Cases Of Sinonasal Cancer Research Articles

Exposures to IARC Carcinogenic Agents in Work Settings Not Traditionally Associated with Sinonasal Cancer Risk: The Experience of the Italian National Sinonasal Cancer Registry.

The aim of this study is to highlight tasks and jobs not commonly considered at high risk for sinonasal cancer (SNC) identified by Regional Operating Centers currently active in the Italian National Sinonasal Cancer Registry (ReNaTuNS), which retrieve occupational histories through a standardized questionnaire. Data on exposures to IARC carcinogenic agents in work settings unknown to be associated with SNC risk were collected and analyzed. Out of 2,208 SNC cases recorded in the ReNaTuNS database, 216 cases and their worked exposure periods were analyzed. Unsuspected jobs with exposure to wood dust include construction-related tasks, production of resins, agriculture and livestock jobs (straw and sawdust), and heel factory work (cork dust). Other examples are hairdressers, bakers (formaldehyde), dressmakers, technical assistants, wool and artificial fiber spinners, and upholsterers (textile dusts). Moreover, settings with coexposure to different agents (e.g., wood with leather dusts and chromium–nickel compounds) were recognized. The study describes jobs where the existence of carcinogenic agents associated with SNC risk is unexpected or not resulting among primary materials employed. The systematic epidemiological surveillance of all epithelial SNC cases with a detailed collection of their work history, as performed by a dedicated population registry, is essential for detecting all potential occupational cases and should be considered in the context of forensic medicine and the compensation process.

Does sinonasal cancer survival differ based on human papillomavirus status?

6565 Background: The sinonasal tract is a lesser known “hot spot” for the human papillomavirus (HPV), compared with the oropharynx. Additionally, unlike the oropharynx, the role of HPV tumor status in the survival and overall prognosis of the sinonasal tract and other non-oropharyngeal head and neck cancer sites remains inconclusive. Understanding differences in survival based on HPV status could be useful clinically, as it has been for HPV-positive oropharyngeal disease. This study examined whether there are survival differences in sinonasal cancer based on HPV status. Methods: This study included adult sinonasal cancer cases diagnosed between 2010 and 2015 in the National Cancer Database. A multivariable Cox proportional hazards model estimated the association between sinonasal cancer HPV status (HPV-positive, HPV-negative) and all-cause mortality while controlling for covariates (sex, age, race/ethnicity, insurance status, urban/rural, county-level household income, county-level percentage without high school diploma, comorbidity score, stage, histology, facility type, and treatment). A second multivariable proportional hazards model stratified HPV-positive tumor status by high-risk HPV (16, 18, 26, 31, 33, 35, 36, 45, 51, 52, 53, 56, 58, 59, 66, 67, 68, 69, 70, 73, 82, and 85) vs. low-risk HPV (6, 11, 32, 34, 40, 42, 44, 54, 61, 62, 64, 71, 72, 74, 81, 83, 84, 87, and 89) and compared their all-cause mortality to HPV-negative patients. Results: There were 1,750 sinonasal cancer patients included in this study, and 484 (27.7%) had HPV-positive disease. Among patients with HPV-positive disease, 75.6% had high-risk types. Mortality risk among all HPV-positive patients combined was 23% lower than HPV-negative patients (aHR = 0.77; 95% CI 0.64, 0.93). After stratifying by high-risk vs. low-risk HPV, high-risk HPV positive patients had 30% lower mortality risk than HPV-negative patients (aHR = 0.70; 95% CI 0.57, 0.88) while risk of mortality did not significantly differ between low-risk HPV-positive patients and HPV-negative sinonasal cancer patients. Conclusions: Sinonasal cancer shows differential survival based on HPV status, and sinonasal cancer patients positive for high-risk HPV had a significantly greater survival advantage than low-risk strains and those with HPV negative disease. HPV status might yet play a role in prognostication of sinonasal cancer, if future studies confirm these findings.

Abstract 4190: Impact of comorbidities and nonclinical factors associated with sinonasal cancer all-cause mortality in the United States

