Kohout J, Motánová A, Sefrna F
Klinika pracovního lékarství Fakultní nemocnice Plzen.
Vnitr Lek. 1993 Nov;39(11):1044-51.
From 614 patients with notified pneumoconiosis who died in 1964-1992 on necropsy carcinoma of the lungs was found in 87, i.e. 14.1% (in 48 it was the cause of death). The incidence in individual years did not differ significantly; on evaluation in relation to the diagnosis of pneumoconiosis an insignificantly more frequent incidence was found in complicated pneumoconiosis of miners. On evaluation by work places miners in black coal mines and workers in quarries were affected more frequently, the difference being at the borderline of statistical significance. As to the histological aspect, most frequently squamous cell carcinoma was involved, the site was most frequently in both upper lobes. The carcinoma was seven times associated with silicotic lesions, with anthracofibrotic lesions six times (a total of 14.9%). In lifetime carcinoma was detected in 55 of the patients who died, i.e. in 63.2%. As to aetiopathogenetic influences, the relationship with smoking is significant. The aetiopathogenesis of carcinoma of the lungs in patients with pneumoconiosis is most probably not uniform-the influence of smoking is beyond doubt, the carcinogenic effect of silica should be considered in patients with carcinoma in the scar. With regard to the repeatedly proved more frequent incidence of carcinoma of the lungs in patients with pneumoconiosis, frequent check-ups of patients with pneumoconiosis focused on possible detection of lung cancer are essential.
在1964年至1992年期间死亡并经尸检的614例已通报尘肺病患者中,发现87例患有肺癌,即14.1%(其中48例死于肺癌)。各年份的发病率无显著差异;按尘肺病诊断进行评估时,发现矿工合并尘肺病的肺癌发病率略高,但无统计学意义。按工作场所评估,黑煤矿工和采石场工人受影响更为频繁,差异接近统计学意义临界值。从组织学方面来看,最常累及的是鳞状细胞癌,发病部位最常见于双侧上叶。该癌症与硅沉着病病变相关7次,与煤尘纤维性病变相关6次(共计14.9%)。在死亡患者中,有55例生前检测到患有癌症,即占63.2%。关于病因发病学影响,与吸烟的关系显著。尘肺病患者肺癌的病因发病机制很可能并不单一——吸烟的影响毋庸置疑,对于瘢痕处患有癌症的患者,应考虑二氧化硅的致癌作用。鉴于反复证实尘肺病患者肺癌发病率更高,对尘肺病患者进行定期检查以重点排查可能的肺癌至关重要。