Linet M S, Yin S N, Travis L B, Li C Y, Zhang Z N, Li D G, Rothman N, Li G L, Chow W H, Donaldson J, Dosemeci M, Wacholder S, Blot W J, Hayes R B
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland 20892-7368, USA.
Environ Health Perspect. 1996 Dec;104 Suppl 6(Suppl 6):1353-64. doi: 10.1289/ehp.961041353.
Previous occupational cohort studies of benzene-exposed workers have for the most part used only death certificates to validate diagnoses of workers developing leukemia and other hematopoietic and lymphoproliferative malignancies and related disorders (HLD). In a follow-up study of 74,828 benzene-exposed workers and a comparison group of 35,805 nonexposed workers from 12 cities in China, we sought to characterized clinicopathologically and to confirm diagnoses of all cases of HLD. Using medical records, laboratory hematology results, and histopathology, U.S. and Chinese expert hematopathologists, blinded to exposure status, carried out a detailed review using standardized evaluation forms. Key among the findings were a notable diversity of malignant and nonneoplastic hematopoietic and lymphoproliferative disorders, documentation of excess myelodysplastic syndromes among benzene workers, and widespread dyspoiesis involving all hematopoietic cell lines. As sophisticated clinicopathologic characterization and corresponding classification schemes for HLD become increasingly widespread, it is recommended that future epidemiologic investigations of benzene workers incorporate similarly detailed morphologic evaluation. In extending follow-up of this cohort of young workers, we will continue to use all available clinical, laboratory hematology, and pathology data as well as cytogenetic and biochemical markers to characterized various HLD outcomes. These careful surveillance mechanisms should also provide additional insight into carcinogenic mechanisms of benzene and allow comparison of the molecular pathogenesis of HLD induced by benzene versus chemotherapy, radiation, or other exposure.
以往针对接触苯的工人开展的职业队列研究，大多仅使用死亡证明来验证罹患白血病及其他造血和淋巴增殖性恶性肿瘤及相关疾病（HLD）的工人的诊断。在中国12个城市的74828名接触苯的工人及35805名未接触苯的工人组成的对照组的随访研究中，我们试图对所有HLD病例进行临床病理特征分析并确诊。美国和中国的血液病理专家在不知晓接触状况的情况下，利用病历、实验室血液学检查结果和组织病理学，通过标准化评估表格进行了详细审查。研究结果的关键之处在于，恶性和非肿瘤性造血及淋巴增殖性疾病具有显著多样性，记录了苯接触工人中骨髓增生异常综合征过多的情况，以及涉及所有造血细胞系的广泛的细胞生成异常。随着HLD复杂的临床病理特征分析及相应分类方案日益普及，建议未来对苯接触工人的流行病学调查纳入同样详细的形态学评估。在对这一青年工人群体进行随访时，我们将继续利用所有可用的临床、实验室血液学和病理学数据以及细胞遗传学和生化标志物，来分析各种HLD结局。这些细致的监测机制还应能为苯的致癌机制提供更多见解，并能比较苯诱导的HLD与化疗、辐射或其他暴露所致HLD的分子发病机制。
