Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Department of Environmental Engineering, National Chung-Hsing University, Taichung, Taiwan.
J Thorac Oncol. 2019 May;14(5):784-792. doi: 10.1016/j.jtho.2018.12.033. Epub 2019 Jan 18.
For never-smokers (smoked <100 lifetime cigarettes), lung cancer (LC) has emerged as an important issue. We aimed to investigate the effects of prevalence changes in tobacco smoking and particulate matter (PM) 2.5 (PM) levels on LC in Taiwan, in relation to contrasting PM levels, between Northern Taiwan (NT) and Southern Taiwan (ST).
We reviewed 371,084 patients with LC to assess smoking prevalence and correlations between the incidence of adenocarcinoma lung cancer (AdLC) and non-AdLC. Two subsets were selected to assess different AdLC stage trends and the effect of PM on survival of patients with AdLC.
From 1995 to 2015, the proportion of male adult ever-smokers decreased from 59.4% to 29.9% whereas the female smoking rate remained low (3.2% to 5.3%). AdLC incidence in males and females increased from 9.06 to 23.25 and 7.05 to 24.22 per 100,000 population, respectively. Since 1993, atmospheric visibility in NT improved (from 7.6 to 11.5 km), but deteriorated in ST (from 16.3 to 4.2 km). The annual percent change in AdLC stages IB to IV was 0.3% since 2009 (95% confidence interval [CI]: -1.9%-2.6%) in NT, and 4.6% since 2007 (95% CI: 3.3%-5.8%) in ST; 53% patients with LC had never smoked. Five-year survival rates for never-smokers, those with EGFR wild-type genes, and female patients with AdLC were 12.6% in NT and 4.5% in ST (hazard ratio: 0.79, 95% CI: 0.70-0.90).
In Taiwan, greater than 50% of patients with LC had never smoked. PM level changes can affect AdLC incidence and patient survival.
对于从不吸烟（吸烟<100 支）的人群，肺癌（LC）已成为一个重要问题。我们旨在研究台湾地区吸烟流行率变化和颗粒物（PM）2.5（PM）水平变化对肺癌的影响，同时考虑到台湾北部（NT）和南部（ST）之间的 PM 水平差异。
我们回顾了 371084 例肺癌患者，评估了吸烟流行率，并分析了腺癌肺癌（AdLC）和非腺癌肺癌（非-AdLC）发病率之间的相关性。选择两个子集来评估不同 AdLC 分期趋势和 PM 对 AdLC 患者生存的影响。
1995 年至 2015 年期间，男性成年吸烟者的比例从 59.4%降至 29.9%，而女性吸烟率保持在较低水平（3.2%至 5.3%）。男性和女性的 AdLC 发病率分别从每 100,000 人 9.06 例增加到 23.25 例和 7.05 例增加到 24.22 例。自 1993 年以来，NT 的大气能见度有所改善（从 7.6 公里增加到 11.5 公里），但 ST 的能见度恶化（从 16.3 公里减少到 4.2 公里）。2009 年以来，NT 中 AdLC 分期 IB 至 IV 的年变化百分比为 0.3%（95%置信区间[CI]：-1.9%-2.6%），2007 年以来 ST 中的年变化百分比为 4.6%（95%CI：3.3%-5.8%）；53%的肺癌患者从未吸烟。NT 中从不吸烟者、EGFR 野生型基因患者和女性 AdLC 患者的 5 年生存率分别为 12.6%和 ST 的 4.5%（风险比：0.79，95%CI：0.70-0.90）。
在台湾，超过 50%的肺癌患者从未吸烟。PM 水平的变化会影响 AdLC 的发病率和患者的生存率。
