Koru-Sengul Tulay, Pinheiro Paulo S, Zhao Wei, Hernandez Monique N, Hernandez Diana R, Maggioni Alessandra, Kobetz Erin N, Caban-Martinez Alberto J, Lee David J
Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States.
Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States.
Front Oncol. 2023 Aug 18;13:1155650. doi: 10.3389/fonc.2023.1155650. eCollection 2023.
Lung cancer is a leading cause of cancer incidence and death in the United States. Although most firefighters are fit and do not smoke, they are exposed to many known carcinogens during and in the aftermath of firefighting activities. Comprehensive epidemiologic investigations on lung cancer survival for both career and volunteer firefighters have not been undertaken.
Data from the Florida Cancer Data System (1981-2014) were linked with firefighter certification records from the Florida State Fire Marshal's Office to identify all patients of this occupational group; lung cancer cause-specific survival data were compared with other occupational groups using Cox regression models with occupation as the main effect. Adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated.
Out of 210,541 male lung cancer cases diagnosed in Florida (1981-2014), 761 were firefighters (604 career, 157 volunteer). Lung cancer death was similar between volunteer (75.2%) and career firefighters (74.0%) but lower than non-firefighters (80.0%). Survival at 5 years was higher among firefighters (29.7%; career: 30.3%; volunteer: 27.4%) than non-firefighters (23.8%). In a multivariable model, compared with non-firefighters, firefighters have significantly higher cause-specific survival (aHR = 0.84; 95% CI: 0.77-0.91; < 0.001). However, there were no significant survival differences between career and volunteer firefighters (1.14; 0.93-1.39; = 0.213). In a separate multivariable model with firefighters as the comparator, other broad occupational groups had significantly lower cause-specific survival [white collar: 1.11 (1.02-1.21); blue collar: 1.15 (1.05-1.25); service: 1.13 (1.03-1.25); others/unknown: 1.21 (1.12-1.32); all -values < 0.02].
Lung cancer survival is significantly higher among firefighters compared with non-firefighters, but there is no significant difference between career and volunteer firefighters. Improved survival for firefighters might be due to a healthy worker effect, lower smoking prevalence relative to other worker groups, and possibly superior treatment adherence and compliance. Many firefighters are cross-trained as EMTs/paramedics and possess a level of medical knowledge that may favorably impact treatment engagement and better navigation of complex cancer care.
肺癌是美国癌症发病率和死亡率的主要原因。尽管大多数消防员身体健康且不吸烟，但他们在灭火活动期间及之后会接触到许多已知的致癌物。尚未对职业消防员和志愿消防员的肺癌生存率进行全面的流行病学调查。
将佛罗里达癌症数据系统（1981 - 2014年）的数据与佛罗里达州消防局长办公室的消防员认证记录相链接，以识别该职业群体的所有患者；使用以职业为主要效应的Cox回归模型，将肺癌特定病因生存率数据与其他职业群体进行比较。计算调整后的风险比（aHR）和95%置信区间（95%CI）。
在佛罗里达州诊断出的210,541例男性肺癌病例（1981 - 2014年）中，有761例是消防员（604名职业消防员，157名志愿消防员）。志愿消防员（75.2%）和职业消防员（74.0%）的肺癌死亡率相似，但低于非消防员（80.0%）。消防员的5年生存率（29.7%；职业消防员：30.3%；志愿消防员：27.4%）高于非消防员（23.8%）。在多变量模型中，与非消防员相比，消防员的特定病因生存率显著更高（aHR = 0.84；95%CI：0.77 - 0.91；P < 0.001）。然而，职业消防员和志愿消防员之间的生存率没有显著差异（1.14；0.93 - 1.39；P = 0.213）。在以消防员为对照的另一个多变量模型中，其他广泛的职业群体的特定病因生存率显著更低[白领：1.11（1.02 - 1.21）；蓝领：1.15（1.05 - 1.25）；服务业：1.13（1.03 - 1.25）；其他/未知：1.21（1.12 - 1.32）；所有P值<0.02]。
与非消防员相比，消防员的肺癌生存率显著更高，但职业消防员和志愿消防员之间没有显著差异。消防员生存率的提高可能归因于健康工人效应、相对于其他工人群体较低的吸烟率，以及可能更好的治疗依从性和顺应性。许多消防员接受了急救医疗技术员/护理人员的交叉培训，拥有一定水平的医学知识，这可能对治疗参与和更好地应对复杂的癌症护理产生有利影响。
