Epidemiological Department, Veneto Region, Italy.
Occupational Health Service, Local Health Unit 3, Venice, Italy.
Am J Ind Med. 2019 Jan;62(1):14-20. doi: 10.1002/ajim.22922. Epub 2018 Nov 25.
Occupational exposure to vinyl chloride monomer (VCM) has been established as a cause of hepatocellular carcinoma (HCC) and liver angiosarcoma (ASL). However, some controversy remains due to conflicting results on liver cirrhosis, and to evidence on HCC based on few confirmed cases. The aim of the study is to clarify the association between VCM exposure and mortality from liver diseases.
In a cohort of 1658 workers involved in VCM production and polymerization, Poisson regression was adopted to estimate rate ratios (RR) across categories of VCM exposure for mortality due to ASL (n = 9), HCC (n = 31) confirmed by histological/clinical records, and the combination of deaths from liver cirrhosis and from liver cancer with clinical/histological evidence of cirrhosis (n = 63).
Cumulative VCM exposure was associated with study outcomes; RRs in the highest compared to the lowest exposure category were: ASL 91.1 (95%Confidence Interval 16.8-497), HCC 5.52 (2.03-15.0), liver cirrhosis 2.60 (1.19-5.67).
The risk of death from liver cirrhosis, as well as from HCC in the largest available series of confirmed cases, increased with VCM exposure.
职业性接触氯乙烯单体（VCM）已被确定为肝细胞癌（HCC）和肝血管肉瘤（ASL）的病因。然而，由于肝硬化方面的结果相互矛盾，以及基于少数确诊病例的 HCC 证据，仍存在一些争议。本研究旨在阐明 VCM 暴露与肝脏疾病死亡率之间的关联。
在一项涉及 1658 名 VCM 生产和聚合工人的队列研究中，采用泊松回归估计了 VCM 暴露类别与 ASL（n=9）、经组织学/临床记录确诊的 HCC（n=31）以及肝硬化和肝癌合并死亡（n=63）的死亡率之间的率比（RR）。
累积 VCM 暴露与研究结果相关；与最低暴露组相比，最高暴露组的 RR 为：ASL 91.1（95%置信区间 16.8-497）、HCC 5.52（2.03-15.0）、肝硬化 2.60（1.19-5.67）。
在最大的确诊病例系列中，肝硬化以及 HCC 的死亡风险随着 VCM 暴露而增加。
