Wang A, Kubo J, Luo J, Desai M, Hedlin H, Henderson M, Chlebowski R, Tindle H, Chen C, Gomez S, Manson J E, Schwartz A G, Wactawski-Wende J, Cote M, Patel M I, Stefanick M L, Wakelee H A
Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford.
Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto.
Ann Oncol. 2015 Jan;26(1):221-230. doi: 10.1093/annonc/mdu470. Epub 2014 Oct 14.
Lung cancer is the leading cause of worldwide cancer deaths. While smoking is its leading risk factor, few prospective cohort studies have reported on the association of lung cancer with both active and passive smoking. This study aimed to determine the relationship between lung cancer incidence with both active and passive smoking (childhood, adult at home, and at work).
The Women's Health Initiative Observational Study (WHI-OS) was a prospective cohort study conducted at 40 US centers that enrolled postmenopausal women from 1993 to 1999. Among 93 676 multiethnic participants aged 50-79, 76 304 women with complete smoking and covariate data comprised the analytic cohort. Lung cancer incidence was calculated by Cox proportional hazards models, stratified by smoking status.
Over 10.5 mean follow-up years, 901 lung cancer cases were identified. Compared with never smokers (NS), lung cancer incidence was much higher in current [hazard ratio (HR) 13.44, 95% confidence interval (CI) 10.80-16.75] and former smokers (FS; HR 4.20, 95% CI 3.48-5.08) in a dose-dependent manner. Current and FS had significantly increased risk for all lung cancer subtypes, particularly small-cell and squamous cell carcinoma. Among NS, any passive smoking exposure did not significantly increase lung cancer risk (HR 0.88, 95% CI 0.52-1.49). However, risk tended to be increased in NS with adult home passive smoking exposure ≥30 years, compared with NS with no adult home exposure (HR 1.61, 95% CI 1.00-2.58).
In this prospective cohort of postmenopausal women, active smoking significantly increased risk of all lung cancer subtypes; current smokers had significantly increased risk compared with FS. Among NS, prolonged passive adult home exposure tended to increase lung cancer risk. These data support continued need for smoking prevention and cessation interventions, passive smoking research, and further study of lung cancer risk factors in addition to smoking. CLINICALTRIALS.GOV: NCT00000611.
肺癌是全球癌症死亡的主要原因。虽然吸烟是其主要危险因素，但很少有前瞻性队列研究报告肺癌与主动吸烟和被动吸烟的关联。本研究旨在确定肺癌发病率与主动吸烟和被动吸烟（儿童期、成年后在家中和工作场所）之间的关系。
女性健康倡议观察性研究（WHI-OS）是一项在美国40个中心进行的前瞻性队列研究，于1993年至1999年招募绝经后妇女。在93676名年龄在50-79岁的多民族参与者中，76304名具有完整吸烟和协变量数据的女性组成了分析队列。肺癌发病率通过Cox比例风险模型计算，并按吸烟状况分层。
在平均10.5年的随访期内，共确诊901例肺癌病例。与从不吸烟者（NS）相比，当前吸烟者（风险比[HR]13.44，95%置信区间[CI]10.80-16.75）和既往吸烟者（FS；HR 4.20，95%CI 3.48-5.08）的肺癌发病率以剂量依赖方式显著更高。当前吸烟者和既往吸烟者患所有肺癌亚型的风险均显著增加，尤其是小细胞癌和鳞状细胞癌。在从不吸烟者中，任何被动吸烟暴露均未显著增加肺癌风险（HR 0.88，95%CI 0.52-1.49）。然而，与无成年后在家中被动吸烟暴露的从不吸烟者相比，成年后在家中被动吸烟暴露≥30年的从不吸烟者的风险有增加趋势（HR 1.61，95%CI 1.00-2.58）。
在这个绝经后女性前瞻性队列中，主动吸烟显著增加了所有肺癌亚型的风险；当前吸烟者的风险比既往吸烟者显著增加。在从不吸烟者中，成年后在家中长期被动吸烟暴露有增加肺癌风险的趋势。这些数据支持继续需要进行吸烟预防和戒烟干预、被动吸烟研究以及除吸烟外肺癌危险因素的进一步研究。临床试验注册：NCT00000611。
