Zhang Jing, Wang Yi, Hua Tingting, Wei Xiaoxia, Jiang Xiangxiang, Ji Mengmeng, Ma Zhimin, Huang Yanqian, Wang Hui, Du Lingbin, Zhu Meng, Xu Lin, Wu Weibing, Ma Hongxia
Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.
Department of Respiratory Diseases, Nanjing Chest Hospital, Nanjing, China.
Front Oncol. 2023 Jul 13;13:1133668. doi: 10.3389/fonc.2023.1133668. eCollection 2023.
Emerging evidence suggests a potential link between psychological distress (anxiety and depression) and lung cancer risk, however, it is unclear whether other factors such as tobacco smoking and genetic susceptibility modify the association.
We included 405,892 UK Biobank participants free of cancer at baseline. Psychological distress was measured using the Patient Health Questionnaire-4 (PHQ-4). A polygenic risk score (PRS) was calculated using 18 lung cancer-associated genetic loci. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
During a median follow-up of 7.13 years, 1754 lung cancer cases were documented. The higher score of psychological distress was associated with an increased risk of lung cancer (HR= 1.07, 95% CI: 1.02-1.11) after adjustment for smoking and other confounders. Mediation analysis revealed that 16.8% (95% CI: 13.0%-20.6%) of the distress-lung cancer association was mediated by smoking. Compared with never smokers with no distress, participants with heavy smoking and high distress had the highest risk of lung cancer (HR=18.57, 95% CI: 14.51-23.76). Both multiplicative and additive interactions were observed between smoking and psychological distress in lung cancer. Furthermore, the greatest relative increase in risk was observed among those with high genetic risk and high distress (HR=1.87, 95%CI: 1.50-2.33), and there was a significant additive interaction between the PRS and psychological distress.
Our results indicate that psychological distress was associated with an elevated risk of incident lung cancer, and such relation was modified by tobacco smoking and genetic susceptibility.
新出现的证据表明心理困扰（焦虑和抑郁）与肺癌风险之间可能存在联系，然而，尚不清楚吸烟和遗传易感性等其他因素是否会改变这种关联。
我们纳入了405892名英国生物银行的参与者，他们在基线时无癌症。使用患者健康问卷-4（PHQ-4）测量心理困扰。使用18个与肺癌相关的基因位点计算多基因风险评分（PRS）。采用多变量Cox回归模型估计风险比（HRs）和95%置信区间（CIs）。
在中位随访7.13年期间，记录了1754例肺癌病例。在调整吸烟和其他混杂因素后，心理困扰得分越高与肺癌风险增加相关（HR = 1.07，95%CI：1.02 - 1.11）。中介分析显示，吸烟介导了16.8%（95%CI：13.0% - 20.6%）的心理困扰与肺癌之间的关联。与无心理困扰的从不吸烟者相比，重度吸烟且心理困扰程度高的参与者患肺癌的风险最高（HR = 18.57，95%CI：14.51 - 23.76）。在肺癌中观察到吸烟与心理困扰之间存在乘法和加法交互作用。此外，在遗传风险高且心理困扰程度高的人群中观察到风险的最大相对增加（HR = 1.87，95%CI：1.50 - 2.33），并且PRS与心理困扰之间存在显著的加法交互作用。
我们的结果表明，心理困扰与肺癌发病风险升高相关，并且这种关系受到吸烟和遗传易感性的影响。
