BACKGROUND & AIMS:
:Associations between previous joint replacement and B-cell lymphoid malignancies have been reported, but despite numerous reports, associations with the disease subtypes have received little attention. Using a UK-based register of haematological malignancies and a matched general population-based cohort, joint replacements from linked hospital inpatient records were examined. Cases diagnosed 2009-2015 who were aged 50 years or more were included; 8,013 mature B-cell neoplasms comprising myeloma (n = 1,763), diffuse large B-cell lymphoma (DLBCL, n = 1,676), chronic lymphocytic leukaemia (CLL, n = 1,594), marginal zone lymphoma (MZL, n = 957), follicular lymphoma (FL, n = 725) and classical Hodgkin lymphoma (CHL, n = 255), together with monoclonal gammopathy of uncertain significance (MGUS, n = 2,138) and monoclonal B-cell lymphocytosis (MBL, n = 632). Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated relative to 10 age- and sex-matched controls using conditional logistic regression. Having had a joint replacement before diagnosis was associated with myeloma (OR = 1.3, 95% CI 1.1-1.5, p = 0.008) and MGUS (OR = 1.3, 95% CI 1.1-1.5, p < 0.001). Excluding replacements in the year before diagnosis, the MGUS risk remained, elevated where two or more joints were replaced (OR = 1.5, 95% CI 1.2-2.0, p = 0.001), with hip (OR = 1.2, 95% CI 1.0-1.5, p = 0.06) or knee replacements (OR = 1.5, 95% CI 1.2-1.8, p < 0.001). Associations with CHL and two or more replacements (OR = 2.7, 95% CI 1.3-5.6, p = 0.005) or hip replacements (OR = 1.9, 95% CI 1.0-3.4, p = 0.04); and between DLBCL and knee replacements (OR = 1.3, 95% CI 1.0-1.6, p = 0.04) were also observed. Our study reports for the first time a relationship between joint replacements and MGUS; while absolute risks of disease are low and not of major public health concern, these findings warrant further investigation.
背景与目标:
:以前的关节置换术与B细胞淋巴样恶性肿瘤之间的关联已有报道,但尽管有许多报道,但与疾病亚型的关联却很少受到关注。使用基于英国的血液系统恶性肿瘤登记表和相匹配的基于人群的队列研究,对相关医院住院记录中的关节置换进行了检查。纳入诊断为2009-2015年且年龄≥50岁的病例; 8,013个成熟的B细胞肿瘤,包括骨髓瘤(n = 1,763),弥漫性大B细胞淋巴瘤(DLBCL,n = 1,676),慢性淋巴细胞性白血病(CLL,n = 1,594),边缘区淋巴瘤(MZL,n = 957),滤泡性淋巴瘤(FL,n = 725)和经典霍奇金淋巴瘤(CHL,n = 255),以及意义不明的单克隆丙种球蛋白病(MGUS,n = 2,138)和单克隆B细胞淋巴瘤(MBL,n = 632)。使用条件逻辑回归,相对于10个年龄和性别匹配的对照,计算了赔率(OR)和95%置信区间(95%CI)。在诊断之前进行过关节置换术的患者与骨髓瘤(OR == 1.3,95%CI 1.1-1.5,p = 0.008)和MGUS(OR == 1.3,95%CI 1.1-1.5,p <0.001)相关。不包括诊断前一年的置换,MGUS风险仍然存在,在两个或多个关节置换时(OR = 1.5,95%CI 1.2-2.0,p = 0.001),髋关节(OR = 1.2,95%CI 1.0- 1.5,p = 0.06)或膝关节置换术(OR = 1.5,95%CI 1.2-1.8,p <0.001)。与CHL和两个或多个置换术(OR = 2.7,95%CI 1.3-5.6,p = 0.005)或髋关节置换术(OR = 1.9,95%CI 1.0-3.4,p = 0.04)的关联;以及在DLBCL和膝关节置换之间(OR = 1.3,95%CI 1.0-1.6,p = 0.04)也被观察到。我们的研究首次报告了关节置换与MGUS之间的关系。尽管疾病的绝对风险很低,而且不涉及主要的公共卫生问题,但这些发现值得进一步调查。