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Epidemiology of Classical Hodgkin Lymphoma and Its Association with Epstein Barr Virus in Northern China

Classical Hodgkin lymphoma (cHL) is a heterogeneous malignancy with a complex etiology and epidemiology. In general, cHL accounts for about 1% of all cancers and ~30% of the lymphoid malignancies worldwide. Epidemiologic studies of cHL demonstrate a remarkable diversity of the incidence according to age, sex, ethnic background, geographic location and socioeconomic status. The highest incidence was reported among Caucasians, followed by African Americans and Hispanics, and the lowest incidence was found in Orientals. Data from the International Agency for Research on Cancer (http://globocan.iarc.fr/) shows a nearly 6-fold difference between Western Europe and East Asia with an incidence of 2.3 and 0.4 per 100,000 inhabitants per year respectively in 2008. A genetic explanation for this difference has been shown in a multi-ethnic study of cHL in the United States that reported the lowest incidence rate in Asian immigrants in comparison to other ethnic origins. However, a trend of increasing incidence of cHL was reported among Chinese immigrants in western countries, suggesting an influence of westernization. The incidence pattern by age was also shown to be different between Caucasian and Oriental populations. Western populations typically have a bimodal age distribution with two peaks near 25 and 60 ys. In Orientals, a first incidence peak usually presents in childhood with a second peak in the elderly, although in Japanese cHL patients the early incidence peak was reported to be absent.

Epstein-Barr virus (EBV) is present in the tumor cells in a proportion of patients and EBV is accepted as a causal agent in these patients. There is a striking variability in the percentage of EBV involved cases between racial groups and geographic locations. The proportion of EBV involvement is almost 100% in Hispanic cHL patients, much lower in Caucasians (20~40%) and intermediate in Orientals. In general, the EBV association with cHL is related to age, being the strongest in children and the elderly. In addition, male sex and the mixed cellularity (MC) histological subtype are associated with EBV+ cHL worldwide .

The current study was undertaken to investigate the epidemiological characteristics of cHL patients from Northern China. In addition, these characteristics were compared to data from a previously reported Dutch cHL patient population.


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