Tse Lap Ah, Mang Oscar Wai-Kong, Yu Ignatius Tak-Sun, Wu Fan, Au Joseph Siu-Kie, Law Stephen Chun-Key
School of Public Health, The Chinese University of Hong Kong, Hong Kong SAR, China.
Lung Cancer. 2009 Oct;66(1):22-7. doi: 10.1016/j.lungcan.2008.12.023. Epub 2009 Jan 30.
We analyzed the time trends of lung cancer by histological subtype in Hong Kong during 1991-2005, and examined how the time trends were influenced by the effects of birth cohort and calendar period of diagnosis. Cancer incidence data were obtained from Hong Kong Cancer Registry and population data from Census and Statistics Department. Age-standardized incidence rates were computed by the direct method using WHO 1966 standard population as reference. Period and cohort effects were assessed by using two separate Poisson regression models adjusting for age. From 1991 to 2005, the incidence rates in Hong Kong Chinese males decreased steadily. The decline in overall lung cancer incidence rates was limited primarily to the decrease in squamous cell carcinoma, which could be explained by the decreasing trend of cigarette smoking. Adenocarcinoma had been the most predominant histological subtype all along. The relatively horizontal trend of adenocarcinoma and the lack of cohort effect implied the important roles of gene-environment interaction and/or the use of low-tar and filter tip cigarettes. Our study suggests that different histological subtypes may represent different disease entities with perhaps some distinct risk factors. The hypotheses generated from this ecological study will need confirmation by subsequent analytic studies.
我们分析了1991年至2005年香港肺癌按组织学亚型划分的时间趋势，并研究了出生队列和诊断日历期的影响如何作用于这些时间趋势。癌症发病率数据来自香港癌症登记处，人口数据来自政府统计处。年龄标准化发病率采用直接法计算，以世界卫生组织1966年标准人口作为参考。通过使用两个单独的泊松回归模型并对年龄进行调整来评估时期和队列效应。1991年至2005年期间，香港中国男性的发病率稳步下降。总体肺癌发病率的下降主要局限于鳞状细胞癌的减少，这可以用吸烟趋势的下降来解释。腺癌一直是最主要的组织学亚型。腺癌相对平稳的趋势以及缺乏队列效应意味着基因 - 环境相互作用和/或使用低焦油和过滤嘴香烟的重要作用。我们的研究表明，不同的组织学亚型可能代表不同的疾病实体，或许具有一些不同的危险因素。这项生态学研究产生的假设需要后续分析研究加以证实。
