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从不吸烟的人患肺癌是另一种疾病

Lung cancer in never smokers — a different disease

原文发布日期：2007-10-01

DOI: 10.1038/nrc2190

类型: Review Article

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要点：

要点翻译：

英文摘要：

摘要翻译：

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文章：

从不吸烟的人患肺癌是另一种疾病

Lung cancer in never smokers — a different disease

原文发布日期：2007-10-01

DOI: 10.1038/nrc2190

类型: Review Article

开放获取: 否

要点：

About 25% of lung cancer cases worldwide are not attributable to tobacco smoking. Thus, lung cancer in never smokers is the seventh leading cause of cancer deaths in the world, killing more people every year than pancreatic or prostate cancers.
Globally, lung cancer in never smokers demonstrates a marked gender bias, occuring more frequently among women. In particular, there is a high proportion of never smokers in Asian women diagnosed with lung cancer.
Although smoking-related carcinogens act on both proximal and distal airways inducing all the major forms of lung cancer, cancers arising in never smokers target the distal airways and favour adenocarcinoma histology.
Environmental tobacco smoke (ETS) is a relatively weak carcinogen and can only account for a minority of lung cancers arising in never smokers.
Although multiple risk factors, including environmental, hormonal, genetic and viral factors, have been implicated in the pathogenesis of lung cancer in never smokers, no clear-cut dominant factor has emerged that can explain the relatively high incidence of lung cancer in never smokers and the marked geographic differences in gender proportions.
Molecular epidemiology studies, in particular of the TP53, KRAS and epidermal growth factor receptor (EGFR) genes, demonstrate strikingly different mutation patterns and frequencies between lung cancers in never smokers and smokers.
There are major clinical differences between lung cancers arising in never smokers and smokers and their response to targeted therapies. Indeed, non-smoking status is the strongest clinical predictor of benefit from the EGFR tyrosine kinase inhibitors.
The above-mentioned facts strongly suggest that lung cancer arising in never smokers is a disease distinct from the more common tobacco-associated forms of lung cancer.
Further efforts are needed to identify the major cause or causes of lung cancers arising in never smokers before successful strategies for prevention, early diagnosis and novel therapies can be implemented.

要点翻译：

全球约25%的肺癌病例与吸烟无关。因此，非吸烟者的肺癌是全球癌症死亡的第七大原因，每年导致的死亡人数超过胰腺癌或前列腺癌。
在全球范围内，非吸烟者的肺癌表现出明显的性别偏见，在女性中更为常见。特别是在被诊断患有肺癌的亚洲女性中，非吸烟者比例很高。
尽管与吸烟相关的致癌物同时作用于近端和远端气道，诱发所有主要类型的肺癌，但非吸烟者罹患的肺癌主要靶向远端气道，且以腺癌组织学类型为主。
环境烟草烟雾（ETS）是一种相对较弱的致癌物，只能解释非吸烟者中少数肺癌病例。
尽管环境、激素、遗传和病毒等多种风险因素与非吸烟者肺癌的发病机制有关，但尚未出现明确的主导因素可以解释非吸烟者中肺癌发病率相对较高以及性别比例的显著地域差异。
分子流行病学研究，特别是对TP53、KRAS和表皮生长因子受体（EGFR）基因的研究，揭示了非吸烟者与吸烟者肺癌在突变模式和频率上的显著差异。
非吸烟者与吸烟者罹患的肺癌在临床表现及对靶向治疗的反应上存在重大差异。事实上，非吸烟状态是预示EGFR酪氨酸激酶抑制剂疗效的最强临床指标。
上述事实强烈表明，非吸烟者罹患的肺癌与更常见的烟草相关型肺癌是两种不同的疾病。
在成功实施预防、早期诊断和创新疗法策略之前，需要进一步努力确定非吸烟者肺癌的主要致病原因。

英文摘要：

Although most lung cancers are a result of smoking, approximately 25% of lung cancer cases worldwide are not attributable to tobacco use, accounting for over 300,000 deaths each year. Striking differences in the epidemiological, clinical and molecular characteristics of lung cancers arising in never smokers versus smokers have been identified, suggesting that they are separate entities. This Review summarizes our current knowledge of this unique and poorly understood disease.