Service d'ORL et de chirurgie cervico-faciale, hôpitaux de Brabois, institut Louis-Mathieu, CHRU de Nancy, rue du Morvan, 54511 Vandoeuvre-les-Nancy cedex, France; Unité Inserm U954, nutrition génétique et exposition aux risques environnementaux, 54505 Vandoeuvre-les-Nancy cedex, France.
Service d'ORL et de chirurgie cervico-faciale, hôpitaux de Brabois, institut Louis-Mathieu, CHRU de Nancy, rue du Morvan, 54511 Vandoeuvre-les-Nancy cedex, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2018 Dec;135(6):383-387. doi: 10.1016/j.anorl.2018.08.012. Epub 2018 Sep 7.
The aim of the present study was to investigate the role of wood dust exposure in intestinal (ITAC) and non-intestinal type (non-ITAC) nasal adenocarcinoma, so as to improve understanding of the oncogenic mechanisms in the light of the recent literature and of evo-devo concepts.
All consecutive patients operated in our institution for nasal adenocarcinoma diagnosed on anatomopathology between May 2004 and February 2014 were included. Surgical specimens were examined twice by independent pathologists, blind to wood dust exposure status. Clinical and demographic data, including wood dust exposure, were collected for the two groups (ITAC and non-IATC).
90 patients (84 ITAC, 6 non-ITAC) were included. No non-ITAC patients had history of wood dust exposure, versus 83/84 cases (99%) in ITAC (mean exposure duration: 30±16 years; range 2-65 years). Only 12 ITAC patients (18%) were still exposed at diagnosis. ITAC may develop long after the end of wood dust exposure (up to 60 years). Eight patients (12%) had exposure durations of less than 5 years. Latency between onset of exposure and onset of disease did not decrease with exposure duration.
Exposure to wood dust, even for short periods of time, incurs a risk of developing ITAC, usually after a long latency period. Any exposure requires lifetime follow-up, to ensure prompt treatment. Factors leading to the development of nasal ITAC and non-ITAC are probably different. The analogy with Barret's esophagus and esophageal adenocarcinoma may shed light on the oncogenesis of nasal ITAC.
本研究旨在探讨木尘暴露在肠型（ITAC）和非肠型（非-ITAC）鼻腺癌中的作用，以期根据近期文献和进化发育概念，提高对致癌机制的认识。
纳入 2004 年 5 月至 2014 年 2 月期间在我院因解剖病理学诊断为鼻腺癌而接受手术的所有连续患者。由两位独立病理学家进行两次检查，检查时对木尘暴露情况不了解。收集两组（ITAC 和非-IATC）的临床和人口统计学数据，包括木尘暴露情况。
共纳入 90 例患者（84 例 ITAC，6 例非-ITAC）。非-ITAC 患者无木尘暴露史，而 ITAC 患者中有 83/84 例（99%）有木尘暴露史（平均暴露时间：30±16 年；范围 2-65 年）。只有 12 例 ITAC 患者（18%）在诊断时仍处于暴露状态。ITAC 可能在木尘暴露结束后很长时间才会发生（最长可达 60 年）。8 例患者（12%）的暴露时间少于 5 年。发病前暴露潜伏期与暴露持续时间无关。
即使暴露时间很短，也会增加发生 ITAC 的风险，通常在很长的潜伏期之后。任何暴露都需要终生随访，以确保及时治疗。导致鼻 ITAC 和非-ITAC 发生的因素可能不同。与 Barrett 食管和食管腺癌的类比可能有助于阐明鼻 ITAC 的致癌机制。
