부산대학교 도서관

In the last 20-30 years has been described a significant incidence increased of the lymphoid neoplasms, the causes of this increment are not known, seems that the diagnosis improvement and the AIDS epidemic has contributed in part in the increased incidence reported lately, but in the majority of cases the risk factors are still unknown.The objectives were to assess the distribution of the lymphoid neoplasms and their histological subtypes in accordance with the World Health Organization (WHO) classification by calculating their incidence rates in our area; to estimate the observed and relative survival and calculate the populational attributable incidence to AIDS.From January 1994 to December 2001, 1.288 patients diagnosed with lymphoid neoplasm were recruited in the population- based Cancer Registry of Girona. Both former pathological and hematological diagnoses were reviewed and some prospectively reclassified following the latest WHO classification.Following criteria established by WHO classification the distribution of lymphoid neoplasms was as follows: 77.3% B-cell neoplasm, 5.9% T-cell neoplasm, 8.7% Hodgkin lymphoma and 8,2% was unclassifiable. From 1994 to 2001 the lymphoid neoplasm crude incidence rates was 35.8 per 100.000 men-year, while it was 25.7 new cases per 100.000 women-year. In children (<15 years old), precursor B-lymphoblastic lymphoma/leukemia (65%) and Hodgkin Lymphoma (20%) were the most frequent lymphoid neoplasm, whereas myeloma (17,8%), diffuse large B-cell lymphoma (13,5%) and B-cell chronic lymphocitic leukemia/small lymphocitic lymphoma (13,3%) showed the highest incidence rate in adults. In Girona Helath Region the geographical incidence pattern of lymphomas was different according to histological subtypes.Nowadays, a higher incidence rate of lymphoid neoplasm was found in men in our area compared with other geographical areas in Spain, which could suggest a faster approximation to the pattern observed in industrialized societies. The cause of this geographical distribution is unknown.5 years relative survival rates of lymphoid neoplasms was 52.5% (CI95% 49.4-55.8). The histological subtypes with a good prognosis were marginal zone-cell lymphoma (MALT) [SR5%: 77.6], Hodgkin lymphoma [SR5%: 75.4]; B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma [SR5%: 73.5]; T and NK-cell lymphoid neoplasms [SR5%: 64.4]. The lymphoid neoplasms with the worst prognosis were Burkitt lymphoma/ leukemia [SR5%: 23.2]; plasma cell myeloma [SR5%: 29.6], diffuse large B-cell lymphoma and precursor B-lymphoblastic leukemia/lymphoma [SR5%: 40.0].By sex, the 5 years relative survival of the lymphoid neoplasms is higher in women than in men, these differences are statistically significant in case of Hodgkin lymphoma, T/NK-cell lymphomas and diffuse large B-cell lymphoma. The variant which has a significant best survival in men, was the precursor B-lymphoblastic leukemia/lymphoma.There is an high risk to devolop lymphomas in AIDS patients, this risk is different according to the type of lymphoma, sex, HIV exposure category and period in relation to AIDS diagnosis. The meta-analysis done in thi study show the risk magnitude and the homogeneity in differents territories. The most frequent histological subtype in these patients were the diffuse large B-cell lymphoma followed by the Burkitt lymphoma. The fraction attributable to AIDS in the populational incidence of non-Hodgkin lymphoma was 8.7% and 2.7% for a Hodgkin lymphoma. This fraction was higher in men. A decreased in the fraction attributable to AIDS in non-Hodgkin lymphoma incidence is confirmed after the introduction of HAART.