环境石棉暴露与肺癌负担及间皮瘤的比较：土耳其农村地区一项33年基于人群的队列研究
Environmental asbestos exposure and lung cancer burden compared with mesothelioma in rural Türkiye: A 33-Year population-based cohort study.
作者
作者单位
- Department of Chest Diseases, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Türkiye; Lung and Pleural Cancers Research and Clinical Center, Eskisehir Osmangazi University, Eskisehir, Türkiye. Electronic address: guntuluak@gmail.com.
- Lung and Pleural Cancers Research and Clinical Center, Eskisehir Osmangazi University, Eskisehir, Türkiye; Department of Public Health, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Türkiye. Electronic address: selmametintas@hotmail.com.
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Senior Staff Specialist, Sydney Local Health District (SLHD), Sydney, Australia. Electronic address: nico.vanzandwijk@sydney.edu.au.
- Lung and Pleural Cancers Research and Clinical Center, Eskisehir Osmangazi University, Eskisehir, Türkiye; Department of Chest Diseases, Acıbadem Eskişehir Hospital, Eskişehir, Türkiye. Electronic address: muzaffermetintas@gmail.com.
摘要
中文
长期环境石棉暴露仍然是肺癌（LC）未被充分认识的病因。我们评估了环境石棉暴露对肺癌死亡率、时间趋势、损失寿命年（YLL）及其与恶性间皮瘤关系的影响，在土耳其农村进行了一项为期33年的人群队列研究。这项回顾性队列纳入了1990年至2022年间在土耳其中部埃斯基谢希尔地区环境石棉暴露及相邻非暴露地区诊断的所有肺癌和间皮瘤病例。使用人年分母计算年龄标准化死亡率、Joinpoint趋势分析、相对危险度（RR）和YLL。该队列包括1,223,765暴露人年和388,401非暴露人年。总体而言，在暴露地区识别出629例肺癌病例，非暴露地区46例，而235例恶性间皮瘤仅发生在暴露地区。环境石棉暴露使肺癌死亡率增加超过4倍（RR，4.11；95% CI，3.02-5.60）。暴露男性和女性的年龄标准化肺癌死亡率分别为每10万人年71.5和8.8，而非暴露人群分别为19.0和0.85。肺癌死亡率随时间增加（男性年变化百分比6.8%，女性13.0%）。肺癌死亡率超过间皮瘤死亡率2.68倍，并造成更大的YLL，而临床病理特征和生存率在两组间相似。长期环境石棉暴露显著增加肺癌死亡率和过早死亡率。尽管间皮瘤仍然是石棉相关的哨兵恶性肿瘤，但肺癌是环境石棉暴露的主要人群水平后果。这些发现支持在流行地区将环境石棉暴露纳入风险评估、监测和低剂量计算机断层扫描筛查策略。
English
Long-term environmental asbestos exposure remains an underrecognized cause of lung cancer (LC). We evaluated the impact of environmental asbestos exposure on LC mortality, temporal trends, years of life lost (YLL), and its relationship with malignant mesothelioma in a 33-year population-based cohort in rural Türkiye. This retrospective cohort included all LC and mesothelioma cases diagnosed between 1990 and 2022 in environmentally asbestos-exposed and adjacent non-exposed districts in Eskişehir region of Central Anatolia. Age-standardized mortality rates, Joinpoint trend analyses, relative risks (RRs), and YLL were calculated using person-year denominators. The cohort comprised 1,223,765 exposed and 388,401 non-exposed person-years. Overall, 629 LC cases were identified in exposed districts and 46 in non-exposed districts, whereas 235 malignant mesothelioma cases occurred only in exposed districts. Environmental asbestos exposure increased LC mortality more than fourfold (RR, 4.11; 95% CI, 3.02-5.60). Age-standardized LC mortality rates were 71.5 and 8.8 per 100,000 person-years among exposed men and women, versus 19.0 and 0.85, respectively, in non-exposed populations. LC mortality increased over time (annual percentage change, 6.8% in men and 13.0% in women). LC mortality exceeded mesothelioma mortality 2.68-fold and accounted for greater YLL, whereas clinicopathological characteristics and survival were similar between groups. Long-term environmental asbestos exposure substantially increases LC mortality and premature mortality. Although mesothelioma remains the sentinel asbestos-related malignancy, LC represents the principal population-level consequence of environmental asbestos exposure. These findings support incorporating environmental asbestos exposure into risk assessment, surveillance, and low-dose computed tomography screening strategies in endemic regions.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q1
- 影响因子
- 5.3
- 新锐分区
- 2区