The epidemiology of sarcoma.
The epidemiology of sarcoma.
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DOI：
10.1186/2045-3329-2-14
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发表时间：
2012-10-04
影响因子：
--
通讯作者：
Schiffman JD
中科院分区：
文献类型：
--
作者：
Burningham Z;Hashibe M;Spector L;Schiffman JD
肉瘤占所有儿童实体恶性肿瘤的20%以上，占所有成人实体恶性肿瘤的不到1%。绝大多数确诊的肉瘤是软组织肉瘤，而恶性骨肿瘤仅占肉瘤的10%以上。肉瘤的风险还不清楚。我们评估了现有文献的流行病学和肉瘤的病因。肉瘤发展的风险可分为环境暴露，遗传易感性和两者之间的相互作用。HIV阳性的个体患卡波西肉瘤的风险增加，即使HHV 8是致病病毒。放射治疗的辐射暴露与某些癌症患者的继发性肉瘤发展密切相关。事实上，恶性骨肿瘤的风险随着骨辐射累积剂量的增加而增加（趋势p <0.001）。最近的一项荟萃分析报告称，有疝气病史的儿童患尤文肉瘤的风险更大（调整后OR 3.2，95% CI 1.9，5.7）。青春期生长突增期的骨发育与骨肉瘤的发生有关。职业因素，如工作类型，行业，暴露于化学品，如除草剂和氯酚已被认为是肉瘤的危险因素。一项病例对照研究发现，园丁的软组织肉瘤风险显著增加（调整后OR 4.1，95%CI 1.00，14.00），但在严格参与农业的人中没有。一项基于欧洲的研究报告称，铁匠、工具制造商或机床操作员患骨肿瘤的风险增加（调整后OR 2.14，95%CI 1.08，4.26）。母亲和父亲的特征，如职业，年龄，吸烟状况和怀孕期间经历的健康状况也被认为是肉瘤的危险因素，并将在未来的研究中进行评估。我们发现的有限的研究证明了与肉瘤风险的显着关系，但其中许多结果现在需要在更大的人群中进一步验证。此外，对文献中评估的每个流行病学关联背后的生物学机制知之甚少。未来的分子流行病学研究可能会增加我们对遗传与环境对儿童和成人这种致命癌症的肿瘤发生的贡献的理解。
Sarcomas account for over 20% of all pediatric solid malignant cancers and less than 1% of all adult solid malignant cancers. The vast majority of diagnosed sarcomas will be soft tissue sarcomas, while malignant bone tumors make up just over 10% of sarcomas. The risks for sarcoma are not well-understood. We evaluated the existing literature on the epidemiology and etiology of sarcoma. Risks for sarcoma development can be divided into environmental exposures, genetic susceptibility, and an interaction between the two. HIV-positive individuals are at an increased risk for Kaposi’s sarcoma, even though HHV8 is the causative virus. Radiation exposure from radiotherapy has been strongly associated with secondary sarcoma development in certain cancer patients. In fact, the risk of malignant bone tumors increases as the cumulative dose of radiation to the bone increases (p for trend <0.001). A recent meta-analysis reported that children with a history of hernias have a greater risk of developing Ewing’s sarcoma (adjusted OR 3.2, 95% CI 1.9, 5.7). Bone development during pubertal growth spurts has been associated with osteosarcoma development. Occupational factors such as job type, industry, and exposures to chemicals such as herbicides and chlorophenols have been suggested as risk factors for sarcomas. A case-control study found a significant increase in soft tissue sarcoma risk among gardeners (adjusted OR 4.1, 95% CI 1.00, 14.00), but not among those strictly involved in farming. A European-based study reported an increased risk in bone tumors among blacksmiths, toolmakers, or machine-tool operators (adjusted OR 2.14, 95% CI 1.08, 4.26). Maternal and paternal characteristics such as occupation, age, smoking status, and health conditions experienced during pregnancy also have been suggested as sarcoma risk factors and would be important to assess in future studies. The limited studies we identified demonstrate significant relationships with sarcoma risk, but many of these results now require further validation on larger populations. Furthermore, little is known about the biologic mechanisms behind each epidemiologic association assessed in the literature. Future molecular epidemiology studies may increase our understanding of the genetic versus environmental contributions to tumorigenesis in this often deadly cancer in children and adults.