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 ].…”

The Prognostic Role of the Immune Microenvironment in Sinonasal Intestinal-Type Adenocarcinoma: A Computer-Assisted Image Analysis of CD3+ and CD8+ Tumor-Infiltrating Lymphocytes

“…Intestinal-type adenocarcinoma (ITAC) of the sinonasal tract is a rare malignant tumor with an annual incidence of approximately 1 case per 100,000 inhabitants in Europe [1][2][3]. ITAC has a strong association with occupational exposure to wood, leather, and cork working and resembles colorectal adenocarcinoma from an immunophenotypic and molecular perspective [2][3][4][5]. Despite the advances in imaging, endoscopic surgery, and multimodal therapies [2,3,6,7], ITAC still represents a challenge in view of the potential to spread towards the orbit, skull base, and intracranial space.…”

Human Microbiota and Breast Cancer—Is There Any Relevant Link?—A Literature Review and New Horizons Toward Personalised Medicine

“…Gut microbiota is an emerging field of research, that is being associated with cancer, through direct and indirect interference in diverse biological processes: host cell proliferation and death, immune system function, chronic inflammation, oncogenic signalling, hormonal and detoxification pathways. Better understanding about this nested and complex interplay between the host and its own microbes has provided important data about how gut microbiota plays a crucial role on the development, treatment and prognosis of cancer, in particularly BC ( Garrett, 2015 ; Roy and Trinchieri, 2017 ; Banerjee et al, 2018 ; Dart, 2019 ; Alpuim Costa et al, 2020a ). For example, a distinct local and/or intestinal microbiota signature may contribute to BC development and an “infected” tumour microenvironment can provide a special fertile habitat for cancer and its stromal cells.…”