Non-Hodgkin lymphoma comprises a disparate set of malignancies of lymphoid tissue, other than Hodgkin's disease, with a wide variety of biological, clinical and prognostic features. The clinical classification of lymphomas has changed considerably in response to advances in medical knowledge, but it has been difficult to assimilate these changes into the International Classification of Diseases (ICD) for Oncology, used by population-based cancer registries for coding cases for international comparison of cancer incidence (Percy et al, 1984). The tenth revision of the ICD provided more rubrics for non-Hodgkin lymphoma (C82–C85, C91.4, C96) than the two available in ICD-9 (200, 202), but cancer registry data were only coded to ICD-10 from 1995 or later. As a result, it is not yet possible to provide long-term comparisons of incidence and survival trends for specific types of non-Hodgkin lymphoma with population-based data. This is also true of mortality data, which were only coded to ICD-10 from 2000 or later, and which are derived from the limited diagnostic information on death certificates, as opposed to the medical records used to register newly diagnosed cases. Mortality data are generally reported for all the non-Hodgkin lymphomas combined. We present survival trends for the same broad category of all the non-Hodgkin lymphomas combined. Non-Hodgkin lymphoma is the most common lympho-haemopoietic malignancy in adults. It ranks as the eighth most common malignancy with almost 8000 new cases diagnosed each year. The male–female ratio is approximately 1.5. Non-Hodgkin lymphoma has tripled in frequency in both sexes since the early 1970s (Quinn et al, 2001), an increase echoed in many countries (Coleman et al, 1993). More than 60% of cases arise in persons aged 60 years or more, and the increase in incidence has been up to five-fold in older men and women, with little change in young adults. Incidence is slightly higher in affluent than deprived men, but there is no difference for women. The causes of NHL are not well established, although solvents, pesticides and other chemicals have been implicated (Blair and Kazerouni, 1997; Lynge et al, 1997; Stellman, 1998). Certain viruses, such as Epstein–Barr virus, HIV and HTLV are known to be potentially lymphoma-inducing (IARC, 1996, 1998), whereas oncogenic viruses have recently been suspected (Metayer et al, 1998). We analysed the data for 78 894 patients registered with non-Hodgkin lymphoma as a first primary malignancy in England and Wales during the period 1986–1999, some 86% of those eligible. Nine per cent of cases were excluded from survival analysis because their recorded survival was zero (date of diagnosis same as date of death): most of these will have been registered from a death certificate only (DCO); hence, their date of diagnosis and their duration of survival were both unknown. These cases could not be reliably distinguished from cases with true zero survival in the national data. The proportion of cases excluded from analysis as DCO was similar in all deprivation groups, and this is unlikely to have had a material impact on estimates of trend or socioeconomic gradient in survival. A further 3% of patients were excluded because the lymphoma was not their first primary malignancy, along with 1.8% whose vital status was unknown at 5 November 2002, when the data were extracted for analysis.
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Open Access
Jun 1, 2023
Min Zhang + 6
