Department of Pathology, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan.
Department of Epidemiology, and.
Blood. 2022 Jan 13;139(2):217-227. doi: 10.1182/blood.2020010475.
Epidemiological data have provided limited and inconsistent evidence on the relationship between radiation exposure and lymphoid neoplasms. We classified 553 lymphoid neoplasm cases diagnosed between 1950 and 1994 in the Life Span Study cohort of atomic bomb survivors into World Health Organization subtypes. Mature B-cell neoplasms represented 58%, mature T-cell and natural killer (NK)-cell neoplasms 20%, precursor cell neoplasms 5%, and Hodgkin lymphoma (HL) 3%, with the remaining 15% classified as non-Hodgkin lymphoid (NHL) neoplasms or lymphoid neoplasms not otherwise specified. We used Poisson regression methods to assess the relationship between radiation exposure and the more common subtypes. As in earlier reports, a significant dose response for NHL neoplasms as a group was seen for males but not females. However, subtype analyses showed that radiation dose was strongly associated with increased precursor cell neoplasms rates, with an estimated excess relative risk per Gy of 16 (95% Confidence interval: 7.0, >533) at age 50. The current data based primarily of tissue-based diagnoses suggest that the association between radiation dose and lymphoid neoplasms as a group is largely driven by the radiation effect on precursor cell neoplasms while presenting no evidence of a radiation dose response for major categories of mature cell neoplasms, either B- or T-/NK-cell, or more specific disease entities (diffuse large B-cell lymphoma, plasma cell myeloma, adult T-cell leukemia/lymphoma) or HL.
流行病学数据提供了有限且不一致的证据，表明辐射暴露与淋巴系统肿瘤之间存在关联。我们将 1950 年至 1994 年期间在原子弹幸存者生命期研究队列中诊断的 553 例淋巴系统肿瘤病例，按照世界卫生组织的分类标准归入特定类型。成熟 B 细胞肿瘤占 58%，成熟 T 细胞和自然杀伤（NK）细胞肿瘤占 20%，前体细胞肿瘤占 5%，霍奇金淋巴瘤（HL）占 3%，其余 15%归入非霍奇金淋巴系统肿瘤或未特指的淋巴系统肿瘤。我们使用泊松回归方法评估了辐射暴露与更常见肿瘤类型之间的关系。与之前的报告一样，我们观察到男性 NHL 肿瘤总体上存在显著的剂量反应，但女性则没有。然而，亚型分析表明，辐射剂量与前体细胞肿瘤的发生率增加密切相关，在 50 岁时，每 Gy 的估计超额相对风险为 16（95%置信区间：7.0，>533）。目前的数据主要基于组织学诊断，表明辐射剂量与淋巴系统肿瘤之间的关联主要是由辐射对前体细胞肿瘤的影响驱动的，而没有证据表明成熟细胞肿瘤（B 细胞或 T/NK 细胞）或更具体的疾病实体（弥漫性大 B 细胞淋巴瘤、浆细胞瘤、成人 T 细胞白血病/淋巴瘤）或 HL 存在辐射剂量反应。
