生物谷報道：美國一項疾病研究顯示,，一種罕見而神秘的癌癥——皮膚T細胞淋巴瘤正在美國悄然增加,。
這項由布朗大學Warren Alpert醫(yī)學院和普羅維登斯醫(yī)學中心的研究人員進行的研究發(fā)現(xiàn),，在1973年到2002年間診斷出的新的皮膚T細胞淋巴瘤病例共有4783個。而且新病例的數(shù)量在每個十年里都有明顯的增長,，增長速度超過3倍,。
這項研究的負責人Martin Weinstock博士表示，這種疾病在相當于一代人的時間里已經(jīng)明顯變得常見了,。目前還不知道造成這種變化的原因是什么,，但是數(shù)據(jù)本身則為人們敲響了警鐘。
皮膚T細胞淋巴瘤是由于皮膚中一種類型的白細胞生長失控所導致的,。這種癌癥轉移很慢,，剛開始往往以皮疹的形式出現(xiàn)。目前,，還不清楚這種類型癌癥的發(fā)病機理,。盡管有一些治療藥物，但目前還無法治愈這種疾病,。
這項研究由Weinstock指導的二年級研究生Vincent Criscione所完成,，他也是發(fā)表在7月的Archives of Dermatology雜志上論文的主要作者。
Criscione利用來自美國癌癥研究所的Surveillance,、Epidemiology and End Results(SEER)計劃的數(shù)據(jù)描述了皮膚T細胞淋巴瘤的變化趨勢：
1．發(fā)生率在30年里穩(wěn)定攀升
2．被確診的男性患者是女性的兩倍
3．黑人比白人更可能患上這種疾病,。
4．這種癌癥多發(fā)生在老年人中，但也發(fā)生其他年齡段的人群中
5．生活在醫(yī)療條件優(yōu)越的地區(qū)的人以及社會經(jīng)濟地位較高的人更可能患這種病,。
原發(fā)性皮膚T細胞淋巴瘤(cutaneous T cell lymphoma,，CTCL)曾稱為蕈樣肉芽腫（granuloma fungoid），是T淋巴細胞（特別是T輔助細胞亞群）起源的一種皮膚原發(fā)淋巴瘤,。呈慢性進行性經(jīng)過,，可累及淋巴結和內臟。目前病因尚不明,，可能與遺傳,、感染和環(huán)境因素可能與本病發(fā)生發(fā)展有關。
其臨床表現(xiàn)可分為紅斑期,、斑塊期和腫瘤期,，但各期表現(xiàn)可重疊。紅斑期,，皮損無特異性,，類似于慢性單純性苔蘚樣變、濕疹,、慢性接觸性皮炎,、脂溢性皮炎、特應性皮炎、副銀屑病等,，多伴有劇烈頑固性瘙癢,。
在斑塊期，可由紅斑期發(fā)展而來或直接在正常皮膚上發(fā)生,。皮損呈形態(tài)不規(guī)則,、界限清楚、略高起的浸潤性斑塊,，顏色暗紅至紫色,，可自行消退，亦可融合形成大的斑塊,，邊緣呈環(huán)狀,、弓形或匍行性，顏面受累時褶皺加深形成“獅面”,。
腫瘤期里,，皮損呈褐紅色隆起性結節(jié)，大小,、形狀各異,，易早期破潰，形成深在性卵圓形潰瘍,，基底被覆壞死性灰白色物質,，潰瘍邊緣卷曲,；繼發(fā)感染可伴疼痛及惡臭,。患者常在數(shù)年內死亡,。偶亦見開始即表現(xiàn)為腫瘤而未經(jīng)紅斑期或斑塊期皮損者,，稱暴發(fā)型皮膚T細胞淋巴瘤，預后差,。除皮膚外,，淋巴結最常受累，其他依次為脾,、肺,、肝、骨髓,、腎臟,、舌或會厭、心臟,、胰腺和甲狀腺,，內臟受累往往在尸檢時才能發(fā)現(xiàn)。
在歐美地區(qū)，皮膚癌是一種廣受關注的疾病,。在生物實驗室里,，紫外燈的使用非常普遍，但這種燈光對人皮膚的損害是大的,，因此從事這類研究的科研人員和學生應該盡可能地避免皮膚直接照射紫外光,，以避免紫外光誘導發(fā)生的皮膚病變。
原始出處:
Archives of Dermatology
Vol. 143 No. 7, July 2007
Incidence of Cutaneous T-Cell Lymphoma in the United States, 1973-2002
Vincent D. Criscione, AB; Martin A. Weinstock, MD, PhD
Arch Dermatol. 2007;143:854-859.
Objective To describe incidence trends for cutaneous T-cell lymphoma (CTCL) in the United States.
Design Population-based study.
Setting Data were obtained from 13 population-based cancer registries of the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute from 1973 through 2002.
Participants A total of 4783 cases of CTCL were identified for the period 1973 through 2002.
Main Outcome Measure Diagnosis of CTCL.
Results The overall annual age-adjusted incidence of CTCL was 6.4 per million persons. Annual incidence increased by 2.9 x 10–6 per decade over the study period. Incidence was higher among blacks (9.0 x 10–6) than among whites (6.1 x 10–6) and was higher among men (8.7 x 10–6) than among women (4.6 x 10–6). The racial differences in incidence decreased with age, while the sex differences increased with age and decreased over time. Substantial geographic variation in incidence was found. Incidence was correlated with high physician density, high family income, high percentage of population with a bachelor's degree or higher, and high home values. Changes in International Classification of Diseases for Oncology (ICD-O) morphologic definitions have resulted in the redistribution of the cases of CTCL among specific subclassifications.
Conclusions The continued rise in incidence of CTCL is substantial, and the cause of this increase is unknown. The racial, ethnic, sex, and geographic differences in incidence may be of etiologic importance. Changes in ICD-O definitions have made it difficult to evaluate incidence trends for subclassifications of CTCL such as mycosis fungoides. In addition, these changes resulted in the creation of ambiguous histologic codes, which may have caused coding errors. These errors along with the lack of independent verification are limitations of our study. An epidemiological investigation using population-based data is important to better understand this disorder.
Author Affiliations: Dermatoepidemiology Unit, VA Medical Center, Department of Dermatology, Rhode Island Hospital, and Departments of Dermatology and Community Health, Brown University, Providence, Rhode Island.
