气温与鼻咽癌特异性死亡的关联及细颗粒物的效应修饰作用OA

[Background]Climate change has raised concerns regarding the health impacts of rising temper-atures.Nasopharyngeal carcinoma(NPC)is geographically clustered in warm regions,implying a potential prognostic role of ambient temperature. [Objective]To investigate the association between ambient temperature and NPC prognosis,and to evaluate effect modification by tumor stage and fine particulate matter(PM2.5)across dif-ferent exposure windows. [Methods]A total of 7 780 NPC patients diagnosed between 2018 and 2020 were enrolled from a cohort at the Sun Yat-sen University Cancer Center.Temperature and PM2.5 data were obtained from public datasets of the National Tibetan Plateau Data Center and ChinaHighAirPollutants(CHAP)and matched to patients'residential addresses to calculate average exposure 6,12,and 36 months prior to the outcome.Cox proportional hazards models were used to assess the associations of temperature(per 1℃increase)with NPC-specific death,recurrence,and metastasis.Stratified analyses were conducted according to primary tumor stage(T stage),re-gional lymph node stage(N stage),and PM2.5 levels to evaluate potential effect modification. [Results]During follow-up,897 NPC-specific deaths,1 722 recurrences,and 1 640 metastases were recorded.Each 1 ℃ increase in ambient temperature was significantly associated with an increased risk of NPC-specific death across all exposure windows(6 month:HR=1.11,95%CI:1.08,1.14;12 month:HR=1.18,95%CI:1.13,1.24;36 month:HR=1.25,95%CI:1.16,1.34).Stratified analysis showed that this as-sociation was more pronounced among patients with tumor stages T3-T4 and lymph node stages N2-N3(for example,at 12 months,the HR for the T3-T4 group was 1.19,95%CI:1.13,1.25;for the N2-N3 group,the HR was 1.21,95%CI:1.14,1.27).In addition,the association between temperature and NPC-specific death was stronger in the high PM2.5 group(defined using median PM2.5 concentrations:23.3,21.8,and 22.5 μg·m-3 for the 6-,12-,and 36-month windows,respectively),with significant interaction effects observed(Pinteraction<0.05).Temperature showed no long-term association with recurrence or metastasis,while weak positive associations(recurrence:6 months,HR=1.04,95%CI:1.02,1.06;12 months,HR=1.06,95%CI:1.03,1.10;metastasis:6 months,HR=1.02,95%CI:1.00,1.05;12 months,HR=1.05,95%CI:1.01,1.10).were observed for the 6-and 12-month windows after adjusting for PM2.5. [Conclusion]Higher ambient temperature is significantly associated with an increased risk of NPC-specific death,especially among patients with advanced T and N stages.Ambient temperature may negatively influence NPC prognosis and act synergistically with PM2.5 exposure.