Departments of Epidemiology.
Departments of Statistics.
Radiat Res. 2019 Sep;192(3):299-310. doi: 10.1667/RR15341.1. Epub 2019 Jul 10.
The Life Span Study (LSS) of atomic bomb survivors has consistently demonstrated significant excess radiation-related risks of liver cancer since the first cancer incidence report. Here, we present updated information on radiation risks of liver, biliary tract and pancreatic cancers based on 11 additional years of follow-up since the last report, from 1958 to 2009. The current analyses used improved individual radiation doses and accounted for the effects of alcohol consumption, smoking and body mass index. The study participants included 105,444 LSS participants with known individual radiation dose and no known history of cancer at the start of follow-up. Cases were the first primary incident cancers of the liver (including intrahepatic bile duct), biliary tract (gallbladder and other and unspecified parts of biliary tract) or pancreas identified through linkage with population-based cancer registries in Hiroshima and Nagasaki. Poisson regression methods were used to estimate excess relative risks (ERRs) and excess absolute risks (EARs) associated with DS02R1 doses for liver (liver and biliary tract cancers) or pancreas (pancreatic cancer). We identified 2,016 incident liver cancer cases during the follow-up period. Radiation dose was significantly associated with liver cancer risk (ERR per Gy: 0.53, 95% CI: 0.23 to 0.89; EAR per 10,000 person-year Gy: 5.32, 95% CI: 2.49 to 8.51). There was no evidence for curvature in the radiation dose response (=0.344). ERRs by age-at-exposure categories were significantly increased among those who were exposed at 0-9, 10-19 and 20-29 years, but not significantly increased after age 30 years, although there was no statistical evidence of heterogeneity in these ERRs ( = 0.378). The radiation ERRs were not affected by adjustment for smoking, alcohol consumption or body mass index. As in previously reported studies, radiation dose was not associated with risk of biliary tract cancer (ERR per Gy: -0.02, 95% CI: -0.25 to 0.30). Radiation dose was associated with a nonsignificant increase in pancreatic cancer risk (ERR per Gy: 0.38, 95% CI: <0 to 0.83). The increased risk was statistically significant among women (ERR per Gy: 0.70, 95% CI: 0.12 to 1.45), but not among men.
自首次癌症发病报告以来，原子弹幸存者寿命研究（LSS）一直表明肝癌与辐射相关的风险显著增加。在这里，我们根据截至上一次报告后 11 年的随访结果（1958 年至 2009 年），提供了有关肝癌、胆道和胰腺癌辐射风险的最新信息。目前的分析使用了改进的个体辐射剂量，并考虑了酒精摄入、吸烟和体重指数的影响。研究参与者包括 105444 名 LSS 参与者，他们在随访开始时已知具有个体辐射剂量且没有已知癌症史。病例是通过与广岛和长崎的基于人群的癌症登记处链接确定的首次原发性肝癌（包括肝内胆管）、胆道（胆囊和其他及未指定部分胆道）或胰腺癌症。使用泊松回归方法估计与 DS02R1 剂量相关的肝（肝和胆道癌）或胰腺（胰腺癌）的超额相对风险（ERR）和超额绝对风险（EAR）。我们在随访期间发现了 2016 例肝癌病例。辐射剂量与肝癌风险显著相关（每 Gy 的 ERR：0.53，95%CI：0.23 至 0.89；每 10000 人年 Gy 的 EAR：5.32，95%CI：2.49 至 8.51）。辐射剂量反应无曲线（=0.344）。暴露于 0-9 岁、10-19 岁和 20-29 岁的个体的 ERR 明显增加，但 30 岁以后的 ERR 没有明显增加，尽管这些 ERR 之间没有统计学意义的异质性（=0.378）。吸烟、饮酒或体重指数的调整并未影响辐射 ERR。与之前的报告研究一样，辐射剂量与胆道癌风险无关（每 Gy 的 ERR：-0.02，95%CI：-0.25 至 0.30）。辐射剂量与胰腺癌风险的增加相关，但无统计学意义（每 Gy 的 ERR：0.38，95%CI：<0 至 0.83）。这种风险增加在女性中具有统计学意义（每 Gy 的 ERR：0.70，95%CI：0.12 至 1.45），但在男性中没有。
