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BACKGROUND@#Xuanwei and Fuyuan are rural counties, located in the late Permian coal poly area of eastern Yunnan and western Guizhou, where lung cancer mortality rates are among the highest in the China, with similarity for both men and women, younger age at diagnosis and death, and higher in rural areas than in urban areas. In this paper, long-term follow-up of lung cancer cases in local peasants was conducted to observe their survival prognosis and its influencing factors.@*METHODS@#Data of patients diagnosed with lung cancer from January 2005 to June 2011, who had lived in Xuanwei and Fuyuan counties for many years, were collected from 20 hospitals at the local provincial, municipal and county levels. To estimate survival outcomes, individuals were followed up until the end of 2021. The 5-year, 10-year and 15-year survival rates were estimated using the Kaplan-Meier method. Survival differences were examined with Kaplan-Meier curves and Cox proportional hazards models.@*RESULTS@#A total of 3,017 cases were effectively followed up (2,537 peasants and 480 non-peasants). The median age at diagnosis was 57 years, and the median follow-up time was 122 months. During the follow-up period, 2,493 cases (82.6%) died. The distribution of cases by clinical stage was as follows: stage I (3.7%), stage II (6.7%), stage III (15.8%), stage IV (21.1%) and unknown stage (52.7%). Treatment at the provincial, municipal and county-level hospitals accounted for 32.5%, 22.2% and 45.3%, respectively, and surgical treatment was performed in 23.3% of cases. The median survival time was 15.4 months (95%CI: 13.9-16.1), and the 5-year, 10-year and 15-year overall survival rates were 19.5% (95%CI: 18.0%-21.1%), 7.7% (95%CI: 6.5%-8.8%) and 2.0% (95%CI: 0.8%-3.9%), respectively. Peasants with lung cancer had a lower median age at diagnosis, higher proportion residing in remote rural areas, and higher use of bituminous coal as a household fuel. They also have a lower proportion of early-stage cases, treatment at provincial or municipal hospitals, and surgical treatment, leading to poorer survival outcomes (HR=1.57). Even when considering factors such as gender, age, residential location, clinical stage at diagnosis, histological type, hospital level of service, and surgical intervention, peasants still exhibit a survival disadvantage. Multivariable Cox model analysis comparing peasants and non-peasants reveals that surgical intervention, tumor-node-metastasis (TNM) stage, and hospital level of service are common factors influencing survival prognosis, while the use of bituminous coal as a household fuel, hospital level of service and adenocarcinoma (compared to squamous cell carcinoma) are independent prognostic factors for lung cancer survival among peasants.@*CONCLUSIONS@#The lower lung cancer survival rate among peasants is associated with their lower socioeconomic status, lower proportion of early-stage diagnoses, lower proportion of surgical interventions, and treatment at provincial-level hospitals. Furthermore, the impact of other factors such as high-risk exposure to bituminous coal pollution on survival prognosis requires further investigation.
Subject(s)
Male , Humans , Female , Lung Neoplasms/epidemiology , China/epidemiology , Adenocarcinoma , Carcinoma, Squamous Cell , CoalABSTRACT
BACKGROUND@#Lung cancer rates among women in rural Xuanwei and Fuyuan counties in eastern Yunnan province, China, are among the highest in the world, even though almost all women are non-smokers, and they tend to develop lung cancer at a younger age than other locations by roughly 5 yr-10 yr. This study investigated the survival of lung cancer patients among female never-smokers.@*METHODS@#The female never-smokers, who had lived for many years in Xuanwei and Fuyuan counties, with lung cancer newly-diagnosed between July 2006 to March 2010, were followed up through the end of 2016. Age-standardized relative survival for all cases was calculated using local life table. The Kaplan-Meier method and Log-rank test were used to analyze the relationship between the variables and the prognosis in univariate analysis. Cox regression analysis was employed in the multivariate analysis.@*RESULTS@#Among 1,250 total subjects, 1,075 died and the remaining 175 were censored during the follow-up, with a median follow-up period of 69 months (95%CI: 61.9-76.0). Overall, the mean age was (54.8 ±10.9) yr, with variable clinical stages: 3.5% of cases were stage I, 8.7% stage II, 20.7% stage III, 29.7% stage IV, and 37.4% stage unknown. The 645 patients(51.6%) with cyto-histological diagnosis contains 303 with Squamous cell carcinoma, and 231 with adenocarcinoma, 24 with small cell, 43 with other specified type and 39 with unknown histological type. Only 215 (17.2%) patients received surgery, 487 (39.0%) were treated without surgery, and 548 (43.8%) did not receive any specific anticancer therapy. The 5-year observed survival rate and age-standardized relative survival were 8.9% (95%CI: 7.0-10.6), and 10.1% (95%CI: 3.7-20.5) respectively, with a median survival of 13.2 months. The 5-year survival rates were 41.1% for stage I, 22.4% for stage II, 5.3% for stage III, 1.3% for stage IV, 11.2% for missing stage, 17.9% for adenocarcinoma, and 5.6% for squamous cell carcinoma respectively. Surgery significantly improved 5-year survival rate compared with non-surgery (34.8% vs 3.2%, P<0.001). The patients with non-treatment, aged 65 years and older, living in rural areas and farmer with low socioeconomic status had poorer survival, whereas the patients treated in provincial hospitals and chest X-ray screening had better survival. Cox multivariate analysis further showed that stage of tumor-node-metastasis (TNM), treatment status, hospital-level, and X-ray screening were factors correlated with survival.@*CONCLUSIONS@#Patients with lung cancer among female never-smokers in Xuanwei and Fuyuan experience poorer survival, because they are less likely to be diagnosed at early stage, as well as less likely to receive surgery and comprehensive treatment. Furthermore low socioeconomic status and poor health security are also responsible for the low survival.
