Au W Y, Gascoyne R D, Gallagher R E, Le N, Klasa R D, Liang R H S, Choy C, Foo W, Connors J M
Department of Medical Oncology, British Columbia Cancer Agency and the University of British Columbia, Vancouver, BC, Canada.
Ann Oncol. 2004 Apr;15(4):626-30. doi: 10.1093/annonc/mdh132.
Compared with the West, Hodgkin's lymphoma in Oriental countries is characterized by a lower incidence rate and a higher proportion of mixed cellularity histology. Both environmental and genetic factors may be involved.
The incidence and pattern of pathology of Hodgkin's lymphoma in the migrant Chinese population (0.4 million) in British Columbia (population 3.2 million) were studied. From a computerized database, all Hodgkin's lymphoma cases diagnosed in British Columbia from 1970 to 1997 were identified. Chinese descent was determined using patient surname by standard methodology and verified from the treatment record or by patient interview. The corresponding figures from the Chinese population in Hong Kong were used for comparison. For incidence rates, the age-specific incidence of Hodgkin's lymphoma in Hong Kong was obtained from the government cancer registry. For comparison of histology subtypes, 200 Hodgkin's lymphoma records from a Hong Kong regional referral center for the same time period were reviewed. Crude and age-standardized incidence rates were calculated by 5-year intervals in terms of age and calendar year, and relative rates were compared between the three populations.
From 1970 to 1997, Hodgkin's lymphoma was diagnosed in 34 Chinese patients in BC, with 24 cases diagnosed from 1970 to 1994. Thus, the crude and age-adjusted incidence rates from 1970 to 1994 were 0.91 and 1.14 per 100,000 per year in the British Columbia Chinese migrant population. Within the same period, 1862 cases of Hodgkin's lymphoma were diagnosed in British Columbia, giving a provincial background crude and age-adjusted incidence rates of 5.2 and 4.87 per 100,000 per year. The number of cases in the Hong Kong Chinese population (1970-1994) was 404, giving crude and age-adjusted incidence rates of 0.32 and 0.31 per 100,000 per year, respectively. Corrected for age and calendar year trends, the observed 25-year incidence of Hodgkin's lymphoma in British Columbia Chinese was significantly lower than expected from the British Columbia background population [24 observed versus 71 expected cases; standardized incidence ratio (SIR) = 0.34; 90% confidence interval (CI) 0.24-0.48; P <0.0001]. On the other hand, it is higher than that expected by extrapolating from the Hong Kong Chinese population (24 observed versus 8.5 expected cases; SIR = 2.81; 90% CI 1.94-3.95; P <0.0001). The difference is mainly accounted for by young patients with nodular sclerosis type disease in the migrant population.
Although any conclusion about the impact of migration on Hodgkin's lymphoma incidence and types in the Chinese population must be considered tentative due to the small number of observed cases and confounding variables such as age, changing diagnostic standards and secular trends in Hodgkin's lymphoma rates, our data demonstrate a tendency for the Chinese population of British Columbia to take on a Western pattern of Hodgkin's lymphoma. This observation provides additional evidence that both genetic and environmental influences play a role in the pathogenesis of this lymphoma, and that environmental factors can exert their influence over a relatively short period of time.
与西方相比，东方国家霍奇金淋巴瘤的特点是发病率较低，混合细胞型组织学比例较高。环境和遗传因素可能都有涉及。
研究了不列颠哥伦比亚省（人口320万）华裔移民人口（40万）中霍奇金淋巴瘤的发病率和病理类型。从计算机数据库中识别出1970年至1997年在不列颠哥伦比亚省诊断的所有霍奇金淋巴瘤病例。通过标准方法根据患者姓氏确定华裔血统，并从治疗记录或患者访谈中进行核实。将香港华人的相应数据用于比较。对于发病率，香港霍奇金淋巴瘤的年龄特异性发病率来自政府癌症登记处。为了比较组织学亚型，回顾了同一时期香港一个区域转诊中心的200份霍奇金淋巴瘤记录。按年龄和日历年每5年间隔计算粗发病率和年龄标准化发病率，并比较三个人群之间的相对发病率。
1970年至1997年，不列颠哥伦比亚省有34名华裔患者被诊断为霍奇金淋巴瘤，其中24例在1970年至1994年被诊断。因此，1970年至1994年不列颠哥伦比亚省华裔移民人口的粗发病率和年龄调整发病率分别为每年每10万人0.91例和1.14例。同一时期，不列颠哥伦比亚省有1862例霍奇金淋巴瘤病例被诊断，该省背景粗发病率和年龄调整发病率分别为每年每10万人5.2例和4.87例。香港华人人口（1970 - 1994年）中的病例数为404例，粗发病率和年龄调整发病率分别为每年每10万人0.32例和0.31例。校正年龄和日历年趋势后，不列颠哥伦比亚省华裔中观察到的25年霍奇金淋巴瘤发病率显著低于根据不列颠哥伦比亚省背景人群预期的发病率[观察到24例，预期71例；标准化发病率（SIR）= 0.34；90%置信区间（CI）0.24 - 0.48；P <0.0001]。另一方面，它高于根据香港华人人口外推预期的发病率（观察到24例，预期8.5例；SIR = 2.81；90% CI 1.94 - 3.95；P <0.0001）。差异主要由移民人群中结节硬化型疾病的年轻患者导致。
尽管由于观察到的病例数量较少以及年龄、不断变化的诊断标准和霍奇金淋巴瘤发病率的长期趋势等混杂变量，关于移民对华人霍奇金淋巴瘤发病率和类型的影响的任何结论都必须被视为初步的，但我们的数据表明不列颠哥伦比亚省的华人有呈现西方霍奇金淋巴瘤模式的趋势。这一观察结果提供了额外证据，表明遗传和环境影响在这种淋巴瘤的发病机制中都起作用，并且环境因素可以在相对较短的时间内发挥其影响。
