Occupational exposure and sinonasal cancer: a systematic review and meta-analysis
Occupational exposure and sinonasal cancer: a systematic review and meta-analysis
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DOI：
10.1186/s12885-015-1042-2
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发表时间：
2015-02-13
期刊：
影响因子：
3.8
通讯作者：
Marinaccio, Alessandro
中科院分区：
文献类型：
--
作者：
Binazzi, Alessandra;Ferrante, Pierpaolo;Marinaccio, Alessandro
背景：鼻窦癌（SNC）与职业暴露有关，但与特定工作和/或木材和皮革粉尘以外的致癌物暴露相关的相对风险通常基于样本量较小或不足，并且观察到的估计范围很大。本文旨在通过对文献进行系统回顾，然后对符合特定纳入标准的研究进行荟萃分析来调查这种关系。方法：使用相关关键词通过 PubMed、Google Scholar 和 Scopus 引擎进行系统搜索。职业接触包括木材和皮革粉尘、甲醛、镍和铬化合物、纺织工业、农业和建筑业。首先使用固定效应模型，对 1985 年后发表的研究进行了病例对照或队列设计的荟萃分析。异质性通过 Q 统计检验进行评估，并通过 I-2 指数进行量化。当异质性假设显得相关时，选择随机效应模型。使用亚组分析探讨异质性来源。结果：在 63 篇综述文章中，28 篇（11 篇队列，17 篇病例对照）用于荟萃分析。观察了研究之间的异质性并使用了随机效应模型。暴露于木屑结果与 SNC 相关（病例对照研究的 RR 池化 = 5.91，95% CI：4.31-8.11，队列研究为 1.61，95% CI：1.10-2.37），以及皮革灰尘（11.89，95% CI：7.69-18.36）。与腺癌的相关性最强（分别为 29.43，95% CI：16.46-52.61 和 35.26，95% CI：20.62-60.28）。 SNC 接触甲醛的风险增加（病例对照为 1.68，95% CI：1.37-2.06，队列研究为 1.09，95% CI：0.66-1.79）、纺织工业（2.03，95% CI：1.47-2.8）、建筑业（1.62，95% CI：1.11-2.36）和发现了镍和铬化合物（18.0，95% CI：14.55-22.27）。子集分析确定了异质性的几个来源，并提出了木尘的暴露-反应关系（p = 0.001）。结论：通过确认职业性致癌物暴露与 SNC 风险之间的关联强度，我们的结果可能为 SNC 的职业病因学提供指示（不仅是木尘和皮革尘）。未来的研究可以集中于特定职业群体，以确认致病因素并确定适当的预防措施。
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 of studies meeting specific inclusion criteria.Methods: Systematic search was made with PubMed, Google Scholar and Scopus engines using related keywords. 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 I-2 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.