Epidemiological studies of risk factors could aid in designing risk stratification tools

K Devaraja
{"title":"Epidemiological studies of risk factors could aid in designing risk stratification tools","authors":"K Devaraja","doi":"10.4103/crst.crst_276_23","DOIUrl":null,"url":null,"abstract":"The latest issue of Cancer Research, Statistics and Treatment contained an interesting article by Michaelraj et al., an epidemiological study on risk factors of head-and-neck squamous cell carcinoma (HNSCC) in south India.[1] I would like to discuss some of the crucial findings of this study and their implications in developing risk stratification models and beyond. This study cross-sectionally analyzed the epidemiological profile of 150 consecutive patients with primary treatment-naïve HNSCC recruited over three years at a tertiary care hospital in Tamil Nadu.[1] As seen in most of the other regions of India, the most common primary site of HNSCC was the oral cavity (40.7%) in this cohort.[2] There were three times more men than women among the diagnosed cases, and only just about a quarter of the study cohort had no exposure to smoking, tobacco chewing, or alcohol (27.3%). Although there existed a significant variability among the men and women regarding the distribution of these risk factors, as per Table 4 in the paper,[1] more than half the men with HNSCC had exposure to multiple risk factors. Furthermore, 66.7% of the overall cohort had exposure to at least one tobacco product. These observations of Michaelraj et al.[1] align with the existing consensus, as they suggest a possible etiopathological role of these known carcinogenic elements, particularly tobacco, the exposure to which is significantly higher among men than women.[3] In Table 5,[1] the authors analyzed the proportional distribution of risk factors in different age groups and found it statistically significant by two-way ANOVA. This table also showed that 91.8% (100/109) of patients with HNSCC exposed to a known risk factor(s) were aged between 41 and 70 years, and only a few patients in the exposed group were outside this range. Additionally, the distribution of all these risk factors (including various combinations of these factors) was seen to peak around the sixth decade of life. Lastly, the patients in the sixth decade of life or older had a higher degree of exposure to multiple risk factors than those in the fifth decade or younger, who had either one risk factor or no exposure at all. All these findings suggest that the putative role of tobacco and alcohol in the carcinogenesis of HNSCC seems to be more relevant in older adults, in their fourth, fifth, and sixth decades of life than in the younger population, a notion that has also been supported by other recent studies.[4] While the relative risk attributable to these known carcinogens is not always predictable, it is understandable that the risk increases with an increase in the duration and severity of exposure to these factors.[5] By these observations, the elderly male with a long-standing use of tobacco, with or without alcohol, would seem to have a higher risk of developing HNSCC, which includes oral cancer. Accordingly, these groups of people, if targeted, would be more likely to benefit from screening programs and preventive interventions, as applicable.[6] By providing the epidemiological profile of risk factors involved, studies like the one by Michaelraj et al. form the basis for developing pre-screening risk-stratification tool(s) aimed at defining an appropriate high-risk population who could benefit from screening programs.[6] A prototype of a risk stratification tool for oral cancer called OraCLE has been proposed recently, which is based on exposure levels to the risk factors, and is awaiting validation studies.[7] Lastly, the status and distribution of human papillomavirus in this study are also in line with the present consensus, as they are known to affect only a small proportion of oropharyngeal tumors in the Indian context.[8,9] Overall, although the present study by Michaelraj et al.[1] does not establish a direct causal association between the studied risk factors and HNSCC, by defining the epidemiological profile of HNSCC in a cohort of patients from south India, it could form the basis for further studies in this regard, and could eventually aid in the design of appropriate screening and preventive strategies as relevant to the study population. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":"7 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancer Research, Statistics, and Treatment","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/crst.crst_276_23","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 1

