Nicholas School of the Environment, Duke University, Durham, NC 27708, United States.
Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, Wake Forest University Baptist Medical Center and Wake Forest Comprehensive Cancer Center, Winston-Salem, NC 27157, United States.
Environ Int. 2017 Oct;107:235-242. doi: 10.1016/j.envint.2017.06.021.
Thyroid cancer is the fastest increasing cancer in the U.S., and papillary thyroid cancer (PTC) accounts for >80% of incident cases. Increasing exposure to flame retardant chemicals (FRs) has raised concerns about their possible role in this 'epidemic'. The current study was designed to test the hypothesis that higher exposure to FRs is associated with increased odds of PTC.
PTC patients at the Duke Cancer Institute were approached and invited to participate. Age- and gender-matched controls were recruited from the Duke Health System and surrounding communities. Because suitable biomarkers of long-term exposure do not exist for many common FRs, and levels of FRs in dust are significantly correlated with exposure, relationships between FRs in household dust and PTC were evaluated in addition to available biomarkers. PTC status, measures of aggressiveness (e.g. tumor size) and BRAF V600E mutation were included as outcomes.
Higher levels of some FRs, particularly decabromodiphenyl ether (BDE-209) and tris(2-chloroethyl) phosphate in dust, were associated with increased odds of PTC. Participants with dust BDE-209 concentrations above the median level were 2.29 times as likely to have PTC [95% confidence interval: 1.03, 5.08] compared to those with low BDE-209 concentrations. Associations varied based on tumor aggressiveness and mutation status; TCEP was more strongly associated with larger, more aggressive tumors and BDE-209 was associated with smaller, less aggressive tumors.
Taken together, these results suggest exposure to FRs in the home, particularly BDE-209 and TCEP, may be associated with PTC occurrence and severity, and warrant further study.
在美国，甲状腺癌是增长最快的癌症，其中甲状腺乳头状癌（PTC）占发病例的 80%以上。人们越来越担心阻燃化学品（FRs）的接触会增加患甲状腺癌的风险。本研究旨在检验假设，即更高的 FRs 暴露与 PTC 发病风险增加相关。
在杜克癌症研究所，对 PTC 患者进行了调查并邀请他们参与。从杜克健康系统及其周边社区招募了年龄和性别匹配的对照。由于许多常见 FRs 没有合适的长期暴露生物标志物，而且家庭灰尘中的 FRs 水平与暴露显著相关，因此除了可用的生物标志物外，还评估了家庭灰尘中 FRs 与 PTC 之间的关系。将 PTC 状态、侵袭性（例如肿瘤大小）和 BRAF V600E 突变作为结局。
灰尘中某些 FRs 的水平较高，特别是十溴二苯醚（BDE-209）和三（2-氯乙基）磷酸酯（TCEP），与 PTC 发病风险增加相关。与灰尘中 BDE-209 浓度低的参与者相比，灰尘中 BDE-209 浓度处于中位数以上的参与者患 PTC 的可能性高 2.29 倍[95%置信区间：1.03，5.08]。这些关联因肿瘤侵袭性和突变状态而异；TCEP 与更大、更具侵袭性的肿瘤更相关，BDE-209 与较小、侵袭性较小的肿瘤更相关。
综合来看，这些结果表明，家中 FRs 的暴露，特别是 BDE-209 和 TCEP，可能与 PTC 的发生和严重程度相关，值得进一步研究。
