Solid Cancer Incidence among the Life Span Study of Atomic Bomb Survivors: 1958-2009.
Solid Cancer Incidence among the Life Span Study of Atomic Bomb Survivors: 1958-2009.
复制标题
DOI：
10.1667/rr14492.1
复制
发表时间：
2017-05
影响因子：
3.4
通讯作者：
Ozasa, Kotaro
中科院分区：
文献类型：
--
作者：
Grant, Eric J.;Brenner, Alina;Sugiyama, Hiromi;Sakata, Ritsu;Sadakane, Atsuko;Utada, Mai;Cahoon, Elizabeth K.;Milder, Caitlin M.;Soda, Midori;Cullings, Harry M.;Preston, Dale L.;Mabuchi, Kiyohiko;Ozasa, Kotaro
这是广岛和长崎原子弹爆炸幸存者生命周期研究（LSS）队列中实体癌发病率的第三次分析，增加了自先前报告分析以来11年的随访数据。对于这一分析，实施了一些变化和改进，包括更新剂量估计（DS02R1）和吸烟的调整。在这里，我们关注所有实体癌的总体情况。符合条件的队列包括105,444名在世的受试者，在随访开始时没有已知的癌症病史。共有80,205名受试者获得了个人剂量估计值，其中25,239人在爆炸发生时不在这两个城市。随访期为1958-2009年，随访3,079,484人年。病例是通过与以人口为基础的广岛和长崎癌症登记处的联系确定的。使用泊松回归方法，利用过度相对风险（ERR）和过度绝对风险（EAR）模型对吸烟进行调整，阐明每Gy加权结肠吸收剂量的辐射相关风险的性质。报告了30岁接触者达到70岁的风险估计。本研究共发现22538例原发性实体癌病例，其中992例与辐射暴露有关。自先前报道的研究以来的11年间（1999-2009年）发生了5,918例（26%）。对于女性，剂量反应符合线性，估计ERR为0.64 / Gy （95% CI: 0.52至0.77）。对于男性，在整个剂量范围和限制剂量范围内观察到显著的上升曲线，因此，使用线性二次模型，导致1 Gy时ERR为0.20 (95% CI: 0.12至0.28)，0.1 Gy时ERR为0.010 （95% CI: - 0.0003至0.021）。ERR剂量反应的形状在男性和女性之间有显著差异。虽然ERR随着年龄的增加而显著下降，但与女性相比，男性的下降速度更快。使用性别平均线性ERR模型显示具有统计学意义的剂量反应的最低剂量范围为0-100毫戈瑞。总之，这一分析表明，实体癌的风险在接触后60多年仍在升高。在剂量反应中观察到性别平均向上弯曲，与吸烟调整无关。目前关于剂量-反应形状的分析结果与先前报道的结果不完全一致，提出了尚未解决的问题。目前，由于剂量反应形态的不确定性，无法得出明确的结论，以自信地指导辐射防护政策。为了充分了解与辐射有关的癌症风险的性质及其对公共卫生的意义，需要对特定器官或器官家族的辐射风险进行一系列分析，并进行后续研究。数据和分析脚本可在http://www.rerf.or.jp下载。
This is the third analysis of solid cancer incidence among the Life Span Study (LSS) cohort of atomic bomb survivors in Hiroshima and Nagasaki, adding eleven years of follow-up data since the previously reported analysis. For this analysis, several changes and improvements were implemented, including updated dose estimates (DS02R1) and adjustment for smoking. Here, we focus on all solid cancers in aggregate. The eligible cohort included 105,444 subjects who were alive and had no known history of cancer at the start of follow-up. A total of 80,205 subjects had individual dose estimates and 25,239 were not in either city at the time of the bombings. The follow-up period was 1958–2009, providing 3,079,484 person-years of follow-up. Cases were identified by linkage with population-based Hiroshima and Nagasaki Cancer Registries. Poisson regression methods were used to elucidate the nature of the radiation-associated risks per Gy of weighted absorbed colon dose using both excess relative risk (ERR) and excess absolute risk (EAR) models adjusted for smoking. Risk estimates were reported for a person exposed at age 30 years with attained age of 70 years. In this study, 22,538 incident first primary solid cancer cases were identified, of which 992 were associated with radiation exposure. There were 5,918 cases (26%) that occurred in the 11 years (1999–2009) since the previously reported study. For females, the dose response was consistent with linearity with an estimated ERR of 0.64 per Gy (95% CI: 0.52 to 0.77). For males, significant upward curvature over the full dose range as well as restricted dose ranges was observed and therefore, a linear-quadratic model was used, which resulted in an ERR of 0.20 (95% CI: 0.12 to 0.28) at 1 Gy and an ERR of 0.010 (95% CI: −0.0003 to 0.021) at 0.1 Gy. The shape of the ERR dose response was significantly different among males and females . While there was a significant decrease in the ERR with increasing attained age, this decrease was more rapid in males compared to females. The lowest dose range that showed a statistically significant dose response using the sex-averaged, linear ERR model was 0–100 mGy . In conclusion, this analysis demonstrates that solid cancer risks remain elevated more than 60 years after exposure. Sex-averaged upward curvature was observed in the dose response independent of adjustment for smoking. Findings from the current analysis regarding the dose-response shape were not fully consistent with those previously reported, raising unresolved questions. At this time, uncertainties in the shape of the dose response preclude definitive conclusions to confidently guide radiation protection policies. Upcoming results from a series of analyses focusing on the radiation risks for specific organs or organ families, as well as continued follow-up are needed to fully understand the nature of radiation-related cancer risk and its public health significance. Data and analysis scripts are available for download at: http://www.rerf.or.jp.