Chin Wei-Shan, Pan Shin-Chun, Huang Ching-Chun, Chen Pei-Jer, Guo Yue Leon
School of Nursing, College of Medicine, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan.
National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.
Liver Cancer. 2022 Jun 15;11(5):474-482. doi: 10.1159/000525346. eCollection 2022 Sep.
Air pollutants are classified as carcinogens by the International Agency for Research on Cancer. Long-term exposure to ambient particulate matter with an aerodiameter of 2.5 μm or lower (PM) has been reported to be linked with increased mortality due to hepatocellular carcinoma (HCC). However, the effects of air pollutants other than PM on HCC-related mortality have not been fully investigated. Accordingly, we conducted this study to assess the effect of long-term exposure to air pollutants (PM and nitrogen dioxide [NO]) on HCC-related mortality.
In 2005, the Taiwan Liver Cancer Network (TLCN) was established by the National Research Program for Genomic Medicine to recruit liver cancer patients from 5 major medical centers in northern, central, and southern Taiwan. The TLCN had successfully recruited 9,344 patients by the end of 2018. In this study, we included 1,000 patients randomly sampled from the TLCN to assess the effect of exposure to air pollutants on HCC mortality after HCC diagnosis. Daily averages of PM and NO concentrations were retrieved from 77 air quality-monitoring stations and interpolated to the townships of patients' residences by using the Kriging method. The effect of air pollutants on HCC survival was assessed using a Cox proportional hazards model.
A total of 940 patients were included in the analysis. After adjusting for potential confounders and mutually adjusting for co-pollutants, we observed that the hazards ratio (95% confidence interval) for HCC-related mortality for every 1-μg/m increase in PM concentration was 1.11 (1.08-1.14) and that for every 1-ppb increase in NO concentration was 1.08 (1.03-1.13).
Our study suggests that long-term exposure to PM and NO was associated with decreased survival time in patients with HCC in Taiwan.
空气污染物被国际癌症研究机构列为致癌物。据报道，长期暴露于空气动力学直径为2.5微米或更低的环境颗粒物（PM）与肝细胞癌（HCC）导致的死亡率增加有关。然而，除PM之外的空气污染物对HCC相关死亡率的影响尚未得到充分研究。因此，我们开展了本研究，以评估长期暴露于空气污染物（PM和二氧化氮[NO]）对HCC相关死亡率的影响。
2005年，国家基因组医学研究计划成立了台湾肝癌网络（TLCN），从台湾北部、中部和南部的5家主要医疗中心招募肝癌患者。到2018年底，TLCN已成功招募9344名患者。在本研究中，我们从TLCN中随机抽取1000名患者，以评估HCC诊断后暴露于空气污染物对HCC死亡率的影响。从77个空气质量监测站获取PM和NO浓度的日平均值，并使用克里金法将其插值到患者居住的乡镇。使用Cox比例风险模型评估空气污染物对HCC生存的影响。
共有940名患者纳入分析。在调整潜在混杂因素并对共污染物进行相互调整后，我们观察到，PM浓度每增加1微克/立方米，HCC相关死亡率的风险比（95%置信区间）为1.11（1.08-1.14），NO浓度每增加1十亿分比，风险比为1.08（1.03-1.13）。
我们的研究表明，长期暴露于PM和NO与台湾HCC患者的生存时间缩短有关。
