German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany.
Sci Rep. 2017 Nov 2;7(1):14903. doi: 10.1038/s41598-017-14805-y.
Seasonal variations in incidence and mortality after a Hodgkin lymphoma (HL) diagnosis have been previously described with partly conflicting results. The goal of this analysis is to provide a comprehensive analysis of these seasonal variations. In total, 41,405 HL cases diagnosed between 1973 and 2012 in the 18 Surveillance, Epidemiology, and End Results registries were included. Cosinor analysis and Cox proportional-hazards models were employed to analyze seasonality of incidence and mortality, respectively. HL shows a sinusoid seasonal incidence pattern (p < 0.001). Estimated incidence in March is 15.4% [95%-CI: 10.8-20.0] higher than in September. This sinusoid pattern is more pronounced at higher latitudes (p = 0.023). The risk of dying within the first three years after a HL diagnosis in winter is significantly increased compared to a HL diagnosis in summer at higher latitudes (HR = 1.082 [95%-CI: 1.009-1.161], p = 0.027). Furthermore, increasing northern latitude increases the additional mortality risk conferred by a diagnosis in winter (p0.033). The seasonality patterns presented here provide epidemiological evidence that Vitamin D might play a protective role in HL. Further evidence on the direct association between Vitamin D levels and the clinical course of HL needs to be collected to advance the understanding of the role of Vitamin D in HL.
季节性发病和死亡变化在霍奇金淋巴瘤（HL）诊断后已有描述，且部分结果相互矛盾。本分析的目的是全面分析这些季节性变化。共纳入了 1973 年至 2012 年间在 18 个监测、流行病学和最终结果登记处诊断的 41405 例 HL 病例。采用余弦分析和 Cox 比例风险模型分别分析发病和死亡的季节性。HL 呈现正弦曲线季节性发病模式（p<0.001）。3 月的估计发病率比 9 月高 15.4%（95%CI：10.8-20.0）。这种正弦模式在较高纬度地区更为明显（p=0.023）。与夏季诊断相比，冬季诊断 HL 后前三年的死亡风险在较高纬度地区显著增加（HR=1.082[95%CI：1.009-1.161]，p=0.027）。此外，随着纬度的升高，冬季诊断带来的额外死亡风险也在增加（p<0.033）。这里呈现的季节性模式为维生素 D 可能在 HL 中发挥保护作用提供了流行病学证据。需要进一步收集关于维生素 D 水平与 HL 临床病程之间直接关联的证据，以加深对维生素 D 在 HL 中的作用的理解。
