Das A, Krishnamurthy A, Ramshankar V, Sagar T G, Swaminathan R
Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India.
Department of Preventive Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India.
Indian J Cancer. 2017 Jan-Mar;54(1):172-177. doi: 10.4103/ijc.IJC_33_17.
Lung cancer continues to remain as one of the leading causes of morbidity and mortality worldwide, despite the decreasing trends in smoking prevalence worldwide. An earlier study from the authors' institute reported the increasing trends of "Nonsmoking associated lung cancers."
All consecutive histologically confirmed patients with lung cancer who presented to the outpatient department over a year (November 2014-October 2015) were included in this current prospective study.
Seven hundred and thirteen patients presented with clinicoradiologically suspicious findings of lung cancer in the said period. A pathological confirmation of lung cancer could be ascertained in 495 patients, and this cohort was further analyzed. The mean age of presentation was 57.76 years; the male to female ratio was approximately 2.5:1. Interestingly, 55.35% of the patients were nonsmokers. Adenocarcinoma (63%) was the predominant histology. Never smokers, both among men (P = 0.02) and women (P = 0.001), presented more frequently with adenocarcinoma histology. Further, 84.9% (45/53) of rural and 76.1% (19/25) of urban women who were never smokers reported exposure to indoor air pollution (secondhand smoke/fuel used for cooking purposes) which was significantly associated with adenocarcinoma histology.
Our study confirmed our initial observation of the changing epidemiology of lung cancer in the Indian subcontinent, paralleling the global trends of rise in adenocarcinoma. Lung cancer in never smokers outnumbering that among smokers was another interesting observation. The take-home message for both the clinicians as well as the policymakers is to study factors beyond tobacco exposure to understand the direction of the current lung cancer epidemic.
尽管全球吸烟率呈下降趋势，但肺癌仍是全球发病和死亡的主要原因之一。作者所在机构的一项早期研究报告了“非吸烟相关肺癌”的上升趋势。
本前瞻性研究纳入了在一年时间内（2014年11月至2015年10月）连续就诊于门诊且经组织学确诊的所有肺癌患者。
在上述期间，713例患者出现了临床放射学上可疑的肺癌表现。495例患者得到了肺癌的病理确诊，并对该队列进行了进一步分析。患者的平均就诊年龄为57.76岁；男女比例约为2.5:1。有趣的是，55.35%的患者不吸烟。腺癌（63%）是主要的组织学类型。男性（P = 0.02）和女性（P = 0.001）中的非吸烟者更常表现为腺癌组织学类型。此外，农村地区84.9%（45/53）的非吸烟女性和城市地区76.1%（19/25）的非吸烟女性报告接触过室内空气污染（二手烟/烹饪用燃料），这与腺癌组织学类型显著相关。
我们的研究证实了我们最初对印度次大陆肺癌流行病学变化的观察，与腺癌上升的全球趋势一致。非吸烟者中的肺癌患者数量超过吸烟者是另一个有趣的观察结果。对于临床医生和政策制定者来说，重要的是研究烟草暴露之外的因素，以了解当前肺癌流行的趋势。
