Long-term air pollution exposure and mortality outcomes in colorectal cancer patients: Evidence from a multicenter longitudinal study

IF 3 3区医学 Q3 ONCOLOGY

Cancer Epidemiology Pub Date : 2025-12-01 Epub Date: 2025-10-25 DOI:10.1016/j.canep.2025.102948

Chih-Wen Wang , Pinpin Lin , Yu-Cheng Chen , Yueh-Hsia Luo , Chih-Da Wu , Ching-Chun Li , Chun-Hung Richard Lin

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引用次数: 0

Abstract

Background

Limited evidence exists regarding the relationship between air pollution and all-cause mortality in colorectal cancer stratified by clinical stages.

Methods

In this retrospective cohort study, initiated in 2010, we included patients with pathologically confirmed colorectal carcinoma. Each participant's address was geocoded to the corresponding village/borough or township, for accurate matching with estimated air pollution concentrations. The risk of all-cause mortality was assessed using Kaplan–Meier analysis and Cox proportional hazards regression models.

Results

Our study enrolled 5126 colorectal cancer patients, with a median survival time of 72.0 months. Higher exposures were associated with greater all-cause mortality: PM_2.5₅ tertile 3 vs tertile 1—HR 1.32 (95 % CI 1.14–1.52) and SO₂ tertile 3 vs tertile 1—HR 1.22 (95 % CI 1.06–1.40). Stage-stratified results showed PM_2.5 remained significant in stages 0–I (HR 1.62, 95 % CI 1.01–2.58) and III (HR 1.39, 95 % CI 1.11–1.73), whereas SO₂ was significant in stages II (HR 1.62, 95 % CI 1.03–2.53) and III (HR 1.34, 95 % CI 1.07–1.67). In multiplicative interactions, each unit increase in PM_2.5 was linked to a 1 % higher hazard (HR = 1.01; 95 % CI, 1.01–1.02), and each unit increase in SO₂ to a 5 % higher hazard (HR = 1.05; 95 % CI, 1.04–1.05). When stage was included additively, the per-unit effects were larger—7 % for PM_2.5 (HR = 1.07; 95 % CI, 1.05–1.10) and 14 % for SO₂ (HR = 1.14; 95 % CI, 1.11–1.17). Overall, pollutant levels and clinical stage jointly heightened all-cause mortality.

Conclusions

Elevated PM_2.5 and SO₂ exposures were significantly associated with higher all-cause mortality, with effect sizes varying by stage and generally stronger in stages 0–I and II–III. Clinical stage interacted both associations, and joint exposure–stage categories showed higher risks, underscoring the need to reduce pollution exposure in high-risk patients.

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结直肠癌患者长期空气污染暴露与死亡率结局：来自多中心纵向研究的证据

背景：空气污染与按临床分期分层的结直肠癌全因死亡率之间的关系证据有限。方法本回顾性队列研究始于2010年，纳入病理确诊的结直肠癌患者。每个参与者的地址都被地理编码到相应的村/区或乡镇，以便与估计的空气污染浓度准确匹配。采用Kaplan-Meier分析和Cox比例风险回归模型评估全因死亡风险。结果本研究共纳入5126例结直肠癌患者，中位生存期为72.0个月。更高的暴露与更高的全因死亡率相关：PM2.5₅tertile 3 vs tertile 1-HR 1.32（95 % CI 1.14-1.52）和SO₂tertile 3 vs tertile 1-HR 1.22（95 % CI 1.06-1.40）。分期分层结果显示，PM2.5在0-I期（HR 1.62, 95 % CI 1.01-2.58）和III期（HR 1.39, 95 % CI 1.11-1.73）仍然显著，而SO₂在II期（HR 1.62, 95 % CI 1.03-2.53）和III期（HR 1.34, 95 % CI 1.07-1.67）显著。在乘法相互作用中，PM2.5每增加一个单位，危害增加1 % (HR = 1.01; 95 % CI, 1.01 - 1.02)，二氧化硫每增加一个单位，危害增加5 % （HR = 1.05; 95 % CI, 1.04-1.05）。当附加阶段时，单位效应更大，PM2.5为7 % (HR = 1.07; 95 % CI, 1.05-1.10)，二氧化硫为14 % （HR = 1.14; 95 % CI, 1.11-1.17）。总体而言，污染物水平和临床分期共同提高了全因死亡率。结论PM2.5和SO2暴露升高与较高的全因死亡率显著相关，且不同阶段的效应大小不同，一般在0-I期和II-III期更强。临床阶段与这两种关联相互作用，联合暴露阶段类别显示出更高的风险，强调需要减少高风险患者的污染暴露。

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来源期刊

Cancer Epidemiology 医学-肿瘤学

CiteScore

4.50

自引率

3.80%

发文量

200

审稿时长

39 days

期刊介绍： Cancer Epidemiology is dedicated to increasing understanding about cancer causes, prevention and control. The scope of the journal embraces all aspects of cancer epidemiology including: • Descriptive epidemiology • Studies of risk factors for disease initiation, development and prognosis • Screening and early detection • Prevention and control • Methodological issues The journal publishes original research articles (full length and short reports), systematic reviews and meta-analyses, editorials, commentaries and letters to the editor commenting on previously published research.