Abstract

The latest issue of Cancer Research, Statistics and Treatment contained an interesting article by Michaelraj et al., an epidemiological study on risk factors of head-and-neck squamous cell carcinoma (HNSCC) in south India.[1] I would like to discuss some of the crucial findings of this study and their implications in developing risk stratification models and beyond. This study cross-sectionally analyzed the epidemiological profile of 150 consecutive patients with primary treatment-naïve HNSCC recruited over three years at a tertiary care hospital in Tamil Nadu.[1] As seen in most of the other regions of India, the most common primary site of HNSCC was the oral cavity (40.7%) in this cohort.[2] There were three times more men than women among the diagnosed cases, and only just about a quarter of the study cohort had no exposure to smoking, tobacco chewing, or alcohol (27.3%). Although there existed a significant variability among the men and women regarding the distribution of these risk factors, as per Table 4 in the paper,[1] more than half the men with HNSCC had exposure to multiple risk factors. Furthermore, 66.7% of the overall cohort had exposure to at least one tobacco product. These observations of Michaelraj et al.[1] align with the existing consensus, as they suggest a possible etiopathological role of these known carcinogenic elements, particularly tobacco, the exposure to which is significantly higher among men than women.[3] In Table 5,[1] the authors analyzed the proportional distribution of risk factors in different age groups and found it statistically significant by two-way ANOVA. This table also showed that 91.8% (100/109) of patients with HNSCC exposed to a known risk factor(s) were aged between 41 and 70 years, and only a few patients in the exposed group were outside this range. Additionally, the distribution of all these risk factors (including various combinations of these factors) was seen to peak around the sixth decade of life. Lastly, the patients in the sixth decade of life or older had a higher degree of exposure to multiple risk factors than those in the fifth decade or younger, who had either one risk factor or no exposure at all. All these findings suggest that the putative role of tobacco and alcohol in the carcinogenesis of HNSCC seems to be more relevant in older adults, in their fourth, fifth, and sixth decades of life than in the younger population, a notion that has also been supported by other recent studies.[4] While the relative risk attributable to these known carcinogens is not always predictable, it is understandable that the risk increases with an increase in the duration and severity of exposure to these factors.[5] By these observations, the elderly male with a long-standing use of tobacco, with or without alcohol, would seem to have a higher risk of developing HNSCC, which includes oral cancer. Accordingly, these groups of people, if targeted, would be more likely to benefit from screening programs and preventive interventions, as applicable.[6] By providing the epidemiological profile of risk factors involved, studies like the one by Michaelraj et al. form the basis for developing pre-screening risk-stratification tool(s) aimed at defining an appropriate high-risk population who could benefit from screening programs.[6] A prototype of a risk stratification tool for oral cancer called OraCLE has been proposed recently, which is based on exposure levels to the risk factors, and is awaiting validation studies.[7] Lastly, the status and distribution of human papillomavirus in this study are also in line with the present consensus, as they are known to affect only a small proportion of oropharyngeal tumors in the Indian context.[8,9] Overall, although the present study by Michaelraj et al.[1] does not establish a direct causal association between the studied risk factors and HNSCC, by defining the epidemiological profile of HNSCC in a cohort of patients from south India, it could form the basis for further studies in this regard, and could eventually aid in the design of appropriate screening and preventive strategies as relevant to the study population. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
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危险因素的流行病学研究有助于设计危险分层工具
最新一期的《癌症研究、统计和治疗》包含了Michaelraj等人的一篇有趣的文章,这是一篇关于印度南部头颈部鳞状细胞癌(HNSCC)危险因素的流行病学研究。[1]我想讨论一下这项研究的一些重要发现,以及它们对发展风险分层模型和其他方面的影响。本研究横断面分析了在泰米尔纳德邦一家三级医院连续招募的150例原发性treatment-naïve HNSCC患者的流行病学资料。[1]与印度大多数其他地区一样,该队列中最常见的HNSCC原发部位为口腔(40.7%)。[2]在确诊病例中,男性是女性的三倍,只有大约四分之一的研究队列没有吸烟、咀嚼烟草或饮酒(27.3%)。尽管这些危险因素的分布在男性和女性之间存在显著差异,但根据本文的表4,[1]超过一半的HNSCC男性暴露于多种危险因素。此外,整个队列中66.7%的人至少接触过一种烟草制品。Michaelraj等人[1]的这些观察结果与现有的共识一致,因为他们认为这些已知的致癌元素,特别是烟草,可能具有致病病理作用,男性接触烟草的比例明显高于女性[3]。在表5中,[1]作者分析了不同年龄段危险因素的比例分布,经双因素方差分析,发现具有统计学意义。该表还显示,暴露于已知危险因素的HNSCC患者中,年龄在41 - 70岁之间的占91.8%(100/109),暴露组中只有少数患者不在此范围内。此外,所有这些风险因素的分布(包括这些因素的各种组合)在生命的第六个十年左右达到顶峰。最后,60岁或以上的患者暴露于多种危险因素的程度高于50岁或以下的患者,这些患者要么只有一种危险因素,要么根本没有暴露。所有这些发现表明,烟草和酒精在HNSCC癌变中的假定作用似乎与老年人更相关,在他们的第四,第五和第六十岁的生活中,而不是在年轻人中,这一观点也得到了其他近期研究的支持。[4]虽然这些已知致癌物的相对风险并不总是可以预测的,但可以理解的是,风险随着暴露于这些因素的持续时间和严重程度的增加而增加。[5]通过这些观察,长期吸烟或不饮酒的老年男性似乎有更高的患HNSCC(包括口腔癌)的风险。因此,如果有针对性,这些人群将更有可能从筛查项目和预防性干预中受益。[6]通过提供相关风险因素的流行病学概况,Michaelraj等人的研究为开发筛查前风险分层工具奠定了基础,这些工具旨在定义合适的高危人群,他们可以从筛查项目中受益。[6]最近提出了一种名为OraCLE的口腔癌风险分层工具的原型,它基于对风险因素的暴露水平,正在等待验证研究。[7]最后,在这项研究中,人乳头瘤病毒的状况和分布也符合目前的共识,因为在印度,它们只影响一小部分口咽肿瘤。[8,9]总体而言,尽管Michaelraj等人[1]的研究并未在所研究的危险因素与HNSCC之间建立直接的因果关系,但通过在印度南部的一组患者中定义HNSCC的流行病学概况,它可以为这方面的进一步研究奠定基础,并最终有助于设计与研究人群相关的适当筛查和预防策略。财政支持及赞助无。利益冲突没有利益冲突。
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来源期刊
CiteScore
5.00
自引率
0.00%
发文量
142
审稿时长
13 weeks
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