喉癌患者中非吸烟者比例的上升：我们是否正面临一种新疾病？

The rising rate of nonsmokers among laryngeal carcinoma patients: Are we facing a new disease?

机构信息

Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

出版信息

Laryngoscope. 2020 Mar;130(3):E108-E115. doi: 10.1002/lary.28067. Epub 2019 May 15.

DOI:10.1002/lary.28067

PMID:31090946

Abstract

OBJECTIVES/HYPOTHESIS: Laryngeal squamous cell carcinoma (SCC) is strongly associated with tobacco smoking. With the rising awareness of tobacco's adverse health effects, we have witnessed a global decrease in tobacco use. Nevertheless, laryngeal SCC remains prevalent and includes a subset of patients lacking the traditional risk factors.

STUDY DESIGN

A two-center retrospective cohort.

METHODS

Medical records of patients diagnosed with laryngeal SCC between 2009 and 2016 were reviewed. Data collected included demographics, smoking status, and tumor site. Patients who have never smoked were designated as nonsmokers.

RESULTS

The study included 330 patients with laryngeal SCC, of whom 75 (22.7%) were nonsmokers; this rate was relatively similar for each of the two institutions independently (21.9% and 25%). There were 285 patients with glottic SCC and 45 with supraglottic SCC. All nonsmoking patients in this cohort had glottic SCC, representing 26.3% (75/285) of the glottic SCC cases. The rate of female patients was significantly higher among nonsmokers. Of the patients with glottic SCC, females represented 25.3% (19/75) of the nonsmokers compared with 12.4% (26/210) of the smokers (P = .008). Mean age at diagnosis was 60.2 ± 17.5 years for nonsmoking glottic SCC patients and 63.6 ± 12.4 years for smokers (P = .280). However, nonsmokers demonstrated a distinct age distribution pattern. Nonsmoking females with glottic SCC demonstrated a bimodal age distribution pattern; 73.7% (14/19) were age <40 years or >75 years at diagnosis.

CONCLUSIONS

The rate of laryngeal SCC in nonsmokers is higher than what has previously been reported, representing a growing proportion, and may suggest a shift in etiology. Knowing that laryngeal SCC in nonsmokers predominantly affects the glottis, and that females and age extremities are more vulnerable, the traditional screening paradigm should be revised.

LEVEL OF EVIDENCE

4 Laryngoscope, 130:E108-E115, 2020.

摘要

目的/假设：喉鳞状细胞癌（SCC）与吸烟密切相关。随着人们对烟草危害健康的认识不断提高，全球吸烟人数有所下降。然而，喉 SCC 仍然很常见，其中一部分患者缺乏传统的危险因素。

研究设计

一项在两个中心进行的回顾性队列研究。

方法

回顾了 2009 年至 2016 年间被诊断为喉 SCC 的患者的病历。收集的数据包括人口统计学、吸烟状况和肿瘤部位。从未吸烟的患者被指定为非吸烟者。

结果

这项研究包括 330 名喉 SCC 患者，其中 75 名（22.7%）是非吸烟者；这一比例在两个机构独立分析时基本相似（分别为 21.9%和 25%）。285 名患者为声门型 SCC，45 名患者为声门上型 SCC。该队列中的所有非吸烟者均患有声门型 SCC，占声门型 SCC 病例的 26.3%（75/285）。非吸烟者中女性患者的比例明显更高。在声门型 SCC 患者中，女性非吸烟者占非吸烟者的 25.3%（19/75），而吸烟者占 12.4%（26/210）（P=.008）。声门型 SCC 非吸烟者的平均诊断年龄为 60.2±17.5 岁，吸烟者为 63.6±12.4 岁（P=.280）。然而，非吸烟者的年龄分布模式明显不同。声门型 SCC 的非吸烟女性表现出双峰年龄分布模式；73.7%（14/19）在诊断时年龄<40 岁或>75 岁。