RT Journal Article
SR Electronic
T1 Air pollution affects lung cancer survival
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 891
OP 898
DO 10.1136/thoraxjnl-2015-207927
VO 71
IS 10
A1 Sandrah P Eckel
A1 Myles Cockburn
A1 Yu-Hsiang Shu
A1 Huiyu Deng
A1 Frederick W Lurmann
A1 Lihua Liu
A1 Frank D Gilliland
YR 2016
UL http://thorax.bmj.com/content/71/10/891.abstract
AB 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.