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Lifestyle factors, autoimmune disease and family history in prognosis of non‐hodgkin lymphoma overall and subtypes
Author(s) -
Simard Julia F.,
Baecklund Fredrik,
Chang Ellen T.,
Baecklund Eva,
Hjalgrim Henrik,
Olov Adami Hans,
Glimelius Bengt,
Smedby Karin E.
Publication year - 2012
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.27944
Subject(s) - medicine , lymphoma , hazard ratio , cause of death , population , family history , proportional hazards model , non hodgkin's lymphoma , disease , national death index , epidemiology , confidence interval , environmental health
Abstract Lifestyle factors and medical history are known to influence risk of non‐Hodgkin lymphoma (NHL). Whether these factors affect the prognosis of NHL, especially its subtypes, is unclear. To investigate this, the association between these factors and all‐cause and lymphoma‐related mortality was assessed in a population‐based cohort of 1,523 Swedish NHL patients included in the Scandinavian Lymphoma Etiology study in 1999–2002. Participants contributed time from NHL diagnosis until death or October 1, 2010, with virtually complete follow‐up through linkage to the Swedish Cause of Death Register. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using stratified and multivariable‐adjusted Cox regression models. During a median follow‐up of 8.8 years, 670 patients (44%) died, with the majority of deaths attributed to lymphoma (86%). Current versus never smoking at diagnosis was associated with increased rate of all‐cause death for all NHL (HR = 1.5, 1.2–1.8) and diffuse large B‐cell lymphoma (HR = 1.8, 1.2–2.7). Low educational level (HR = 1.3, 1.1–1.7, <9 vs . >12 years) and NHL risk‐associated autoimmune disease (HR = 1.4, 1.0–1.8) were associated with death for all NHL combined. However, evidence of an association with lymphoma‐related death was limited. Body mass index, recent sunbathing and family history of hematopoietic malignancy were not consistently associated with death after NHL or its specific subtypes. These results add to the evidence that cigarette smoking, socioeconomic status and certain autoimmune diseases affect survival after NHL. Further investigations are needed to determine how these factors should be incorporated into clinical prognostic assessment.