Characterization of initial clinical symptoms and risk factors for sinonasal adenocarcinomas: results of a case-control study.
ABSTRACT Sinonasal adenocarcinoma is a rare cancer, frequently associated with occupational exposure to inhalable wood dust. Among the EU member States, Germany was reported to have the highest number of exposed workers. Location and long latency make early diagnosis difficult. This case-control study was aimed at assessing potential risk factors and at characterizing initial clinical symptoms, both serving as matrix to identify persons at increased risk and to improve management of this cancer.
Of 58 patients, 31 diagnosed with sinonasal adenocarcinoma (cases) between 1973 and 2007 were identified and underwent standardized interview on clinical data. A total of 85 patients diagnosed over the same period with carcinoma of the oral cavity served as controls.
The ethmoid was confirmed as the predominant site of adenocarcinoma associated with wood dust exposure, whereas the nasal cavity was most commonly affected in patients denying any exposure to wood dust. Cases were significantly engaged in mainly woodworking occupations compared to controls. The main initial clinical symptoms were nasal obstruction 6 months (71%) and epistaxis 4 years (41.9%) prior to diagnosis. Hardwood dust from beech and oak proved to be the most common occupational exposure, with a mean exposure period of 32.3 years and a latency of 43.5 (34-58) years.
Our investigation confirms the importance of regular screenings for persons exposed to wood dust even years after the end of occupational or private exposure. Banal clinical symptoms such as epistaxis and nasal obstruction might be predictive, requiring early and thorough investigation.
SourceAvailable from: Pierpaolo Ferrante[Show abstract] [Hide abstract]
ABSTRACT: Background: Sinonasal cancer (SNC) has been related to occupational exposures, but the relative risk associated to specific jobs and/or carcinogen exposures other than wood and leather dust is generally based on small or inadequate sample sizes and the range of observed estimates is large. This paper is aimed at investigating such relationship through a systematic review of the literature followed by a meta-analysis. Methods: Systematic search was made with PubMed, Google Scholar and Scopus engines. Occupational exposures include wood and leather dust, formaldehyde, nickel and chromium compounds, textile industry, farming and construction. Meta-analysis of published studies after 1985 with a case-control or cohort design was performed, firstly using the fixed-effect model. Heterogeneity was assessed with the Q statistical test and quantified by the I2 index. When the heterogeneity hypothesis appeared relevant, the random-effect model was chosen. Sources of heterogeneity were explored using subgroup analyses. Results: Out of 63 reviewed articles, 28 (11 cohort, 17 case-control) were used in the meta-analysis. Heterogeneity among studies was observed and random-effects models were used. Exposure to wood dust results associated with SNC (RRpooled = 5.91, 95% CI: 4.31-8.11 for the case-control studies and 1.61, 95% CI: 1.10-2.37 for the cohort studies), as well as to leather dust (11.89, 95% CI: 7.69-18.36). The strongest associations are with adenocarcinomas (29.43, 95% CI: 16.46-52.61 and 35.26, 95% CI: 20.62-60.28 respectively). An increased risk of SNC for exposures to formaldehyde (1.68, 95% CI: 1.37-2.06 for the case control and 1.09, 95% CI: 0.66-1.79 for the cohort studies), textile industry (2.03, 95% CI: 1.47-2.8), construction (1.62, 95% CI: 1.11-2.36) and nickel and chromium compounds (18.0, 95% CI: 14.55-22.27) was found. Subset analyses identified several sources of heterogeneity and an exposure-response relationship was suggested for wood dust (p = 0.001). Conclusions: By confirming the strength of association between occupational exposure to causal carcinogens and SNC risk, our results may provide indications to the occupational etiology of SNC (not only wood and leather dusts). Future studies could be focused on specific occupational groups to confirm causative agents and to define appropriate preventive measures.BMC Cancer 02/2015; 2015(1):15-49. DOI:10.1186/s12885-015-1042-2 · 3.32 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: But de l’étude Analyser de manière rétrospective les résultats carcinologiques et la morbidité de la chirurgie de l’adénocarcinome de l’ethmoïde et identifier les facteurs influençant la survie. Population et méthode Entre 1990 et 2009, 42 patients ont été traités. Les données analysées étaient la symptomatologie, les données de l’imagerie, les données histologiques, le stade TNM, les traitements réalisés, la morbidité et la survie globale et sans récidive des patients. Résultats Quarante et un hommes et une femme ont été traités avec une moyenne d’âge au diagnostic de 61,5 ans. L’exposition au bois était retrouvée dans 85,7 % des cas. Vingt patients (47,6 %) présentaient un stade T4 lors du diagnostic. Trente-trois patients (78,5 %) ont été traités par chirurgie puis radiothérapie. Près de la moitié des patients opérés ont présenté une récidive. La survie globale spécifique à cinq ans était de 44,2 % et la survie sans récidive à cinq ans était de 46,4 %. Les facteurs de mauvais pronostic retrouvés étaient l’envahissement cérébro-méningé, l’envahissement orbitaire et la récidive locale. Conclusion Cette série retrouve les données épidémiologiques de l’adénocarcinome de l’ethmoïde décrites dans la littérature et confirme l’influence des facteurs de mauvais pronostic. La survie de ces patients dépend directement du contrôle local de ces tumeurs et semble être améliorée par une approche transfaciale unique.11/2011; 128(5):252-258. DOI:10.1016/j.aforl.2011.04.006
[Show abstract] [Hide abstract]
ABSTRACT: We report a case of Wegener's granulomatosis clinically mistaken for carcinoma in a 21-year-old girl presenting with an ulcerated mass of the nasopharynx associated with enlarged laterocervical nodes. The lesion was clinically suspected as malignant on the basis of clinical and radiological findings (namely, computed tomography scan and positron emission tomography). However, multiple biopsies were not conclusive for malignancy showing histological change suggestive of Wegener's granulomatosis. A serum determination of cANCA supported the diagnosis of Wegener's granulomatosis. Clinical findings and image studies suggested an erroneous diagnosis of malignancy whereas a definitive diagnosis of Wegener's granulomatosis was achieved only after repeated biopsies thus leading to a correct therapeutic approach. The Wegener granulomatosis must be added to the list of the differential diagnoses of the masses of the nasopharynx associated with or without enlarged laterocervical nodes.09/2013; 2013:839451. DOI:10.1155/2013/839451