糖尿病與非何杰金氏惡性淋巴瘤發病及預後之相關性

研究目的：利用一個回溯性世代研究加上一個病例-對照研究設計來檢視「過去罹患糖尿病」是否會增加罹患非何杰金氏惡性淋巴瘤的危險性，且評估「過去罹患糖尿病」是否會進一步影響罹患非何杰金氏惡性淋巴瘤之後的預後和存活率。方法：病例組共242位，取自於2000年1月至2003年3月間轉診到林口長庚紀念醫院放射腫瘤科接受放射治療的非何杰金氏惡性淋巴瘤的病患，他們皆曾經由病理切片確診為罹患非何杰金氏惡性淋巴瘤。對照組乃選自在基隆社區所進行的複合式篩檢的受檢者。病例組與對照組的成員皆曾經填過一份基本資料問卷，其內容包括有關糖尿病及高血壓的過去病史，有關抽煙、喝酒、嚼檳榔等諸因子。統計分析利用邏輯迴歸模式來計算出「過去罹患糖尿病」與其它諸危險因子影響罹患非何杰金氏惡性淋巴瘤的危險性之勝算比。利用Cox迴歸模式來進一步評估「過去罹患糖尿病」是否會影響罹患非何杰金氏惡性淋巴瘤之後的預後和存活率。結果：單變項分析結果顯示過去罹患糖尿病會明顯提高罹患非何杰金氏惡性淋巴瘤的危險性 (勝算比, 2；95% 信賴區間, 1.405 ~ 3.180)。在調整控制了其它的相關因子之後，多變項分析仍顯示過去罹患糖尿病是增加惡性淋巴瘤罹病率的一個具有統計顯著意義的危險因子 (勝算比, 1.875；95% 信賴區間, 1.215 ~ 2.892；p值= 0.0045)。當針對某些與惡性淋巴瘤或其疾病有關的特徵做次族群分析時，發現過去罹患糖尿病增加之後罹患非何杰金氏惡性淋巴瘤的危險性在T-淋巴球、淋巴結外發病、以及非侷限性且非低惡性度者特別地顯著。在存活分析方面，單變項分析顯示過去罹有糖尿病的人死於惡性淋巴瘤相關死因的比率多出33 %，不過其並未達統計上顯著意義 (p值= 0.479)。多變數分析顯示過去罹有糖尿病對於死於惡性淋巴瘤的影響程度會隨著追蹤時間而有所變化，如此的修飾作用在統計上達邊緣性顯著意義 (p值= 0.054) 結論：本研究發現「過去罹患糖尿病」對於非何杰金氏惡性淋巴瘤的發病確實是一個獨立的危險因子，尤其是當惡性淋巴瘤發病於淋巴結外，細胞來源屬於T淋巴球，或是其疾病的狀態屬於非侷限性且非低惡性度時。過去罹患糖尿病對於死於惡性淋巴瘤相關死因的危險性的影響可說是一個加速因子。

關鍵字

非何杰金氏惡性淋巴瘤；糖尿病；存活率

並列摘要

Purpose: The aim of this study was to use a retrospective cohort study in conjunction with a case-control study to elucidate the effect of pre-existing DM history on the risk of developing NHL; and to assess whether pre-existing DM history can further affect cumulative survival after NHL diagnosis. Methods: We used a retrospective cohort to set up a case-control study. The cases consisted of 242 subjects with pathologically confirmed NHL who were referred to the Department of Radiation Oncology in Chang-Gung Memorial Hospital (CGMH) for radiotherapy between January 2000 and March 2004. The controls were derived from a population-based multiple screening program, called Keelung Community based Integrated Screening (KCIS). The subjects of both cases and controls had ever filled out a questionnaire about the past history including DM, hypertension, and some life-style factors such as alcohol drinking and smoking. Logistic regression model was employed to calculate the odds ratios of the risk factors investigated to evaluate the association between pre-existing DM and the occurrence of NHL. Basic and advanced survival analyses were used to assess whether pre-existing DM history can further affect cumulative survival after NHL diagnosis. Results: The presence of prior diagnosis of DM was associated with an increased risk of NHL development (odds ratio, 2.144; 95% confidence interval, 1.405 ~ 3.180). After controlling for other relevant factors, preexisting DM history was found to be an independent risk factor for the occurrence of NHL (OR, 1.875; 95% CI, 1.215 ~ 2.892 [p= 0.0045]). When subgroup analyses regarding certain tumor or disease characteristics were performed, the impact of preexisting DM history was particularly manifested in some subgroups such as the tumors of T-cell origin. In univariate analysis for survival, patients with DM conferred an extra 33% of death from causes related to NHL. However, the association was not statistically significant (P= 0.479). Multi-variable analysis with the incorporation of the first interaction term between survival time and presence of DM after controlling for other available factors revealed that the effect of DM on risk for death from NHL varied with follow-up time. Such an effect modification was marginally statistically significant (P=0.054). Conclusion: It was found that preexisting DM history was an independent risk factor for the occurrence of NHL, particularly for those with extranodal involvement, of T-cell origin, and which were not localized or low grade. Preexisting DM history was also an accelerated factor for the risk of death from causes related to NHL.

並列關鍵字

diabetes mellitus ； survival

參考文獻

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糖尿病與非何杰金氏惡性淋巴瘤發病及預後之相關性

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