{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T20:23:10Z","timestamp":1770322990922,"version":"3.49.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The palatine tonsils and adenoids are critical inductive sites for the mucosa-associated lymphoid tissue (MALT) system, educating B cells for salivary defense. While their removal is common, the long-term impact on mucosal autoimmunity remains unclear. We hypothesized that disrupting this lymphoid network increases susceptibility to Sj\u00f6gren\u2019s syndrome (SS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the TriNetX US Collaborative Network (2006\u20132023), we conducted a retrospective cohort study matching 302,737 patients who underwent tonsillectomy\/adenoidectomy with 302,737 non-surgical controls (propensity score-matched 1:1). Hazard ratios (HR) for incident SS were estimated using Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The surgical cohort exhibited a significantly elevated risk of SS (HR 1.52; 95% CI 1.23\u20131.87; p&amp;lt;0.001) compared to controls. This risk was most profound in individuals operated on before age 18 (HR 2.27) and in African American patients (HR 2.26). Sensitivity analyses using negative outcome controls (e.g., burns, injuries) confirmed the specificity of the association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tonsillectomy is independently associated with an increased risk of SS. These findings suggest that early-life removal of nasopharyngeal lymphoid tissue may disrupt the MALT axis, impairing oral tolerance and predisposing to salivary autoimmunity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1760386","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T06:44:24Z","timestamp":1770273864000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical removal of Waldeyer\u2019s ring and long-term risk of Sj\u00f6gren\u2019s syndrome: a population-based cohort study investigating the mucosal immune link"],"prefix":"10.3389","volume":"17","author":[{"given":"Hua-Wei","family":"Chi","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Cardinal Tien Hospital and Fu Jen Catholic University","place":["New Taipei, Taiwan"]},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, National Taiwan University Hospital","place":["Taipei, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chia-Hung","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Cardinal Tien Hospital and Fu Jen Catholic University","place":["New Taipei, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Hsun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medical Research, Chung Shan Medical University Hospital","place":["Taichung, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun-Hou","family":"Liao","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Cardinal Tien Hospital and School of Medicine, Fu-Jen Catholic University","place":["New Taipei, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingchih","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Hospital Management, Graduate Institute of Business Administration, Fu Jen Catholic University","place":["New Taipei, Taiwan"]},{"name":"Artificial Intelligence Development Center, Fu Jen Catholic University","place":["New Taipei, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeng-Wen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Cardinal Tien Hospital and Fu Jen Catholic University","place":["New Taipei, Taiwan"]},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, National Taiwan University Hospital","place":["Taipei, Taiwan"]},{"name":"Department of Hospital Management, Graduate Institute of Business Administration, Fu Jen Catholic University","place":["New Taipei, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James Cheng-Chung","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital","place":["Taichung, Taiwan"]},{"name":"Graduate Institute of Integrated Medicine, China Medical University","place":["Taichung, Taiwan"]},{"name":"Institute of Medicine\/Department of Nursing, Chung Shan Medical University","place":["Taichung, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2015.2016","article-title":"Toward adenotonsillectomy in children: A review for the general pediatrician","volume":"169","author":"Ingram","year":"2015","journal-title":"JAMA 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