Stellman S D, Muscat J E, Thompson S, Hoffmann D, Wynder E L
Division of Epidemiology, American Health Foundation, New York, New York 10017, USA.
Cancer. 1997 Aug 1;80(3):382-8. doi: 10.1002/(sici)1097-0142(19970801)80:3<382::aid-cncr5>3.0.co;2-u.
Over the past few decades, the incidence of adenocarcinoma (AC) of the lung increased much more rapidly than that of squamous cell carcinoma (SCC) in men and women. During this time period, filter cigarettes with substantially reduced "tar" and nicotine yields in the smoke came to dominate the market.
The risk of SCC and AC in lifelong smokers of filter cigarettes relative to lifelong nonfilter cigarette smokers was assessed in a case-control study performed between 1977 and 1995 with 2292 lung carcinoma patients and 1343 hospital controls who were current smokers.
Odds ratios (OR) for SCC in male and female subjects who had smoked filter cigarettes exclusively during their lives were slightly reduced relative to lifetime nonfilter cigarette smokers in men (OR = 0.8; 95% confidence interval [CI], 0.5-1.2), and significantly reduced in women (OR = 0.4; 95% CI, 0.2-0.8). No reduction in risk was observed for AC of the lung in men or women.
Evidence that the increasing predominance of AC over SCC may be due in part to the reduced risk of SCC (but not AC) associated with lifelong filter cigarette smoking is strongest in women; for men, further studies that include larger numbers of lifetime filter smokers are needed to confirm this finding. A lack of protection against AC from low yield filter cigarettes may result from smokers' "compensating" with deeper and more frequent inhalation, thereby increasing delivery of carcinogens to the peripheral lung. The smoke of modern cigarettes also contains higher concentrations of nitrosamines that primarily produce AC.
在过去几十年中，男性和女性肺癌腺癌（AC）的发病率增长速度远快于鳞状细胞癌（SCC）。在此期间，烟雾中“焦油”和尼古丁含量大幅降低的过滤嘴香烟开始主导市场。
在1977年至1995年进行的一项病例对照研究中，评估了终生吸过滤嘴香烟的吸烟者相对于终生吸非过滤嘴香烟的吸烟者患SCC和AC的风险，该研究纳入了2292例肺癌患者和1343名现吸烟的医院对照者。
与终生吸非过滤嘴香烟的男性相比，终生仅吸过滤嘴香烟的男性和女性患SCC的比值比（OR）略有降低（OR = 0.8；95%置信区间[CI]，0.5 - 1.2），而女性显著降低（OR = 0.4；95% CI，0.2 - 0.8）。未观察到男性或女性肺癌AC风险降低。
AC在发病率上逐渐超过SCC，部分原因可能是终生吸过滤嘴香烟使SCC（而非AC）风险降低，这一证据在女性中最为明显；对于男性，需要进一步纳入更多终生吸过滤嘴香烟者的研究来证实这一发现。低产量过滤嘴香烟未能预防AC，可能是因为吸烟者通过更深更频繁的吸入来“代偿”，从而增加了致癌物向肺外周的输送。现代香烟烟雾中还含有更高浓度的亚硝胺，主要引发AC。
