Müller Antonia M S, Ihorst Gabriele, Mertelsmann Roland, Engelhardt Monika
Hematology and Oncology Department, University of Freiburg Medical Hospital, Hugstetterstr. 55, 79106 Freiburg, Germany.
Ann Hematol. 2005 Jan;84(1):1-12. doi: 10.1007/s00277-004-0939-7. Epub 2004 Oct 9.
While for most cancers incidence and mortality are decreasing, those of non-Hodgkin's lymphoma (NHL) are steadily increasing. Research to define reasons for this increase is extensive, but has not yet resolved them. We have conducted a literature analysis on trends regarding changes in the incidence, geographic distribution, and etiologic factors of NHL. From our own and previous analyses, an increasing NHL incidence at a rate of 3-4% per year was observed for the 1970s and 1980s. This stabilized in the 1990s, nevertheless still with an annual rise of 1-2%, resulting in almost a doubling of the NHL incidence. This rise has been noted worldwide, particularly in elderly persons >55 years. Concerning gender subgroups, a male predominance throughout all age groups is apparent. Although the NHL incidence has historically been higher in whites than blacks, disproportional increases have recently been observed in the latter group. Increases in high-grade NHL and extranodal disease are predominant. Differences in geographic distribution are striking for follicular lymphoma, which is more common in Western countries than elsewhere. Asians have higher rates of aggressive NHL, T-cell lymphomas, and extranodal disease. In the Middle East, high rates of intestinal extranodal disease are observed, whereas in Africa, endemic Burkitt's lymphoma accounts for a substantial proportion. Risks for developing NHL include immunosuppression and a causal link between infectious agents, and lymphomagenesis has also been determined, particularly for human T-cell leukemia/lymphoma virus type 1 (HTLV-1), Epstein-Barr virus (EBV), and Helicobacter pylori infections. Exposure to environmental agents and occupational risks have been studied; however, their significance is as yet uncertain.
虽然大多数癌症的发病率和死亡率正在下降，但非霍奇金淋巴瘤（NHL）的发病率却在稳步上升。为确定这种上升原因的研究广泛，但尚未找到答案。我们对NHL发病率、地理分布和病因因素变化趋势进行了文献分析。从我们自己及之前的分析来看，在20世纪70年代和80年代，观察到NHL发病率以每年3%-4%的速度上升。在20世纪90年代趋于稳定，不过仍以每年1%-2%的速度上升，导致NHL发病率几乎翻倍。这种上升在全球范围内都有出现，尤其是在55岁以上的老年人中。在性别亚组方面，各年龄组中男性占主导地位明显。虽然历史上白人的NHL发病率高于黑人，但最近在后一组中观察到了不成比例的增长。高级别NHL和结外疾病的增加最为显著。滤泡性淋巴瘤的地理分布差异显著，在西方国家比其他地方更为常见。亚洲人侵袭性NHL、T细胞淋巴瘤和结外疾病的发病率较高。在中东地区，肠道结外疾病的发病率较高，而在非洲，地方性伯基特淋巴瘤占很大比例。患NHL的风险包括免疫抑制以及感染因子与淋巴瘤发生之间的因果关系也已确定，特别是对于人类T细胞白血病/淋巴瘤病毒1型（HTLV-1）、爱泼斯坦-巴尔病毒（EBV）和幽门螺杆菌感染。已经对接触环境因素和职业风险进行了研究；然而，它们的重要性尚不确定。
