Clarke Christina A, Glaser Sally L, Dorfman Ronald F, Bracci Paige M, Eberle Erin, Holly Elizabeth A
Northern California Cancer Center, Union City, California, USA.
Cancer Epidemiol Biomarkers Prev. 2004 Jan;13(1):138-43. doi: 10.1158/1055-9965.epi-03-0250.
Incidence rates of non-Hodgkin's lymphomas (NHLs) have nearly doubled in recent decades. Understanding the reasons behind these trends will require detailed surveillance and epidemiological study of NHL subtypes in large populations, using cancer registry or other multicenter data. However, little is known regarding the reliability of NHL diagnosis and subtype classification in such data, despite implications for the accuracy of incidence statistics and studies. Expert pathological re-review was completed for 1526 NHL patients who were reported to the Greater Bay Area Cancer Registry and who participated in a large population-based case-control study. Agreement of registry diagnosis with expert diagnosis and with International Classification of Diseases for Oncology-2 (Working Formulation) subtype classifications was measured with positive predictive values and kappa statistics. Agreement of registry and expert diagnoses was high (98%). Thirty patients were found on review not to have NHL; most of these had leukemia. For subtypes, agreement of registry and expert classification was more moderate (59%). Agreement varied substantially by subtype from 5% to 100% and was 77% for the most common subtype, diffuse large cell lymphoma. Seventy-seven percent of 128 registry-unclassified lymphomas were assigned a subtype on re-review. Our analyses suggest excellent diagnostic reliability but poorer subtype reliability of NHL in cancer registry data information that is critical to the interpretation of lymphoma time trends. Thus, overall NHL incidence and survival statistics from the early 1990s are probably accurate, but subtype-specific statistics could be substantially biased, especially because of high (15-20%) proportions of unclassified lymphomas.
近几十年来，非霍奇金淋巴瘤（NHL）的发病率几乎翻了一番。要了解这些趋势背后的原因，需要利用癌症登记处或其他多中心数据，对大量人群中的NHL亚型进行详细监测和流行病学研究。然而，尽管这些数据对发病率统计和研究的准确性有影响，但对于此类数据中NHL诊断和亚型分类的可靠性却知之甚少。对向大湾区癌症登记处报告并参与一项大型人群病例对照研究的1526例NHL患者进行了专家病理复查。通过阳性预测值和kappa统计量来衡量登记诊断与专家诊断以及与国际肿瘤疾病分类-2（工作分类法）亚型分类的一致性。登记诊断与专家诊断的一致性很高（98%）。复查发现30例患者实际上没有患NHL；其中大多数患有白血病。对于亚型，登记分类与专家分类的一致性较为一般（59%）。不同亚型的一致性差异很大，从5%到100%不等，最常见的亚型弥漫大B细胞淋巴瘤的一致性为77%。在重新复查时，128例登记未分类淋巴瘤中有77%被指定了一个亚型。我们的分析表明，癌症登记数据中NHL的诊断可靠性极佳，但亚型可靠性较差，而这些数据对于解释淋巴瘤时间趋势至关重要。因此，20世纪90年代初以来的总体NHL发病率和生存统计数据可能是准确的，但亚型特异性统计数据可能存在很大偏差，尤其是因为未分类淋巴瘤的比例较高（15 - 20%）。
