1
|
Huh DA, Choi YH, Kim L, Park K, Lee J, Hwang SH, Moon KW, Kang MS, Lee YJ. Air pollution and survival in patients with malignant mesothelioma and asbestos-related lung cancer: a follow-up study of 1591 patients in South Korea. Environ Health 2024; 23:56. [PMID: 38858710 PMCID: PMC11163745 DOI: 10.1186/s12940-024-01094-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/01/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Despite significant advancements in treatments such as surgery, radiotherapy, and chemotherapy, the survival rate for patients with asbestos-related cancers remains low. Numerous studies have provided evidence suggesting that air pollution induces oxidative stress and inflammation, affecting acute respiratory diseases, lung cancer, and overall mortality. However, because of the high case fatality rate, there is limited knowledge regarding the effects of air pollution exposures on survival following a diagnosis of asbestos-related cancers. This study aimed to determine the effect of air pollution on the survival of patients with malignant mesothelioma and asbestos-related lung cancer. METHODS We followed up with 593 patients with malignant mesothelioma and 998 patients with lung cancer identified as asbestos victims between 2009 and 2022. Data on five air pollutants-sulfur dioxide, carbon monoxide, nitrogen dioxide, fine particulate matter with a diameter < 10 μm, and fine particulate matter with a diameter < 2.5 μm-were obtained from nationwide atmospheric monitoring stations. Cox proportional hazard models were used to estimate the association of cumulative air pollutant exposure with patient mortality, while adjusting for potential confounders. Quantile-based g-computation was used to assess the combined effect of the air pollutant mixture on mortality. RESULTS The 1-, 3-, and 5-year survival rates for both cancer types decreased with increasing exposure to all air pollutants. The estimated hazard ratios rose significantly with a 1-standard deviation increase in each pollutant exposure level. A quartile increase in the pollutant mixture was associated with a 1.99-fold increase in the risk of malignant mesothelioma-related mortality (95% confidence interval: 1.62, 2.44). For lung cancer, a quartile increase in the pollutant mixture triggered a 1.87-fold increase in the mortality risk (95% confidence interval: 1.53, 2.30). CONCLUSION These findings support the hypothesis that air pollution exposure after an asbestos-related cancer diagnosis can negatively affect patient survival.
Collapse
Affiliation(s)
- Da-An Huh
- Institute of Health Sciences, Korea University, Anam-ro 145, Seongbuk-gu, Seoul, 02841, South Korea.
| | - Yun-Hee Choi
- Department of Ophthalmology, Korea University College of Medicine, Anam-ro 145, Seongbuk- gu, Seoul, 02841, South Korea
| | - Lita Kim
- Department of Health and Safety Convergence Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul, 02841, South Korea
- L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Anam-ro 145, Seongbuk-gu, Seoul, 02841, South Korea
| | - Kangyeon Park
- Department of Health and Safety Convergence Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul, 02841, South Korea
- L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Anam-ro 145, Seongbuk-gu, Seoul, 02841, South Korea
| | - Jiyoun Lee
- School of Health and Environmental Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul, 02841, South Korea
| | - Se Hyun Hwang
- School of Health and Environmental Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul, 02841, South Korea
| | - Kyong Whan Moon
- L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Anam-ro 145, Seongbuk-gu, Seoul, 02841, South Korea
- School of Health and Environmental Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul, 02841, South Korea
| | - Min-Sung Kang
- Environmental Health Center for Asbestos, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, 31151, South Korea.
