Tobacco smoking and some types of occupational exposures have consistently been considered as important etiologic factors of lung cancer in industrial countries. At the First World Conference of Lung Cancer (Wyndwer, ...Tobacco smoking and some types of occupational exposures have consistently been considered as important etiologic factors of lung cancer in industrial countries. At the First World Conference of Lung Cancer (Wyndwer, 1983), it was stressed that more attention should be paid to finding out the causes of lung cancer in non-smokers.In Xuanwei County, Yunnan Province, annual lung cancer death rate was 27.7 per 100,000 in males, among China's highest, and 25.3 per 100,000 in females, the China's highest. The female's lung cancer death rate in Xuanwei County was even much higher than that of the same period in USA white women (ECACM, 1979; Mulvihill, 1976). Marked district variation in cancer mortality exists within Xuanwei County. The county can be divided into high-, medium- and low-mortality areas. Over 90% of the population arc farmers. The local residents traditionally burned three major kinds of fuels: 'smoky' coal, 'smokeless' coal and 'wood', for heating and cooking. The three lung cancer high mortality areas, including 'Chengguan', 'Rongcheng' and 'Laibin' communes, mainly burned the 'smoky' coal from Laibin smoky-coal mine. The fuel was burned in a shallow, unventilated fire pit in the floor of the dwelling. Fuel burning in shallow unventilated pits has resulted in high indoor air pollution levels. The concentrations of airborne particles (pm 10) inside houses during smoky coal and wood combustion were very high. Indoor concentration of suspended particulates and dichloromethane extractable organics were 24.4mg/m3 and 17.6mg/m3 in burning of 'smoky' coal; 22.3mg/m3, 12.3mg/m3 for burning wood; and 1.8mg/m3, O.Smg/m-1 for burning of smokeless coals. Levels of individual polycyclic aromatic hydrocarbons, including benzo(a)pyrene, were generally highest during burning of smoky coal, intermediate in burning wood, and least in smokeless coal. Women did most household chores, which include starting fire and cooking. Less than 0.2% of females smoked tobacco. The population-based case-control study presented here is 展开更多
背景与目的云南东部农村地区宣威市、富源县女性居民主要从事农业生产和家务工作,基本不吸烟,但肺癌死亡率却是世界上最高的,而且发病、死亡年龄提前。本研究对宣威、富源非吸烟女性肺癌生存状况及其影响因素进行分析。方法以2006年-201...背景与目的云南东部农村地区宣威市、富源县女性居民主要从事农业生产和家务工作,基本不吸烟,但肺癌死亡率却是世界上最高的,而且发病、死亡年龄提前。本研究对宣威、富源非吸烟女性肺癌生存状况及其影响因素进行分析。方法以2006年-2010年被当地省、市、县9家医院新诊断、并纳入"非吸烟女性肺癌病例对照研究项目"的常住户籍女性肺癌病例为研究对象随访至2016年末。通过Life-table法进行全部病例生存分析,评估人群相对生存率和年龄别标化相对生存率。应用Kaplan-Meier法和Cox比例风险模型分别进行单因素生存分析、分层分析和多因素分析。结果随访的1,250例病例中,死亡1,075例,删失175例,随访中位时间为69个月(95%CI:61.9-76.0)。病例平均年龄(54.8±10.9)岁,I期、II期、III期、IV期和未知分期分别占3.5%、8.7%、20.7%、29.7%和37.4%;手术、非手术治疗和未治疗分别占17. 2%、39.0%和43. 8%,组织学、细胞学诊断占51.6%。中位生存时间13.2个月,5年观察生存率、相对生存率、年龄标化相对生存率分别为8.9%(95%CI:7.0-10.6)、9.4%(95%CI:7.6-11.5)和10.1%(95%CI:3.7-20.5)。I期、II期、III期、IV期、未分期5年生存率分别为41.1%、22.4%、5. 3%、1. 3%、11.2%;手术治疗、非手术治疗、未治疗分别为34.8%和3.2%、4.7%;腺癌、鳞癌分别为17.9%和5.6%。省级医院治疗、X线胸部筛查、非农民职业、城镇居住、65岁以下年龄等因素有利于提高生存率,而市县级医院治疗、农民职业、乡村居住、65岁以上年龄等则生存率较低。分层分析显示,任意原发灶-淋巴结-远处转移(tumornode-met a st a si s,T N M)分期,无论腺癌或鳞癌患者,行手术治疗的生存率明显高于非手术治疗;与未治疗病例相比非手术治疗仅在III期显示差异;腺癌生存率大于鳞癌不仅仅因为早期和手术病例较多,在III期、未分期也显示明显生存优势。不同级别展开更多
