The incidence of leukemia, lymphoma and multiple myeloma among atomic bomb survivors: 1950-2001.
The incidence of leukemia, lymphoma and multiple myeloma among atomic bomb survivors: 1950-2001.
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DOI：
10.1667/rr2892.1
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发表时间：
2013-03
影响因子：
3.4
通讯作者：
Mabuchi K
中科院分区：
文献类型：
--
作者：
Hsu WL;Preston DL;Soda M;Sugiyama H;Funamoto S;Kodama K;Kimura A;Kamada N;Dohy H;Tomonaga M;Iwanaga M;Miyazaki Y;Cullings HM;Suyama A;Ozasa K;Shore RE;Mabuchi K
白血病风险的显著增加是广岛和长崎原子弹爆炸幸存者中观察到的辐射暴露的第一个也是最引人注目的晚期效应。本文分析了自上次关于这些恶性肿瘤的综合报告以来14年，原子弹幸存者寿命研究队列中辐射对白血病、淋巴瘤和多发性骨髓瘤发病率的影响。这些分析利用了113，011名队列成员的肿瘤和白血病登记发病率数据，从1950年底到2001年底随访了360万人年。除了对慢性淋巴细胞白血病或成人T细胞白血病（两者似乎都与辐射无关）以外的所有白血病的额外风险进行详细分析外，我们还介绍了主要造血系统恶性肿瘤类型的结果：急性淋巴细胞白血病，慢性淋巴细胞白血病，急性髓细胞白血病，慢性髓细胞白血病，成人T细胞白血病，霍奇金和非霍奇金淋巴瘤以及多发性骨髓瘤。泊松回归方法被用来表征辐射剂量反应关系的形状，并在数据允许的范围内，调查与性别，达到的年龄，暴露年龄和暴露时间的超额风险的变化。与之前专注于描述超额绝对利率的报告相反，我们考虑了超额绝对利率（EAR）和超额相对风险（ERR）模型，发现ERR模型通常可以提供与EAR模型相当的超额风险描述，有时甚至更简约。白血病研究结果表明，除慢性淋巴细胞白血病或成人T细胞白血病外，其他白血病的剂量反应呈非线性，这种非线性随接触时间和接触年龄的不同而显著不同，许多证据表明这种非线性是由急性髓细胞白血病风险引起的。虽然白血病的过度风险一般随着年龄的增长或暴露后的时间而下降，但有证据表明，与辐射相关的过度白血病风险，特别是急性髓性白血病，在整个随访期间一直持续到爆炸后的55年。在早期的分析中，有一个弱的建议，辐射剂量反应的非霍奇金淋巴瘤的男性，没有迹象表明这种影响的妇女。没有证据表明霍奇金淋巴瘤或多发性骨髓瘤与辐射相关的过度风险。
A marked increase in leukemia risks was the first and most striking late effect of radiation exposure seen among the Hiroshima and Nagasaki atomic bomb survivors. This paper presents analyses of radiation effects on leukemia, lymphoma, and multiple myeloma incidence in the Life Span Study cohort of atomic bomb survivors updated 14 years since the last comprehensive report on these malignancies. These analyses make use of tumor- and leukemia-registry-based incidence data on 113,011 cohort members with 3.6 million person-years of follow-up from late 1950 through the end of 2001. In addition to a detailed analysis of the excess risk for all leukemias other than chronic lymphocytic leukemia or adult T-cell leukemia (neither of which appear to be radiation-related), we present results for the major hematopoietic malignancy types: acute lymphoblastic leukemia, chronic lymphocytic leukemia, acute myeloid leukemia, chronic myeloid leukemia, adult T-cell leukemia, Hodgkin and non-Hodgkin lymphoma, and multiple myeloma. Poisson regression methods were used to characterize the shape of the radiation dose response relationship and, to the extent the data allowed, to investigate variation in the excess risks with sex, attained age, exposure age, and time since exposure. In contrast to the previous report that focused on describing excess absolute rates, we considered both excess absolute rate (EAR) and excess relative risk (ERR) models and found that ERR models can often provide equivalent and sometimes more parsimonious descriptions of the excess risk than EAR models. The leukemia results indicated that there was a non-linear dose response for leukemias other than chronic lymphocytic leukemia or adult T-cell leukemia, which varied markedly with time and age at exposure, with much of the evidence for this non-linearity arising from the acute myeloid leukemia risks. Although the leukemia excess risks generally declined with attained age or time since exposure, there was evidence that the radiation-associated excess leukemia risks, especially for acute myeloid leukemia, had persisted throughout the follow-up period out to – 55 years after the bombings. As in earlier analyses, there was a weak suggestion of a radiation dose response for non-Hodgkin lymphoma among men with no indication of such an effect among women. There was no evidence of radiation-associated excess risks for either Hodgkin lymphoma or multiple myeloma.