Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan.
Int J Clin Oncol. 2011 Aug;16(4):287-93. doi: 10.1007/s10147-010-0160-8. Epub 2011 May 13.
Recent interest in lung cancer without a history of tobacco smoking has led to the classification of a distinct disease entity of 'non-smoking-associated lung cancer'. In this review article, we have made an overview of the recent literature concerning both the epidemiology and clinical features of lung cancer in never smokers, and have brought 'non-smoking-associated lung cancer' into relief. The etiology of lung cancer in never smokers remains indefinite although many putative risk factors have been described including secondhand smoking, occupational exposures, pre-existing lung diseases, diet, estrogen exposure, etc. Non-small cell lung cancer (NSCLC) in never smokers is clinically characterized by an increased incidence in females and a higher occurrence of adenocarcinoma in comparison to NSCLC in ever smokers in both surgical patients and non-resectable advanced-stage patients. Furthermore, the prognosis of never-smoking NSCLC is better than that of smoking-related NSCLC in both surgical patients and non-resectable advanced-stage patients. Recently recognized novel gene mutations such as EGFR (epidermal growth factor receptor) mutations are largely limited to never smokers or light smokers, and the expression of this gene is responsible for the clinical efficacy of gefitinib, an epidermal growth factor receptor-tyrosine kinase inhibitor. NSCLC with the EML4 (echinoderm microtubule-associated protein-like 4)-ALK (anaplastic lymphoma kinase) fusion gene is also more likely to occur in never smokers and in those with adenocarcinoma histology, and is expected to benefit from ALK inhibitors. In consideration of the future increase in never-smoking NSCLC or 'non-smoking-associated lung cancer', both clinical trials and investigations are needed.
近年来，人们对从不吸烟的肺癌患者产生了浓厚的兴趣，由此将“非吸烟相关肺癌”这一独特的疾病实体进行了分类。在这篇综述文章中，我们对从不吸烟者的肺癌流行病学和临床特征的最新文献进行了综述，并对“非吸烟相关肺癌”进行了详细阐述。尽管已经描述了许多可能的危险因素，包括二手烟、职业暴露、既往肺部疾病、饮食、雌激素暴露等，但从不吸烟者肺癌的病因仍不确定。从不吸烟者的非小细胞肺癌（NSCLC）在临床特征上表现为女性发病率增加，与曾吸烟者相比，腺癌的发生率更高，无论是手术患者还是不可切除的晚期患者均如此。此外，从不吸烟者的 NSCLC 预后要好于与吸烟相关的 NSCLC，无论是手术患者还是不可切除的晚期患者均如此。最近发现的新型基因突变，如 EGFR（表皮生长因子受体）突变，主要局限于从不吸烟者或轻度吸烟者，而该基因突变的表达则是吉非替尼（一种表皮生长因子受体酪氨酸激酶抑制剂）临床疗效的决定因素。EML4（echinoderm microtubule-associated protein-like 4）-ALK（anaplastic lymphoma kinase）融合基因的 NSCLC 也更可能发生在从不吸烟者和腺癌患者中，并且有望从 ALK 抑制剂中获益。考虑到未来从不吸烟的 NSCLC 或“非吸烟相关肺癌”的增加，需要开展临床试验和研究。
