Chronic obstructive pulmonary disease is associated with lung cancer mortality in a prospective study of never smokers
Chronic obstructive pulmonary disease is associated with lung cancer mortality in a prospective study of never smokers
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DOI：
10.1164/rccm.200612-1792oc
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发表时间：
2007-08-01
影响因子：
24.7
通讯作者：
Thun, Michael J.
中科院分区：
文献类型：
--
作者：
Turner, Michelle C.;Chen, Yue;Thun, Michael J.
理由：一些研究表明，以前的肺部疾病可能会增加患肺癌的风险。在一般人群中，澄清既往肺部疾病与肺癌风险之间的关系是很重要的。目的：美国一项前瞻性研究对448,600名基线无癌症的终身不吸烟者进行了调查，研究了自我报告的医生诊断的慢性支气管炎和肺气肿与肺癌死亡率之间的关系。方法：在1982年至2002年的20年随访期间，发生了1759例肺癌死亡。使用Cox比例风险模型获得肺癌死亡率与慢性支气管炎和肺气肿相关以及这两种疾病的校正风险比（hr）。测量结果和主要结果：肺癌死亡率与肺气肿（HR, 1.66； 95%可信区间[CI]， 1.06, 2.59）以及肺气肿和慢性支气管炎的联合终点（HR, 2.44, 95% Cl, 1.22, 4.90）在男性和女性的联合分析中均显著相关。在整体分析中，未观察到单独与慢性支气管炎相关（HR, 0.96; 95% Cl, 0.72, 1.28），尽管男性的相关性（HR, 1.59; 95% Cl, 0.95,2.66）强于女性（HR, 0.82; 95% Cl, 0.58, 1.16；相互作用p， 0.04）。在排除早期随访的分析中，肺气肿和肺癌之间的关联更强。结论：这项大型前瞻性研究加强了肺癌风险增加与非恶性肺部疾病，特别是肺气肿相关的证据，即使在终身不吸烟的人群中也是如此。
Rationale: Several studies have suggested that previous lung disease may increase the risk of lung cancer. It is important to clarify the association between previous lung disease and lung cancer risk in the general population.Objectives: The association between self-reported physician-diagnosed chronic bronchitis and emphysema and lung cancer mortality was examined in a U.S. prospective study of 448,600 lifelong nonsmokers who were cancer-free at baseline.Methods: During the 20-year follow-up period from 1982 to 2002, 1,759 lung cancer deaths occurred. Cox proportional hazards models were used to obtain adjusted hazard ratios (HRs) for lung cancer mortality associated with chronic bronchitis and emphysema as well as for both of these diseases together.Measurements and Main Results: Lung cancer mortality was significantly associated with both emphysema (HR, 1.66; 95% confidence interval [CI], 1.06, 2.59) and with the combined endpoint of emphysema and chronic bronchitis (HR, 2.44, 95% Cl, 1.22, 4.90) in analyses that combined men and women. No association was observed with chronic bronchitis alone (HR, 0.96; 95% Cl, 0.72, 1.28) in the overall analysis, although the association was stronger in men (HR, 1.59; 95% Cl, 0.95,2.66) than women (HR, 0.82; 95% Cl, 0.58, 1.16; p for interaction, 0.04). The association between emphysema and lung cancer was stronger in analyses that excluded early years of follow-up.Conclusions: This large prospective study strengthens the evidence that increased lung cancer risk is associated with nonmalignant pulmonary conditions, especially emphysema, even in lifelong nonsmokers.