Abstract
Globally, air pollution is the fourth leading risk factor for death, while lung cancer (LC) is the leading cause of cancer-related death. The aim of this study was to explore the prognostic factors of LC and the influence of high fine particulate matter (PM2.5) on LC survival. Data on LC patients were collected from 133 hospitals across 11 cities in Hebei Province from 2010 to 2015, and survival status was followed up until 2019. The personal PM2.5 exposure concentration (μg/m3) was matched according to the patient’s registered address, calculated from a 5-year average for every patient, and stratified into quartiles. The Kaplan–Meier method was used to estimate overall survival (OS), and Cox’s proportional hazard regression model was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). The 1-, 3-, and 5-year OS rates of the 6429 patients were 62.9%, 33.2%, and 15.2%, respectively. Advanced age (75 years or older: HR = 2.34, 95% CI: 1.25–4.38), subsite at overlapping (HR = 4.35, 95% CI: 1.70–11.1), poor/undifferentiated differentiation (HR = 1.71, 95% CI: 1.13–2.58), and advanced stages (stage III: HR = 2.53, 95% CI: 1.60–4.00; stage IV: HR = 4.00, 95% CI: 2.63–6.09) were risk factors for survival, while receiving surgical treatment was a protective factor (HR = 0.60, 95% CI: 0.44–0.83). Patients exposed to light pollution had the lowest risk of death with a 26-month median survival time. The risk of death in LC patients was greatest at PM2.5 concentrations of 98.7–108.9 μg/m3, especially for patients at advanced stage (HR = 1.43, 95% CI: 1.29–1.60). Our study indicates that the survival of LC is severely affected by relatively high levels of PM2.5 pollution, especially in those with advanced-stage cancer.
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Data availability
Due to privacy concerns of the cohort and patients in the follow-up phase, the datasets created and/or analyzed during this study are not publicly available. However, upon reasonable request, these can be obtained from the associated authors.
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Acknowledgments
We gratefully thank the 133 hospitals including the Fourth Hospital of Hebei Medical University, for their cooperation with regard to providing, sorting, and verifying the cancer data.
Funding
This work was supported by the Key Research and Development Program of Hebei Province (grant numbers 22377716D).
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All authors contributed to the study conception and design. Yanyu Liu: formal analysis, visualization, methodology, and writing—original draft. Daojuan Li: data curation and project administration. Meng Ren: software acquisition and validation. Feng Qu: investigation and supervision. Yutong He: conceptualization, resource acquisition, funding acquisition, and writing—review and editing. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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The study was approved by the Ethics Committee of the Fourth Hospital of Hebei Medical University. All the participants signed a free and informed consent form.
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Supplementary Information
Figure S1.
Kaplan Meier curves representing the overall survival of the investigated LC patients based on individual factors. (PNG 5237 kb)
Figure S2.
Kaplan Meier curves representing the overall survival of the investigated LC patients based on lifestyle factors. (PNG 4421 kb)
Figure S3.
Kaplan Meier curves representing the overall survival of the investigated LC patients based on the tumor characteristics. (PNG 5091 kb)
Figure S4.
Kaplan Meier curves representing the overall survival of the investigated LC patients based on the types of tumor treatment. (PNG 3528 kb)
Figure S5.
Relationship between PM2.5 and LC survival times. (PNG 213 kb)
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Liu, Y., Li, D., Ren, M. et al. Effect of high-level PM2.5 on survival in lung cancer: a multicenter cohort study from Hebei Province, China. Environ Sci Pollut Res 30, 82094–82106 (2023). https://doi.org/10.1007/s11356-023-28147-y
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DOI: https://doi.org/10.1007/s11356-023-28147-y