肺癌与吸烟流行病学研究进展

郑莹Es#matednumbersprevCasesDeaths5-yearprev.CasesDeaths5-yearprev.oredevelopedregionsLessdevelopedregions751UnitedStatesof112America37%38%34%33%36%29%36%38%32%SR%enincreasedbetweenandtheearlysresulDnginagreaterthanincreaseinfemalelungcancermortalitysince1950.Diseasecategory(ICD-9code)MenwomenMenwomenLip’oralCavity’pharynx(140一149)6.32.72.01.910.93.45.12.3OeSophaguSOeSophaguS(150)3.61.31.92.26.84.57.82.8StomaCh(151)1.81.71.01.02.01.51.41.3PanCreaSPanCreaS(157)2.31.31.41.42.32.3Larynx(161)10.08.63.83.114.66.313.05.2TraChea’bronChuS’lung(162)11.45.02.72.623.38.712.74.5Cervixuteri(180)Urinarybladder(188)2.91.82.92.33.32.12.2Kidney’otherurinary(189)1.81.81.41.52.71.71.3ACutemyeloidleukaemia(204一208)1.61.61.01.01.91.31.1CS’CurrentSmokerS;FS’formerSmokerS;ICD-9’InternationalClassificationofDiseases,9thRevision;NA’notappliCable.NaDonalCancerInsDtuteChangesinCigareLeRelatedDiseaseRisksandTheirImplicaDonsrevenDonandControlSmokingandTobaccoControlMonographNoBethesdaMDUSancerInsDtuteNIHPublicaDonNo.97-4213).pTobaccouseinbillionromcountriesananalysisofnationallyrepresentativecrosssectionalhouseholdsurvey))现在吸烟40.00%率%(%男男男男男男女15~1910~2425~2930~3435~3940~4445~4950~5455~5960~6465~6970~74≥75烟草流行及其死亡的模式世界主要国家的肺癌发病趋势——女性Trendsinage-standardizedlungcancerincidenceanddeathratesbysex,UnitedStates,1975–2005AnnualreporttothenaDononthestatusofcancer005,featuringtrendsinlungcancer,tobaccouse,andtobaccocontrol.JNatlCancerInst2008.上海市区肺癌年龄别发上海市区肺癌年龄别发病率趋势10055-599411970197519801985199019952000200520102015女性Cttt0.86%t940-44101970197519801985199019952000200520102015Ct2.64%t1.18%------------tt•平均吸烟量•戒烟前持续时间•开始吸烟年龄•烟草的种类吸烟与终身累积死亡率TheEffectsofaSmokingCessa#onInterven#onon14.5-YearMortality:ARandomizedClinicalTrialortalityratesatyearsbycauseandsmokingstatusRatesweresignicantlydierentforcoronary heartdiseaseCHDcardiovasculardiseaseCVDlungcancerandothercausesofdeath(log-ranktest).AnnInternMed2005;142(4):233-239.doi:10.7326/0003-4819-142-4-200502150-00005–欧美国家10-15%–东南亚女性50%•驱动基因：例如EGFR变异–非吸烟者肺癌–吸烟者肺癌者•被动吸烟者暴露越多EGFR变异越少？异Frenchna#onalcohort(BioCAST/IFCT-1002)TheFrenchCoopera5veThoracicIntergroupCouraudS1,DebieuvreD1,MoreauL1,EurRespirJ.Noimpactofpassivesmokeonthesoma#cprofileoflungcancersinnever-smokers.2015May;45(5):1415-25.doi:10.1183/09031936.00097314.Epub2015Mar5.果的曼哈顿图ABC)。究(GWAS)：烟草相关的易感位点较少