法国基于人群的病例对照研究（WELCA 研究）：女性肺癌发病风险与终生吸烟史的关系。
Risk of lung cancer among women in relation to lifetime history of tobacco smoking: a population-based case-control study in France (the WELCA study).
机构信息
Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Team Exposome and Heredity, Villejuif, France.
AP-HP, Tenon Hospital, Pathology, 4 rue de la Chine, Paris, France.
出版信息
BMC Cancer. 2021 Jun 16;21(1):711. doi: 10.1186/s12885-021-08433-z.
BACKGROUND
This study aims to provide new insights on the role of smoking patterns and cigarette dependence in female lung cancer, and to examine differences by histological subtype.
METHODS
We conducted a population-based case-control study in the great Paris area among women including 716 incident cases diagnosed between 2014 and 2017 and 757 age-matched controls. Detailed data on smoking history was collected during in-person interviews to assess intensity and duration of tobacco smoking, time since cessation, smoking habits (depth of smoke inhalation, use of filter, type of tobacco, and type of cigarettes) and Fagerström test for cigarette dependence. The comprehensive smoking index (CSI), a score modelling the combined effects of intensity, duration and time since quitting smoking was determined for each subject. Multivariable logistic regression models were fitted to calculate odds ratios (ORs) and their confidence intervals (95%CI) of lung cancer associated with smoking variables.
RESULTS
Lung cancer risk increased linearly with intensity and duration of tobacco smoking while it decreased with time since cessation, to reach the risk in never-smokers after 20 years of abstinence. The combined effect of intensity and duration of tobacco smoking was more than multiplicative (p-interaction 0.012). The OR in the highest vs the lowest quartile of CSI was 12.64 (95%CI 8.50; 18.80) (p-trend < 0.001). The risk of small cell or squamous cell carcinomas increased with the CSI more sharply than the risk of adenocarcinomas. Deep smoke inhalation, dark vs blond tobacco, conventional vs light cigarettes, and unfiltered vs filtered cigarettes, as well as having mixed smoking habits, were found to be independent risk factors. Having high cigarette addiction behaviours also increased the risk after adjusting for CSI.
CONCLUSION
This study provides additional insights on the effects of tobacco smoking patterns on lung cancer risk among women.
背景
本研究旨在为吸烟模式和香烟依赖在女性肺癌中的作用提供新的见解，并研究组织学亚型的差异。
方法
我们在大巴黎地区进行了一项基于人群的病例对照研究，纳入了 716 名 2014 年至 2017 年间确诊的女性肺癌患者（病例组）和 757 名年龄匹配的对照者（对照组）。通过面对面访谈收集详细的吸烟史数据，评估吸烟强度、持续时间、戒烟时间、吸烟习惯（吸烟深度、使用滤嘴、烟草类型和香烟类型）和香烟依赖的 Fagerström 测试。为每个受试者确定综合吸烟指数（CSI），该指数对吸烟强度、持续时间和戒烟时间的综合效应进行建模。使用多变量逻辑回归模型计算与吸烟变量相关的肺癌风险的比值比（OR）及其 95%置信区间（95%CI）。
结果
肺癌风险随吸烟强度和持续时间呈线性增加，而随戒烟时间的延长而降低，在戒烟 20 年后达到从不吸烟者的风险水平。吸烟强度和持续时间的综合效应超过了相乘效应（p 交互作用=0.012）。CSI 最高四分位数与最低四分位数相比，OR 为 12.64（95%CI 8.50；18.80）（p 趋势<0.001）。与小细胞癌或鳞状细胞癌相比，腺癌的风险随 CSI 增加的幅度更大。深吸烟、深色与浅色烟草、传统与轻烟、无滤嘴与有滤嘴香烟，以及混合吸烟习惯，都是独立的危险因素。在调整 CSI 后，高吸烟成瘾行为也会增加风险。
结论
本研究为吸烟模式对女性肺癌风险的影响提供了更多的见解。
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