PM2.5 Exposure and Cervical Cancer Survival in Liaoning Province, Northeastern China

Particulate matters with a diameter of 2.5 µm or less (PM 2.5 ) were frequently reported to be associated with increased cancer incidences, but few studies have explored the associations between PM 2.5 exposure and cancer survival. We retrospectively analyzed the association between PM 2.5 exposure and the overall survival (OS) of cervical cancer patients who resided in 14 urban areas of the Liaoning Province, Northeastern China during January 2014-October 2021. Patients from urban areas who finished the recommended treatments with complete follow-up information were included. The PM 2.5 monitoring data of each urban area of Liaoning Province was retrieved, and individual exposure to PM 2.5 after diagnosis was calculated as the average daily concentration in the residence from the discharged day to death day or the last follow-up day. Log-rank tests and cox-regression were performed to examine the relationships between PM 2.5 exposure and cervical cancer survival. A total of 1753 cervical cancer patients were finally included, among whom 804 (45.9%) were from Shenyang City, the capital of Liaoning Province. The median average daily concentration of PM 2.5 that the patients were exposed to was 45.0 (interquartile range 38.2-50.0) µg/m 3 . Both log-rank tests (grouped by quartiles, p <0.001) and cox-regression (continuous, HR=1.06, 95%CI 1.04-1.08) indicated that PM 2.5 was significantly associated with shorter OS. Sensitivity analysis also confirmed the robustness of our findings. For the subgroup analysis, only the OS of stage II and stage III patients were associated with PM exposure. Our findings gave an insight that PM 2.5 exposure was associated with shorter OS of cervical cancer patients.