Hildesheim A, Dosemeci M, Chan C C, Chen C J, Cheng Y J, Hsu M M, Chen I H, Mittl B F, Sun B, Levine P H, Chen J Y, Brinton L A, Yang C S
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland 20892, USA.
Cancer Epidemiol Biomarkers Prev. 2001 Nov;10(11):1145-53.
Our objective was to evaluate the link between occupational exposures to wood dust, formaldehyde, and solvents and the development of nasopharyngeal carcinoma (NPC). A case-control study was conducted among 375 newly diagnosed cases of NPC in Taipei, Taiwan, and 325 community controls matched to cases on sex, age, and geographical residence (99 and 87% response rates, respectively). Most cases (>90%) were diagnosed with WHO Types 2 or 3 (nonkeratinizing and undifferentiated carcinomas), whereas the remaining cases were diagnosed with WHO Type 1 (squamous cell carcinomas). A complete occupational history was obtained via a personal interview and blindly assessed by an industrial hygienist for intensity and probability of exposure to wood dust, formaldehyde, and solvents. Information on socio-demographic characteristics, cigarette smoking, dietary consumption of nitrosamines, and other potential confounding factors was obtained via a personal interview. Blood specimens were tested for human leukocyte antigen class I/II genotypes, polymorphisms in cytochrome P450 2E1 genotype, and various anti-EBV antibodies known to be associated with NPC. Analysis was performed using logistic regression; relative risk (RR) estimates and 95% confidence intervals (CI) were calculated. Individuals exposed to wood dust had an adjusted RR of 1.7 (95% CI = 1.0-3.0). Those exposed to wood dust for >10 years had an adjusted RR of 2.4 (95% CI = 1.1-5.0; p(trend) = 0.02). Risk was strongest for those first exposed before the age of 25 years and those seropositive to EBV. Individuals exposed to formaldehyde were at a more modest and nonsignificant increased risk of NPC (RR = 1.4; 95% CI = 0.93-2.2). Those exposed to formaldehyde for >10 years had an adjusted RR of 1.6 (95% CI = 0.91-2.9). The association between formaldehyde and NPC was stronger in analyses restricted to EBV seropositive individuals (RR = 2.7; 95% CI = 1.2-5.9). However, no dose response was observed with increasing duration or cumulative use. No association was observed between solvent exposure and NPC (RR = 1.2; 95% CI = 0.86-1.7). Occupational exposure to wood dust is likely to be involved in the development of NPC, a finding that is consistent with the known link between wood exposure and nasal adenocarcinomas. Formaldehyde exposure is less clearly linked to NPC, whereas exposure to solvents is unlikely to be involved in NPC pathogenesis.
我们的目标是评估职业性接触木尘、甲醛和溶剂与鼻咽癌（NPC）发病之间的联系。在台湾台北对375例新诊断的NPC病例和325名社区对照者进行了一项病例对照研究，对照者在性别、年龄和居住地区方面与病例相匹配（应答率分别为99%和87%）。大多数病例（>90%）被诊断为WHO 2型或3型（非角化性和未分化癌），其余病例被诊断为WHO 1型（鳞状细胞癌）。通过个人访谈获取完整的职业史，并由一名工业卫生学家对接触木尘、甲醛和溶剂的强度和可能性进行盲法评估。通过个人访谈获取社会人口学特征、吸烟、亚硝胺饮食摄入及其他潜在混杂因素的信息。对血液标本进行人类白细胞抗原I/II类基因型、细胞色素P450 2E1基因型多态性以及已知与NPC相关的各种抗EB病毒抗体检测。采用逻辑回归进行分析；计算相对危险度（RR）估计值和95%置信区间（CI）。接触木尘的个体调整后的RR为1.7（95%CI=1.0 - 3.0）。接触木尘超过10年的个体调整后的RR为2.4（95%CI=1.1 - 5.0；p趋势=0.02）。对于那些在25岁之前首次接触木尘的人和EB病毒血清阳性者，风险最高。接触甲醛的个体患NPC的风险有适度增加但无统计学意义（RR = 1.4；95%CI = 0.93 - 2.2）。接触甲醛超过10年的个体调整后的RR为1.6（95%CI = 0.91 - 2.9）。在仅限于EB病毒血清阳性个体的分析中，甲醛与NPC之间的关联更强（RR = 2.7；95%CI = 1.2 - 5.9）。然而，未观察到随着接触时间延长或累积使用量增加出现剂量反应。未观察到溶剂接触与NPC之间存在关联（RR = 1.2；95%CI = 0.86 - 1.7）。职业性接触木尘可能与NPC的发病有关，这一发现与已知的木材接触与鼻腺癌之间的联系一致。甲醛接触与NPC的联系不太明确，而溶剂接触不太可能参与NPC的发病机制。
