Associations of chest X-ray trajectories, smoking, and the risk of lung cancer in two population-based cohort studies
ObjectivesDespite the increasing use of computed tomography (CT), chest X-ray (CXR) remains the first-line investigation for suspected lung cancer (LC) in primary care. However, the associations of CXR trajectories, smoking and LC risk remain unknown.MethodsA total of 52,486 participants from the PL...
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Frontiers Media S.A.
2023-07-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1203320/full |
| _version_ | 1797777718516908032 |
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| author | Ya Liu Zhuowei Feng Zeyu Fan Yu Zhang Chenyang Li Xiaomin Liu Hongyuan Duan Xiaonan Cui Liwen Zhang Chao Sheng Lei Yang Ying Gao Xing Wang Qing Zhang Zhangyan Lyu Fangfang Song Yubei Huang Fengju Song |
| author_facet | Ya Liu Zhuowei Feng Zeyu Fan Yu Zhang Chenyang Li Xiaomin Liu Hongyuan Duan Xiaonan Cui Liwen Zhang Chao Sheng Lei Yang Ying Gao Xing Wang Qing Zhang Zhangyan Lyu Fangfang Song Yubei Huang Fengju Song |
| author_sort | Ya Liu |
| collection | DOAJ |
| description | ObjectivesDespite the increasing use of computed tomography (CT), chest X-ray (CXR) remains the first-line investigation for suspected lung cancer (LC) in primary care. However, the associations of CXR trajectories, smoking and LC risk remain unknown.MethodsA total of 52,486 participants from the PLCO and 22,194 participants from the NLST were included. The associations of CXR trajectories with LC risk were evaluated with multivariable COX regression models and pooled with meta-analyses. Further analyses were conducted to explore the stratified associations by smoking status and the factors associated with progression and regression in CXR.ResultsCompared to stable negative CXR (CXRSN), HRs (95%CIs) of LC incidence were 2.88(1.50–5.52), 3.86(2.03–7.35), and 1.08(0.80–1.46) for gain of positive CXR (CXRGP), stable positive CXR (CXRSP), and loss of positive CXR (CXRLP), while the risk of LC mortality were 1.58(1.33–1.87), 2.56(1.53–4.29), and 1.05(0.89–1.25). Similar trends were observed across different smoking status. However, LC risk with CXRGP overweighed that with CXRSP among ever smokers [2.95(2.25–3.88) vs. 2.59(1.33–5.02)] and current smokers [2.33(1.70–3.18) vs. 2.26(1.06–4.83)]. Moreover, compared to CXRSN among never smokers, even no progression in CXR, the HRs(95%CIs) of LC incidence were 7.39(5.60–9.75) and 31.45(23.58–41.95) for ever and current smokers, while risks of LC mortality were 6.30(5.07–7.81) and 27.17(21.65–34.11). If participants gained positive CXR, LC incidence risk significantly climbed to 22.04(15.37–31.60) and 71.97(48.82–106.09) for ever and current smokers, while LC mortality risk climbed to 11.90(8.58–16.50) and 38.92(27.04–56.02). CXRLP was associated with decreased LC risk. However, even smokers lost their positive CXR, and the increased risks of LC incidence and mortality did not decrease to non-significant level. Additionally, smoking was significantly associated with increased risk of CXRGP but not CXRLP.ConclusionLC risk differed across CXR trajectories and would be modified by smoking status. Comprehensive intervention incorporating CXR trajectories and smoking status should be recommended to reduce LC risk. |
| first_indexed | 2024-03-12T23:07:42Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-12T23:07:42Z |
| publishDate | 2023-07-01 |
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| series | Frontiers in Oncology |
| spelling | doaj.art-8664507333f4412595daf9cbfcfaa7522023-07-18T10:17:22ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-07-011310.3389/fonc.2023.12033201203320Associations of chest X-ray trajectories, smoking, and the risk of lung cancer in two population-based cohort studiesYa Liu0Zhuowei Feng1Zeyu Fan2Yu Zhang3Chenyang Li4Xiaomin Liu5Hongyuan Duan6Xiaonan Cui7Liwen Zhang8Chao Sheng9Lei Yang10Ying Gao11Xing Wang12Qing Zhang13Zhangyan Lyu14Fangfang Song15Yubei Huang16Fengju Song17Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, ChinaDepartment of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, ChinaDepartment of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, ChinaDepartment of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, ChinaDepartment of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, ChinaDepartment of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, ChinaDepartment of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, ChinaDepartment of