Abstract
Pneumonic-type lung adenocarcinoma (P-ADC) represents a distinct subset of lung cancer with specific clinical, radiological, and pathological features. Given the weak association with tobacco-smoking and the striking similarities with jaagsiekte sheep retrovirus (JSRV)-induced ovine pulmonary adenocarcinoma, it has been suggested that a zoonotic viral agent infecting pulmonary cells may predispose to P-ADC in humans. Our objective was to explore whether exposure to domestic small ruminants may represent a risk factor for P-ADC. We performed a multicenter case-control study recruiting patients with P-ADC as cases and patients with non-P-ADC non-small cell lung cancer as controls. A dedicated 356-item questionnaire was built to evaluate exposure to livestock. A total of 44 cases and 132 controls were included. At multivariate analysis, P-ADC was significantly more associated with female gender (Odds-ratio (OR) = 3.23, 95% confidence interval (CI): 1.32–7.87, p = 0.010), never- smoker status (OR = 3.57, 95% CI: 1.27–10.00, p = 0.015), personal history of extra-thoracic cancer before P-ADC diagnosis (OR = 3.43, 95% CI: 1.10–10.72, p = 0.034), and professional exposure to goats (OR = 5.09, 95% CI: 1.05–24.69, p = 0.043), as compared to other subtypes of lung cancer. This case-control suggests a link between professional exposure to goats and P-ADC, and prompts for further epidemiological evaluation of potential environmental risk factors for P-ADC.
Highlights
Lung cancer is the leading cause of cancer-related death worldwide, and is related to cigarette smoking in the majority of patients
The identification of environmental risk factors that may predispose to lung cancer requires a deep analysis of leisure and professional activities in specific subgroups of patients for whom tobacco smoking may not represent a major carcinogen
We show that case-control study is an appropriate approach to assess potential associations between pneumonic-type adenocarcinoma (P-ADC) and exposure to domestic small ruminants, as previous virology studies have failed to isolate a causal infectious agent
Summary
Lung cancer is the leading cause of cancer-related death worldwide, and is related to cigarette smoking in the majority of patients. The disease arises in individuals who are never or little smokers, mostly presenting with adenocarcinoma-type histology [1,2] Among these tumours, pneumonic-type adenocarcinoma (P-ADC) represents a subset with a distinct pathological and radiological presentation and a specific clinical course: higher female: male ratio, lower relationship with tobacco smoking, predominant lepidic growth, diffuse alveolar consolidation [3,4]. Pneumonic-type adenocarcinoma (P-ADC) represents a subset with a distinct pathological and radiological presentation and a specific clinical course: higher female: male ratio, lower relationship with tobacco smoking, predominant lepidic growth, diffuse alveolar consolidation [3,4] The carcinogenesis of this tumour entity is poorly understood. It has been described for a long time as an animal model for human P-ADC, as the two tumours share strikingly similar clinical, radiological and pathological features [7,8]
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