| | - Yong-Jin Lee
- Environmental Health Center for Asbestos, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, 31151, South Korea
- Department of Occupational & Environmental Medicine, Soonchunhyang University, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, 31151, South Korea
| |
Collapse
|
2
|
Ponce S, Cedrés S, Ricordel C, Isambert N, Viteri S, Herrera-Juarez M, Martinez-Marti A, Navarro A, Lederlin M, Serres X, Zugazagoitia J, Vetrhus S, Jaderberg M, Hansen TB, Levitsky V, Paz-Ares L. ONCOS-102 plus pemetrexed and platinum chemotherapy in malignant pleural mesothelioma: a randomized phase 2 study investigating clinical outcomes and the tumor microenvironment. J Immunother Cancer 2023; 11:e007552. [PMID: 37661097 PMCID: PMC10476122 DOI: 10.1136/jitc-2023-007552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND ONCOS-102, an oncolytic adenovirus expressing granulocyte-macrophage colony-stimulating factor, can alter the tumor microenvironment to an immunostimulatory state. Combining ONCOS-102 with standard-of-care chemotherapy for malignant pleural mesothelioma (MPM) may improve treatment outcomes. METHODS In this open-label, randomized study, patients with unresectable MPM received intratumoral ONCOS-102 (3×1011 virus particles on days 1, 4, 8, 36, 78, and 120) and pemetrexed plus cisplatin/carboplatin (from day 22), or pemetrexed plus cisplatin/carboplatin alone. The primary endpoint was safety. Overall survival (OS), progression-free survival, objective response rate, and tumor immunologic activation (baseline and day 36 biopsies) were also assessed. RESULTS In total, 31 patients (safety lead-in: n=6, randomized: n=25) were enrolled. Anemia (15.0% and 27.3%) and neutropenia (40.0% and 45.5%) were the most frequent grade ≥3 adverse events (AEs) in the ONCOS-102 (n=20) and chemotherapy-alone (n=11) cohorts. No patients discontinued ONCOS-102 due to AEs. No statistically significant difference in efficacy endpoints was observed. There was a numerical improvement in OS (30-month OS rate 34.1% vs 0; median OS 20.3 vs 13.5 months) with ONCOS-102 versus chemotherapy alone in chemotherapy-naïve patients (n=17). By day 36, ONCOS-102 was associated with increased T-cell infiltration and immune-related gene expression that was not observed in the control cohort. Substantial immune activation in the tumor microenvironment was associated with survival at month 18 in the ONCOS-102 cohort. CONCLUSIONS ONCOS-102 plus pemetrexed and cisplatin/carboplatin was well tolerated by patients with MPM. In injected tumors, ONCOS-102 promoted a proinflammatory environment, including T-cell infiltration, which showed association with survival at month 18.
Collapse
Affiliation(s)
- Santiago Ponce
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Susana Cedrés
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Charles Ricordel
- Department of Pulmonology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | | | - Santiago Viteri
- Department of Medical Oncology, Instituto Oncológico Rosell, Grupo Quironsalud, Hospital Universitario Dexeus, Barcelona, Spain
| | | | - Alex Martinez-Marti
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Alejandro Navarro
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Mathieu Lederlin
- Department of Radiology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Xavier Serres
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Jon Zugazagoitia
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
- H12O-CNIO Lung Cancer Research Unit, Madrid, Spain
- Department of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Sylvia Vetrhus
- Research and Development, Circio Holding ASA, Oslo, Norway
| | | | | | | | - Luis Paz-Ares
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
- H12O-CNIO Lung Cancer Research Unit, Madrid, Spain
- Department of Medicine, Complutense University of Madrid, Madrid, Spain
| |
Collapse
|
3
|
Huang J, Chan SC, Pang WS, Chow SH, Lok V, Zhang L, Lin X, Lucero-Prisno DE, Xu W, Zheng ZJ, Elcarte E, Withers M, Wong MCS. Global Incidence, Risk Factors, and Temporal Trends of Mesothelioma: A Population-Based Study. J Thorac Oncol 2023; 18:792-802. [PMID: 36775192 DOI: 10.1016/j.jtho.2023.01.095] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/30/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
INTRODUCTION Mesothelioma is an uncommon type of cancer which has received little attention. This study aims to evaluate the global disease burden; trends of mesothelioma by age, sex, and geographic locations; and its risk factors on the population level. METHODS The Global Cancer Observatory, Cancer Incidence in Five Continents Plus, and Global Burden of Disease were accessed for mesothelioma incidence and its risk factors worldwide. The associations between mesothelioma incidence and asbestos were evaluated for each country by multivariable linear regression analysis by sex and age. Average annual percentage change (AAPC) was calculated using Joinpoint regression to evaluate the epidemiologic trends of mesothelioma. RESULTS The age-standardized rate of mesothelioma was 0.30 per 100,000 persons with Northern Europe reporting the highest incidence rates. The incidence rate of the male population was much higher than that of the females. Countries with higher human development index (β = 0.119, confidence interval [CI]: 0.073-0.166, p < 0.001), gross domestic product per capita (β = 0.133, CI: 0.106-0.161, p < 0.001), and asbestos exposure (β = 0.087, CI: 0.073-0.102, p < 0.001) had higher mesothelioma. The overall trend of mesothelioma incidence was decreasing, although an increase was observed in Bulgaria (AAPC: 5.56, 95% CI: 2.94-8.24, p = 0.001) and Korea (AAPC: 3.24, 95% CI: 0.08-6.49, p = 0.045). CONCLUSIONS There was a substantial declining incidence trend of mesothelioma in the past decade possibly related to the restriction of the use of asbestos in some countries. Meanwhile, the increasing trend in mesothelioma incidence observed in females might be indicative of an increase in environmental exposure to mineral fibers.
