Adami J, Frisch M, Yuen J, Glimelius B, Melbye M
Department of Cancer Epidemiology, University Hospital, Uppsala, Sweden.
BMJ. 1995 Jun 10;310(6993):1491-5. doi: 10.1136/bmj.310.6993.1491.
To investigate a possible link between exposure to ultraviolet light and the almost epidemic increase in non-Hodgkin's lymphoma worldwide. Because ultraviolet light is known to cause skin cancers, the association between non-Hodgkin's lymphoma and skin cancer was studied.
Secondary occurrence of either malignant melanoma or squamous cell skin cancer in cohorts of patients with a first diagnosis of either non-Hodgkin's lymphoma or chronic lymphocytic leukaemia, and vice versa, were studied. Expected numbers of subsequent cancers were calculated by sex, age, and period specific national incidence rates multiplied by the person years under observation in the cohorts.
Denmark (1943-89) and Sweden (1958-89).
Four population based cohorts identified in the nationwide cancer registries (34,641 people with non-Hodgkin's lymphoma, 17,400 with chronic lymphocytic leukaemia, 34,989 with malignant melanoma, 25,980 with squamous cell skin cancer). A total of 562,085 person years were accrued for the analysis.
The ratios of observed to expected cancers (the standardised incidence ratio) served as a measure of the relative risk.
The relative risk for developing squamous cell skin cancer was 5.5 (95% confidence interval 4.6 to 6.6) among patients with non-Hodgkin's lymphoma and 8.6 (7.2 to 10.3) among patients with chronic lymphocytic leukaemia. The relative risks remained high over more than 15 years of follow up. Relative risks for malignant melanoma were 2.4 (1.8 to 3.2) for patients with non-Hodgkin's lymphoma and 3.1 (2.1 to 4.4) for patients with chronic lymphocytic leukaemia. After squamous cell skin cancer had been diagnosed there was a twofold excess risk for non-Hodgkin's lymphoma and chronic lymphocytic leukaemia. By contrast, in each of the cohorts the general cancer risks excluding skin and lymphoproliferative malignancies were close to the expected.
The occurrence of non-Hodgkin's lymphoma and skin cancer are strongly associated; this supports the hypothesis that the secular increase in exposure to ultraviolet light may have contributed to the increasing incidence of non-Hodgkin's lymphoma in recent decades.
调查紫外线暴露与全球非霍奇金淋巴瘤近乎流行的增长之间可能存在的联系。由于已知紫外线会导致皮肤癌，因此对非霍奇金淋巴瘤与皮肤癌之间的关联进行了研究。
研究首次诊断为非霍奇金淋巴瘤或慢性淋巴细胞白血病的患者队列中恶性黑色素瘤或鳞状细胞皮肤癌的二次发病情况，反之亦然。通过按性别、年龄和特定时期的国家发病率乘以队列中观察到的人年数来计算后续癌症的预期数量。
丹麦（1943 - 1989年）和瑞典（1958 - 1989年）。
在全国癌症登记处确定的四个基于人群的队列（34641例非霍奇金淋巴瘤患者、17400例慢性淋巴细胞白血病患者、34989例恶性黑色素瘤患者、25980例鳞状细胞皮肤癌患者）。总共积累了562085人年用于分析。
观察到的癌症与预期癌症的比率（标准化发病率）作为相对风险的衡量指标。
非霍奇金淋巴瘤患者发生鳞状细胞皮肤癌的相对风险为5.5（95%置信区间4.6至6.6），慢性淋巴细胞白血病患者为8.6（7.2至10.3）。在超过15年的随访中，相对风险仍然很高。非霍奇金淋巴瘤患者发生恶性黑色素瘤的相对风险为2.4（1.8至3.2），慢性淋巴细胞白血病患者为3.1（2.1至4.4）。在诊断出鳞状细胞皮肤癌后，非霍奇金淋巴瘤和慢性淋巴细胞白血病的风险增加了两倍。相比之下，在每个队列中，排除皮肤和淋巴增殖性恶性肿瘤后的总体癌症风险接近预期。
非霍奇金淋巴瘤和皮肤癌的发生密切相关；这支持了以下假设，即近几十年来紫外线暴露的长期增加可能导致了非霍奇金淋巴瘤发病率的上升。
