Cancer of the larynx is the seventh most common malignant disease among middle-aged men in Croatia. Morbidity ratio between men and women is 17:1. Etiology of disease is directly connected with the tobacco use while genetic influences have not yet been studied enough. Digito-palmar dermatoglyphs analysis has already been used in studying the genetic etiology of certain malignant diseases (lung, breast, cervical, colorectal, melanoma and gastric cancer). We have analyzed correlation of quantitative and qualitative traits between two groups (group of 40 men with larynx cancer versus control group of 100 phenotypically healthy men). Quantitative statistical analysis (descriptive statistics, multivariate and univariate analysis) has not shown statistically significant difference except for the latent structure using factor analysis. Qualitative analysis has shown statistically significant difference among two investigated groups thus suggesting the faster changes of the qualitative features under the influence of the ecological factors

Damir Letinić

Jasna Miličić

Milan Rudić

English

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Coll. Antropol. 29 (2005) 1: 179–183UDC 572.524:616.22-006Original scientific paperDermatoglyphs and Larynx CancerMilan Rudi}1, Jasna Mili~i}2 and Damir Letini}31 ENT Department, General Hospital Zadar, Zadar, Croatia2 Institute for Anthropological Research, Zagreb, Croatia3 Department of Pediatrics, General Hospital Zadar, Zadar, CroatiaA B S T R A C TCancer of the larynx is the seventh most common malignant disease among middle-aged men in Croatia. Morbidityratio between men and women is 17:1. Etiology of disease is directly connected with the tobacco use while genetic influ-ences have not yet been studied enough. Digito-palmar dermatoglyphs analysis has already been used in studying thegenetic etiology of certain malignant diseases (lung, breast, cervical, colorectal, melanoma and gastric cancer). Wehave analyzed correlation of quantitative and qualitative traits between two groups (group of 40 men with larynx can-cer versus control group of 100 phenotypically healthy men). Quantitative statistical analysis (descriptive statistics,multivariate and univariate analysis) has not shown statistically significant difference except for the latent structureusing factor analysis. Qualitative analysis has shown statistically significant difference among two investigated groupsthus suggesting the faster changes of the qualitative features under the influence of the ecological factors.Key words: dermatoglyphs, larynx cancer, genetic influencesIntroductionThe head and neck oncology shows a special interestin the larynx cancer (carcinoma laryngis)1,2. The in-crease in the incidence of this malignant disease hasbeen notified since the last five decades, mainly amongthe male population. The highest incidence rates havebeen reported in Sao Paolo, Brazil (17/100000), USAConnecticut (12.6/100000) and Poona, India (12.9/100000). In Europe the highest incidence has been re-corded in the Mediterranean region and the lowest inthe northern Europe1–3. In Croatia, every year there areabout 400 new diagnosed patients. Morbidity ratio be-tween men and women is 17:14. Planocellular type ofcarcinoma is the most frequent one, while other typeslike basalioma and adenocarcinoma are very rare. Car-cinoma occurs in 65% of all cases located in the glotticregion of the larynx and has the best prognosis. In the30% of cases tumor is located in the supraglottic region,and in 5% of all cases it is located in the subglottic re-gion and has the worst prognosis5–6. Early diagnosis hasan important impact on the therapy decision and the fi-nal prognosis. Five-year survival rate for the supra-glottic carcinoma without neck metastasis is 80–90%,while with the cervical lymph nodes affected it dropsdown to 30–50%. Glottic carcinoma has 80–90% five-year survival rate if the vocal cords are not affected.With the vocal cords affected it drops down to 50–60%7–8. Etiology of the disease is directly connected withthe tobacco use, while genetic influences have not yetbeen studied enough7–9. Histological changes of epithe-lium found in smokers (hyperkeratosis without atypia)increase the risk of the invasive carcinoma of the larynxby 3%, while hyperkeratosis with atypia increase therisk of invasive carcinoma by 