Collapse
Affiliation(s)
- Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China; Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Sze Chai Chan
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Wing Sze Pang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Shui Hang Chow
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Veeleah Lok
- Department of Global Public Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Lin Zhang
- School of Population and Global Health, The University of Melbourne, Victoria, Australia; School of Public Health, The Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xu Lin
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wanghong Xu
- School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, People's Republic of China
| | | | - Mellissa Withers
- Department of Population and Health Sciences, Institute for Global Health, University of Southern California, Los Angeles, California
| | - Martin C S Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China; Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China; School of Public Health, The Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Global Health, School of Public Health, Peking University, Beijing, People's Republic of China.
| | | |
Collapse
|
4
|
Huh DA, Chae WR, Choi YH, Kang MS, Lee YJ, Moon KW. Disease Latency according to Asbestos Exposure Characteristics among Malignant Mesothelioma and Asbestos-Related Lung Cancer Cases in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15934. [PMID: 36498008 PMCID: PMC9738972 DOI: 10.3390/ijerph192315934] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
Korea was one of the major consumers of asbestos in the late 1900s, and asbestos-related disease patients have been reported continuously to date, owing to long disease latency. Several studies have been conducted to predict the future incidence of malignant mesothelioma and lung cancer in Korea, but little is understood about the latency time. Therefore, the aim of this study is to estimate the latency period of malignant mesothelioma and asbestos-related lung cancer in Korea and its determinants. We obtained information from the Environmental Health Centers for Asbestos in Korea on the history of asbestos exposure and demographic characteristics of 1933 patients with malignant mesothelioma and asbestos-related lung cancer. In our study, the latency periods for malignant mesothelioma and lung cancer were 33.7 and 40.1 years, respectively. Regardless of the disease type, those with a history of exposure related to the production of asbestos-containing products or asbestos factories had the shortest latency period. In addition, we observed that those who worked in or lived near asbestos mines tended to have a relatively long disease latency. Smoking was associated with shorter latency, but no linear relationship between the lifetime smoking amount (expressed in pack years) and latent time was observed. In addition, the age of initial exposure showed a negative linear association with the latency period for mesothelioma and lung cancer.
Collapse
Affiliation(s)
- Da-An Huh
- Institute of Health Sciences, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Woo-Ri Chae
- Department of Health and Safety Convergence Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Yun-Hee Choi
- Department of Health and Safety Convergence Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea
- BK21 FOUR R&E Center for Learning Health System, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Min-Sung Kang
- Asbestos Environmental Health Center, Soonchunhyang University Cheonan Hospital, Soonchunhyang 6-gil 31, Dongnam-gu, Cheonan-si 31151, Republic of Korea
| | - Yong-Jin Lee
- Asbestos Environmental Health Center, Soonchunhyang University Cheonan Hospital, Soonchunhyang 6-gil 31, Dongnam-gu, Cheonan-si 31151, Republic of Korea
- Department of Occupational & Environmental Medicine, Soonchunhyang University, Soonchunhyang 6-gil 31, Dongnam-gu, Cheonan-si 31151, Republic of Korea
| | - Kyong-Whan Moon
- BK21 FOUR R&E Center for Learning Health System, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea
- Department of Health and Environmental Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea
| |
Collapse
|
5
|
Impact of Naturally Occurring Asbestos on Asbestos Ban: Regulations and Experience of the Republic of Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020742. [PMID: 35055562 PMCID: PMC8775668 DOI: 10.3390/ijerph19020742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 02/05/2023]
Abstract
This review examined the main issues debated in Korea regarding the production and use of materials containing naturally occurring asbestos (NOA) as impurities, and investigated the impacts of these debates on the asbestos ban, as well as the future implications. In Korea, incidents associated with the production and use of NOA-contaminated talc powders, construction rocks, serpentinites, and dolomite rocks raised public concern and led to accelerating the ban on asbestos. The main controversies concern policies on appropriate asbestos content limits, whether materials containing a trace amount of NOA should be banned, and the control of materials with high human exposure risk. To address recurring controversies, the implementation of preventive measures to manage elongated mineral particles and the use of transmission electron microscopy for more sensitive analysis need to be discussed, along with reaching social agreement on the controversial policies. To minimize the potential exposure to asbestos that may occur during the production and use of industrial minerals in the future, it is necessary to apply occupational exposure control measures and monitor the health effects of the relevant population groups. These national policies on NOA should be prepared based on close collaboration and discussion with policymakers, industry stakeholders, and related academic experts.
