Abstract
Chinese women have the highest rate of lung cancer among female never-smokers in the world, and the etiology is poorly understood. To assess the association between metabolomics and lung cancer risk among never-smoking women. This nested case-control study included 275 never-smoking female patients with lung cancer and 289 never-smoking cancer-free control participants from the prospective Shanghai Women's Health Study recruited from December 28, 1996, to May 23, 2000. Validated food frequency questionnaires were used for the collection of dietary information. Metabolomic analysis was conducted from November 13, 2015, to January 6, 2016. Data analysis was conducted from January 6, 2016, to November 29, 2018. Untargeted ultra-high-performance liquid chromatography-tandem mass spectrometry and nuclear magnetic resonance metabolomic profiles were characterized using prediagnosis urine samples. A total of 39 416 metabolites were measured. Incident lung cancer. Among the 564 women, those who developed lung cancer (275 participants; median [interquartile range] age, 61.0 [52-65] years) and those who did not develop lung cancer (289 participants; median [interquartile range] age, 62.0 [53-66] years) at follow-up (median [interquartile range] follow-up, 10.9 [9.0-11.7] years) were similar in terms of their secondhand smoke exposure, history of respiratory diseases, and body mass index. A peak metabolite, identified as 5-methyl-2-furoic acid, was significantly associated with lower lung cancer risk (odds ratio, 0.57 [95% CI, 0.46-0.72]; P < .001; false discovery rate = 0.039). Furthermore, this peak was weakly correlated with self-reported dietary soy intake (ρ = 0.21; P < .001). Increasing tertiles of this metabolite were associated with lower lung cancer risk (in comparison with first tertile, odds ratio for second tertile, 0.52 [95% CI, 0.34-0.80]; and odds ratio for third tertile, 0.46 [95% CI, 0.30-0.70]), and the association was consistent across different histological subtypes and follow-up times. Additionally, metabolic pathway analysis found several systemic biological alterations that were associated with lung cancer risk, including 1-carbon metabolism, nucleotide metabolism, oxidative stress, and inflammation. This prospective study of the untargeted urinary metabolome and lung cancer among never-smoking women in China provides support for the hypothesis that soy-based metabolites are associated with lower lung cancer risk in never-smoking women and suggests that biological processes linked to air pollution may be associated with higher lung cancer risk in this population.
Highlights
Lung cancer is the leading cause of cancer mortality among men and women, accounting for 27% of all cancer deaths worldwide and nearly 158 040 deaths in the United States in 2015.1 most cases of lung cancer are caused by active tobacco smoking, approximately 25% occur in never-smokers.[2]
Increasing tertiles of this metabolite were associated with lower lung cancer risk, and the association was consistent across different histological subtypes and follow-up times
Using an false discovery rate (FDR) cutoff of 10% to adjust for multiple comparisons, 3 urinary metabolites by ultra-high-performance liquid chromatography–tandem mass spectrometry (UPLC-MS) were significantly associated with lower lung cancer risk (Table 2)
Summary
Lung cancer is the leading cause of cancer mortality among men and women, accounting for 27% of all cancer deaths worldwide and nearly 158 040 deaths in the United States in 2015.1 most cases of lung cancer are caused by active tobacco smoking, approximately 25% occur in never-smokers.[2] Asian individuals ( Chinese women) have a higher rate of lung cancer among never-smokers compared with individuals of European descent[3]; the etiology and risk factors of this malignant neoplasm independent of smoking are poorly understood.[4] it is imperative to understand the etiology of lung cancer and identify new biomarker targets or metabolomic profiles as potential diagnostic and screening tools for lung cancer. Both studies were conducted in populations of European descent and had small numbers of neversmokers
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