Zheng Wenlong, Jiang Guohong, Wang Chong, Xun Luning, Shen Chengfeng, Zhang Shuang, Zhang Hui, Zhou Qingxin, Xie Meiqiu, Xue Xiaodan, Wang Dezheng, Lv Jun
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
NCDs Preventive Department, Tianjin Centers for Disease Control and Prevention, Tianjin, China.
Tob Induc Dis. 2024 Sep 9;22. doi: 10.18332/tid/192191. eCollection 2024.
The purpose of this study was to examine the prevalence, clinical characteristics, and changing trends of non-smokers with lung cancer (LC) based on data from a population-wide cancer registry in northern China.
The study used LC incidence and follow-up data from 2010 to 2019 from the Cancer Registry System of Tianjin city, which included 82769 cases. Trends in the incidence and proportion of non-smokers with LC were examined by joinpoint regression analysis. Life table and Cox survival analyses were used to calculate the survival rates and compare the death hazard ratios (HRs) in different groups, respectively.
Among the 82769 new diagnosis cases of LC during 2010 to 2019, there were 34589 (41.8%) current smokers, 14913 (18.0%) ex-smokers, 28123 (34.0%) non-smokers, and 5144 (6.2%) unknowns. The proportion of non-smokers changed slightly from 2010 (35.36%) to 2019 (36.87%) (annual percentage change, APC= -0.01%, p>0.05). This proportion declined in men (2010 vs 2019; 22.06% vs 20.66%) and increased in women (2010 vs 2019; 53.02% vs 62.35%), and in the 0-44 years age group it showed an upward trend from 2015 to 2019 (APC=4.82%, 95% CI: 1.8-7.9). Compared with smokers with LC, non-smokers with LC were predominantly females (64.15% vs 27.26%), had a predominantly adenocarcinoma histological subtypes (76.71% vs 42.22%), and had a 20% lower risk of death than smokers (HR=0.80; 95% CI: 0.78-0.81).
The proportion of non-smokers with LC was relatively high in northern China, with an increasing trend in the proportion of females and younger age groups. Non-smokers with LC had different epidemiological and clinical characteristics compared with smokers with LC.
本研究旨在基于中国北方一项全人群癌症登记数据，调查非吸烟肺癌患者的患病率、临床特征及变化趋势。
本研究使用了天津市癌症登记系统2010年至2019年的肺癌发病率和随访数据，共纳入82769例病例。通过Joinpoint回归分析研究非吸烟肺癌患者的发病率和比例趋势。分别使用生命表和Cox生存分析计算生存率并比较不同组的死亡风险比（HR）。
在2010年至2019年期间确诊的82769例肺癌新发病例中，有34589例（41.8%）当前吸烟者，14913例（18.0%）既往吸烟者，28123例（34.0%）非吸烟者，5144例（6.2%）情况不明者。非吸烟者的比例从2010年的35.36%略有变化至2019年的36.87%（年百分比变化，APC = -0.01%，p>0.05）。该比例在男性中下降（2010年与2019年相比；22.06%对20.66%），在女性中上升（2010年与2019年相比；53.02%对62.35%），在0至44岁年龄组中从2015年至2019年呈上升趋势（APC = 4.82%，95%CI：1.8 - 7.9）。与吸烟肺癌患者相比，非吸烟肺癌患者以女性为主（64.15%对27.26%），组织学亚型以腺癌为主（76.71%对42.22%），死亡风险比吸烟者低20%（HR = 0.80；95%CI：0.78 - 0.81）。
中国北方非吸烟肺癌患者的比例相对较高，女性和年轻年龄组的比例呈上升趋势。与吸烟肺癌患者相比，非吸烟肺癌患者具有不同的流行病学和临床特征。
