Mortality from liver angiosarcoma, hepatocellular carcinoma, and cirrhosis among vinyl chloride workers

Background:Occupational exposure to vinyl chloride monomer (VCM) has beenestablished as a causeof hepatocellular carcinoma (HCC) and liver angiosarcoma (ASL).However, some controversy remains due to conflicting results on liver cirrhosis, and toevidence on HCC based on few confirmed cases. The aim of the study is to clarify theassociation between VCM exposure and mortality from liver diseases.Methods:In a cohortof 1658 workers involvedin VCM production and polymerization,Poisson regression was adopted to estimate rate ratios (RR) across categories of VCMexposureformortalityduetoASL(n=9),HCC(n= 31)confirmedbyhistological/clinicalrecords, and the combination of deaths from liver cirrhosis and from liver cancer withclinical/histological evidence of cirrhosis (n=63).Results:Cumulative VCM exposure was associated with study outcomes; RRs in thehighest compared to the lowest exposure category were: ASL 91.1 (95%ConfidenceInterval 16.8-497), HCC 5.52 (2.03-15.0), liver cirrhosis 2.60 (1.19-5.67).Conclusions:The risk of death from liver cirrhosis, as well as from HCC in the largestavailable series of confirmed cases, increased with VCM exposure