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. 2016 Oct;71(10):891-8.
doi: 10.1136/thoraxjnl-2015-207927. Epub 2016 Aug 4.

Air pollution affects lung cancer survival

Sandrah P Eckel  1 , Myles Cockburn  1 , Yu-Hsiang Shu  2 , Huiyu Deng  1 , Frederick W Lurmann  3 , Lihua Liu  1 , Frank D Gilliland  1
Affiliations

Air pollution affects lung cancer survival

Sandrah P Eckel et al. Thorax. 2016 Oct.

Abstract

Rationale: Exposure to ambient air pollutants has been associated with increased lung cancer incidence and mortality, but due to the high case fatality rate, little is known about the impacts of air pollution exposures on survival after diagnosis. This study aimed to determine whether ambient air pollutant exposures are associated with the survival of patients with lung cancer.

Methods: Participants were 352 053 patients with newly diagnosed lung cancer during 1988-2009 in California, ascertained by the California Cancer Registry. Average residential ambient air pollutant concentrations were estimated for each participant's follow-up period. Cox proportional hazards models were used to estimate HRs relating air pollutant exposures to all-cause mortality overall and stratified by stage (localised only, regional and distant site) and histology (squamous cell carcinoma, adenocarcinoma, small cell carcinoma, large cell carcinoma and others) at diagnosis, adjusting for potential individual and area-level confounders.

Results: Adjusting for histology and other potential confounders, the HRs associated with 1 SD increases in NO2, O3, PM10, PM2.5 for patients with localised stage at diagnosis were 1.30 (95% CI 1.28 to 1.32), 1.04 (95% CI 1.02 to 1.05), 1.26 (95% CI 1.25 to 1.28) and 1.38 (95% CI 1.35 to 1.41), respectively. Adjusted HRs were smaller in later stages and varied by histological type within stage (p<0.01, except O3). The largest associations were for patients with early-stage non-small cell cancers, particularly adenocarcinomas.

Conclusions: These epidemiological findings support the hypothesis that air pollution exposures after lung cancer diagnosis shorten survival. Future studies should evaluate the impacts of exposure reduction.

Keywords: Clinical Epidemiology; Lung Cancer.

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Figures

Figure 1
Figure 1. Adjusteda hazard ratios and 95% confidence intervals for all-cause mortality associated with a standard deviation (SD) increase in air pollutant exposure,bc stratified by stage and histology at diagnosis
aAdjusted for age, sex, race/ethnicity, marital status, education index, SES, RUCA, distance to primary interstate highway, distance to primary US and State highways, month of diagnosis, year of diagnosis, and initial treatment bSD values: 10.2 ppb for NO2, 11.9 ppb for O3, 12.1 μg/m3 for PM10, and 5.3 μg/m3 for PM2.5 cPM2.5 results are only for the subset of patients whose cancer was diagnosed in 1998 or later
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References

    1. Schottenfeld D, Fraumeni J. Cancer Epidemiology and Prevention. New York: Oxford University Press;
    1. Alberg AJ, Brock MV, Samet JM. Epidemiology of lung cancer: looking to the future. J Clin Oncol. 2005;23(14):3175–3185. - PubMed
    1. Kanodra NM, Silvestri GA, Tanner NT. Screening and early detection efforts in lung cancer. Cancer. 2015;121(9):1347–1356. - PubMed
    1. Pilkington G, Boland A, Brown T, Oyee J, Bagust A, Dickson R. A systematic review of the clinical effectiveness of first-line chemotherapy for adult patients with locally advanced or metastatic non-small cell lung cancer. Thorax. 2015;70(4):359–367. - PubMed
    1. Rosell R, Karachaliou N. Lung cancer in 2014: Optimizing lung cancer treatment approaches. Nat Rev Clin Oncol. 2015;12(2):75–76. - PubMed

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