A Potential Link Between Prolonged Cork Exposure and Intestinal-Type Sinonasal Adenocarcinoma – Special Findings of a Retrospective Cohort Analysis

Abstract

Introduction: intestinal-type sinonasal adenocarcinoma (ITAC) is a rare epithelium tumor of the nasal cavities and paranasal sinuses. Exposure to wood and leather dusts is a strong etiological factor related to its development. Prolonged cork exposure has rarely been associated. Materials and Methods: thirty-seven-year (1981-2018) retrospective cohort analysis of all consecutive patients with sinonasal cancer (SNC) followed at our institution. Medical records were reviewed to determine patient demographics, occupational/environmental exposure, location and extent of the tumor, stage, histopathology findings, treatment strategies, and oncologic outcomes. Survival analysis was done using Kaplan-Meier method. Results: we evaluated 379 patients with SNC, including 39 (10.3%) ITAC. Patient median age was 73 years (range 49-87), 56% male and 69% with identified professional occupational exposure (54% for cork; 69.2% considering only those for which an agent has been identified). Seventy-two percent had locally advanced disease (stage III or IVA-B). The initial treatment was surgery in 77%, and 54% received adjuvant radiotherapy. The median time to progression, progression-free survival, and overall-survival was 2.36 years (95% CI 1.54-8.70), 1.96 years (95% CI 1.43-3.74), and 3.51 years (95% CI 2.33-10.02), respectively. Conclusion: ITAC is an uncommon malignancy that grows silently, which contributes to delayed diagnosis, advanced stage and low survival rates. In our cohort, we observed a high prevalence of cork occupational exposure. This finding may lead to the implementation of protection measures and suggest a potential link to be further studied.

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

“…In a CAREX project, workers exposed to bark are exposed to wood dust mainly on this chemical basis [ 16 ]. Suberosis is a recognized form of pneumoconiosis that affects cork workers, while only recently, SNC cases were observed (prevalently intestinal-type adenocarcinomas) among subjects occupationally exposed to cork dust [ 17 , 18 , 19 , 20 ].…”

Low-dose nivolumab and cabozantinib in recurrent intestinal-type papillary adenocarcinoma of the sinonasal region

“…These cancers usually arise from the nasoethmoidal complex, including the ethmoidal roof, cribriform plate, posterior ethmoidal cells, middle turbinate and the posterior superior septum. In a cohort of 379 patients with sinonasal malignancy, ITAC represented 10% of all the histological subgroups, with occupational exposure and, specifically cork exposure in 69% and 54% of patients, respectively 13. Wood dust is recognised as a carcinogen found in association with this malignancy, particularly in cases arising from the ethmoid bone.…”

AGO2-RIP-Seq reveals miR-34/miR-449 cluster targetome in sinonasal cancers

“…Malignant tumours of the nasal cavity and paranasal sinuses (sinonasal cancers, SNCs) account for 0.2% of all human primary malignant neoplasms, with an incidence of 0.1-1.4 new cases/year/100,000 inhabitants [1]. SNCs are a heterogeneous group of rare tumours mainly associated with occupational exposure [2,3]. Epithelial tumours, which include sinonasal adenocarcinoma (SNADC) and sinonasal squamous cell carcinoma (SNSCC), are linked to wood and leather dust exposure at the workplace [3,4].…”