Lung cancer risk among female textile workers exposed to endotoxin
Lung cancer risk among female textile workers exposed to endotoxin
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DOI：
10.1093/jnci/djk063
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发表时间：
2007-03-07
影响因子：
10.3
通讯作者：
Checkoway, Harvey
中科院分区：
文献类型：
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作者：
Astrakianakis, George;Seixas, Noah S.;Checkoway, Harvey
背景自20世纪70年代以来，棉纺织业工人患肺癌的风险降低。细菌内毒素是原棉纤维和棉尘的一种污染物，已被提出作为一种保护剂，可通过先天性和获得性免疫系统发挥作用。我们研究内毒素暴露与肺癌风险之间的关联在一个队列的女性textile workers.Methods我们进行了一项病例队列研究嵌套在一个队列的267400名女性纺织工人在上海，中国。我们比较了从1989年1月1日至1998年12月31日诊断为肺癌的628例患者的累积暴露史，以及与队列中所有癌症患者按5岁年龄组频率匹配的3184名无肺癌参考子队列的累积暴露史。所有参与者的累积内毒素暴露量基于历史测量值和本研究的其他测量值。通过考克斯比例风险模型的风险比（HR）估计相对风险和95%置信区间（Cls）。我们通过使用具有0、5、10、15或20年滞后时间的累积暴露来解释疾病潜伏期，从而进行了确定性-反应趋势分析。所有分析均控制了年龄和吸烟状况。所有的统计学检验都是双侧的。结果内毒素的累积暴露与肺癌风险呈显著负相关。在20年的滞后时间内，反向趋势最大，与未暴露相比，最高内毒素暴露与肺癌风险统计学显著降低40%相关（HR = 0.60，95% CI = 0.43至0.83;五分位数P趋势= 0.002）。据报道，2000年上海市女性肺癌发病率为19.1/100000，在这一人群中，内毒素暴露20年后，肺癌风险估计会降低，该队列中肺癌的发病率降低了约7.6/100000结论：长期高水平暴露于内毒素，与无暴露相比，似乎与该队列中肺癌风险降低相关。
Background Reduced risk of lung cancer among workers in the cotton textile industry has been observed since the 1970s. Bacterial endotoxin, a contaminant of raw cotton fiber and cotton dust, has been proposed as a protective agent that may act through the innate and acquired immune systems. We examine the association between endotoxin exposure and lung cancer risk in a cohort of female textile workers.Methods We conducted a case-cohort study nested within a cohort of 267400 female textile workers in Shanghai, China. We compared the cumulative exposure histories of 628 case patients diagnosed with incident lung cancer from January 1, 1989, through December 31, 1998, with those of a lung cancer-free reference subcohort of 3184 workers who were frequency matched by 5-year age-groups to all cancer patients in the cohort. Cumulative endotoxin exposure for all participants was based on historic measurements and on additional measurements for this study. Relative risks and 95% confidence intervals (Cls) were estimated by hazard ratios (HRs) from Cox proportional hazards models. We conducted exposure-response trend analyses by use of cumulative exposures with lag times of 0, 5, 10, 15, or 20 years to account for disease latency. All analyses controlled for age and smoking status. All statistical tests were two-sided.Results Cumulative exposure to endotoxin was strongly, statistically significantly, and inversely associated with lung cancer risk. The inverse trend was greatest with a 20-year lag time, for which highest endotoxin exposure was associated with a statistically significantly 40% less risk of lung cancer (HR = 0.60, 95% Cl = 0.43 to 0.83; P-trend across quintiles = .002) than nonexposure. From a reported population rate of lung cancer among women in Shanghai of 19.1 per 100000 for the year 2000 and the estimated reduction in risk of lung cancer observed for 20 years of endotoxin exposure in this population of workers, the incidence of lung cancer in this cohort was reduced by approximately 7.6 per 100000 (range = 3.2-10.9 per 100000).Conclusions Long-term and high-level exposure to endotoxin, compared with no exposure, appears to be associated with a reduced risk of lung cancer in this cohort.