台灣土壤重金屬與不同肺癌組織病理型態之相關研究

Different tumor types of lung cancer in relation to soil heavy metals in Taiwan

黃景揚(Jing-Yang Huang)

指導教授 ： 廖勇柏

中山醫學大學/健康管理學院/公共衛生學系碩士班/碩士(2011年)

https://doi.org/10.6834/CSMU.2011.00137

摘要

研究目的：區分不同組織病理型態之肺癌，觀察其發生的時間趨勢及地理變異，並探討土壤重金屬濃度的地理變異情形與肺腺癌及肺鱗狀細胞癌之關係。

研究方法：資料來源台灣癌症登記系統1981至2005年新發生肺癌病例及台灣環保署土壤重金屬含量調查報告，第一期(1982-1986)以及第三期(1992-1999)兩次調查結果。以APC-Model 估算肺癌發生之年代效應，以Poisson Regression 模式估算1982-1986土壤重金屬濃度與2001-2005年肺癌發生之相對危險性(Relative Risk, RR)。並以兩時期土壤重金屬濃度變化趨勢估算計算2001-2005年肺癌發生之相對危險性及1986-2005年ASIR的趨勢。

結果：不論男女性，肺腺癌及肺鱗狀細胞癌皆為上升的趨勢。其中男性肺腺癌log(RR)，自1981-1985年為-0.78上升至2001-2005年0.93。女性肺腺癌log(RR)，自-1.17上升至1.21。男性肺鱗狀細胞癌log(RR)，自-0.59上升至0.55。女性肺鱗狀細胞癌log(RR)，自-0.38上升至0.22。以鄉鎮別土壤重金屬濃度四分位分層，土壤中銅與男、女性肺腺癌具有劑量效應關係；鉻、鎳及鋅則與男、女性肺鱗狀細胞癌具有劑量效應關係。以兩時期土壤重金屬濃度變化趨勢估算之結果呈現僅有在男性肺鱗狀細胞癌，暴露於兩時期鉻及鎳都為高的區域有較高的RR值，分別為1.59(95%CI: 1.37-1.83)及1.33(95%CI: 1.17-1.51)，且鉻及鎳在趨勢檢定上亦達到顯著；男性肺腺癌則未發現相關性。在女性分層下，肺腺癌及肺鱗狀細胞癌皆未發現任何顯著較高的結果。

結論：本研究結論為台灣1981-2005年男、女性肺腺癌及肺鱗狀細胞癌的年代效應為逐年上升，且具有地理變異性。土壤中鉻及鎳濃度與鄉鎮別男性肺鱗狀細胞癌發生率有關。

關鍵字

肺腺癌 ； 肺鱗狀細胞癌 ； APC-Model ； 土壤重金屬 ； 時空變異

並列摘要

Study objective
This study analysis the spatial and temporal variations of different tumor types of lung cancer incidence rate in Taiwan from 1981-2005, and to explore the relation between soil heavy metals concentration and different tumor types of lung cancer incidence for both gender.
Material and methods
Data on cancer registry system from 1981-2005 and two periods (1982-1986 and 1992-1999) of soil heavy metal concentrations survey data, included soil Arsenic, Cadmium, Chromium, Copper, Lead, Mercury, Nickel, Zinc concentrations was collected from DOH and EAP respectively. To estimate the period effects of different tumor types of lung cancer incidence by APC-Model. Poisson regression model was used to develop relative risks (RRs) of lung adenocarcinoma (lung AC) and lung squamous-cell carcinoma (lung SCC) from 2001-2005 when exposure to different soil heavy metals levels from 1982-1986. In order to prevent the misclassification of exposure, the exposure groups divide into [low-low], [median-median], [high-high] levels according to two periods of soil heavy metals concentrations, and estimate the RRs from 2001-2005 and trends of age standardized incidence rate of lung cancer from 1986-2005 for these exposure groups.
Results
Both male and female, lung AC and lung SCC trends are rising from 1981-2005. The period effect of male lung AC log(RR) increased from -0.78 (1981-1985) to 0.93 (2001-2005), female lung AC log(RR) increased from -1.17 to 1.21, male lung SCC log(RR) increased from -0.59 to 0.55, female lung SCC log(RR) increased from -0.38 to 0.22. Lung cancer RRs of exposure levels by quartile township soil heavy metals concentrations show that soil Copper was related with both male and female lung AC (P value for trend was significant), soil Chromium, Nickel and Zinc was related with both male and female lung SCC (P value for trend was significant). When exposure levels was [high-high] level of two periods soil heavy metals concentrations compares with [low-low] level, there are highest male lung SCC RRs for [high-high] level of soil Chromium (RR=1.59, 95%C.I.=1.37-1.83) and Nickel (RR=1.33, 95%C.I.=1.17-1.83) respectively (P values for trend were also significant for soil Chromium and Nickel). But male lung AC and female lung AC and lung SCC didn’t find any association with soil heavy metals.
Conclusion
This study finds that period effect of lung AC and lung SCC are increased for both male and female from 1981-2005 in Taiwan, and There were spatial variations for lung AC and lung SCC age standardized incidence rate. Township soil Chromium and Nickel concentrations were association with Township male lung SCC incidence.

並列關鍵字

Lung adenocarcinoma ； Lung squamous-cell carcinoma ； APC-Model ； Soil heavy metals ； Spatial and temporal variations

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