Julia Krabbe, Katja Maria Steffens, Sarah Drießen, Thomas Kraus
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引用次数: 0
Abstract
Background: Molecular pathways found to be important in pulmonary fibrosis are also involved in cancer pathogenesis, suggesting common pathways in the development of pulmonary fibrosis and lung cancer.
Research question: Is pulmonary fibrosis from exposure to occupational carcinogens an independent risk factor for lung cancer?
Study design and methods: A comprehensive search of PubMed, Embase, Web of Science and Cochrane databases with over 100 search terms regarding occupational hazards causing pulmonary fibrosis was conducted. After screening and extraction, quality of evidence and eligibility criteria for meta-analysis were assessed. Meta-analysis was performed using a random-effects model.
Results: 52 studies were identified for systematic review. Meta-analysis of subgroups identified silicosis as a risk factor for lung cancer when investigating odds ratios for silicosis in autopsy studies (OR 1.47, 95% CI 1.13-1.90) and for lung cancer mortality in patients with silicosis (OR 3.21, 95% CI 2.67-3.87). Only considering studies with an adjustment for smoking as a confounder identified a significant increase in lung cancer risk (OR 1.58, 95% CI 1.34-1.87). However, due to a lack of studies including cumulative exposure, no adjustments could be included. In a qualitative review, no definitive conclusion could be reached for asbestosis and silicosis as independent risk factors for lung cancer, partly because the studies did not take cumulative exposure into account.
Interpretation: This systematic review confirms the current knowledge regarding asbestosis and silicosis, indicating a higher risk of lung cancer in exposed individuals compared to exposed workers without fibrosis. These individuals should be monitored for lung cancer, especially when asbestosis or silicosis is present.
背景：在肺纤维化中发现的重要分子通路也参与了癌症的发病过程，这表明肺纤维化和肺癌的发病过程存在共同的通路：研究问题：接触职业致癌物导致的肺纤维化是否是肺癌的独立风险因素？对 PubMed、Embase、Web of Science 和 Cochrane 数据库中 100 多个有关职业危害导致肺纤维化的检索词进行了全面检索。经过筛选和提取后，对证据质量和荟萃分析的资格标准进行了评估。采用随机效应模型进行荟萃分析：共确定了 52 项研究进行系统性审查。在调查尸检研究中矽肺的几率比（OR 1.47，95% CI 1.13-1.90）和矽肺患者肺癌死亡率的几率比（OR 3.21，95% CI 2.67-3.87）时，亚组的荟萃分析确定矽肺是肺癌的危险因素。只有将吸烟作为混杂因素进行调整的研究才发现肺癌风险显著增加（OR 1.58，95% CI 1.34-1.87）。然而，由于缺乏包括累积暴露的研究，因此无法纳入调整因素。在一项定性综述中，对于石棉沉滞症和矽肺作为肺癌独立风险因素的说法，无法得出明确的结论，部分原因是这些研究没有将累积暴露考虑在内：本系统综述证实了目前有关石棉沉滞症和矽肺病的知识，表明与没有纤维化的接触工人相比，接触石棉沉滞症和矽肺病的人患肺癌的风险更高。应对这些人进行肺癌监测，尤其是在存在石棉沉滞症或矽肺病的情况下。
期刊介绍：
The European Respiratory Review (ERR) is an open-access journal published by the European Respiratory Society (ERS), serving as a vital resource for respiratory professionals by delivering updates on medicine, science, and surgery in the field. ERR features state-of-the-art review articles, editorials, correspondence, and summaries of recent research findings and studies covering a wide range of topics including COPD, asthma, pulmonary hypertension, interstitial lung disease, lung cancer, tuberculosis, and pulmonary infections. Articles are published continuously and compiled into quarterly issues within a single annual volume.
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