文摘Tobacco smoking and some types of occupational exposures have consistently been considered as important etiologic factors of lung cancer in industrial countries. At the First World Conference of Lung Cancer (Wyndwer, 1983), it was stressed that more attention should be paid to finding out the causes of lung cancer in non-smokers.In Xuanwei County, Yunnan Province, annual lung cancer death rate was 27.7 per 100,000 in males, among China's highest, and 25.3 per 100,000 in females, the China's highest. The female's lung cancer death rate in Xuanwei County was even much higher than that of the same period in USA white women (ECACM, 1979; Mulvihill, 1976). Marked district variation in cancer mortality exists within Xuanwei County. The county can be divided into high-, medium- and low-mortality areas. Over 90% of the population arc farmers. The local residents traditionally burned three major kinds of fuels: 'smoky' coal, 'smokeless' coal and 'wood', for heating and cooking. The three lung cancer high mortality areas, including 'Chengguan', 'Rongcheng' and 'Laibin' communes, mainly burned the 'smoky' coal from Laibin smoky-coal mine. The fuel was burned in a shallow, unventilated fire pit in the floor of the dwelling. Fuel burning in shallow unventilated pits has resulted in high indoor air pollution levels. The concentrations of airborne particles (pm 10) inside houses during smoky coal and wood combustion were very high. Indoor concentration of suspended particulates and dichloromethane extractable organics were 24.4mg/m3 and 17.6mg/m3 in burning of 'smoky' coal; 22.3mg/m3, 12.3mg/m3 for burning wood; and 1.8mg/m3, O.Smg/m-1 for burning of smokeless coals. Levels of individual polycyclic aromatic hydrocarbons, including benzo(a)pyrene, were generally highest during burning of smoky coal, intermediate in burning wood, and least in smokeless coal. Women did most household chores, which include starting fire and cooking. Less than 0.2% of females smoked tobacco. The population-based case-control study presented here is
文摘背景与目的云南东部农村地区宣威市、富源县女性居民主要从事农业生产和家务工作,基本不吸烟,但肺癌死亡率却是世界上最高的,而且发病、死亡年龄提前。本研究对宣威、富源非吸烟女性肺癌生存状况及其影响因素进行分析。方法以2006年-2010年被当地省、市、县9家医院新诊断、并纳入"非吸烟女性肺癌病例对照研究项目"的常住户籍女性肺癌病例为研究对象随访至2016年末。通过Life-table法进行全部病例生存分析,评估人群相对生存率和年龄别标化相对生存率。应用Kaplan-Meier法和Cox比例风险模型分别进行单因素生存分析、分层分析和多因素分析。结果随访的1,250例病例中,死亡1,075例,删失175例,随访中位时间为69个月(95%CI:61.9-76.0)。病例平均年龄(54.8±10.9)岁,I期、II期、III期、IV期和未知分期分别占3.5%、8.7%、20.7%、29.7%和37.4%;手术、非手术治疗和未治疗分别占17. 2%、39.0%和43. 8%,组织学、细胞学诊断占51.6%。中位生存时间13.2个月,5年观察生存率、相对生存率、年龄标化相对生存率分别为8.9%(95%CI:7.0-10.6)、9.4%(95%CI:7.6-11.5)和10.1%(95%CI:3.7-20.5)。I期、II期、III期、IV期、未分期5年生存率分别为41.1%、22.4%、5. 3%、1. 3%、11.2%;手术治疗、非手术治疗、未治疗分别为34.8%和3.2%、4.7%;腺癌、鳞癌分别为17.9%和5.6%。省级医院治疗、X线胸部筛查、非农民职业、城镇居住、65岁以下年龄等因素有利于提高生存率,而市县级医院治疗、农民职业、乡村居住、65岁以上年龄等则生存率较低。分层分析显示,任意原发灶-淋巴结-远处转移(tumornode-met a st a si s,T N M)分期,无论腺癌或鳞癌患者,行手术治疗的生存率明显高于非手术治疗;与未治疗病例相比非手术治疗仅在III期显示差异;腺癌生存率大于鳞癌不仅仅因为早期和手术病例较多,在III期、未分期也显示明显生存优势。不同级别