30%1,6. Polycyclic hydro-carbons found in the tobacco smoke are proven to becontact carcinogens, especially in patients with a higheractivity of aryl hydrocarbo hydroxilaze enzyme1–3,6,7.Other possible factors include alcohol, GERD (gastroesophageal reflux disease) and other carcinogens6–9. Ge-netic predisposition and the role of genetic factors in theetiology of larynx cancer and other solid malignant headand neck tumors are still unclear and thus have beenvery actively studied10–11. Mutation in p53 gene hasbeen found in 60% of laryngeal malignoma12–14. Altera-tions of p16 gene are most frequently noticed in the car-cinomas of the upper aero-digestive tract15. Mutationsin the chromosome 3 (in Europe) and chromosome 8 (inUSA) and, as well as alteration of CENP-F gene, bcl-2179Received for publication May 14, 2004U:\coll-antropolo\coll-antro-1-2005\rudic.vp17. lipanj 2005 08:32:40Plate: 1 of 5Color profile: DisabledBlack  150 lpi at 45 degreesand p27 further suggest the importance of genetic influ-ences in the larynx cancer development16–25.Dermatoglyphs (epidermis patterns on fingers, palmsand soles) start developing between the 5th and the 6thweek of the intrauterine development and by the 21stweek they are completely formed, and remain un-changed26. They are relevant for the understanding ofthe human development and for the differentiation inthe early stages of the embriogenesis, which makesthem important in studies of the human medical pa-thology26,27. So far, digito-palmar dermatoglyphs havebeen used in many studies attempting to understandthe genetic etiology of different malignant diseases28(Table 1). The results have shown differences of thedermatoglyphics features between patients and healthysubjects.In the present study we tested the hypothesis of ge-netic predisposition of larynx cancer. Embryological de-velopment of the larynx starts at about the same timeand from the same embryological layers as the develop-ment of the skin, from which the dermatoglyphs de-velop. Changes in embryological period could have influ-ences on development of the cancer but they could alsohave reflection on the expression of the dermatoglyphicpatterns. We tested this hypothesis by comparing thedermatoglyphs of digito-palmar complex of group of la-rynx cancer patients versus group of healthy individuals.Materials and MethodIn our research we have analyzed digito-palmar der-matoglyphs of 40 male patients with the confirmed di-M. Rudi} et al.: Dermatoglyphs and Larynx Cancer, Coll. Antropol. 29 (2005) 1: 179–183180TABLE 1RESULTS OF THE DERMATOGLYPHS ANALYSIS FOR THE DIFFERENT MALIGNANT DISEASESBreast cancer29,30 Lower total finger ridge count, lower a-b rcSignificant differences between a-b and c-d rcCervix cancer31 Higher frequencies of whorls on fingers, lower atd angleLower number of finger and palmar ridgesBronchopulmonary cancer32,33 Differences in palmar variables, high discriminant classification, biological distancedifferencesColorectal cancer28 Lower atd angleGastric cancer34 Differences in palmar variables, lower atd angleMelanoma35 Lower finger ridge count on 1st, 4th and 5th finger and c-d rc and atd angle on both handsin males and femalesTABLE 2FACTOR ANALYSIS FOR THE VARIABLES IN THE GROUP OF PATIENTS DIAGNOSED WITH LARYNX CANCERVariables Factor I Factor II Factor III Factor IV Factor V Factor VIFRR 1 –0.085 0.103 0.156 0.009 –0.018 0.814FRR 2 0.305 0.068 0.267 0.038 0.738 0.128FRR 3 0.706 –0.292 0.074 0.138 0.412 –0.075FRR 4 0.861 0.005 0.180 0.019 –0.103 0.247FRR 5 0.572 –0.066 0.381 –0.078 0.196 0.468a-b rcR –0.029 –0.096 0.920 0.100 0.012 0.130b-c rcR 0.146 0.178 –0.042 0.915 0.015 0.027c-d rcR 0.175 0.319 0.461 0.411 –0.002 –0.443atd R –0.061 0.927 0.149 0.121 0.023 –0.014FRL 1 0.226 0.042 0.027 0.025 0.543 0.542FRL 2 0.062 0.105 –0.019 –0.004 0.904 –0.073FRL 3 0.778 0.029 –0.024 0.167 0.264 –0.220FRL 4 0.858 0.053 0.051 –0.219 0.119 –0.164FRL 5 0.668 0.086 0.042 0.144 0.125 0.493a-b rcL 0.269 0.204 0.775 0.108 0.185 0.077b-c rcL –0.108 0.056 0.248 0.892 0.019 –0.007c-d rcL –0.041 0.524 0.347 0.424 0.197 –0.464atd L 0.031 0.912 –0.100 0.100 0.104 0.146Variance percentage 20.299 12.677 11.995 11.955 11.450 11.322U:\coll-antropolo\coll-antro-1-2005\rudic.vp17. lipanj 2005 08:32:40Plate: 2 of 5Color profile: DisabledBlack  150 lpi at 45 degreesagnosis of planocellular carcinoma of the larynx, ageranging