全球肺癌的发病率和代谢综合征（MetS）的流行率均在增加。MetS与肺癌之间的关系仍然存在争议。MetS及其组分与肺癌的风险是否相关？我们采用多变量Cox回归模型估计了MetS相关变量对肺癌风险的危险比（HR），包括整体风险和组织学亚型在UK Biobank中。按性别、吸烟状况和药物使用进行分层分析。利用HR曲线检验代谢标志物与肺癌风险之间的非线性关系。本研究共纳入了331,877名参与者，其中77,173名参与者在入组时患有MetS。在中位随访时间为10.9年的过程中，2425名参与者出现了肺癌作为原发部位。MetS的HR值分别为1.21（95%CI：1.09，1.33），1.28（95%CI：1.10，1.50）和1.16（95%CI：0.94，1.44），与整体肺癌、腺癌和鳞状细胞癌的风险相关。该HR值随着代谢异常数量的增加而增加，对于患有一到五种疾病的个体，其值从1.11增加到1.4∼1.5。低高密度脂蛋白胆固醇（HDL-C）水平下降、腰围增加和高血糖与肺癌呈正相关。MetS与肺癌之间的关系受性别的调节作用影响，女性的影响更强（p=0.031）。尽管吸烟对风险的修饰效应不具有统计学意义，但吸烟者中肺癌由MetS引起的风险增加。肺癌与HDL-C、腰围和糖化血红蛋白之间存在非线性关系。MetS相关的肺癌风险增加表明在肺癌的初级预防和高风险人群筛查选择中应考虑代谢状态和标志物的重要性。 版权所有 ©2023. Elsevier Inc.出版

Both the incidence of lung cancer and the prevalence of metabolic syndrome (MetS) have been increasing worldwide. The relationship between MetS and lung cancer remains controversial.Is the risk of lung cancer associated with MetS and its components?Multivariable Cox regression models were used to estimate the hazard ratio (HR) of MetS-related variables on lung cancer risk, both overall and by histological subtype, in UK Biobank. Stratified analyses were conducted by sex, smoking status, and use of medication. HR curves were used to test the non-linear associations between the metabolic markers and the risk of lung cancer.Of the 331,877 participants included in this study, a total of 77,173 participants had MetS at enrollment. During a median follow-up of 10.9 years, 2425 participants developed lung cancer as the primary site. The HRs of MetS were 1.21 (95%CI: 1.09, 1.33), 1.28 (95%CI: 1.10, 1.50), and 1.16 (95%CI: 0.94, 1.44) on the risk of overall lung cancer, adenocarcinoma, and squamous cell carcinoma, respectively. The HRs increased with the number of metabolic abnormalities from 1.11 to 1.4∼1.5 for those with one to five disorders. Positive association with lung cancer was observed for low high-density lipoprotein cholesterol (HDL-C), elevated waist circumference, and hyperglycaemia. The relationship between MetS and lung cancer was modified by sex, with a stronger effect in women (p=0.031). The risk of lung cancer due to MetS was mainly elevated among smokers, although the modification effect of smoking was not statistically significant. A non-linear association was found between lung cancer and HDL-C, waist circumference, and glycated haemoglobin.The increased risk of lung cancer associated with MetS suggests the importance of taking metabolic status and markers into the primary prevention of lung cancer and the selection of high-risk populations for lung cancer screening.Copyright © 2023. Published by Elsevier Inc.