Baaken Dan, Hammer Gaël P, Seidenbusch Michael C, Schneider Karl, Spix Claudia, Blettner Maria, Pokora Roman, Lorenz Eva
Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University, Mainz, Germany.
J Radiol Prot. 2019 Jul 25;39(4):1074-1091. doi: 10.1088/1361-6498/ab3506.
Studies on children exposed to ionising radiation by computed tomography (CT) indicate an increased risk of leukemia and central nervous system (CNS) tumors. Evidence of the risks associated with diagnostic x-ray examinations, the most frequent examination in pediatric radiology, in which the radiation dose is up to 750 times lower compared to CT examinations, is less clear. This study presents results of the second follow-up for the risk of childhood cancer in a cohort of children (<15 years) with diagnostic x-ray exposure at a large German hospital during 1976-2003 followed for additional 10 years until 2016. With a latency period of 6 months, 92 998 children contributed 794 549 person-years. The median effective dose was 7 μSv. Hundred incident cancer cases were identified: 35 leukemia, 13 lymphomas, 12 CNS tumors, 15 blastomas, 15 sarcomas and 10 other solid tumors, consisting of six germ cells tumors, three thyroid cancers and one adrenocortical carcinoma. For all cancer cases combined the standardised incidence ratio (SIR) was 1.14 (95% confidence interval (CI) 0.93-1.39), for leukemia 1.15 (95% CI 0.63-1.61), for lymphomas 1.03 (95% CI 0.55-1.76), for CNS tumors 0.65 (95% CI 0.34-1.14), for blastomas 1.77 (95% CI 0.91-2.91), for sarcomas 1.28 (95% CI 0.71-2.11) and for other solid tumors 2.38 (95% CI 1.14-4.38). Dose-response analysis using Poisson regression revealed no significant trend for dose groups. Results did not differ substantially with a latency period of 2 years for all cancer entities and 5 years for solid tumors in sensitivity analyses. Overall, the null results of the first follow-up were confirmed. Although an association between radiation exposure and a risk for certain solid tumors like thyroid cancer is known, the significantly increased SIR in the group of other solid tumors must be critically interpreted in the context of the small number of cases and the very low doses of radiation exposure in this group.
关于儿童因计算机断层扫描（CT）接触电离辐射的研究表明，患白血病和中枢神经系统（CNS）肿瘤的风险增加。与诊断性X线检查相关风险的证据尚不太明确，诊断性X线检查是儿科放射学中最常见的检查，其辐射剂量比CT检查低多达750倍。本研究呈现了对1976年至2003年期间在一家大型德国医院接受诊断性X线照射的儿童队列（<15岁）进行的儿童癌症风险第二次随访结果，该队列随后又随访了10年直至2016年。潜伏期为6个月，92998名儿童贡献了794549人年。中位有效剂量为7微希沃特。共确定了100例癌症病例：35例白血病、13例淋巴瘤、12例中枢神经系统肿瘤、15例胚细胞瘤、15例肉瘤和10例其他实体瘤，其中包括6例生殖细胞肿瘤、3例甲状腺癌和1例肾上腺皮质癌。所有癌症病例合并的标准化发病比（SIR）为1.14（95%置信区间（CI）0.93 - 1.39），白血病为1.15（95%CI 0.63 - 1.61），淋巴瘤为1.03（95%CI 0.55 - 1.76），中枢神经系统肿瘤为0.65（95%CI 0.34 - 1.14），胚细胞瘤为1.77（95%CI 0.91 - 2.91），肉瘤为1.28（95%CI 0.71 - 2.11），其他实体瘤为2.38（95%CI 1.14 - 4.38）。使用泊松回归进行的剂量反应分析显示剂量组无显著趋势。在敏感性分析中，所有癌症实体的潜伏期为2年，实体瘤的潜伏期为5年时，结果无实质性差异。总体而言，首次随访的阴性结果得到了证实。虽然已知辐射暴露与某些实体瘤如甲状腺癌的风险之间存在关联，但在病例数量较少且该组辐射暴露剂量极低的背景下，其他实体瘤组中显著升高的标准化发病比必须谨慎解读。