from 29–78 (mean age 62.2±10.2). Control groupconsisted of 100 phenotypically healthy subjects of thesame population, age ranged from 50–74 years (meanage 60.4±5.0) and who have never been diagnosed withany type of malignant disease36. The digito-palmar printswere taken and quantitative and qualitative dermato-glyps features were analyzed according to the standardCummins and Midlo methods26,37.The analysis of quantitative digito-palmar dermato-glyphs features (descriptive statistics, multivariate andunivariate variance analysis, discriminate and factoranalysis) included 18 variables (finger ridge counts onthe right and the left hand: FRR1, FRR2, FRR3, FRR4,FRR5, FRL1, FRL2, FRL3, FRL4, FRL5; palmar ridge-counts on the right and left hand: a-b rcR, b-c rcR, c-drcR, a-b rcL, b-c rcL, c-d cL; and the atd angles: atdR,atdL). Separately we analyzed qualitative features ofthe fingers, palms and the axial triradius. In order toevaluate differences between the two investigated groupswe used the 2 test.ResultsQuantitative statistical analysis (descriptive statis-tics, multivariate and univariate analysis) of the two in-vestigated groups did not reveal any statistically signifi-cant difference, except for the latent structure by factoranalysis. The results of the factor analysis for the pa-tients and the healthy control subjects are presented inTable 2 in male patients and Table 3 in control group.In the latent structure six factors were extracted inthe male patients’ group and five factors in the controlgroup. The total variance percent in the group of malepatients was 79.69%, while for the control group was71.85%. The largest variance percent was found in thefirst factor for the both groups and it was 20.29% in thegroup of male patients, while in the control group it was25.91%, which is five percent higher.The analysis of the qualitative traits of the digito-palmar dermatoglyphs (in which the 2 test was used)showed statistically significant differences. The fingerM. Rudi} et al.: Dermatoglyphs and Larynx Cancer, Coll. Antropol. 29 (2005) 1: 179–183181TABLE 3FACTOR ANALYSIS OF VARIABLES IN THE GROUP OF THE HEALTHY CONTROL SUBJECTSVariables Factor I Factor II Factor III Factor IV Factor VFRR 1 0.530 –0.198 0.142 0.633 –0.025FRR 2 0.801 –0.061 0.219 0.124 0.045FRR 3 0.824 0.027 –0.054 0.170 0.019FRR 4 0.692 0.223 0.460 –0.096 0.057FRR 5 0.392 0.039 0.795 0.065 –0.048a-b rcR –0.240 0.706 0.305 0.144 –0.103b-c rcR 0.159 0.264 0.067 0.762 0.152c-d rcR 0.095 0.780 –0.103 –0.068 0.181atd R –0.058 0.079 0.039 –0.035 0.937FRL 1 0.559 –0.015 0.111 0.466 –0.163FRL 2 0.792 –0.017 0.197 0.193 0.060FRL 3 0.831 0.094 0.189 0.009 –0.098FRL 4 0.687 0.097 0.498 –0.027 0.040FRL 5 0.407 –0.025 0.708 0.221 0.006a-b rcL –0.087 0.669 0.163 0.312 –0.103b-c rcL –0.044 0.508 0.142 0.640 0.183c-d rcL 0.237 0.787 –0.218 0.035 0.037atd L 0.051 –0.079 –0.057 0.186 0.888Variance percentage 25.912 14.303 10.851 10.628 10.158TABLE 4RESULTS OF THE CHI SQUARE FOR THE FINGER PATERNSFinger paterns 2 pRight 2=6.475 p0.091Left 2=7.308 p0.063Total 2=26.76 p0.005TABLE 5RESULTS OF THE CHI SQUARE TEST FOR THE PALMARPATERNS2 pThenar and 1st interdigital area 2=3.111 p0.0782nd interdigital area 2=0.583 p0.4453rd interdigital area 2=86.889 p0.0014th interdigital area 2=1.645 p0.1997Hypothenar 2=2.158 p0.1418U:\coll-antropolo\coll-antro-1-2005\rudic.vp17. lipanj 2005 08:32:41Plate: 3 of 5Color profile: DisabledBlack  150 lpi at 45 degreesanalysis revealed difference between the two investi-gated groups at the probability level of p0.005 (Table4). Difference for the palm was detected at the probabili-ty level of p0.001 mainly for the III interdigital area(Table 5). Statistically significant difference was alsodetected for the frequency of the axial triradius, (2=38.685, p0.001).DiscussionLarynx cancer is the seventh on the malignant disea-ses incidence list among men in Croatia, which is 3% ofall malignant diseases in the male population4. The roleof genetic and hereditary influences on the etiology ofthe disease is lately very actively studied and needs tobe more evaluated. In the present study while evaluat-ing the dermatoglyphic features of the two differentgroups (40 patients diagnosed with planocellular type ofthe larynx cancer and 100 phenotypically healthy sub-jects), we have tried to investigate the hypothesis of ge-netic predisposition of