Guan Yufan, Shen Jie, Zhang Kai, Fuemmeler Bernard F, Zhao Hua
Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA.
Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, Albany, NY 12222, USA.
Cancers (Basel). 2024 Sep 23;16(18):3235. doi: 10.3390/cancers16183235.
Allostatic load (AL) is a biomarker of chronic stress associated with various chronic diseases. No study has evaluated the relationship between AL and lung cancer risk. To address this gap, we analyzed the association between AL and the development of lung cancer in 344,380 participants from the UK Biobank. During the follow-up period from 2006 to 2020, 2517 participants were diagnosed with incident lung cancer. Participants who developed lung cancer had significantly higher AL compared to cancer-free controls (mean: 3.49 vs. 2.87, < 0.001). In the multivariate analysis, a marginally significant association was observed between higher AL and increased lung cancer risk (per one AL unit: Hazard Ratio [HR] = 1.02, 95% Confidence Interval [CI]: 0.99, 1.04). In the categorical analysis, individuals with high AL (AL > 2) had a 15% higher risk of lung cancer compared to those with low AL (AL ≤ 2) (HR = 1.15, 95% CI: 1.05, 1.25). Stratified analyses revealed that this increased risk was only observed in former (HR = 1.38, 95% CI: 1.06, 1.43) and current smokers (HR = 1.25, 95% CI: 1.10, 1.42) but not in never-smokers (HR = 0.93, 95% CI: 0.74, 1.17). Moreover, we found that demographics, socioeconomics, and other health behaviors could modify the risk association. Finally, among cigarette smoking-related variables, a significant trend of increasing AL was observed with higher pack-years, longer smoking duration, earlier age of smoking initiation, and later age of smoking cessation. These findings suggest that higher AL is associated with an increased risk of lung cancer. The results need to be further confirmed in additional studies.
应激负荷（AL）是一种与多种慢性疾病相关的慢性应激生物标志物。尚无研究评估AL与肺癌风险之间的关系。为填补这一空白，我们分析了英国生物银行中344380名参与者的AL与肺癌发生之间的关联。在2006年至2020年的随访期间，2517名参与者被诊断为新发肺癌。与未患癌症的对照组相比，患肺癌的参与者的AL显著更高（平均值：3.49对2.87，<0.001）。在多变量分析中，观察到较高的AL与肺癌风险增加之间存在边缘显著关联（每增加一个AL单位：风险比[HR]=1.02，95%置信区间[CI]：0.99，1.04）。在分类分析中, 与低AL（AL≤2）者相比，高AL（AL>2）者患肺癌的风险高15%（HR = 1.15，95%CI：1.05，1.25）。分层分析显示，这种风险增加仅在既往吸烟者（HR = 1.38，95%CI：1.06，1.43）和当前吸烟者（HR = 1.25，95%CI：1.10，1.42）中观察到，而在从不吸烟者中未观察到（HR = 0.93，95%CI：0.74，1.17）。此外，我们发现人口统计学、社会经济学和其他健康行为可以改变风险关联。最后，在与吸烟相关的变量中，随着吸烟包年数增加、吸烟持续时间延长、开始吸烟年龄较早和戒烟年龄较晚，观察到AL有显著增加趋势。这些发现表明，较高的AL与肺癌风险增加有关。结果需要在更多研究中进一步证实。
