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. 2024 Jun 10;23(1):56.
doi: 10.1186/s12940-024-01094-y.

Air pollution and survival in patients with malignant mesothelioma and asbestos-related lung cancer: a follow-up study of 1591 patients in South Korea

Da-An Huh  1 , Yun-Hee Choi  2 , Lita Kim  3   4 , Kangyeon Park  3   4 , Jiyoun Lee  5 , Se Hyun Hwang  5 , Kyong Whan Moon  4   5 , Min-Sung Kang  6 , Yong-Jin Lee  7   8
Affiliations

Air pollution and survival in patients with malignant mesothelioma and asbestos-related lung cancer: a follow-up study of 1591 patients in South Korea

Da-An Huh et al. Environ Health. .

Abstract

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).

Conclusion: These findings support the hypothesis that air pollution exposure after an asbestos-related cancer diagnosis can negatively affect patient survival.

Keywords: Air pollution; Exposure mixtures; Lung cancer; Malignant mesothelioma; Survival analysis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Restricted cubic spline regression analysis for malignant mesothelioma-related mortality risk with pollutant exposure levels. Hazard ratio (HR, solid lines) and 95% confidence interval (CI, gray area) for risk of malignant mesothelioma-related mortality along with the changes of standardized (A) SO2, (B) CO, (C) NO2, (D) PM10, and (E) PM2.5 exposure levels from the restricted cubic splines regression model. Models were adjusted for age at diagnosis, sex, smoking status, cancer cell type, type of treatment, asbestos exposure modalities, and month of diagnosis
Fig. 2
Fig. 2
Restricted cubic spline regression analysis for the mortality risk of asbestos-related lung cancer with pollutant exposure levels. Hazard ratio (HR, solid lines) and 95% confidence interval (CI, gray area) for risk of asbestos-related lung cancer mortality along with the changes of standardized (A) SO2, (B) CO, (C) NO2, (D) PM10, and (E) PM2.5 exposure levels from the restricted cubic splines regression model. Models were adjusted for age at diagnosis, sex, smoking status, cancer cell type, type of treatment, asbestos exposure modalities, and month of diagnosis
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