BACKGROUND Cutaneous T-cell lymphoma (CTCL) is a rare form of non-Hodgkin lymphoma arising in the skin. Geographic clustering of CTCL has recently been reported, but its association with environmental factors is unknown. Benzene and trichloroethylene (TCE) are environmental toxins with carcinogenic properties. The authors investigated associations between geographic clustering of CTCL incidence in the state of Georgia with benzene and TCE exposure. METHODS The statewide county-level incidence of CTCL within Georgia was obtained from the Georgia Cancer Registry for the years 1999 to 2015. Standardized incidence ratios (SIRs) were calculated by dividing observed cases by expected cases using national incidence rates by age, sex, and race. Clustering of CTCL was analyzed using spatial analyses. County-level concentrations of benzene and TCE between 1996 and 2014 were collected from the Environmental Protection Agency's National Air Toxics Assessment database. Linear regression analyses on CTCL incidence were performed comparing SIRs with levels of benzene and TCE by county. RESULTS There was significant geographic clustering of CTCL in Georgia, particularly around Atlanta, which was correlated with an increased concentration of benzene and TCE exposure. Among the 4 most populous counties in Georgia, CTCL incidence was between 1.2 and 1.9 times higher than the state average, and benzene and TCE levels were between 2.9 and 8.8 times higher. CONCLUSIONS The current results demonstrate nonrandom geographic clustering of CTCL incidence in Georgia. To the authors' knowledge, this is the first analysis to identify a correlation between geographic clustering of CTCL and environmental toxic exposures.

中文翻译：

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皮肤T细胞淋巴瘤的聚集与佐治亚州环境毒素苯和三氯乙烯水平的升高有关。

背景技术皮肤T细胞淋巴瘤（CTCL）是在皮肤中发生的非霍奇金淋巴瘤的罕见形式。CTCL的地理聚类最近已有报道，但与环境因素的关联尚不清楚。苯和三氯乙烯（TCE）是具有致癌特性的环境毒素。作者研究了佐治亚州与苯的CTCL发生率的地理聚类与TCE暴露之间的关联。方法从佐治亚州癌症登记处获得1999年至2015年全州县级CTCL的发病率。标准发病率（SIR）通过将观察到的病例除以预期病例得出，并使用年龄，性别和种族。使用空间分析法分析了CTCL的聚类。从环境保护局的国家空气毒性评估数据库中收集了1996年至2014年县级苯和三氯乙烯的浓度。对CTCL发生率进行线性回归分析，比较各县的SIR与苯和TCE的水平。结果在佐治亚州，特别是亚特兰大附近，CTCL出现了明显的地理集群，这与苯浓度和三氯乙酸的浓度增加有关。在佐治亚州四个人口最多的县中，CTCL的发病率是该州平均水平的1.2至1.9倍，苯和TCE的水平则高出2.9至8.8倍。结论当前的结果表明佐治亚州CTCL发病率的非随机地理聚类。据作者所知，