Saku T, Hayashi Y, Takahara O, Matsuura H, Tokunaga M, Tokunaga M, Tokuoka S, Soda M, Mabuchi K, Land C E
Department of Pathology, Nagasaki University School of Dentistry, Japan.
Cancer. 1997 Apr 15;79(8):1465-75.
Malignant and benign tumors of the salivary glands have been associated with exposure to ionizing radiation from various sources, including the atomic bombings in Hiroshima and Nagasaki. However, questions remain unanswered regarding the nature and size of the risk and specific types of tumors involved.
The incidence and pathology of malignant and benign tumors of the salivary glands was studied in the Life Span Study cohort of atomic bomb survivors followed by the Radiation Effects Research Foundation (RERF) in Hiroshima and Nagasaki, Japan. Incident cases diagnosed during the period 1950-1987 were ascertained from the tumor and tissue registries of Hiroshima and Nagasaki and supplemented by additional case findings from autopsy, biopsy, and surgical specimens maintained at RERF and other institutions. Pathology slides and medical documents were reviewed by a panel of four pathologists who classified tumors using the World Health Organization classification scheme. Analyses were performed of histologic features associated with radiation exposure.
Of 145 tumors of the salivary glands identified (119 of the major and 26 of the minor salivary glands), 120 (83%) were histologically confirmed by the current investigators. Among 41 malignant tumors, the frequency of mucoepidermoid tumor was disproportionately high at high radiation doses (P = 0.04); among 94 benign tumors, the frequency of Warthin's tumor increased with increasing radiation dose (P = 0.06). The nature of the tumor was undetermined for the remaining ten cases. Mortality from malignant tumors of the salivary gland was inversely related to radiation dose, reflecting the predominance of mucoepidermoid carcinoma at high dose levels in this series. In one case with high radiation exposure, mucoepidermoid carcinoma of the parotid gland was accompanied by a preexisting or coexisting Warthin's tumor.
These findings, supported by population-based analyses in a companion study reported elsewhere, suggest a causal role for ionizing radiation in salivary gland tumorigenesis, particularly for mucoepidermoid carcinoma, and in the induction of one type of benign tumor (Warthin's tumor).
唾液腺的恶性和良性肿瘤与包括广岛和长崎原子弹爆炸在内的各种来源的电离辐射暴露有关。然而，关于风险的性质和大小以及所涉及肿瘤的具体类型，问题仍然没有答案。
在日本广岛和长崎由辐射效应研究基金会（RERF）跟踪的原子弹幸存者寿命研究队列中，研究了唾液腺恶性和良性肿瘤的发病率及病理情况。1950年至1987年期间诊断出的发病病例从广岛和长崎的肿瘤及组织登记处确定，并由RERF和其他机构保存的尸检、活检及手术标本的额外病例发现进行补充。由四名病理学家组成的小组审查病理切片和医疗文件，他们使用世界卫生组织分类方案对肿瘤进行分类。对与辐射暴露相关的组织学特征进行了分析。
在确定的145例唾液腺肿瘤中（119例大唾液腺肿瘤和26例小唾液腺肿瘤），120例（83%）经本研究人员组织学证实。在41例恶性肿瘤中，高辐射剂量下黏液表皮样癌的发生率异常高（P = 0.04）；在94例良性肿瘤中，沃辛瘤的发生率随辐射剂量增加而增加（P = 0.06）。其余10例病例的肿瘤性质未确定。唾液腺恶性肿瘤的死亡率与辐射剂量呈负相关，反映出本系列中高剂量水平下黏液表皮样癌占主导。在一例高辐射暴露病例中，腮腺黏液表皮样癌伴有先前存在或同时存在的沃辛瘤。
这些发现，在其他地方报道的一项配套研究中的基于人群的分析支持下，表明电离辐射在唾液腺肿瘤发生中起因果作用，特别是对黏液表皮样癌，以及在一种良性肿瘤（沃辛瘤）的诱发中起作用。
