Experiment Center, School of Public Health, Fujian Medical University, Fuzhou, Fujian, 350122, People's Republic of China.
Department of Thoracic Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian, People's Republic of China.
Respir Res. 2021 Jul 23;22(1):210. doi: 10.1186/s12931-021-01802-z.
Although cigarette smoking is a major risk factor for lung cancer, the incidence rate of lung cancer among non-smokers is notable. The etiology and potential mechanism of non-smoker lung cancer are worthy of further research. This study was designed to explore the collective effects of environmental factors and the relationship between environmental exposure index (EEI) and lung cancer among non-smokers by evaluating the joint effects among lung disease history, environmental factors, and family history of lung cancer without smoking confounders.
A total of 767 never-smoked lung cancer cases and 767 sex- and age-matched controls were selected from the department of Thoracic Surgery and Respiratory Medicine of three hospitals in Fujian, China. We used two methods to develop the EEI according to 12 statistically significant environmental risk factors. Restricted cubic spline (RCS) was applied to analyze the non-linear relationship between EEI and lung cancer in non-smokers. Combined effects, additive interaction, and multiplicative interaction were assessed among lung disease history, EEI, and family history of lung cancer to estimate susceptibility to develop lung cancer.
Lung disease history, especially asthma, was significantly associated with an increased risk of lung cancer with an odds ratio (OR) for asthma history of 14.720 (95% CI: 1.877-115.449). Family history of lung cancer was related to susceptibility of lung cancer (OR = 3.347, 95% CI: 1.930-5.806). According to type of relatives and cancer, a parental or children's history and a sibling's history of lung cancer were significantly associated with an increased risk of lung cancer. The positive association between EEI and lung cancer was apparently stronger in those with lung disease history or family lung cancer history. Furthermore, there was a addictive interaction between EEI and lung disease history, and a possibly addictive interaction between EEI and family lung cancer history on development of lung cancer.
There were combined effects among lung disease history, environmental exposures, and family history of lung cancer toward susceptibility to lung cancer in Chinese non-smokers. Non-smokers who had a family history of lung cancer were at higher risk of lung cancer than non-smokers who had lung disease history. Non-smokers with family cancer history may obtain benefits from removal of environmental exposures and active treatment of lung disease.
尽管吸烟是肺癌的主要危险因素，但不吸烟者的肺癌发病率也不容忽视。非吸烟者肺癌的病因和潜在机制值得进一步研究。本研究旨在通过评估无吸烟混杂因素的肺病病史、环境因素和肺癌家族史之间的联合作用，探讨环境因素的综合作用以及环境暴露指数（EEI）与非吸烟者肺癌之间的关系。
本研究共纳入 767 例从未吸烟的肺癌病例和 767 例性别和年龄匹配的对照组，均来自中国福建三家医院的胸外科和呼吸内科。我们使用两种方法根据 12 个具有统计学意义的环境风险因素来制定 EEI。限制性立方样条（RCS）用于分析 EEI 与非吸烟者肺癌之间的非线性关系。评估肺病病史、EEI 和肺癌家族史之间的联合作用、相加交互作用和相乘交互作用，以评估患肺癌的易感性。
肺病病史，尤其是哮喘，与肺癌风险增加显著相关，哮喘病史的比值比（OR）为 14.720（95%CI：1.877-115.449）。肺癌家族史与肺癌易感性有关（OR=3.347，95%CI：1.930-5.806）。根据亲属类型和癌症类型，父母或子女的肺癌史以及兄弟姐妹的肺癌史与肺癌风险增加显著相关。EEI 与肺癌之间的正相关关系在有肺病病史或肺癌家族史的患者中明显更强。此外，EEI 与肺病病史之间存在相加交互作用，EEI 与肺癌家族史之间可能存在相加交互作用，均与肺癌的发生有关。
在中国非吸烟者中，肺病病史、环境暴露和肺癌家族史之间存在联合作用，导致肺癌易感性增加。有肺癌家族史的非吸烟者患肺癌的风险高于有肺病病史的非吸烟者。有家族癌症史的非吸烟者可能从环境暴露的消除和肺部疾病的积极治疗中获益。
