Center of Excellence in Environmental Toxicology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Departments of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Geography and Urban Studies, Temple University, Philadelphia, PA 19122, USA.
Center of Excellence in Environmental Toxicology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Medicine, Pulmonary, Allergy, and Critical Care Division, Hospital of University of Pennsylvania, Philadelphia, PA 19104, USA.
Lung Cancer. 2022 Aug;170:65-73. doi: 10.1016/j.lungcan.2022.06.004. Epub 2022 Jun 10.
Lung cancer is a leading cause of cancer death in the United States. Exposure to outdoor air pollution (OAP) is associated with increased lung cancer incidence, however little is known about the association of OAP and survival after diagnosis.
We investigated the effects of OAP and lung cancer survival in Pennsylvania using data from Pennsylvania Cancer Registry. The study population consisted of 252,123 patients diagnosed between 1990 and 2017. The Environmental Protection Agency's ambient air monitoring network provided information on OAP exposure of NO, O, PM, and PM. Mean OAP exposures were calculated by interpolating exposure concentrations from the five nearest monitors within a 50-kilometer radius of each patient's residential address from date of diagnosis to date of death or last contact. Cox proportional-hazards models were used to estimate the hazard ratios (HR) for OAP exposures for overall and lung cancer-specific survival. Statistical analyses were stratified by SEER cancer stage groupings (localized, regional, and distant) and adjusted for individual-level and area-level covariates.
Median survival time was 0.76 [CIs: 0.75, 0.77] years for the study population and for localized, regional, and distant site diagnosis were 2.2 [CIs: 2.17, 2.23], 1.13 [CIs: 1.12, 1.15], and 0.42 [CIs: 0.41, 0.43] years, respectively. NO indicated the greatest HR which increased with increasing magnitude of exposure across all cancer staging groups for deaths before 2-years post-diagnosis. HRs varied by stage and magnitude of OAP exposure with greatest overall effects shown in NO followed by PM, O and PM. A subgroup analysis of patients with treatment status information (2010-2017) showed similar associations of increasing HRs with increasing exposure.
These findings supported the hypotheses that OAP can influence the carcinogenic process, impairing chemotherapy treatment, and provide important public health implications since environmental factors are not often considered in prognosis of survival after diagnosis.
肺癌是美国癌症死亡的主要原因。暴露于室外空气污染（OAP）与肺癌发病率的增加有关，但是对于 OAP 与诊断后生存的关系知之甚少。
我们使用宾夕法尼亚癌症登记处的数据，研究了宾夕法尼亚州 OAP 和肺癌生存之间的关系。研究人群由 1990 年至 2017 年间诊断出的 252,123 名患者组成。环境保护署的环境空气监测网络提供了有关 NO、O、PM 和 PM 暴露的信息。通过对每个患者居住地址的 50 公里半径内的五个最近的监测器的暴露浓度进行插值，计算出 OAP 暴露的平均浓度。Cox 比例风险模型用于估计 OAP 暴露与总生存和肺癌特异性生存的危险比（HR）。统计分析按 SEER 癌症分期分组（局部、区域和远处）进行分层，并根据个体水平和区域水平的协变量进行调整。
研究人群的中位生存时间为 0.76 年（置信区间：0.75，0.77），局部、区域和远处部位诊断的中位生存时间分别为 2.2 年（置信区间：2.17，2.23）、1.13 年（置信区间：1.12，1.15）和 0.42 年（置信区间：0.41，0.43）。在诊断后 2 年内死亡的所有癌症分期组中，NO 均显示出最大的 HR，并且随着暴露程度的增加而增加。HR 因阶段和 OAP 暴露程度而异，总体影响最大的是 NO，其次是 PM、O 和 PM。对具有治疗状况信息的患者（2010-2017 年）进行的亚组分析显示，随着暴露程度的增加，HR 呈递增趋势，存在相似的关联。
这些发现支持了以下假设：OAP 可以影响致癌过程，削弱化疗治疗效果，并具有重要的公共卫生意义，因为环境因素在诊断后生存的预后中通常未被考虑。
