Laforest L, Luce D, Goldberg P, Bégin D, Gérin M, Demers P A, Brugère J, Leclerc A
Institut National de la Santé et de la Recherche Médicale, Unité 88, Saint-Maurice, 14 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France.
Occup Environ Med. 2000 Nov;57(11):767-73. doi: 10.1136/oem.57.11.767.
A case-control study was conducted in France to assess possible associations between occupational exposures and squamous cell carcinomas of the larynx and hypopharynx.
The study was restricted to men, and included 201 hypopharyngeal cancers, 296 laryngeal cancers, and 296 controls (patients with other tumour sites). Detailed information on smoking, alcohol consumption, and lifetime occupational history was collected. Occupational exposure to seven substances (formaldehyde, leather dust, wood dust, flour dust, coal dust, silica dust, and textile dust) was assessed with a job exposure matrix. Exposure variables used in the analysis were probability, duration, and cumulative level of exposure. Odds ratios (ORs) with their 95% confidence intervals (95% CIs) were estimated by unconditional logistic regression, and were adjusted for major confounding factors (age, smoking, alcohol, and when relevant other occupational exposures).
Hypopharyngeal cancer was found to be associated with exposure to coal dust (OR 2.31, 95% CI 1.21 to 4.40), with a significant rise in risk with probability (p<0.005 for trend) and level (p<0.007 for trend) of exposure. Exposure to coal dust was also associated with an increased risk of laryngeal cancer (OR 1.67, 95% CI 0.92 to 3.02), but no dose-response pattern was found. A significant relation, limited to hypopharyngeal cancer, was found with the probability of exposure to formaldehyde (p<0.005 for trend), with a fourfold risk for the highest category (OR 3.78, 95% CI 1.50 to 9.49). When subjects exposed to formaldehyde with a low probability were excluded, the risk also increased with duration (p<0.04) and cumulative level of exposure (p<0.14). No significant association was found for any other substance.
These results indicate that exposure to formaldehyde and coal dust may increase the risk of hypopharyngeal cancer.
在法国开展了一项病例对照研究，以评估职业暴露与喉癌和下咽癌之间可能存在的关联。
该研究仅限于男性，纳入了201名下咽癌患者、296名喉癌患者以及296名对照（其他肿瘤部位的患者）。收集了有关吸烟、饮酒和终生职业史的详细信息。使用工作暴露矩阵评估了对七种物质（甲醛、皮革粉尘、木粉尘、面粉粉尘、煤尘、二氧化硅粉尘和纺织粉尘）的职业暴露情况。分析中使用的暴露变量为暴露概率、持续时间和累积暴露水平。通过无条件逻辑回归估计比值比（OR）及其95%置信区间（95%CI），并针对主要混杂因素（年龄、吸烟、饮酒以及相关时的其他职业暴露）进行了调整。
发现下咽癌与煤尘暴露有关（OR 2.31，95%CI 1.21至4.40），随着暴露概率（趋势p<0.005）和暴露水平（趋势p<0.007）的增加，风险显著上升。煤尘暴露也与喉癌风险增加有关（OR 1.67，95%CI 0.92至3.02），但未发现剂量反应模式。发现仅在下咽癌中，甲醛暴露概率与之存在显著关系（趋势p<0.005），最高类别风险增加四倍（OR 3.78，95%CI 1.50至9.4）。排除低概率暴露于甲醛的受试者后，风险也随着持续时间（p<0.04）和累积暴露水平（p<0.14）的增加而增加。未发现其他任何物质存在显著关联。
这些结果表明，甲醛和煤尘暴露可能会增加下咽癌风险。
