Institute of Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
Institute of Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Eur Respir Rev. 2024 Feb 14;33(171). doi: 10.1183/16000617.0224-2023. Print 2024 Jan 31.
Molecular pathways found to be important in pulmonary fibrosis are also involved in cancer pathogenesis, suggesting common pathways in the development of pulmonary fibrosis and lung cancer.
Is pulmonary fibrosis from exposure to occupational carcinogens an independent risk factor for lung cancer?
A comprehensive search of PubMed, Embase, Web of Science and Cochrane databases with over 100 search terms regarding occupational hazards causing pulmonary fibrosis was conducted. After screening and extraction, quality of evidence and eligibility criteria for meta-analysis were assessed. Meta-analysis was performed using a random-effects model.
52 studies were identified for systematic review. Meta-analysis of subgroups identified silicosis as a risk factor for lung cancer when investigating odds ratios for silicosis in autopsy studies (OR 1.47, 95% CI 1.13-1.90) and for lung cancer mortality in patients with silicosis (OR 3.21, 95% CI 2.67-3.87). Only considering studies with an adjustment for smoking as a confounder identified a significant increase in lung cancer risk (OR 1.58, 95% CI 1.34-1.87). However, due to a lack of studies including cumulative exposure, no adjustments could be included. In a qualitative review, no definitive conclusion could be reached for asbestosis and silicosis as independent risk factors for lung cancer, partly because the studies did not take cumulative exposure into account.
This systematic review confirms the current knowledge regarding asbestosis and silicosis, indicating a higher risk of lung cancer in exposed individuals compared to exposed workers without fibrosis. These individuals should be monitored for lung cancer, especially when asbestosis or silicosis is present.
在肺纤维化中发现的重要分子途径也参与了癌症的发病机制，这表明肺纤维化和肺癌的发展存在共同途径。
职业性致癌物暴露引起的肺纤维化是否是肺癌的独立危险因素？
对 PubMed、Embase、Web of Science 和 Cochrane 数据库进行了全面检索，使用了 100 多个与导致肺纤维化的职业危害相关的检索词。经过筛选和提取，评估了meta 分析的证据质量和纳入标准。使用随机效应模型进行 meta 分析。
系统评价共确定了 52 项研究。亚组分析发现，在研究尸检研究中硅肺的比值比（OR 1.47，95%CI 1.13-1.90）和硅肺患者的肺癌死亡率（OR 3.21，95%CI 2.67-3.87）时，硅肺是肺癌的危险因素。仅考虑调整吸烟混杂因素的研究，发现肺癌风险显著增加（OR 1.58，95%CI 1.34-1.87）。然而，由于缺乏包括累积暴露在内的研究，因此无法进行调整。在定性综述中，对于石棉肺和硅肺作为肺癌的独立危险因素，无法得出明确的结论，部分原因是这些研究没有考虑累积暴露。
这项系统综述证实了目前关于石棉肺和硅肺的知识，表明暴露个体患肺癌的风险高于无纤维化的暴露工人。这些个体应监测肺癌，特别是在存在石棉肺或硅肺时。
