吸烟对男性肺癌患者组织学分型的影响及其趋势分析

Effect of Smoking on Lung Cancer Histology and Its Epidemiology in Chinese Male

背景与目的已有的研究发现我国肺癌患者的组织学亚型分布有变化。本研究旨在探讨吸烟对我国男性肺癌患者组织学分型的影响及变化趋势。方法收集和整理2000年-2012年中国医学科学院肿瘤医院诊治的男性肺癌患者人口学、吸烟史、组织学等信息,用年度百分比变化(annual percentage change,APC)进行趋势检验。结果入选肺癌14,106例,其中吸烟11,750例,不吸烟2,356例。吸烟患者中,鳞癌的比例为39.38%,腺癌29.85%;2000年-2012年,鳞癌比例从44.19%下降至35.50%(APC=-1.9%,P<0.001);腺癌从15.25%上升至41.85%(APC=6.8%,P<0.001);腺鳞癌从4.13%降低至0.72%(APC=-14.9%,P<0.001)。不吸烟患者中,腺癌53.86%,鳞癌16.64%;腺癌从38.03%上升至67.83%(APC=4.3%,P<0.001);大细胞癌和腺鳞癌呈波动变化。结论肺腺癌在男性吸烟和非吸烟肺癌患者中的比例均显著上升,其非吸烟因素暴露与肺癌的关系应进一步深入研究。

Background and objective Studies found that there were changes in histological subtypes of lung cancer patients in China. This study investigated the effect of smoking on lung cancer histology and its trend in Chinese male. Methods Demographic, smoking history and histological information about male lung cancer patients diagnosed or treated from 2000 to 2012 was collected from Cancer Hospital, Chinese Academy of Medical Science. Trends of histological subtypes calculated with annual percentage change（APC）. Results A total of 14,106 patients with lung cancer were enrolled, with smoking 11,750 cases and non-smoking 2,356 cases. The main histological type of smoking lung cancer was squamous cell carcinoma（SCC）（39.38%）, followed by adenocarcinoma（ADC）（29.85%）. Among smokers, the proportion of SCC decreased from 44.19% to 35.50%（APC=-1.9%, P〈0.001）, however, the ADC increased from 15.25% to 41.85%（APC=6.8%, P〈0.001）. Adenosquamous carcinoma（ASC） was from 4.13% to 0.72%（APC=-14.9%, P〈0.001）. In non-smokers, the ADC was 53.86%, and SCC was 16.64%. ADC increased from 38.03% to 67.83%（APC=4.3%, P〈0.001）. Distributions of LCC and ASC were scattered. Conclusion Proportion of ADC increased significantly in smoking and non-smoking lung cancer patients, and the relationship between non-smoking factor exposure and lung cancer should be further studied.