Yu I T S, Tse L A, Leung C C, Wong T W, Tam C M, Chan A C K
Department of Community and Family Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Ann Oncol. 2007 Jun;18(6):1056-63. doi: 10.1093/annonc/mdm089.
The link between silica dust/silicosis and lung cancer is still very controversial. We examined the relationship between silica dust exposure and/or silicosis and lung cancer in a large cohort of silicotic workers in Hong Kong.
All workers with silicosis in Hong Kong diagnosed during the period 1981-1998 were followed up till the end of 1999 to ascertain their vital status and causes of death. Standardized mortality ratio (SMR) for lung cancer and other major causes of death were calculated. Axelson's indirect method was used to adjust for smoking effect. Multiple Cox regression models were carried out to examine the exposure-response relationship between silica dust and lung cancer.
About 10% (86) of all 853 deaths were from lung cancer, giving a SMR of 1.69 [95% confidence interval (CI) 1.35-2.09]. Lung cancer SMR for caisson and surface construction workers were 2.39 (95% CI 1.50-3.62) and 1.61 (95% CI 1.21-2.10), respectively, which became 1.56 (95% CI 0.98-2.36) and 1.09 (95% CI 0.82-1.42) after adjusting for smoking. No consistent exposure-response relationship was detected between silica dust or severity of silicosis and lung cancer death.
Our cohort study did not offer positive support to a link between silica or silicosis and lung cancer.
矽尘/矽肺与肺癌之间的联系仍极具争议。我们在香港一大群矽肺工人中研究了矽尘暴露和/或矽肺与肺癌之间的关系。
对1981年至1998年期间在香港诊断出的所有矽肺工人进行随访，直至1999年底，以确定他们的生命状态和死亡原因。计算了肺癌及其他主要死因的标准化死亡比（SMR）。采用阿克塞尔森间接法调整吸烟影响。进行多因素Cox回归模型以研究矽尘与肺癌之间的暴露-反应关系。
853例死亡中约10%（86例）死于肺癌，标准化死亡比为1.69[95%置信区间（CI）1.35 - 2.09]。沉箱工人和地面建筑工人的肺癌标准化死亡比分别为2.39（95%CI 1.50 - 3.62）和1.61（95%CI 1.21 - 2.10），调整吸烟因素后分别变为1.56（95%CI 0.98 - 2.36）和1.09（95%CI 0.82 - 1.42）。未检测到矽尘或矽肺严重程度与肺癌死亡之间存在一致的暴露-反应关系。
我们的队列研究未为矽尘或矽肺与肺癌之间的联系提供肯定支持。
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