Tokarskaya Z B, Okladnikova N D, Belyaeva Z D, Drozhko E G
Biophysical Institute, Ministry for Public Health and Medicinal Industry, Chelyabinsk, Russia.
Health Phys. 1995 Sep;69(3):356-66. doi: 10.1097/00004032-199509000-00007.
For the estimation of radiation lung cancer risk for a human being it is important to take into account different etiological factors because of the polyetiology of this disease. This work was the aim of a retrospective investigation ("case-control") of 500 workers of a nuclear enterprise that had been gamma-irradiated in a wide dose range and had had exposure to airborne 239Pu. One hundred sixty-two persons contracted lung cancer (morbidity), and 338 persons that had not fallen ill served as pair control. Eleven potential risk factors were evaluated using a logistic regression model, five insignificant factors were excluded, and the remaining factors were arranged (by odds ratio) in decreasing order: smoking > plutonium pneumosclerosis > plutonium incorporation in body > chronic obstructive pulmonary diseases (COPD) > decrease of body mass > external gamma-irradiation. The percentage of histologically confirmed adenocarcinoma among the nuclear enterprise workers was 74%, which is significantly higher than 33% among the population that did not work at the enterprise, particularly in the case of high (more than 11 kBq) plutonium incorporation by the nuclear workers. The localization of tumors in this cohort is more frequently in the lower and middle lung lobes and at the periphery. Each of the histological types of lung cancer has manifested a different degree of correlation with particular factors. The adenocarcinoma has the most frequent correlation with the radiation factors; the odds ratio for plutonium incorporation and plutonium pneumosclerosis is 2.9 (95% CI = 1.0-8.4); for external gamma-irradiation the odds ratio is 1.9 (0.99-3.5); the odds ratio for smoking is 4.3 (1.9-9.9). The squamous-cell carcinoma has the highest correlation with non-occupational factors: with smoking the OR is 6.8 (1.2-38.7), with the chronic obstructive pulmonary diseases the odds ratio is 3.9 (1.8-8.4), and with body mass decrease the odds ratio is 2.1 (0.94-4.6); odds ratio for plutonium incorporation is 4.2 (1.4-12.8). The small-cell carcinoma has correlation with body mass decrease [odds ratio = 2.9 (1.2-7.6)] and high level of smoking [smoking index > 500; odds ratio = 3.5 (1.4-8.9)]. The portion of the occupational cancers among the workers of the nuclear enterprise, evaluated on the base of attributive risk, is 26%, with 57% for adenocarcinoma, 9% for squamous-cell carcinoma, and 8% for small-cell carcinoma. The investigation is continued to assess the dose-effect and factors interactions.
由于肺癌具有多病因性，因此在评估人类辐射性肺癌风险时，考虑不同的病因因素非常重要。这项工作旨在对一家核企业的500名工人进行回顾性调查（“病例对照”），这些工人曾在很宽的剂量范围内受到γ射线照射，并接触过空气中的239Pu。162人患肺癌（发病率），338名未患病的人作为配对对照。使用逻辑回归模型评估了11个潜在风险因素，排除了5个无显著影响的因素，其余因素按优势比降序排列为：吸烟＞钚肺硬化＞钚在体内的蓄积＞慢性阻塞性肺疾病（COPD）＞体重减轻＞外照射γ射线。核企业工人中经组织学确诊的腺癌百分比为74%，显著高于未在该企业工作人群中的33%，特别是在核工人钚摄入量高（超过11 kBq）的情况下。该队列中的肿瘤更常位于肺下叶和中叶以及周边。肺癌的每种组织学类型与特定因素表现出不同程度的相关性。腺癌与辐射因素的相关性最常见；钚蓄积和钚肺硬化的优势比为2.9（95%可信区间=1.0-8.4）；外照射γ射线的优势比为1.9（0.99-3.5）；吸烟的优势比为4.3（1.9-9.9）。鳞状细胞癌与非职业因素的相关性最高：吸烟的比值比为6.8（1.2-38.7），慢性阻塞性肺疾病的优势比为3.9（1.8-8.4），体重减轻的优势比为2.1（0.94-4.6）；钚蓄积的优势比为4.2（1.4-12.8）。小细胞癌与体重减轻[优势比=2.9（1.2-7.6）]和高吸烟水平[吸烟指数＞500；优势比=3.5（1.4-8.9）]相关。根据归因风险评估，核企业工人中职业性癌症的比例为26%，其中腺癌为57%，鳞状细胞癌为9%，小细胞癌为8%。调查仍在继续，以评估剂量效应和因素间的相互作用。