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Objective Xuanwei, Yunnan, is one of the areas with the highest incidence of lung cancer in China and in the world as well. This study was to explore the differential expressions of lncRNAs and mRNAs, establish a competing endogenous RNA (ceRNA) coexpression network, and find some new ideas for the diagnosis and treatment of lung cancer in the Xuanwei area.Methods Using the gene chip of the lncRNA + mRNA expression profile, we examined 10 pairs of samples of lung cancer and adjacent normal tissues from the patients in the Xuanwei area and analyzed differentially expressed mRNAs with such bioinformatics Methods as gene ontology (GO), Kyoto Encyclopedia Genomes (KEGG) pathway and network analyses.Results By comparison between the lung cancer and adjacent normal tissues, 384 differentially expressed lncRNAs were identified (fold change≥2.0, P<0.05), in which 78 were upregulated, with abParts as the most differentially expressed (fold change=7.522, and 306 downregulated, with XLOG-012046 as the most differentially expressed (fold change=9.001). Among the 946 differentially expressed mRNAs identified (fold change≥2.0, P<0.05), SPP1 was the most significantly upregulated (fold change=16.500) and AGER was the most significantly downregulated (fold change=14.377). Both up- and downregulated expressions of lncRNA and mRNA were found in the lung cancer tissue of the patients, the upregulated expression of mRNA involved mainly the calcium ion signaling pathway, phagosomes and hematopoietic cell lineage, while the downregulated expression of mRNA chiefly involved in the hematopoietic cell lineage and calcium ion signaling pathway. lncRNAs were correlated with mRNAs in a one-to-one or one-to-many manner, with the coexpression of p14245 (LINC00472) with Q9H8W2 and XLOG-005764. The expressions of SEMA5A and SEMA6A regulated by ENSG00000244513.2 (ceRNA score=0.461) and ENSG00000257424.1 (ceRNA score=0.372) were both decreased in the mRNA expression profile. SEMA5A participated mainly in cell adhesion, bioadhesion, and vasculature development, while SEMA6A chiefly in cell-surface receptor signal transduction, cell movement, and cytoskeleton.Conclusion The expression profile of differentially expressed lncRNAs was identified by microarray in the lung cancer tissue of the patients in Xuanwei, which may become a novel biomarker or therapeutic target of lung cancer in this area.
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The morbidity and mortality rates of lung cancer in Xuanwei city, Yunnan province, China are the highest in the global scope. Since 1980s, the studies conducted in this region supported by international health organizations have been focused on the epidemiology, pathogenesis and molecular biology of Xuanwei lung cancer. With the development of molecular detection techniques and the application of next-generation sequencing technique, great progress has been achieved in understanding the environmental risk factors which cause this disease and the improvement of diagnostic methods and therapeutic measures in Xuanwei city. This review surveys the recent development in research of lung cancer in this area from the perspectives of environmental risks, mutation and expression of cancer-related genes, and the diagnosis and drug treatment. Moreover, the positive role of next-generation sequencing technique in diagnosis and treatment of Xuanwei lung cancer will be discussed.
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Objective:To study the frequency and distribution of HLA-A alleles and HLA-A*02 subtypes in the lung cancer patients in Yunnan Xuanwei area.This study aims at providing the significant genetic information for lung cancer research and treatment.Methods:Genomic DNA samples were collected from lung cancer patients and healthy donors residing in Yunnan Xuanwei area.HLA-A alleles and HlA-A*02 subtypes were typed by PCR-SSP assay.Case-control study was used to study the difference of frequency distribution between patients and normal controls.The polymorphisms of HLA-A*02 were also observed in cancer patients.Results:The positive rates of HLA-A*02 was significantly higher in cancer patients than in healthy controls (P=0.004,OR=2.432,95% CI=1.314-4.500),which were 68.75% and 47.50%,respectively.The gene frequency of HLA-A*02 was significantly higher in cancer patients than in healthy controls(P