Cleghorn F R, Manns A, Falk R, Hartge P, Hanchard B, Jack N, Williams E, Jaffe E, White F, Bartholomew C
Division of Cancer Etiology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
J Natl Cancer Inst. 1995 Jul 5;87(13):1009-14. doi: 10.1093/jnci/87.13.1009.
We previously reported from a case-control analysis that T-cell non-Hodgkin's lymphoma (NHL) was strongly associated with human T-lymphotropic virus type I (HTLV-I) infection in Jamaica and Trinidad and that the relative risk for HTLV-I infection was very high in younger patients.
The objective of this study was to estimate the age-specific incidence rates of NHL among HTLV-I-infected and HTLV-I-uninfected adults in Jamaica and Trinidad.
Population rates of HTLV-I infection were calculated from available census reports and serosurvey data. Incidence rates for NHL were calculated from all incident cases in Jamaica during 1984-1987 (n = 135) and from all incident cases in Trinidad during 1986-1990 (n = 117). Using biopsy material, we determined whether the immunophenotype of the tumor cells was T cell, B cell, or other. NHL incidence rates were computed according to HTLV-I status, age, sex, and tumor phenotype for each country separately and for both countries combined by weighting to the relative population size of each country.
The age-standardized NHL incidence rate (mean +/- SE) in Jamaica was 1.9 +/- 0.2 per 100,000 person-years (PY). In Trinidad, the rate was 2.9 +/- 0.4 per 100,000 PY. Overall, the incidence of NHL increased with age and was higher in males than in females. In the HTLV-I-infected population, the incidence of NHL was inversely related to age, and age-specific rates were higher in males than in females. The NHL incidence in those estimated to have acquired HTLV-I infection in childhood, however, showed no sex difference, and one in 1300 such carriers (95% confidence interval: one in 1100 to one in 1600) per annum were estimated to be at such risk. For T-cell NHL, as proxy for adult T-cell lymphoma/leukemia, incidence was highest in those patients infected with HTLV-I early in life (perinatally or via breast milk), with high, sustained risk from early adulthood in both sexes.
While overall NHL incidence rates reveal that HTLV-I endemicity does not impose an exaggerated lymphoma burden on these populations, the risk for lymphoma among carriers who acquire infection early in life is dramatic and is consistent with the hypothesis that virus exposure early in life is most important for lymphoma-genesis.
Studies of HTLV-I carriers known to be infected in childhood may provide insight into markers intermediate in the lympho-magnetic process. Strategies to disrupt early-life transmission of HTLV-I, notably mother-infant transmission, may be critical in reducing the burden of lymphoreticular disease in these populations.
我们之前通过病例对照分析报告称，在牙买加和特立尼达，T细胞非霍奇金淋巴瘤（NHL）与I型人类嗜T淋巴细胞病毒（HTLV-I）感染密切相关，且年轻患者感染HTLV-I的相对风险非常高。
本研究的目的是估计牙买加和特立尼达HTLV-I感染和未感染成年人中NHL的年龄别发病率。
根据现有的人口普查报告和血清学调查数据计算HTLV-I感染的人群发病率。NHL发病率根据1984 - 1987年牙买加的所有新发病例（n = 135）和1986 - 1990年特立尼达的所有新发病例（n = 117）计算得出。我们使用活检材料确定肿瘤细胞的免疫表型是T细胞、B细胞还是其他。分别针对每个国家以及将两个国家按相对人口规模加权合并后，根据HTLV-I状态、年龄、性别和肿瘤表型计算NHL发病率。
牙买加年龄标准化的NHL发病率（均值±标准误）为每10万人年1.9±0.2。在特立尼达，该发病率为每10万人年2.9±0.4。总体而言，NHL发病率随年龄增加，男性高于女性。在HTLV-I感染人群中，NHL发病率与年龄呈负相关，年龄别发病率男性高于女性。然而，估计在儿童期获得HTLV-I感染的人群中，NHL发病率无性别差异，估计每年每1300名此类携带者中有1人（95%置信区间：每1100人中有1人至每1600人中有1人）处于该风险中。对于T细胞NHL，作为成人T细胞淋巴瘤/白血病的替代指标，发病率在生命早期（围产期或通过母乳）感染HTLV-I的患者中最高，成年后男女均有高且持续的风险。
虽然总体NHL发病率表明HTLV-I的地方性流行并未给这些人群带来过高的淋巴瘤负担，但生命早期感染的携带者患淋巴瘤的风险显著，这与生命早期接触病毒对淋巴瘤发生最为重要的假设一致。
对已知在儿童期感染的HTLV-I携带者的研究可能有助于深入了解淋巴细胞发生过程中的中间标志物。破坏HTLV-I生命早期传播，尤其是母婴传播的策略，对于减轻这些人群的淋巴网状疾病负担可能至关重要。
