Risks of leukemia in Japanese atomic bomb survivors, in women treated for cervical cancer, and in patients treated for ankylosing spondylitis
Risks of leukemia in Japanese atomic bomb survivors, in women treated for cervical cancer, and in patients treated for ankylosing spondylitis
复制标题
DOI：
10.2307/3580328
复制
发表时间：
1999-09-01
影响因子：
3.4
通讯作者：
Muirhead, CR
中科院分区：
文献类型：
--
作者：
Little, MP;Weiss, HA;Muirhead, CR
通过对三个暴露人群（日本原子弹幸存者、接受宫颈癌治疗的妇女以及因强直性脊柱炎接受辐射的患者）进行汇总分析，研究了辐射诱发白血病的剂量-反应关系。在 283,139 名研究对象中总共观察到 383 例白血病。考虑到除慢性淋巴细胞白血病之外的所有白血病，最佳相对风险模型的剂量反应具有代表诱导的纯二次项和与高剂量细胞灭菌一致的指数项；添加线性归纳项并没有改善模型的拟合度。相对风险随着暴露时间的增加和年龄的增加而降低，并且数据集之间的模型参数存在显着性（P < 0.00001）差异。这些差异部分与三种主要放射源性白血病亚型（急性髓系白血病、急性淋巴细胞白血病、慢性髓系白血病）模型之间的显着差异（P = 0.003）有关。当三个数据集一起考虑但对三种白血病亚型分别重复分析时，对于每种亚型，最佳模型包括剂量的二次项和指数项。对于急性粒细胞白血病和慢性粒细胞白血病，相对风险随着暴露后时间的增加而降低，而对于急性淋巴细胞白血病，相对风险随着年龄的增加而降低。对于单独考虑的每种白血病亚型，没有迹象表明研究之间的相对风险及其作为剂量、年龄和时间函数的分布存在差异（所有三种亚型的 P > 0.10）。当单独考虑白血病亚型时，三个数据集之间差异不显着的迹象可以用随机变异来解释，尽管暴露剂量率方案的差异、骨髓内剂量分布不均匀、细胞灭菌效应调整不充分或剂量测定错误可能发挥了作用。 (C) 1999 年，辐射研究学会。
The dose-response relationship for radiation-induced leukemia was examined in a pooled analysis of three exposed populations: Japanese atomic bomb survivors, women treated for cervical cancer, and patients irradiated for ankylosing spondylitis. A total of 383 leukemias were observed among 283,139 study subjects. Considering all leukemias apart from chronic lymphocytic leukemia, the optimal relative risk model had a dose response with a purely quadratic term representing induction and an exponential term consistent with cell sterilization at high doses; the addition of a linear induction term did not improve the fit of the model. The relative risk decreased with increasing time since exposure and increasing attained age, and there were significant (P < 0.00001) differences in the parameters of the model between datasets. These differences were related in part to the significant differences (P = 0.003) between the models fitted to the three main radiogenic leukemia subtypes (acute myeloid leukemia, acute lymphocytic leukemia, chronic myeloid leukemia). When the three datasets were considered together but the analysis was repeated separately for the three leukemia subtypes, for each subtype the optimal model included quadratic and exponential terms in dose. For acute myeloid leukemia and chronic myeloid leukemia, there were reductions of relative risk with increasing time after exposure, whereas for acute lymphocytic leukemia the relative risk decreased with increasing attained age. For each leukemia subtype considered separately, there was no indication of a difference between the studies in the relative risk and its distribution as a function of dose, age and time (P > 0.10 for all three subtypes). The nonsignificant indications of differences between the three datasets when leukemia subtypes were considered separately may be explained by random variation, although a contribution from differences in exposure dose-rate regimens, inhomogeneous dose distribution within the bone marrow, inadequate adjustment for cell sterilization effects, or errors in dosimetry could have played a role. (C) 1999 by Radiation Research Society.