Chiu Brian C H, Weisenburger Dennis D
Department of Preventive Medicine, Northwestern University Medical School, and Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA.
Clin Lymphoma. 2003 Dec;4(3):161-8. doi: 10.3816/clm.2003.n.025.
The incidence of non-Hodgkin's lymphoma (NHL) has increased approximately 80% since the 1970s, and is now the fifth most common cancer in the United States. The incidence of NHL is approximately 50% higher among men than women and 35% higher among white people than black people. The incidence rates of all subtypes of NHL have increased, especially diffuse large-cell and immunoblastic subtypes. Extranodal NHL has increased more rapidly than nodal NHL. The overall NHL incidence rates stabilized in the early 1990s and then began to decrease between 1996 and 2000, resulting in part from a decrease in the incidence of AIDS. The incidence of NHL types not associated with AIDS and NHL in groups at low risk of AIDS has continued to increase throughout the 1990s. The increasing incidence of NHL is poorly understood. Improved diagnostic techniques, the effects of the human immunodeficiency virus epidemic, and immunosuppressive therapies accounted for only one third of the increase. Increase in NHL may be attributed to immunodeficiency, various infections, familial aggregation, blood transfusion, genetic susceptibility to NHL, diet, and chemical exposures to pesticides and solvents. Some studies also suggest that associations between risk factors and specific NHL subtypes may be stronger than associations between the same risk factors and NHL in aggregate. Future epidemiologic studies should incorporate the new World Health Organization classification of NHL and new techniques such as cytogenetic molecular analyses to identify subtype-specific etiologic factors. Evaluation of polymorphisms in genes involved in immune function, inflammation, and the activation or detoxification of environmental and occupational chemicals is also warranted.
自20世纪70年代以来，非霍奇金淋巴瘤（NHL）的发病率增加了约80%，目前是美国第五大常见癌症。NHL的发病率男性比女性高约50%，白人比黑人高35%。NHL所有亚型的发病率均有所上升，尤其是弥漫大细胞和免疫母细胞亚型。结外NHL的增长速度比结内NHL更快。NHL的总体发病率在20世纪90年代初趋于稳定，然后在1996年至2000年期间开始下降，部分原因是艾滋病发病率的下降。在整个20世纪90年代，与艾滋病无关的NHL类型以及艾滋病低风险人群中的NHL发病率持续上升。NHL发病率上升的原因尚不清楚。诊断技术的改进、人类免疫缺陷病毒流行的影响以及免疫抑制疗法仅占发病率上升原因的三分之一。NHL发病率的增加可能归因于免疫缺陷、各种感染、家族聚集、输血、对NHL的遗传易感性、饮食以及接触农药和溶剂等化学物质。一些研究还表明，风险因素与特定NHL亚型之间的关联可能比相同风险因素与总体NHL之间的关联更强。未来的流行病学研究应纳入世界卫生组织新的NHL分类以及细胞遗传学分子分析等新技术，以确定亚型特异性病因因素。对参与免疫功能、炎症以及环境和职业化学物质激活或解毒的基因多态性进行评估也是必要的。