Abstract Introduction: The anatomical complexity of the sinonasal region contributes to the poor prognosis and relative rarity of sinonasal cancer. While several studies have focused on the major clinical factors associated with survival, the burden of comorbidities and its impact on all-cause mortality of sinonasal cancer is unknown. Objective: This study aimed at describing the impact of comorbidities and nonclinical factors on all-cause mortality of sinonasal cancer in the United States. Methods: In this retrospective cohort study (n=10769), adult cases of sinonasal cancer (International Classification of Diseases for Oncology, third edition typology codes: C30.0, C30.1, C31.0-C31.3, C31.8, C31.9) diagnosed from 2004 through 2013. The outcome of interest was all-cause mortality. Independent variables included treatment type, time to treatment, staging, comorbidity scoring, histology, HPV test status, age, gender, race, facility type, distance to facility, insurance, local income, and urban level. Survival analysis was conducted via multivariable extended Cox regression with Heaviside adjustment for time-varying component of treatment variables. Results: In this cohort, 79% were whites, 60% males, and mean age of diagnosis was 63.5 years. Approximately 1-in-5 patients (18.6%) had a major comorbidity (Charlson-Deyo score ≥ 1) at the time of sinonasal cancer diagnosis. In the final model, after controlling for clinical factors including stage of presentation, treatment modality, HPV status, and histological subtypes, increasing Charlson-Deyo comorbid score was associated with a corresponding increase in hazard of mortality [(aHR score of 1 = 1.25; 95% CI 1.16, 1.35), (aHR score of 2+ = 1.62; 95% CI 1.42, 1.84). There were significant effects of race and socioeconomic status on all-cause mortality. Males (aHR = 1.11; 95% CI 1.05, 1.18); blacks (aHR = 1.12, 95% CI 1.02, 1.24); those uninsured (aHR = 1.40; 95% CI 1.21, 1.62) or covered by Medicaid (aHR = 1.48; 95% CI 1.31, 1.66); and patients living in zip-codes with lower median income quartile (aHR <$30,000 = 1.17; 95% CI 1.06, 1.29) all had greater hazard of all-cause mortality. Additionally, treatment at community cancer programs was associated with increased hazard of mortality (aHR = 1.14, 95% CI 1.01, 1.28) compared with being treated at an academic/research program. Conclusions: Besides clinical factors such as stage of presentation, severe comorbid disease is most associated with all-cause mortality among patients with sinonasal cancer. Additionally, other nonclinical factors associated with sinonasal cancer all-cause mortality included race, insurance status, income, histological subtypes of the cancers, and comorbidity scores. Understanding the impact of these factors on mortality could help clinicians in disease prognostication and management of patients with sinonasal cancer. Note: This abstract was not presented at the meeting. Citation Format: Premal B. Desai, Aleksandr R. Bukatko, Matthew C. Simpson, Eric Adjei Boakye, Jason W. Greenberg, Greg M. Ward, Ronald J. Walker, Jastin L. Antisdel, Nosayaba Osazuwa-Peters. Impact of comorbidities and nonclinical factors associated with sinonasal cancer all-cause mortality in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4190.

Effect of elderly status on postoperative complications in patients with sinonasal cancer.

Elderly patients with multiple comorbidities may be at higher risk of postoperative complications. With an increasingly aging population, more data assessing for predisposing factors are needed in this at-risk group. In this study, we analyzed the effect of elderly status on relative comorbidities and complications of sinonasal cancer (SNC) patients receiving surgery. A retrospective database analysis was performed using cases from the Nationwide Inpatient Sample (NIS) from 2003 to 2012. Patients with a diagnosis of malignant neoplasm of the nasal cavity or paranasal sinuses, who received surgery for sinonasal malignancy, including neck dissections, were selected. Demographics of interest included age, sex, race, type of admission, mean length of stay, and median hospital charges. Elderly and nonelderly patients were compared for differences in rates of acute medical complications, acute surgical complications, and relevant procedures during hospitalization. Of the 920 cases identified in the NIS, 382 (41.5%) were elderly (≥65 years). Cases of SNC were more frequently seen in males than females (p < 0.001). Elderly patients had significantly higher comorbidity rates compared with nonelderly patients, which included congestive heart failure, hypertension, diabetes, chronic pulmonary disease, and chronic renal failure (p < 0.001 for all). Elderly patients more frequently had postoperative cardiac complications (6.0% vs 0.5%, p < 0.001), but this finding was not statistically significant on multivariate analysis when controlling for race, sex, and comorbidities. Elderly status is not an independent factor for postoperative complications in patients undergoing surgery for sinonasal malignancy.

Sinonasal cancer in the Italian national surveillance system: Epidemiology, occupation, and public health implications.

Sinonasal cancer (SNC) is a rare tumor with predominant occupational etiology associated with exposures to specific carcinogens. The aim of this study is to describe SNC cases recorded in Italy in the period 2000-2016. Clinical information, occupational history, and lifestyle habits of SNC cases collected in the Italian Sinonasal Cancer Register were examined. Age-standardized rates were estimated. Overall, 1529 cases were recorded. The age-standardized incidence rates per 100 000 person-years were 0.65 in men and 0.26 in women. Occupational exposures were predominant among the attributed exposure settings, primarily to wood and leather dusts. Other putative causal agents included chrome, solvents, tannins, formaldehyde, textile dusts, and pesticides. Many cases had unknown exposure. Epidemiological surveillance of SNC cases and their occupational history is fundamental for monitoring the occurrence of the disease in exposed workers in industrial sectors generally not considered at risk of SNC as well as in non-occupational settings.

