Thompson D E, Mabuchi K, Ron E, Soda M, Tokunaga M, Ochikubo S, Sugimoto S, Ikeda T, Terasaki M, Izumi S
Department of Epidemiologic Pathology, Radiation Effects Research Foundation, Nagasaki, Japan.
Radiat Res. 1994 Feb;137(2 Suppl):S17-67.
This report presents, for the first time, comprehensive data on the incidence of solid cancer and risk estimates for A-bomb survivors in the extended Life Span Study (LSS-E85) cohort. Among 79,972 individuals, 8613 first primary solid cancers were diagnosed between 1958 and 1987. As part of the standard registration process of the Hiroshima and Nagasaki tumor registries, cancer cases occurring among members of the LSS-E85 cohort were identified using a computer linkage system supplemented by manual searches. Special efforts were made to ensure complete case ascertainment, data quality and data consistency in the two cities. For all sites combined, 75% of the cancers were verified histologically, 6% were diagnosed by direct observation, 8% were based on a clinical diagnosis, and 12.6% were ascertained by death certificate only. A standard set of analyses was carried out for each of the organs and organ systems considered. Depending on the cancer site, Dosimetry System 1986 (DS86) organ or kerma doses were used for computing risk estimates. Analyses were based on a general excess relative risk model (the background rate times one plus the excess relative risk). Analyses carried out for each site involved fitting the background model with no dose effect, a linear dose-response model with no effect modifiers, a linear-quadratic dose-response model with no effect modifiers, and a series of linear dose-response models that included each of the covariates (sex, age at exposure, time since exposure, attained age and city) individually as effect modifiers. Because the tumor registries ascertain cancers in the registry catchment areas only, an adjustment was made for the effects of migration. In agreement with prior LSS findings, a statistically significant excess risk for all solid cancers was demonstrated [excess relative risk at 1 Sv (ERR1Sv) = 0.63; excess absolute risk (EAR) per 10(4) person-year sievert (PY Sv) = 29.7]. For cancers of the stomach (ERR1SV = 0.32), colon (ERR1SV = 0.72), lung (ERR1SV = 0.95), breast (ERR1SV = 1.59), ovary (ERR1SV = 0.99), urinary bladder (ERR1SV = 1.02) and thyroid (ERR1SV = 1.15), significant radiation associations were observed. There was some indication of an increase in tumors of the neural tissue (excluding the brain) among persons exposed to the bombs before age 20. For the first time, radiation has been associated with liver (ERR1SV = 0.49) and nonmelanoma skin (ERR1SV = 1.0) cancer incidence in the LSS cohort. The present analysis also strengthened earlier findings, based on a smaller number of cases, of an effect of A-bomb radiation on salivary gland cancer.(ABSTRACT TRUNCATED AT 400 WORDS)
本报告首次呈现了扩大后的寿命研究（LSS - E85）队列中原子弹幸存者实体癌发病率的综合数据及风险估计。在79972名个体中，1958年至1987年间诊断出8613例原发性实体癌。作为广岛和长崎肿瘤登记处标准登记流程的一部分，通过计算机链接系统并辅以人工搜索来识别LSS - E85队列成员中发生的癌症病例。在这两个城市，为确保病例完全确诊、数据质量和数据一致性付出了特别努力。所有部位合计，75%的癌症经组织学证实，6%通过直接观察诊断，8%基于临床诊断，12.6%仅通过死亡证明确诊。对所考虑的每个器官和器官系统都进行了一套标准分析。根据癌症部位，使用1986年剂量测定系统（DS86）器官或比释动能剂量来计算风险估计值。分析基于一般超额相对风险模型（背景率乘以1加超额相对风险）。对每个部位进行的分析包括拟合无剂量效应的背景模型、无效应修饰因子的线性剂量反应模型、无效应修饰因子的线性 - 二次剂量反应模型，以及一系列将每个协变量（性别、受照年龄、受照后时间、达到年龄和城市）单独作为效应修饰因子的线性剂量反应模型。由于肿瘤登记处仅在登记区域内确诊癌症，因此对迁移的影响进行了调整。与寿命研究先前的结果一致，所有实体癌显示出具有统计学意义的超额风险[1Sv时的超额相对风险（ERR1Sv）= 0.63；每10⁴人年西弗（PY Sv）的超额绝对风险（EAR）= 29.7]。对于胃癌（ERR1SV = 0.32）、结肠癌（ERR1SV = 0.72）、肺癌（ERR1SV = 0.95）、乳腺癌（ERR1SV = 1.59）、卵巢癌（ERR1SV = 0.99）、膀胱癌（ERR1SV = 1.02）和甲状腺癌（ERR1SV = 1.15），观察到显著的辐射关联。有迹象表明，20岁之前受原子弹爆炸影响的人群中神经组织（不包括脑）肿瘤有所增加。在寿命研究队列中，首次发现辐射与肝癌（ERR1SV = 0.49）和非黑色素瘤皮肤癌（ERR1SV = 1.0）的发病率有关。本分析还强化了基于较少病例数的早期发现，即原子弹辐射对唾液腺癌有影响。（摘要截选至400字）
