any of Sweden's 28 pathology departments, and LPM as having a relevant disease code in the Swedish Cancer Register. During follow-up, there were 551 deaths (CD: n = 200; non-CD: n = 351). Individuals with CD+LPM were at an increased risk of death compared with LPM-only individuals [adjusted hazard ratio (aHR) = 1.23; 95 % confidence interval (CI) = 1.02-1.48]. However, this excess risk was only seen in the first year after LPM diagnosis (aHR = 1.76), with HRs decreasing to 1.09 in years 2-5 after LPM diagnosis and to 0.90 thereafter. Individuals with CD and non-Hodgkin lymphoma (NHL) were at a higher risk of any death as compared with NHL-only individuals (aHR = 1.23; 95 % CI = 0.97-1.56). This excess risk was due to a higher proportion of T cell lymphoma in CD patients. Stratifying for T- and B cell status, the HR for death in individuals with CD+NHL was 0.77 (95 % CI = 0.46-1.31). In conclusion, we found no evidence that co-existing CD influences survival in individuals with LPM. The increased mortality in the first year after LPM diagnosis is related to the predominance of T-NHL in CD individuals. Individuals with CD+LPM should be informed that their prognosis is similar to that of individuals with LPM only. However, this study had low statistical power to rule our excess mortality in patients with CD and certain LPM subtypes.

Place, publisher, year, edition, pages
2013. Vol. 28, no 6, p. 475-483
Keywords [en]
Cancer, Celiac, Coeliac, Death, Lymphoproliferative, Malignancy mortality
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-30188DOI: 10.1007/s10654-013-9789-8ISI: 000321243900004OAI: oai:DiVA.org:oru-30188DiVA, id: diva2:640340
Available from: 2013-08-13 Created: 2013-08-13 Last updated: 2018-05-19Bibliographically approved

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Ludvigsson, Jonas F.

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