Epidemiology of brain lymphoma among people with or without acquired immunodeficiency syndrome
Epidemiology of brain lymphoma among people with or without acquired immunodeficiency syndrome
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DOI：
10.1093/jnci/88.10.675
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发表时间：
1996-05-15
期刊：
影响因子：
--
通讯作者：
Parkin, W
中科院分区：
文献类型：
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作者：
Cote, TR;Manns, A;Parkin, W
背景：近年来，脑淋巴瘤的发病率急剧上升，可能是由于获得性免疫缺陷综合征（AIDS）患者发生脑淋巴瘤的风险增加。目的：本研究的目的是估计AIDS患者或非AIDS患者脑淋巴瘤的独立发病率和生存率，并了解这种癌症的流行病学特征。我们将9个州和地方卫生部门的艾滋病和癌症登记报告联系起来，比较了艾滋病患者和非艾滋病患者的人口统计学、组织学和脑淋巴瘤病例的生存率，这些数据限于70岁以下的人群，我们计算了艾滋病患者脑淋巴瘤的发病率，并将观察到的病例与预期的病例进行了比较，差异使用泊松检验进行了统计分析。采用卡方检验、Student’st检验和线性趋势卡方检验比较艾滋病患者和非艾滋病患者脑淋巴瘤的流行病学特征，采用logrank检验比较Kaplan-Meier技术估计的生存率，所有P值均为双侧。我们将50989份艾滋病登记报告与859398份癌症登记报告（数据从1981年到1990年）相匹配，发现431人同时患有艾滋病和脑淋巴瘤。在艾滋病患者中，发生脑淋巴瘤的人比没有脑淋巴瘤的人更有可能是白人（70%比59%；P < .001），同性恋是他们唯一的人类免疫缺陷病毒危险因素(75%比64%；P < 0.001)，在431例患者中，223例在诊断为艾滋病后的47465人-年观察期间发展为脑淋巴瘤，艾滋病患者脑淋巴瘤的绝对发病率为4.7/1000人-年（95%可信区间= 4.1-5.3/1000人-年），比一般人群的基线发病率高出3600倍，从1980年到1989年，脑淋巴瘤的总计数增加了9倍，其中大部分增加来自艾滋病患者。但非艾滋病人群的发病率也有显著上升（1982年为0.04/10万，1989年为0.28/10万）（χ 2检验，P < 0.05）。艾滋病合并脑淋巴瘤患者的中位生存期最短（2个月），无艾滋病的脑淋巴瘤患者的中位生存期中等（5-7个月），无脑淋巴瘤的艾滋病患者的中位生存期最长（14个月）（所有比较P < 0.05）。该分析区分了艾滋病患者和非艾滋病患者脑淋巴瘤发病率的不同流行病学，并显示艾滋病患者脑淋巴瘤发病率比一般人群高出数千倍。该研究记录了艾滋病相关脑淋巴瘤对一般人群总体发病率的压倒性影响，并显示了在非艾滋病人群中显著上升的趋势，尽管幅度较小。这项研究强调，更需要为这一迅速蔓延的流行病提供卫生保健资源。
Background: In recent years, brain lymphoma incidence has dramatically increased, presumably because of elevated risk of brain lymphoma among persons with acquired immunodeficiency syndrome (AIDS), Purpose: The objective of this study was to estimate independent incidence and survival rates of brain lymphoma among persons with or without AIDS and to understand the epidemiologic features of this cancer, Methods: We linked AIDS and cancer registry reports at nine state and local health departments and compared the demographics, histology, and survival of brain lymphoma cases among persons with or without AIDS, The data were limited to people under 70 years of age, We calculated the incidence of brain lymphoma among persons with AIDS and compared observed cases with those expected, The differences were statistically analyzed using the Poisson test, Epidemiologic features of brain lymphoma in persons with or without AIDS were compared using the chi-squared test, the Student's t test, and the chi-squared test for linear trend, The logrank test was used to compare survival rates estimated by the Kaplan-Meier technique, All P values were two-sided, Results: We matched 50 989 AIDS registry reports to 859 398 cancer registry reports (data from 1981 to 1990) and found 431 people with both AIDS and brain lymphoma, Among people with AIDS, those developing brain lymphoma versus those without brain lymphoma were more likely to be white (70% versus 59%; P < .001) and had homosexuality as their only human immunodeficiency virus risk factor (75% versus 64%; P < .001), Of the 431 patients, 223 developed brain lymphomas during 47 465 person-years of observation after diagnosis of AIDS, The absolute incidence rate of brain lymphoma among persons with AIDS was 4.7/1000 person-years (95% confidence interval = 4.1-5.3/1000 person-years), 3600-fold higher than the base-line rate in the general population, From 1980 through 1989, overall counts of brain lymphoma increased ninefold, Most of this increase was derived from persons with AIDS, but a substantial increase also occurred among persons without AIDS (0.04/100 000 in 1982 to 0.28/100 000 in 1989) (chi-squared test for trend; P < .05). The median survival was shortest for persons with AIDS and brain lymphoma (2 months), was intermediate for persons with brain lymphoma without AIDS (5-7 months), and was longest for persons with AIDS without brain lymphoma (14 months) (P < .05 for all comparisons), Conclusions: This analysis distinguishes the separate epidemiologies of brain lymphoma incidence among persons with or without AIDS and shows brain lymphoma incidence among persons with AIDS to be several thousand-fold higher than that in the general population, The study documents the overwhelming effect of AIDS-associated brain lymphoma on the overall rate in the general population and demonstrates a significantly rising trend, although of a lesser magnitude, among persons without AIDS, Implications: This study emphasizes a greater need to bring health care resources to this burgeoning epidemic.