Collapse
|
6
|
Survival of Korean Patients with Malignant Pleural Mesothelioma Compensated for the Asbestos Injury Relief. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11209713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: The purpose of this study was to identify the epidemiologic characteristics and prognostic factors for malignant pleural mesothelioma in Korea, which are currently insufficient. The data were derived from malignant mesothelioma patients who registered under the Asbestos Injury Relief Act; Methods: A total of 728 patients received compensation from the Asbestos Injury Relief Act due to malignant mesothelioma between 2011 and 2015. Of these, 313 patients (43.0%) with malignant pleural mesothelioma were included in the study. The study variables were sex (male, female), age at diagnosis (<59, 60–69, ≥70), smoking history (yes, no), surgery (yes, no), chemotherapy (yes, no), occupational exposure to asbestos (yes, no), and histological subtype (epithelioid, nonepithelioid); Results: Median survival of mesothelioma was 8.0 months (95% confidence interval: 6.2 to 9.8). The 1-year, 2-year, and 5-year survival rates (%) were 43.5%, 23.6%, and 12.5%, respectively. In multivariate analysis of Cox’s proportional hazards model; sex, age, smoking history, occupational asbestos exposure, and histological subtype were not significant prognostic factors, but surgery and chemotherapy combined was a significant predictor; Conclusions: Although the representativeness of these data is limited, our study estimates the epidemiologic characteristics of malignant pleural mesothelioma. Non-occupational exposure had a similar prognosis to occupational asbestos exposure, and there was no sex difference. In addition, it was found that receiving a combination of surgery and chemotherapy affects the survival rate, but there is a limitation in that factors such as performance status, comorbidities, and stage that contribute to survival are not considered.
Collapse
|
7
|
The Epidemiologic Characteristics of Malignant Mesothelioma Cases in Korea: Findings of the Asbestos Injury Relief System from 2011-2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910007. [PMID: 34639307 PMCID: PMC8508037 DOI: 10.3390/ijerph181910007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 11/25/2022]
Abstract
(1) Background: The purpose of this study was to investigate the epidemiological characteristics of malignant mesothelioma in Korea by investigating cases compensated under the asbestos injury relief system. (2) Methods: A total of 407 compensated cases between 2011 and 2015 were reviewed using medical records and resident registrations in order to investigate the dates of diagnosis and death. Asbestos exposure and patients’ general characteristics were investigated through face-to-face interviews. The standardized incidence ratio was calculated as the number of observations from 2005 to 2014 per exposure region in Korea, using the mid-annual population of each region in 2009 as the standard population. (3) Results: Among the 407 cases, 65.1% were male. The pleura and peritoneum were affected in 76.9% and 23.1% of cases, respectively. For peritoneal mesothelioma, the median survival duration was longer (p = 0.005), and the proportion of affected women was higher than that in pleural mesothelioma. The standardized incidence ratio (95% CI) by province of primary exposure was Chungnam 3.33 (2.51–4.35), Ulsan 1.85 (0.97–3.21), and Seoul 1.32 (1.06–1.63). (4) Conclusions: Although the representativeness of the data is limited, it is sufficient to assume the epidemiologic characteristics of malignant mesothelioma, help improve the compensation system, and contribute to future policies.
Collapse
|