title: Epidemiology of classical Hodgkin lymphoma and its association with Epstein Barr virus in Northern China.
abstract: BACKGROUND
  The incidence of classical Hodgkin lymphoma (cHL) and its association with Epstein-Barr virus (EBV) varies significantly with age, sex, ethnicity and geographic location. This is the first report on epidemiological features of cHL patients from Northern regions of China. These features are compared to data from a previously published Dutch cHL population.
  
  
  RESULTS
  157 cHL patients diagnosed between 1997 and 2008 in the North of China were included after histopathological re-evaluation. The Dutch population-based cohort consisted of 515 cHL patients diagnosed between 1987 and 2000. EBV status was determined by in situ hybridization of EBV- encoded small RNAs. In the Chinese population, tumor cells of 39% of the cHL patients were EBV+ and this was significantly associated with male sex, mixed cellularity subtype and young age (<20 y). The median age of the Chinese patients was 9 years younger than that of the Dutch patients (28 y vs. 37 y). In addition, the age distribution between the two populations was strikingly different in both the EBV+ subgroups (p<0.001) and the EBV- subgroups (p = 0.01). The mixed cellularity subtype was almost 3x more frequent amongst the Chinese (p<0.001).
  
  
  CONCLUSIONS
  CHL patients from Northern regions of China show a distinctive age distribution pattern with a striking incidence peak of EBV+ mixed cellularity cases among children and adolescents and another high incidence peak of EBV- nodular sclerosis cases in young adults. In comparison to Dutch cHL patients there are pronounced differences in age distribution, subtype and EBV status, presumably caused by complex gene-environmental interactions.
authors.affiliation: Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Xin
authors.initials: X
authors.lastname: Huang
authors.forename: Ilja
authors.initials: I
authors.lastname: Nolte
authors.forename: Zifen
authors.initials: Z
authors.lastname: Gao
authors.forename: Hans
authors.initials: H
authors.lastname: Vos
authors.forename: Bouke
authors.initials: B
authors.lastname: Hepkema
authors.forename: Sibrand
authors.initials: S
authors.lastname: Poppema
authors.forename: Anke
authors.initials: A
authors.lastname: van den Berg
authors.forename: Arjan
authors.initials: A
authors.lastname: Diepstra
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D005260:Female; D004854:Herpesvirus 4, Human / Q000502:physiology*; D006689:Hodgkin Disease / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D055815:Young Adult