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一项基于人群的研究中化学物质暴露与急性髓系白血病和骨髓增生异常综合征的风险

Chemical exposures and risk of acute myeloid leukemia and myelodysplastic syndromes in a population-based study.

作者信息

Poynter Jenny N, Richardson Michaela, Roesler Michelle, Blair Cindy K, Hirsch Betsy, Nguyen Phuong, Cioc Adina, Cerhan James R, Warlick Erica

机构信息

Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN.

Masonic Cancer Center, University of Minnesota, Minneapolis, MN.

出版信息

Int J Cancer. 2017 Jan 1;140(1):23-33. doi: 10.1002/ijc.30420. Epub 2016 Sep 24.

Abstract

Benzene exposure is one of the few well-established risk factors for myeloid malignancy. Exposure to other chemicals has been inconsistently associated with hematologic malignancies. We evaluated occupational and residential chemical exposures as risk factors for acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) using population-based data. AML and MDS cases were identified by the Minnesota Cancer Surveillance System. Controls were identified through the Minnesota driver's license/identification card list. Chemical exposures were measured by self-report. Unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CI). We included 265 MDS cases, 420 AML cases and 1388 controls. We observed significant associations between both MDS and AML and benzene (OR = 1.77, 95% CI 1.19, 2.63 and OR = 2.10, 95% CI 1.35, 3.28, respectively) and vinyl chlorides (OR = 2.05, 95% CI 1.15, 3.63 and OR = 2.81, 95% CI 1.14, 6.92). Exposure to soot, creosote, inks, dyes and tanning solutions and coal dust were associated with AML (range ORs = 2.68-4.03), while no association was seen between these exposures and MDS (range ORs = 0.57-1.68). Pesticides and agricultural chemicals were not significantly associated with AML or MDS. Similar results were observed in analyses stratified by sex. In addition to providing risk estimates for benzene from a population-based sample, we also identified a number of other occupational and residential chemicals that were significantly associated with AML; however, all exposures were reported by only a small percentage of cases (≤10%). While chemical exposures play a clear role in the etiology of myeloid malignancy, these exposures do not account for the majority of cases.

摘要

接触苯是为数不多的已明确的髓系恶性肿瘤风险因素之一。接触其他化学物质与血液系统恶性肿瘤的关联并不一致。我们使用基于人群的数据评估职业和居住环境中的化学物质暴露作为急性髓系白血病(AML)和骨髓增生异常综合征(MDS)的风险因素。AML和MDS病例由明尼苏达癌症监测系统识别。对照通过明尼苏达驾照/身份证列表确定。化学物质暴露通过自我报告进行测量。使用无条件逻辑回归计算比值比(OR)和95%置信区间(CI)。我们纳入了265例MDS病例、420例AML病例和1388名对照。我们观察到MDS和AML与苯(OR分别为1.77,95%CI 1.19,2.63和OR为2.10,95%CI 1.35,3.28)以及氯乙烯(OR分别为2.05,95%CI 1.15,3.63和OR为2.81,95%CI 1.14,6.92)之间存在显著关联。接触煤烟、杂酚油、油墨、染料和鞣革溶液以及煤尘与AML相关(OR范围为2.68 - 4.03),而这些暴露与MDS之间未观察到关联(OR范围为0.57 - 1.68)。农药和农用化学品与AML或MDS无显著关联。在按性别分层的分析中观察到类似结果。除了从基于人群的样本中提供苯的风险估计外,我们还确定了一些其他职业和居住环境中的化学物质与AML显著相关;然而,所有暴露仅在一小部分病例(≤10%)中报告。虽然化学物质暴露在髓系恶性肿瘤的病因中起明确作用,但这些暴露并不能解释大多数病例。

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