Clinical manifestations and STK11 germline mutations in Taiwanese patients with Peutz–Jeghers syndrome

Clinical manifestations and molecular basis of Taiwanese patients with Peutz-Jeghers syndrome (PJS) were investigated to add the knowledge of phenotype and genotype of the disease. Based on the Pathology Data Bank and the Colorectal Cancer Register, we collected their clinical data. The entire coding sequence of the STK11 gene was amplified and analyzed by sequencing using the genomic DNA. Fifteen patients diagnosed with PJS from 11 unrelated families were collected until 2015. The median age at the onset of symptoms was 19 years with intussusception as the most frequent presenting symptom. Ten patients developing 11 cancers at various anatomical sites, including two cases of sinonasal cancer, two lung cancers, two breast cancers, two rectal cancers, two gynecological cancers and one small bowel cancer. Five of the deceased patients had died of cancers. The median age of diagnosis of first cancer in the probands was 32 years. Seventy patients (7 of 10) diagnosed before age of 40. Mutations found in eight families included five novel mutations (exon 6, c.843 ins G; exon 8, c.2065 delete A; exon 8, c.G923A, nonsense; exon 6, c.748dupA; and mTOR c.5107dupA) and three previously reported mutations. The other three PJS families without detectable STK11 mutations did not develop malignancies so far. This is the first comprehensive study of patients with Peutz-Jeghers syndrome in the Taiwanese. We have demonstrated that the phenotype of Peutz-Jeghers syndrome varies greatly among the patients. Patients with detectable STK11 mutations have very high risk of developing cancers.

Prevalence of occupational hazards in patients with different types of epithelial sinonasal cancers

Occupational exposure to carcinogens contributes greatly to the etiology of sinonasal cancer (SNC), but the role of different risk factors in determining different histological subtypes is disputed. All consecutive surgical epithelial SNC cases (case-series study) underwent a systematic occupational medicine examination to determine previous exposure to a wide range of work-related chemical hazards. We investigated 65 SNC cases including intestinal-type adenocarcinoma [ITAC] squamous-cell carcinoma [SCC], and others. Occupational exposure was recognized for 39 cases. Occupational exposures were sensibly more frequent among ITAC than among SCC or other histotypes. Occupational exposure in ITAC cases was to leather or wood dust only, while among non-ITAC cases, we recognised exposure to formaldehyde, solvents and metal fumes. A high proportion of SNC with occupational exposure originated in the ethmoidal epithelium. In our case-series of SNC, a very high frequency of previous occupational exposure to carcinogens was detected, suggesting that occupational hazards may be associated to the aetiopathogenesis, primarily for ITAC, but also for other histotypes. Besides leather or wood, other chemical agents must be recognized as occupational risk factors.

Sinonasal cancer and occupational exposure in a population-based registry.

We examined occupational exposures among subjects with sinonasal cancer (SNC) recorded in a population-based registry in the Lombardy Region, the most populated and industrialized Italian region. The registry collects complete clinical information and exposure to carcinogens regarding all SNC cases occurring in the population of the region. In the period 2008–2011, we recorded 210 SNC cases (137 men, 73 women). The most frequent occupational exposures were to wood (44 cases, 21.0%) and leather dust (29 cases, 13.8%), especially among men: 39 cases (28.5%) to wood and 23 cases (16.8%) to leather dust. Exposure to other agents was infrequent (<2%). Among 62 subjects with adenocarcinoma, 50% had been exposed to wood dust and 30.7% to leather dust. The proportions were around 10% in subjects with squamous cell carcinoma and about 20% for tumors with another histology. The age-standardized rates (×100,000 person-years) were 0.7 in men and 0.3 in women. Complete collection of cases and their occupational history through a specialized cancer registry is fundamental to accurately monitor SNC occurrence in a population and to uncover exposure to carcinogens in different industrial sectors, even those not considered as posing a high risk of SNC, and also in extraoccupational settings.

ENVIRONMENTAL CAUSES FOR SINONASAL CANCERS IN PET DOGS, AND THEIR USEFULNESS AS SENTINELS OF INDOOR CANCER RISK

A case-control study was conducted to investigate the environmental causes of sinonasal cancers among pet dogs. Sinonasal cancer (SNC) cases and digestive cancer controls from the years 1989 through 1993 were obtained from a veterinary histopathology database. Owners were mailed a self-administered survey requesting information on canine factors, owner demographics, household exposures (including environmental tobacco smoke), and local pollution. A total of 129 case owners and 176 control owners returned completed surveys: a response rate of approximately 72% . Only household exposures were associated with increased SNC risk. Use of indoor coal or kerosene heaters represented the strongest risk factors, with significant adjusted odds ratios of 4.2 and 2.2 respectively. Environmental tobacco smoke exposure was not a risk factor and was suggestive of a nonsignificant, mildly protective effect at the lower exposure levels. Increasing nasal length was a significant risk factor, and there was effect modification between nasal length and coal or kerosene combustion. No self-reported measures of local pollution, such as urban status or residence within 1 mile of a factory, were associated with SNC risk. These results suggest that canine SNC has a strong environmental component and highlight the importance of indoor exposures, especially from fossil fuel combustion products. These results also suggest that pet dogs represent excellent sentinels for indoor cancer risk and that canine SNC cases can be used as early markers of household exposure to carcinogenic combustion products.