Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
Am J Epidemiol. 2012 Oct 1;176(7):573-85. doi: 10.1093/aje/kws151. Epub 2012 Sep 17.
To clarify the role of previous lung diseases (chronic bronchitis, emphysema, pneumonia, and tuberculosis) in the development of lung cancer, the authors conducted a pooled analysis of studies in the International Lung Cancer Consortium. Seventeen studies including 24,607 cases and 81,829 controls (noncases), mainly conducted in Europe and North America, were included (1984-2011). Using self-reported data on previous diagnoses of lung diseases, the authors derived study-specific effect estimates by means of logistic regression models or Cox proportional hazards models adjusted for age, sex, and cumulative tobacco smoking. Estimates were pooled using random-effects models. Analyses stratified by smoking status and histology were also conducted. A history of emphysema conferred a 2.44-fold increased risk of lung cancer (95% confidence interval (CI): 1.64, 3.62 (16 studies)). A history of chronic bronchitis conferred a relative risk of 1.47 (95% CI: 1.29, 1.68 (13 studies)). Tuberculosis (relative risk = 1.48, 95% CI: 1.17, 1.87 (16 studies)) and pneumonia (relative risk = 1.57, 95% CI: 1.22, 2.01 (12 studies)) were also associated with lung cancer risk. Among never smokers, elevated risks were observed for emphysema, pneumonia, and tuberculosis. These results suggest that previous lung diseases influence lung cancer risk independently of tobacco use and that these diseases are important for assessing individual risk.
为了阐明既往肺部疾病(慢性支气管炎、肺气肿、肺炎和肺结核)在肺癌发展中的作用,作者对国际肺癌联盟的研究进行了汇总分析。共纳入了 17 项研究(1984 年至 2011 年),包括 24607 例病例和 81829 例对照(非病例),这些研究主要在欧洲和北美进行。研究采用基于自我报告的既往肺部疾病诊断数据,通过逻辑回归模型或 Cox 比例风险模型,根据年龄、性别和累计吸烟量进行校正,得出了研究特异性的效应估计值。采用随机效应模型对估计值进行汇总。还进行了按吸烟状况和组织学分层的分析。肺气肿病史使肺癌风险增加 2.44 倍(95%置信区间:1.64,3.62(16 项研究))。慢性支气管炎病史使相对风险增加 1.47(95%置信区间:1.29,1.68(13 项研究))。结核病(相对风险=1.48,95%置信区间:1.17,1.87(16 项研究))和肺炎(相对风险=1.57,95%置信区间:1.22,2.01(12 项研究))也与肺癌风险相关。在从不吸烟者中,肺气肿、肺炎和结核病的风险显著增加。这些结果表明,既往肺部疾病独立于吸烟影响肺癌风险,这些疾病对于评估个体风险非常重要。
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