吸烟史各项指标与肺癌风险的关系：蒙特利尔的病例对照研究。
Risk of lung cancer in relation to various metrics of smoking history: a case-control study in Montreal.
机构信息
University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada.
Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.
出版信息
BMC Cancer. 2018 Dec 19;18(1):1275. doi: 10.1186/s12885-018-5144-5.
BACKGROUND
Few epidemiologic findings are as well established as the association between smoking and lung cancer. It is therefore somewhat surprising that there is not yet a clear consensus about the exposure-response relationships between various metrics of smoking and lung cancer risk. In part this is due to heterogeneity of how exposure-response results have been presented and the relative paucity of published results using any particular metric of exposure. The purposes of this study are: to provide new data on smoking-lung cancer associations and to explore the relative impact of different dimensions of smoking history on lung cancer risk.
METHODS
Based on a large lung cancer case-control study (1203 cases and 1513 controls) conducted in Montreal in 1996-2000, we estimated the lifetime prevalence of smoking and odds ratios in relation to several smoking metrics, both categorical and continuous based on multivariable unconditional logistic regression.
RESULTS
Odds ratios (ORs) for ever vs never smoking were 7.82 among males and 11.76 among females. ORs increased sharply with every metric of smoking examined, more so for duration than for daily intensity. In models using continuous smoking variables, all metrics had strong effects on OR and mutual adjustment among smoking metrics did not noticeably attenuate the OR estimates, indicating that each metric carries some independent risk-related information. Among all the models tested, the one based on a smoking index that integrates several smoking dimensions, provided the best fitting model. Similar patterns were observed for the different histologic types of lung cancer.
CONCLUSIONS
This study provides many estimates of exposure-response relationships between smoking and lung cancer; these can be used in future meta-analyses. Irrespective of the histologic type of lung cancer and the smoking metric examined, high levels of smoking led to high levels of risk, for both men and women.
背景
吸烟与肺癌之间的关联是少数几项得到充分证实的流行病学发现之一。因此，对于吸烟的各种指标与肺癌风险之间的暴露-反应关系，目前尚未达成明确共识，这有点令人惊讶。部分原因是暴露-反应结果的呈现方式存在异质性，以及使用任何特定暴露指标发表的结果相对较少。本研究的目的是：提供吸烟与肺癌关联的新数据，并探讨吸烟史不同维度对肺癌风险的相对影响。
方法
基于 1996-2000 年在蒙特利尔进行的一项大型肺癌病例对照研究（1203 例病例和 1513 例对照），我们使用多变量非条件逻辑回归估计了终生吸烟流行率和与几种吸烟指标（基于多变量非条件逻辑回归的分类和连续）的比值比。
结果
男性的比值比（OR）为 7.82，女性为 11.76。与从不吸烟者相比，所有吸烟指标的 OR 均急剧增加，持续时间的 OR 增加幅度大于每日吸烟量。在使用连续吸烟变量的模型中，所有指标对 OR 均有强烈影响，且吸烟指标之间的相互调整并未明显减弱 OR 估计值，表明每个指标都携带一些独立的与风险相关的信息。在测试的所有模型中，基于整合了几个吸烟维度的吸烟指数的模型提供了最佳拟合模型。对于不同组织学类型的肺癌，也观察到了类似的模式。
结论
本研究提供了许多吸烟与肺癌之间暴露-反应关系的估计值；这些估计值可用于未来的荟萃分析。无论肺癌的组织学类型和所检查的吸烟指标如何，高水平的吸烟都会导致男性和女性的高风险。
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