肺癌术后康复期间的野火暴露与总生存期的关系

SCI

5 August 2023

Association of Wildfire Exposure While Recovering From Lung Cancer Surgery With Overall Survival 

（JAMA Oncology, IF: 28.4）

Danlu Zhang; Yuzhi Xi; Daniel J. Boffa; Yang Liu; Leticia M. Nogueira

CORRESPONDENCE TO: leticia. nogueira@cancer.org

IMPORTANCE 重要性

With a changing climate, wildfire activity in the US has increased dramatically, presenting multifaceted and compounding health hazards. Individuals discharged from the hospital following surgical resection of non–small cell lung cancer (NSCLC) are potentially at higher risk from wildfires’ health hazards.

随着气候的变化，美国的野火急剧增加，对健康造成了多方面和复杂的危害。非小细胞肺癌（NSCLC）术后出院的病人可能面临野火对健康造成危害的更高风险。

OBJECTIVE 目的  

To assess the association between wildfire exposure and postoperative long-term overall survival among patients with lung cancer in the US. 

评估美国肺癌患者野火暴露与术后长期总生存率之间的关系。

DESIGN, SETTING, AND PARTICIPANTS 设计和参与者  

In this cohort study, individuals who underwent curative-intent NSCLC resection between January 1, 2004, and December 31, 2019, were selected from the National Cancer Database. Daily wildfire information was aggregated at the zip code level from the National Aeronautics and Space Administration Fire Information for Resource Management System. The data analysis was performed between July 19, 2022, and April 14, 2023. 

在这项队列研究中，从美国国家癌症数据库中选取了2004-1-1至2019-12-31期间NSCLC根治性切除术的患者。野火信息是从美国国家航空航天局的资源管理火灾信息系统中按邮政编码汇总的。

EXPOSURE 暴露  

An active wildfire detected at the zip code of residence between 0 and 3, 4 and 6, or 7 and 12 months after NSCLC surgery.

术后 0 至 3 个月、4 至 6 个月或 7 至 12 个月期间，在居住地的邮政编码中检测到野火。

MAIN OUTCOME 主要结果  

Overall survival was defined as the interval between age at hospital discharge and age at death, last contact, or study end, whichever came first. Cox proportional hazards were used for estimating hazard ratios (HRs) adjusted for sex, region, metropolitan category, health insurance type, comorbidities, tumor size, lymph node involvement, era, and facility type. 

总生存期定义为出院年龄与死亡年龄、最后一次接触年龄或研究结束年龄之间的时间间隔，以时间在先者为准。在估算危险比时采用了Cox模型，并对性别、地区、城市类别、医疗保险类型、合并症、肿瘤大小、淋巴结受累情况、年代和医疗机构类型进行了调整。

RESULTS 结果  

A total of 466 912 individuals included in the study (249 303 female and [53.4] and 217 609 male [46.6%]; mean [SD] age at diagnosis, 67.3 [9.9] years), with 48 582 (10.4%) first exposed to a wildfire between 0 and 3 months, 48 328 (10.6%) between 4 and 6 months, and 71 735 (15.3%) between 7 and 12 months following NSCLC surgery. Individuals exposed to a wildfire within 3 months (adjusted HR [AHR], 1.43; 95% CI, 1.41-1.45), between 4 and 6 months (AHR, 1.39; 95% CI, 1.37-1.41), and between 7 and 12 months (AHR, 1.17; 95% CI, 1.15-1.19) after discharge from the hospital following stage I to III NSCLC resection had worse overall survival than unexposed individuals. 

共有 466 912 人（女性 249 303 人 [53.4%]，男性 217 609 人 [46.6%]；诊断时的平均 [SD] 年龄为 67.3 [9.9] 岁）参与了这项研究，其中 48 582 人（10.4%）在 NSCLC 术后的 0 至 3 个月内首次暴露于野火，48328 人（10.6%）在 4 至 6 个月内首次暴露于野火，71 735 人（15.3%）在 7 至 12 个月内首次暴露于野火。I期至III期NSCLC术后出院后3个月内遭遇野火（调整后HR [AHR]，1.43；95% CI，1.41-1.45）、4个月至6个月内（AHR，1.39；95% CI，1.37-1.41）以及7个月至12个月内（AHR，1.17；95% CI，1.15-1.19）遭遇野火的患者的总生存率低于未遭遇野火的患者。

CONCLUSIONS 结论  

In this cohort study, wildfire exposure was associated with worse overall survival following NSCLC surgical resection, suggesting that patients with lung cancer are at greater risk from the health hazards of wildfires and need to be prioritized in climate adaptation efforts. 

在这项队列研究中，野火暴露与 NSCLC术后较差的总生存率有关，这表明肺癌患者面临野火危害健康的更大风险，需要在气候适应方面优先考虑。

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