Radiology, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin, ChinaHebei Key Laboratory of Environment and Human Health, Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, ChinaDepartment of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, ChinaKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital and Institute, Beijing, ChinaHealth Management Center, Tianjin Medical University General Hospital, Tianjin, ChinaHealth Management Center, Tianjin Medical University General Hospital, Tianjin, ChinaHealth Management Center, Tianjin Medical University General Hospital, Tianjin, ChinaDepartment of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, ChinaDepartment of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, ChinaDepartment of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, ChinaDepartment of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, ChinaObjectivesDespite the increasing use of computed tomography (CT), chest X-ray (CXR) remains the first-line investigation for suspected lung cancer (LC) in primary care. However, the associations of CXR trajectories, smoking and LC risk remain unknown.MethodsA total of 52,486 participants from the PLCO and 22,194 participants from the NLST were included. The associations of CXR trajectories with LC risk were evaluated with multivariable COX regression models and pooled with meta-analyses. Further analyses were conducted to explore the stratified associations by smoking status and the factors associated with progression and regression in CXR.ResultsCompared to stable negative CXR (CXRSN), HRs (95%CIs) of LC incidence were 2.88(1.50–5.52), 3.86(2.03–7.35), and 1.08(0.80–1.46) for gain of positive CXR (CXRGP), stable positive CXR (CXRSP), and loss of positive CXR (CXRLP), while the risk of LC mortality were 1.58(1.33–1.87), 2.56(1.53–4.29), and 1.05(0.89–1.25). Similar trends were observed across different smoking status. However, LC risk with CXRGP overweighed that with CXRSP among ever smokers [2.95(2.25–3.88) vs. 2.59(1.33–5.02)] and current smokers [2.33(1.70–3.18) vs. 2.26(1.06–4.83)]. Moreover, compared to CXRSN among never smokers, even no progression in CXR, the HRs(95%CIs) of LC incidence were 7.39(5.60–9.75) and 31.45(23.58–41.95) for ever and current smokers, while risks of LC mortality were 6.30(5.07–7.81) and 27.17(21.65–34.11). If participants gained positive CXR, LC incidence risk significantly climbed to 22.04(15.37–31.60) and 71.97(48.82–106.09) for ever and current smokers, while LC mortality risk climbed to 11.90(8.58–16.50) and 38.92(27.04–56.02). CXRLP was associated with decreased LC risk. However, even smokers lost their positive CXR, and the increased risks of LC incidence and mortality did not decrease to non-significant level. Additionally, smoking was significantly associated with increased risk of CXRGP but not CXRLP.ConclusionLC risk differed across CXR trajectories and would be modified by smoking status. Comprehensive intervention incorporating CXR trajectories and smoking status should be recommended to reduce LC risk.https://www.frontiersin.org/articles/10.3389/fonc.2023.1203320/fulllung cancerchest X-raytrajectorysmokingincidencemortality |
| spellingShingle | Ya Liu Zhuowei Feng Zeyu Fan Yu Zhang Chenyang Li Xiaomin Liu Hongyuan Duan Xiaonan Cui Liwen Zhang Chao Sheng Lei Yang Ying Gao Xing Wang Qing Zhang Zhangyan Lyu Fangfang Song Yubei Huang Fengju Song Associations of chest X-ray trajectories, smoking, and the risk of lung cancer in two population-based cohort studies Frontiers in Oncology lung cancer chest X-ray trajectory smoking incidence mortality |
| title | Associations of chest X-ray trajectories, smoking, and the risk of lung cancer in two population-based cohort studies |
| title_full | Associations of chest X-ray trajectories, smoking, and the risk of lung cancer in two population-based cohort studies |
| title_fullStr | Associations of chest X-ray trajectories, smoking, and the risk of lung cancer in two population-based cohort studies |
| title_full_unstemmed | Associations of chest X-ray trajectories, smoking, and the risk of lung cancer in two population-based cohort studies |
| title_short | Associations of chest X-ray trajectories, smoking, and the risk of lung cancer in two population-based cohort studies |
| title_sort | associations of chest x ray trajectories smoking and the risk of lung cancer in two population based cohort studies |
| topic | lung cancer chest X-ray trajectory smoking incidence mortality |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1203320/full |
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