Department of Science and High Technology, University of Insubria, 22100 Como, Italy.
Occupational Health Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Int J Environ Res Public Health. 2022 Mar 13;19(6):3390. doi: 10.3390/ijerph19063390.
The PRIMATE study is an Italian translational research project, which aims to identify personalized biomarkers associated with clinical characteristics of malignant pleural mesothelioma (MPM). For this purpose, characteristics of MPM patients with different degrees of asbestos exposure will be compared to identify somatic mutations, germline polymorphism, and blood inflammatory biomarkers. In this framework, we assessed exposure to asbestos for 562 cases of MPM extracted from the Lombardy region Mesothelioma Registry (RML), for which a complete interview based on a standardized national questionnaire and histopathological specimens were available. Exposure assessment was performed: (1) through experts' evaluation (considered as the gold standard for the purpose of this study), according to the guidelines of the Italian National Mesothelioma Registry (ReNaM) and (2) using a job-exposure matrix (SYN-JEM) to obtain qualitative (ever/never) and quantitative estimates of occupational asbestos exposure (cumulative exposure expressed in fibers per mL (f/mL)). The performance of SYN-JEM was evaluated against the experts' evaluation. According to experts' evaluation, occupational asbestos exposure was recognized in 73.6% of men and 23.6% of women; furthermore, 29 men (7.8%) and 70 women (36.9%) had non-occupational exposure to asbestos. When applying SYN-JEM, 225 men (60.5%) and 25 women (13.2%) were classified as occupationally exposed, with a median cumulative exposure higher for men (1.7 f/mL-years) than for women (1.2 f/mL-years). The concordance between the two methods (Cohen's kappa) for occupational exposure assessment was 0.46 overall (0.41 in men, and 0.07 in women). Sensitivity was higher in men (0.73) than in women (0.18), while specificity was higher in women (0.88) than in men (0.74). Overall, both methods can be used to reconstruct past occupational exposure to asbestos, each with its own advantages and limitations.
PRIMATE 研究是一个意大利转化研究项目，旨在确定与恶性胸膜间皮瘤（MPM）临床特征相关的个体化生物标志物。为此，将比较不同石棉暴露程度的 MPM 患者的特征，以识别体细胞突变、种系多态性和血液炎症生物标志物。在这个框架内，我们评估了从伦巴第地区间皮瘤登记处（RML）提取的 562 例 MPM 病例的石棉暴露情况，这些病例均有完整的访谈，基于标准化的全国问卷和组织病理学标本。暴露评估是通过专家评估（被认为是本研究的金标准）进行的，根据意大利国家间皮瘤登记处（ReNaM）的指南进行，并使用职业暴露矩阵（SYN-JEM）进行，以获得职业石棉暴露的定性（是否有）和定量估计（以每毫升纤维表示的累积暴露量（f/mL））。评估了 SYN-JEM 与专家评估的吻合度。根据专家评估，职业性石棉暴露在男性中占 73.6%，在女性中占 23.6%；此外，29 名男性（7.8%）和 70 名女性（36.9%）有非职业性石棉暴露。当应用 SYN-JEM 时，225 名男性（60.5%）和 25 名女性（13.2%）被归类为职业暴露，男性的累积暴露中位数较高（1.7 f/mL-年）高于女性（1.2 f/mL-年）。两种方法（Cohen's kappa）对职业暴露评估的一致性总体为 0.46（男性为 0.41，女性为 0.07）。男性的敏感性较高（0.73），女性的敏感性较低（0.18），而女性的特异性较高（0.88），男性的特异性较低（0.74）。总体而言，两种方法都可用于重建过去的职业性石棉暴露，各有其优点和局限性。
