空气污染与恶性间皮瘤和石棉相关肺癌患者的生存：对韩国 1591 名患者的随访研究。

Air pollution and survival in patients with malignant mesothelioma and asbestos-related lung cancer: a follow-up study of 1591 patients in South Korea.

机构信息

Institute of Health Sciences, Korea University, Anam-ro 145, Seongbuk-gu, Seoul, 02841, South Korea.

Department of Ophthalmology, Korea University College of Medicine, Anam-ro 145, Seongbuk- gu, Seoul, 02841, South Korea.

出版信息

Environ Health. 2024 Jun 10;23(1):56. doi: 10.1186/s12940-024-01094-y.

DOI:10.1186/s12940-024-01094-y

PMID:38858710

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11163745/

Abstract

BACKGROUND

Despite significant advancements in treatments such as surgery, radiotherapy, and chemotherapy, the survival rate for patients with asbestos-related cancers remains low. Numerous studies have provided evidence suggesting that air pollution induces oxidative stress and inflammation, affecting acute respiratory diseases, lung cancer, and overall mortality. However, because of the high case fatality rate, there is limited knowledge regarding the effects of air pollution exposures on survival following a diagnosis of asbestos-related cancers. This study aimed to determine the effect of air pollution on the survival of patients with malignant mesothelioma and asbestos-related lung cancer.

METHODS

We followed up with 593 patients with malignant mesothelioma and 998 patients with lung cancer identified as asbestos victims between 2009 and 2022. Data on five air pollutants-sulfur dioxide, carbon monoxide, nitrogen dioxide, fine particulate matter with a diameter < 10 μm, and fine particulate matter with a diameter < 2.5 μm-were obtained from nationwide atmospheric monitoring stations. Cox proportional hazard models were used to estimate the association of cumulative air pollutant exposure with patient mortality, while adjusting for potential confounders. Quantile-based g-computation was used to assess the combined effect of the air pollutant mixture on mortality.

RESULTS

The 1-, 3-, and 5-year survival rates for both cancer types decreased with increasing exposure to all air pollutants. The estimated hazard ratios rose significantly with a 1-standard deviation increase in each pollutant exposure level. A quartile increase in the pollutant mixture was associated with a 1.99-fold increase in the risk of malignant mesothelioma-related mortality (95% confidence interval: 1.62, 2.44). For lung cancer, a quartile increase in the pollutant mixture triggered a 1.87-fold increase in the mortality risk (95% confidence interval: 1.53, 2.30).

CONCLUSION

These findings support the hypothesis that air pollution exposure after an asbestos-related cancer diagnosis can negatively affect patient survival.

摘要

背景

尽管手术、放疗和化疗等治疗方法取得了重大进展，但与石棉相关的癌症患者的生存率仍然较低。许多研究提供的证据表明，空气污染会导致氧化应激和炎症，影响急性呼吸道疾病、肺癌和总体死亡率。然而，由于高病死率，对于空气污染暴露对石棉相关癌症诊断后患者生存的影响知之甚少。本研究旨在确定空气污染对恶性间皮瘤和石棉相关肺癌患者生存的影响。

方法

我们对 2009 年至 2022 年间确诊为恶性间皮瘤和肺癌的 593 名石棉受害者和 998 名患者进行了随访。从全国大气监测站获得了五种空气污染物（二氧化硫、一氧化碳、二氧化氮、直径<10μm 的细颗粒物和直径<2.5μm 的细颗粒物）的数据。使用 Cox 比例风险模型来估计累积空气污染物暴露与患者死亡率之间的关联，同时调整潜在的混杂因素。基于分位数的 g 计算用于评估空气污染物混合物对死亡率的综合影响。

结果

两种癌症的 1 年、3 年和 5 年生存率均随所有空气污染物暴露量的增加而降低。每个污染物暴露水平增加一个标准差，估计的危害比显著上升。污染物混合物的四分位增加与恶性间皮瘤相关死亡率风险增加 1.99 倍（95%置信区间：1.62，2.44）相关。对于肺癌，污染物混合物的四分位增加与死亡率风险增加 1.87 倍（95%置信区间：1.53，2.30）相关。