the disease. The descriptive sta-tistical analysis did not show any difference betweenthe investigated groups except for the latent structureusing factor analysis. In the latent structure six factorswere extracted in the male patients’ group with the totalvariance percent of 79.69, and five factors in the controlgroup with the total variance percent of 71.85. The ana-lysis of the qualitative traits of the digito-palmar der-matoglyphs shows the following statistically significantdifferences: for the finger variables at the probabilitylevel of p0.005, for the palm variables at p0.001, andfor the position of axial triradius at p0.001.Although the results of the quantitative analysis, ex-cept latent structure, do not show significant differen-ces, the genetic influences on the development of the lar-ynx cancer cannot be underestimated. The explanationmight be in a possible influence of the different set ofgenes in the formation of the quantitative features ofthe digito-palmar dermatoglyphs, other than those, whichmight influence the etiology of the disease. The resultsof the qualitative analysis reveal statistically signifi-cant differences thus suggesting faster changes of thequalitative features under the influence of the environ-mental factors.R E F E R E N C E S1. LEBOVICS, R. S., Neoplasms of head and neck. In: Harrison'sprinciples of internal medicine. (Mc Graw-Hill, New York, 1994). — 2.CUMMINGS, W. C., J. M. FREDRICKSON, L. A. HARKER, C. J. KRA-USE, D. E. SCHULLER: Otolaryngology-head and neck surgery. (MosbyYear Book, St. Louis, 1998). — 3. BAILEY, B. J.: Otolaryngology-headand neck surgery. (Lippincott Williams and Wilkins, Philadelphia, 2001).— 4. HRVATSKI ZAVOD ZA JAVNO ZDRAVSTVO: Incidencija raka uHrvatskoj 2000. (Bilten br. 25, Zagreb, 2002). — 5. VINCENT, T., H.SAMUEL, A. R. STEVEN: Cancer: Principles and practice of oncology.(Lippincott Williams and Wilkins, Philadelphia, 2001). — 6. LUIS, B.H., B. S. ROY, K. I. H. WAUN, B. BERNARD, B. W. BRUCE: Head andneck cancer. 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Jad., 24 (1994) 39.— 33. MILI^I], J., R. PAVI]EVI], Int. J. Anthropol., 13 (1998) 24. —34. @IVANOVI]-POSILOVI], G., J. MILI^I], D. BO@I]EVI], Coll.Antropol., 27 (2003) 213. — 35. POPOVI], [., The analysis of quantita-tive dermatoglyphic traits of the digito-palmar omplex in patients withmelanoma malignant. In croat. Mr. Sc. Thesis. (Postgraduate study ofNatural History, University of Zagreb, Zagreb, 1981). — 36. LETINI],D., J. MILI^I], Lije~. Vjesn., 120 (1998) 53. — 37. CUMMINS, H., C.MIDLO: Fingerprints, palms and soles. (Dover Publications. New York.1961).M. Rudi}ENT Department, General Hospital Zadar, Bo`e Peri~i}a 5, 23000 Zadar, CroatiaM. Rudi} et al.: Dermatoglyphs and Larynx Cancer, Coll. Antropol. 29 (2005) 1: 179–183182U:\coll-antropolo\coll-antro-1-2005\rudic.vp17. lipanj 2005 08:32:42Plate: 4 of 5Color profile: DisabledBlack  150 lpi at 45 degreesDERMATOGLIFI I RAK GRKLJANAS A @ E T A KRak grkljana zauzima sedmo mjesto na ljestvici incidencije karcinoma u mu{karaca u Hrvatskoj. Javlja se uglav-nom u srednjoj i starijoj `ivotnoj dobi. Odnos obolijevanja mu{karaca naspram `ena iznosi 17:1. Razvoj bolesti direk-tno se povezuje s pu{enjem, dok genetski utjecaji jo{ nisu do kraja razja{njeni. Analiza digito-palmarnih dermatoglifave} je kori{tena u procjenama genetske osnove nekih malignih bolesti (karcinom dojke, plu}a, melanom, karcinomdebelog crijeva te `eluca). U ovom radu analizirana je korelacija kvalitativnih i kvantitativnih svojstava dermatoglifadigito-palmarnog kompleka izme|u skupine 40 mu{karaca oboljelih od karcinoma grkljana i kontrolne skupine 100fenotipski zdravih mu{karaca. Statisti~kom obradom kvantitativnih svojstava (deskriptivna statistika, multivarija-tna i univarijatna analiza varijance) nije dobivena signifikantna razlika, osim prikazom latentne strukture faktor-skom analizom. Analiza kvalitativnih svojstava pokazala je heterogenost izme|u dviju ispitivanih skupina {to uka-zuje na njihovo br`e mijenjanje pod utjecajem okolinskih faktora.M. Rudi} et al.: Dermatoglyphs and Larynx Cancer, Coll. Antropol. 29 (2005) 1: 179–183183U:\coll-antropolo\coll-antro-1-2005\rudic.vp17. lipanj 2005 08:32:42Plate: 5 of 5Color profile: DisabledBlack  150 lpi at 45 degrees

Dermatoglyphs and Larynx Cancer

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