背景:尽管手术等治疗方法取得了重大进展,放射治疗,和化疗,石棉相关癌症患者的生存率仍然很低。大量研究提供的证据表明,空气污染会引起氧化应激和炎症,影响急性呼吸系统疾病,肺癌,和总死亡率。然而,因为病死率高,在诊断石棉相关癌症后,关于空气污染暴露对生存的影响的知识有限。这项研究旨在确定空气污染对恶性间皮瘤和石棉相关肺癌患者生存的影响。
方法:我们在2009年至2022年间对593例恶性间皮瘤患者和998例肺癌患者进行了随访。关于五种空气污染物——二氧化硫的数据,一氧化碳,二氧化氮,直径<10μm的细颗粒物,从全国大气监测站获得直径<2.5μm的细颗粒物。Cox比例风险模型用于估计累积空气污染物暴露与患者死亡率的关系。同时调整潜在的混杂因素。基于分位数的g计算用于评估空气污染物混合物对死亡率的综合影响。
结果:1-,3-,两种癌症的5年生存率随着暴露于所有空气污染物的增加而下降。随着每种污染物暴露水平增加1个标准偏差,估计的危险比显着增加。污染物混合物的四分位数增加与恶性间皮瘤相关死亡率的风险增加1.99倍相关(95%置信区间:1.62,2.44)。对于肺癌,污染物混合物的四分位数增加导致死亡风险增加1.87倍(95%置信区间:1.53,2.30).
结论:这些发现支持以下假设:石棉相关癌症诊断后暴露于空气污染会对患者的生存产生负面影响。
BACKGROUND: Despite significant advancements in treatments such as surgery, radiotherapy, and chemotherapy, the survival rate for patients with asbestos-related cancers remains low. Numerous studies have provided evidence suggesting that air pollution induces oxidative stress and inflammation, affecting acute respiratory diseases, lung cancer, and overall mortality. However, because of the high case fatality rate, there is limited knowledge regarding the effects of air pollution exposures on survival following a diagnosis of asbestos-related cancers. This
study aimed to determine the effect of air pollution on the survival of patients with malignant mesothelioma and asbestos-related lung cancer.
METHODS: We followed up with 593 patients with malignant mesothelioma and 998 patients with lung cancer identified as asbestos victims between 2009 and 2022. Data on five air pollutants-sulfur dioxide, carbon monoxide, nitrogen dioxide, fine particulate matter with a diameter < 10 μm, and fine particulate matter with a diameter < 2.5 μm-were obtained from nationwide atmospheric monitoring stations. Cox proportional hazard models were used to estimate the association of cumulative air pollutant exposure with patient mortality, while adjusting for potential confounders. Quantile-based g-computation was used to assess the combined effect of the air pollutant mixture on mortality.
RESULTS: The 1-, 3-, and 5-year survival rates for both cancer types decreased with increasing exposure to all air pollutants. The estimated hazard ratios rose significantly with a 1-standard deviation increase in each pollutant exposure level. A quartile increase in the pollutant mixture was associated with a 1.99-fold increase in the risk of malignant mesothelioma-related mortality (95% confidence interval: 1.62, 2.44). For lung cancer, a quartile increase in the pollutant mixture triggered a 1.87-fold increase in the mortality risk (95% confidence interval: 1.53, 2.30).
CONCLUSIONS: These findings support the hypothesis that air pollution exposure after an asbestos-related cancer diagnosis can negatively affect patient survival.