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Association between myelofibrosis and risk of non-hematologic malignancies: a population-based retrospective cohort study.
Annals of Hematology ( IF 3.5 ) Pub Date : 2020-03-10 , DOI: 10.1007/s00277-020-03973-z
Walid Saliba 1, 2 , Maria Khudyakova 3 , Elena Mishchenko 4 , Shai Cohen 2, 3 , Gad Rennert 1, 2 , Meir Preis 2, 4
Affiliation  

Controversy regarding the risk of non-hematologic malignancies in myelofibrosis patients still exists. We aimed to examine the association between myelofibrosis and non-hematologic malignancies. A cohort of 1,469,790 adults without a diagnosis of myelofibrosis was identified on 1 January 2007, from the electronic medical records of the largest healthcare provider in Israel. Participants were followed up until 31 December 2015, for the occurrence of myelofibrosis. All cases of myelofibrosis were adjudicated by reviewing patients' electronic medical files. Using risk set sampling, four randomly selected controls (without myelofibrosis) were matched to each case of myelofibrosis on age, sex, ethnicity, and index date. Patients with and without myelofibrosis were followed from the index date until 31 December 2016 for the occurrence of non-hematologic malignancies based on the data from the Israel National Cancer Registry. The study included 550 patients with myelofibrosis and 2200 matched controls. Non-hematologic cancers occurred in 35 patients with myelofibrosis and 138 patients without myelofibrosis, reflecting a crude incidence rate of 27.9 and 15.3 per 1000 person-years, respectively. Myelofibrosis was independently associated with increased risk of non-hematologic malignancies with propensity score adjusted HR of 1.85 (95% CI, 1.09-3.15). No significant association was detected between myelofibrosis and the specific sites of non-hematologic malignancies. Treatment with ruxolitinib was not significantly associated with non-hematologic malignancies HR 1.36 (0.60-3.11). In conclusion, myelofibrosis appears to be associated with increased risk of non-hematologic malignancies. However, this study raises concerns about surveillance bias, suggesting that the association might be attributed to earlier detection rather than real increased risk.

中文翻译:

骨髓纤维化与非血液系统恶性肿瘤风险之间的关联:一项基于人群的回顾性队列研究。

关于骨髓纤维化患者非血液系统恶性肿瘤风险的争议仍然存在。我们旨在检查骨髓纤维化与非血液系统恶性肿瘤之间的关联。根据以色列最大的医疗服务提供者的电子病历,于2007年1月1日确定了一组1,469,790名未诊断出骨髓纤维化的成年人。随访直至2015年12月31日,因为发生了骨髓纤维化。通过检查患者的电子病历来判定所有骨髓纤维化病例。使用风险集抽样,将四个随机选择的对照(无骨髓纤维化)与每个年龄,性别,种族和索引日期的骨髓纤维化病例相匹配。根据以色列国家癌症登记处的数据,从索引日期起至2016年12月31日,追踪有无骨髓纤维化的患者是否发生非血液系统恶性肿瘤。该研究包括550名骨髓纤维化患者和2200名匹配的对照。非血液学癌症发生在35例骨髓纤维化患者和138例非骨髓纤维化患者中,分别反映每千人年27.9和15.3的粗略发病率。骨髓纤维化与非血液系统恶性肿瘤风险增加独立相关,倾向评分调整后的HR为1.85(95%CI,1.09-3.15)。在骨髓纤维化与非血液系统恶性肿瘤的特定部位之间未发现显着关联。鲁索替尼治疗与非血液系统恶性肿瘤HR 1。36(0.60-3.11)。总之,骨髓纤维化似乎与非血液系统恶性肿瘤风险增加有关。但是,这项研究引起了人们对监视偏见的担忧,表明这种关联可能归因于早期发现,而不是实际增加的风险。
更新日期:2020-03-10
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