Brooks Daniel R, Austin John H M, Heelan Robert T, Ginsberg Michelle S, Shin Victor, Olson Sara H, Muscat Joshua E, Stellman Steven D
Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA.
Cancer Epidemiol Biomarkers Prev. 2005 Mar;14(3):576-81. doi: 10.1158/1055-9965.EPI-04-0468.
Adenocarcinoma has replaced squamous cell carcinoma as the most common cell type of lung cancer in the United States. It has been proposed that this shift is due to the increased use of filter and lower-tar cigarettes, resulting in increased delivery of smoke to peripheral regions of the lungs, where adenocarcinoma usually occurs. We reviewed radiologic data to evaluate the hypothesis that tumors in smokers of cigarettes with lower-tar yield are more likely to occur peripherally than tumors in smokers of higher-yield cigarettes.
At two urban academic medical centers, we reviewed computed tomographic scans, chest radiographs, and medical records to assign tumor location (peripheral or central) for 330 smokers diagnosed with carcinoma of the lung between 1993 and 1999. We compared the proportion of tumors in a peripheral versus central location by lifetime filter use and average lifetime tar rating (< 21 and > or = 21 mg).
Tumor location (69% peripheral and 31% central) was unrelated to cigarette filter use. Smokers of cigarettes with lower-tar ratings were more likely than those with higher ratings to have peripheral rather than central tumors (odds ratio, 1.76; 95% confidence interval, 0.89-3.47). When restricted to subjects with adenocarcinoma or squamous cell carcinoma, the odds ratio (95% confidence interval) was 2.31 (1.05-5.08).
Among cigarette smokers with lung cancer, use of cigarettes with lower-tar yield was associated with preferential occurrence of tumors in peripheral sites. Our findings support the hypothesis that changes in smoking associated with lower-tar cigarettes have led to a shift in the location of smoking-related lung cancer.
在美国，腺癌已取代鳞状细胞癌成为肺癌最常见的细胞类型。有人提出，这种转变是由于过滤嘴香烟和低焦油香烟的使用增加，导致更多烟雾输送到肺部外周区域，而腺癌通常发生在这些区域。我们回顾了放射学数据，以评估低焦油含量香烟吸烟者的肿瘤比高焦油含量香烟吸烟者的肿瘤更易发生在肺部外周的假设。
在两家城市学术医疗中心，我们回顾了计算机断层扫描、胸部X光片和病历，以确定1993年至1999年间被诊断为肺癌的330名吸烟者的肿瘤位置（外周或中央）。我们根据终生过滤嘴使用情况和平均终生焦油评级（<21毫克和≥21毫克）比较了外周与中央位置肿瘤的比例。
肿瘤位置（69%外周和31%中央）与香烟过滤嘴使用无关。低焦油评级香烟的吸烟者比高焦油评级香烟的吸烟者更易发生外周而非中央肿瘤（优势比，1.76；95%置信区间，0.89 - 3.47）。当仅限于腺癌或鳞状细胞癌患者时，优势比（95%置信区间）为2.31（1.05 - 5.08）。
在肺癌吸烟者中，使用低焦油含量香烟与肿瘤在外周部位的优先发生有关。我们的研究结果支持这样的假设，即与低焦油香烟相关的吸烟习惯改变导致了吸烟相关肺癌发生位置的转变。
