title: Relevance of both individual risk factors and occupational exposure in cancer survival studies: the example of intestinal type sinonasal adenocarcinoma.
abstract: OBJECTIVE
  Wood dust is a well-established risk factor for intestinal type sinonasal adenocarcinoma. The 5-year overall survival has varied from 20% to 80% according T1-T4 stages; 5-year survival according to histologic subtype has varied from 20% to 50%. To date, no study has evaluated whether environmental, occupational, and personal risk factors have any impact on both overall and cancer-specific survival. We aimed to determine whether exposure to carcinogenic risk factors besides wood exposure can influence the survival of patients with sinonasal ethmoid carcinoma.
  
  
  METHODS
  Retrospective cohort study of the association of survival data and occupational and personal carcinogenic risk factors.
  
  
  METHODS
  All patients hospitalized for ethmoid adenocarcinoma at the Nantes University Hospital between 1988 and 2004 were included . Data concerning TNM classification, histology, type and quality of tumor resection at the macro- and microscopic level, and occupational and personal exposure to carcinogens were collected. Statistical analysis was conducted using univariate and multivariate linear regression.
  
  
  RESULTS
  A total of 98 patients were included with a response rate of 98%. Data showed 86% of patients had been exposed to wood dust. The 5-year survival was 62%. We first identified four factors that independently influenced overall survival: diplopia (P = .0159), spread to the orbit (P = .0113), bilateral involvement (P = .0134), TNM stage (P < .001). When the analysis included all occupational environmental factors (wood dust, solvent, and metals exposure) as well as personal risk factors, the length of exposure to metals (P = .0307) and tobacco exposure (P = .0031) also were found to influence 5-year overall survival. We identified high prevalence of colon cancer (4%) and double cancer (18%).
  
  
  CONCLUSIONS
  We showed exposure to both environmental (tobacco) and occupational (metal dust) factors could influence survival in the diagnosis of a cancer. Our study suggests that screening for colon cancer should be offered to wood dust workers. A prospective multicentric study should be necessary to confirm our results.
authors.affiliation: Occupational Medicine Institute, Nantes University, France. dominique.tripodi@chu-nantes.fr
authors.forename: Dominique
authors.initials: D
authors.lastname: Tripodi
authors.forename: Christophe
authors.initials: C
authors.lastname: Ferron
authors.forename: Olivier
authors.initials: O
authors.lastname: Malard
authors.forename: Claude Beauvillain
authors.initials: CB
authors.lastname: de Montreuil
authors.forename: Lucie
authors.initials: L
authors.lastname: Planche
authors.forename: Veronique
authors.initials: V
authors.lastname: Sebille-Rivain
authors.forename: Claude
authors.initials: C
authors.lastname: Roedlich
authors.forename: Sylvia
authors.initials: S
authors.lastname: Quéméner
authors.forename: Karine
authors.initials: K
authors.lastname: Renaudin
authors.forename: Claire
authors.initials: C
authors.lastname: Longuenesse
authors.forename: Christian
authors.initials: C
authors.lastname: Verger
authors.forename: Khaled
authors.initials: K
authors.lastname: Meflah
authors.forename: Catherine
authors.initials: C
authors.lastname: Gratas
authors.forename: Christian
authors.initials: C
authors.lastname: Géraut
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D004391:Dust; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008670:Metals / Q000009:adverse effects*; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D009790:Occupations; D010255:Paranasal Sinus Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*
chemical_list: D004391:Dust; D008670:Metals; D014028:Tobacco Smoke Pollution