Harbron Richard W, Pasqual Elisa
Population Health Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.
NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, United Kingdom.
J Radiol Prot. 2020 Nov 20;40(4). doi: 10.1088/1361-6498/abbe37.
The ability of ionising radiation to induce lymphoma is unclear. Here, we present a narrative review of epidemiological evidence of the risk of lymphoma, including chronic lymphocytic leukaemia (CLL) and multiple myeloma (MM), among various exposed populations including atomic bombing survivors, industrial and medical radiation workers, and individuals exposed for medical purposes. Overall, there is a suggestion of a positive dose-dependent association between radiation exposure and lymphoma. The magnitude of this association is highly imprecise, however, with wide confidence intervals frequently including zero risk. External comparisons tend to show similar incidence and mortality rates to the general population. Currently, there is insufficient information on the impact of age at exposure, high versus low linear energy transfer radiation, external versus internal or acute versus chronic exposures. Associations are stronger for males than females, and stronger for non-Hodgkin lymphoma and MM than for Hodgkin lymphoma, while the risk of radiation-induced CLL may be non-existent. This broad grouping of diverse diseases could potentially obscure stronger associations for certain subtypes, each with a different cell of origin. Additionally, the classification of malignancies as leukaemia or lymphoma may result in similar diseases being analysed separately, while distinct diseases are analysed in the same category. Uncertainty in cell of origin means the appropriate organ for dose response analysis is unclear. Further uncertainties arise from potential confounding or bias due to infectious causes and immunosuppression. The potential interaction between radiation and other risk factors is unknown. Combined, these uncertainties make lymphoma perhaps the most challenging malignancy to study in radiation epidemiology.
电离辐射诱发淋巴瘤的能力尚不清楚。在此，我们对包括原子弹爆炸幸存者、工业和医疗辐射工作者以及因医疗目的而受照的个体在内的各类受照人群中淋巴瘤（包括慢性淋巴细胞白血病（CLL）和多发性骨髓瘤（MM））风险的流行病学证据进行了叙述性综述。总体而言，有迹象表明辐射暴露与淋巴瘤之间存在剂量依赖性正相关。然而，这种关联的程度极不精确，置信区间很宽，常常包含零风险。外部比较往往显示其发病率和死亡率与一般人群相似。目前，关于暴露年龄、高与低线性能量传递辐射、外照射与内照射或急性与慢性照射的影响，信息不足。男性的关联比女性更强，非霍奇金淋巴瘤和MM的关联比霍奇金淋巴瘤更强，而辐射诱发CLL的风险可能不存在。这种对多种疾病的宽泛分类可能会掩盖某些亚型更强的关联，每种亚型都有不同的起源细胞。此外，将恶性肿瘤分类为白血病或淋巴瘤可能导致相似的疾病被分别分析，而不同的疾病却被归为同一类别。起源细胞的不确定性意味着剂量反应分析的合适器官尚不清楚。由于感染原因和免疫抑制导致的潜在混杂或偏倚引发了更多的不确定性。辐射与其他风险因素之间的潜在相互作用尚不清楚。综合起来，这些不确定性使得淋巴瘤可能成为辐射流行病学中最难研究的恶性肿瘤。
