对橙剂或 2,3,7,8-四氯二苯并对二恶英与淋巴恶性肿瘤的流行病学的批判性回顾。

A critical review of the epidemiology of Agent Orange or 2,3,7,8-tetrachlorodibenzo-p-dioxin and lymphoid malignancies.

机构信息

Health Sciences Practice, Exponent, Inc., Menlo Park, CA; Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA.

Institute for Translational Epidemiology and the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY.

出版信息

Ann Epidemiol. 2015 Apr;25(4):275-292.e30. doi: 10.1016/j.annepidem.2015.01.002. Epub 2015 Jan 30.

DOI:10.1016/j.annepidem.2015.01.002

PMID:25794766

Abstract

PURPOSE

Establishing a causal relationship between 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and risk of specific lymphoid cancers, including non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), and multiple myeloma (MM), would be useful for risk assessment.

METHODS

This article systematically and critically reviews epidemiologic studies of the association between exposure to TCDD or TCDD-contaminated herbicides and risk of lymphoid malignancies. These include studies of military, industrial, accidental environmental, and general environmental exposure to Agent Orange or TCDD.

RESULTS

Collectively, the epidemiologic evidence from industrial cohorts suggests a positive association with NHL mortality, but results are not consistent across other studies, a clear exposure-response gradient is not evident, and data are insufficient to conclude that the association is causal. Furthermore, available studies provide little information on NHL incidence or specific NHL subtypes. Epidemiologic studies do not show an association of TCDD exposure with HL, whereas the indication of a positive association with MM in a limited number of studies, but not others, remains to be confirmed in additional research. Exposure classification error and small numbers are important limitations of the available epidemiologic studies.

CONCLUSIONS

Overall, a causal effect of TCDD on NHL, HL, MM, or subtypes of these lymphoid malignancies has not been established.

摘要

目的

如果能够确定 2,3,7,8-四氯二苯并对二恶英（TCDD）与特定淋巴癌（包括非霍奇金淋巴瘤（NHL）、霍奇金淋巴瘤（HL）和多发性骨髓瘤（MM））风险之间存在因果关系，将有助于进行风险评估。

方法

本文系统地、批判性地回顾了 TCDD 或 TCDD 污染的除草剂暴露与淋巴恶性肿瘤风险之间关联的流行病学研究。这些研究包括对接触 Agent Orange 或 TCDD 的军事、工业、意外环境和一般环境暴露的研究。

结果

从工业队列获得的流行病学证据表明，TCDD 暴露与 NHL 死亡率之间存在正相关，但其他研究的结果并不一致，没有明显的暴露-反应梯度，而且数据不足以得出关联是因果关系的结论。此外，现有研究提供的关于 NHL 发病率或特定 NHL 亚型的信息很少。流行病学研究表明 TCDD 暴露与 HL 之间没有关联，而在少数研究中表明与 MM 之间存在正相关，但其他研究则没有，这一关联仍需要在进一步的研究中加以证实。暴露分类错误和样本数量少是现有流行病学研究的重要局限性。