Righini Christian Adrien, Karkas Alexandre, Morel Nils, Soriano Edouard, Reyt Emile
Clinique ORL, Pôle tête et cou et chirurgie réparatrice, CHU de Grenoble, F-38043 Grenoble, France.
Presse Med. 2008 Sep;37(9):1229-40. doi: 10.1016/j.lpm.2008.03.010. Epub 2008 May 27.
To review the risk factors for squamous cell carcinoma of the oral cavity, pharynx, and larynx.
Review of the literature using the Medline digital database (1980-2007). Previously published studies or studies not found in the database were included if relevant. Four types of studies were selected: (1) epidemiological, (2) toxicologic, (3) clinical, and (4) fundamental research. Publications concerning cancer of the nasopharynx were excluded. This work is based upon the ANAES guide for analysis of the literature and rating of guidelines, published in January 2000.
The principal risk factors are tobacco and alcohol. Other risk factors, particularly infectious (viral) or environmental (nutritional and occupational), are also involved. From this analysis we conclude that: (1) most clinical and fundamental publications concern smoking and alcohol use; (2) studies of other risk factors are relatively old, especially those concerning nutritional and occupational factors; (3) most publications have a low level of scientific proof (grade C, levels 3 and 4). These 3 points explain the delay in the analysis of risk factors for upper aerodigestive tract (UADT) cancers.
We must make up for this delay by prospective studies that include very large samples and use thorough and multivariate statistical analyses to estimate the impact of various toxic substances on the incidence of UADT cancer. This demands: (1) awareness on the part of all physicians who manage this type of cancer of the need to ask questions about exposure to risk factors besides than tobacco and alcohol; (2) collaboration between these physicians as well as with general practitioners, epidemiologists, nutritionists, and occupational physicians.
回顾口腔、咽及喉鳞状细胞癌的危险因素。
使用Medline数字数据库（1980 - 2007年）对文献进行回顾。若相关，纳入先前发表的研究或数据库中未找到的研究。选择了四种类型的研究：（1）流行病学研究，（2）毒理学研究，（3）临床研究，（4）基础研究。排除有关鼻咽癌的出版物。本研究基于2000年1月发表的ANAES文献分析及指南评级指南。
主要危险因素是烟草和酒精。其他危险因素，特别是感染性（病毒）或环境性（营养和职业）因素也有涉及。通过该分析我们得出以下结论：（1）大多数临床和基础出版物关注吸烟和饮酒；（2）对其他危险因素的研究相对陈旧，尤其是那些关于营养和职业因素的研究；（3）大多数出版物的科学证据水平较低（C级，3级和4级）。这三点解释了上消化道（UADT）癌症危险因素分析的延迟。
我们必须通过前瞻性研究来弥补这一延迟，这些研究应包括非常大的样本，并使用全面的多变量统计分析来估计各种有毒物质对上消化道癌症发病率的影响。这需要：（1）所有诊治这类癌症的医生意识到除了烟草和酒精外，询问危险因素暴露情况的必要性；（2）这些医生之间以及与全科医生、流行病学家、营养学家和职业医生之间的合作。
