PO.PS01.12 · 人群科学
PM2.5 和黑碳水平与肺癌患者死亡率升高相关
PM2.5 and black carbon levels associated with increased mortality in lung cancer patients
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
肺癌是美国癌症死亡的首要原因。近年来，从不吸烟者中的肺癌发病率一直在上升。此外，肺癌患者治疗反应的异质性尚未得到充分阐明。室外空气污染（OAP）是一种已知的肺部致癌物，但对于 OAP 对肺癌生存和预后的影响知之甚少。因此，本研究旨在评估 OAP 暴露与肺癌生存之间的关联。我们开展了一项回顾性队列研究，从纽约布朗克斯的 Montefiore Einstein 综合癌症中心（MECCC）的一个由 8,793 名非小细胞肺癌（NSCLC）患者组成的队列中收集患者和临床数据。基于患者的地理编码地址估算了对 OAP 的环境暴露。通过将来自不同仪器的气溶胶光学厚度反演值与 GEOS-Chem 化学传输模型相结合来估算污染物。使用地理加权回归将数据校准至区域地面观测值。使用 Kaplan-Meier 曲线和 Cox 比例风险模型进行定量分析。采用逐步回归模型选择混杂变量，包括吸烟、性别、年龄、组织学、分期、治疗（移植、手术、化疗、放疗）以及其他污染物（NH4、有机物、SO4）。诊断时暴露于 >9ug/m3 的 PM2.5 和高于中位数水平的黑碳，分别与肺癌总生存率下降 8% 和 6% 相关（p<0.0001）。在所有性别、吸烟和组织学分组中，PM2.5 与肺癌生存率下降 5-9% 相关（p<0.0001）。黑碳在男性（p=0.01）、女性（p<0.0001）、从不吸烟者（p=0.05）或曾吸烟者（p<0.0001）以及腺癌（p<0.0001）亚组中与肺癌生存率下降 4-9% 相关。与既往研究一致，我们观察到 PM2.5 暴露与肺癌生存率下降之间的关联。此前研究未检验的黑碳也与肺癌生存率下降相关。未来研究需要探索其他地理空间相关暴露、OAP 与肺癌生存之间的关系。
查看英文原文 English abstract
Lung cancer is the leading cause of cancer mortality in the United States. Over recent years, lung cancer incidence among never-smokers has been rising. Additionally, heterogeneity in treatment responses among patients with lung cancer have not been fully elucidated. Outdoor air pollution (OAP) is a known lung carcinogen, but little is known about the effects of OAP on lung cancer survival and prognosis. Therefore, this study aimed to assess the association between OAP exposure and lung cancer survival. A retrospective cohort study was conducted by gathering patient and clinical data from a cohort of 8,793 non-small cell lung cancer (NSCLC) patients from the Montefiore Einstein Comprehensive Cancer Center (MECCC) in the Bronx, NY. Environmental exposure to OAP was estimated based on the patients' geo-coded addresses. Pollutants were estimated by combining Aerosol Optical Depth retrievals from different instruments with the GEOS-Chem chemical transport model. The data were calibrated to regional ground-based observations using a geographically weighted regression. Quantitative analyses were performed using Kaplan-Meier curves and Cox proportional hazard models. Stepwise regression model selection for confounding variables, including smoking, sex, age, histology, stage, treatment (transplant, surgery, chemotherapy, radiation), and other pollutants (NH 4 , organic matter, SO 4 ) was used. Exposure to >9ug/m 3 of PM2.5 and >median levels of Black Carbon at the time of diagnosis were associated with an 8% and 6% decrease in overall lung cancer survival, respectively (p<0.0001). PM2.5 was associated with decreased lung cancer survival by 5-9% in all sex, smoking, and histology groups (p<0.0001). Black Carbon was associated with a 4-9% decrease in lung cancer survival in male (p=0.01), female (p<0.0001), never (p=0.05) or ever (p<0.0001) smoker, and Adenocarcinoma (p<0.0001) subgroups. Consistent with previous studies, we observed an association between PM2.5 exposure and decreased lung cancer survival. Black Carbon, not tested in previous studies, was also associated with decreased lung cancer survival. Future research is needed to explore the relationship(s) between additional geospatially correlated exposures, OAP, and lung cancer survival.
利益披露 Disclosure
V. A. Chu, None..
X. Xie, None..
K. Pradhan, None..
G. S. Downward, None..
T. E. Rohan, None..
H. Cheng, None..
B. Stiles, None..
X. Xue, None..
T. Nobel, None..
A. Shastri, None..
H. Hosgood, None.