PO.PS01.12 · 人群科学
长期空气污染与按组织学亚型划分的肺癌发病率
Long-term air pollution and lung cancer incidence by histological subtypes
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：基于全球大型队列研究，长期空气污染暴露与肺癌发病之间的证据日益增多。少数后续研究提示该关联可能因组织学亚型而异，尽管研究结果并不一致。本研究旨在利用一个纳入 200 万成年人的具人群代表性的队列，考察空气污染是否比其他亚型更强地影响某种特定组织学亚型的肺癌。
方法：我们的研究人群包括 2,346,332 名成年人，他们在 2007 年时年龄在 30 岁及以上，参加了 2005-2007 年的健康检查，并在与韩国中央癌症登记处相链接的国民健康保险服务数据库中回顾性随访至 2020 年。我们基于国际肿瘤疾病分类识别了三种组织学亚型的肺癌发病，包括腺癌（AD）、鳞状细胞癌（SqCC）和小细胞癌（SCC）。个体层面的长期暴露即直径 ≤ 2.5 µg/m3 的颗粒物（PM2.5）和二氧化氮（NO2），是通过既往验证的暴露预测模型在区级家庭住址估算的 5 年平均浓度。随后，我们应用时变 Cox 比例风险模型，估算 PM2.5 和 NO2 每增加 10 µg/m3 和 10 ppb 时肺癌发病的风险比。
结果：在 13 年间发生的 20,811 例新发肺癌病例中，AD、SqCC 和 SCC 分别占 52%、21% 和 10%。我们未发现两种污染物与总肺癌发病之间的关联（PM2.5：HR=1.065，95% CI=0.957-1.186；NO2：0.980，0.957-1.004）。然而，PM2.5 与 SqCC 相关（1.353，1.054-1.738），但与 AD（0.892，0.722-1.038）和 SCC（1.148，0.818-1.609）无关。相比之下，NO2 与 AD 显示出关联（1.064，1.027-1.102），但与 SqCC（0.905，0.861-0.951）和 SCC（0.956，0.888-1.029）无关。
讨论：我们发现的按污染物和组织学亚型划分的不同关联，提示不同污染物在肺癌发生中具有不同的机制性作用。
查看英文原文 English abstract
Background: There is mounting evidence of long-term exposure to air pollution and incidence of lung cancer based on large cohort studies worldwide. A few subsequent studies have suggested that the association may vary by histological subtypes, although findings have been inconsistent. This study aimed to investigate whether air pollution affects a specific histological subtype of lung cancer more than the others using a population-representative cohort including 2 million adults.
Methods: Our study population includes 2,346,332 adults who were aged 30 years or over in 2007, participated in health examinations for 2005-2007, and were retrospectively followed-up until 2020 in the National Health Insurance Services database linked with the Korea Central Cancer Registry of South Korea. We identified lung cancer incidence of three histological subtypes, including adenocarcinoma (AD), squamous cell carcinoma (SqCC), and small cell carcinoma (SCC), based on the International Classification Diseases for Oncology. Individual-level long-term exposures to particulate matter ≤ 2.5 µg/m 3 in diameter (PM 2.5 ) and nitrogen dioxide (NO 2 ) were 5-year average concentrations estimated at district-level home addresses by previously-validated exposure prediction models. Then, we applied time-varying Cox proportional hazard model to estimate hazard ratios of lung cancer incidence for 10 µg/m 3 and 10 ppb increases in PM 2.5 and NO 2 respectively.
Results: For 20,811 new lung cancer cases occurred over 13 years, AD, SqCC, and SCC made up 52, 21, and 10 %, respectively. We found no association of total lung cancer incidence for both pollutants (PM 2.5 : HR=1.065, 95% CI=0.957-1.186; NO 2 : 0.980, 0.957-1.004). However, PM 2.5 was associated with SqCC (1.353, 1.054 -1.738), but not associated with AD (0.892, 0.722-1.038) and SCC (1.148,0.818-1.609). In contrast, NO 2 showed the association for AD (1.064, 1.027-1.102) but not for SqCC 0.905 (0.861 - 0.951) and SSC 0.956 (0.888 - 1.029).
Discussion: Our findings of different associations by pollutants and histological subtypes suggest different mechanistic roles in lung cancer development depending on the pollutant.
利益披露 Disclosure
S. Kim, None.