Risk factors for colorectal cancer in Crohn's colitis: a case-control study

BACKGROUND: Few data exist regarding exposures associated with colorectal cancer (CRC) in patients with Crohn's colitis. The aim of this study was to identify exposures that alter the risk of CRC in patients with Crohn's colitis. METHODS: The Research Patient Database Registry at Massachusetts General Hospital was searched to identify cases and controls. Cases had a confirmed diagnosis of Crohn's disease involving at least one third of the colon and a confirmed diagnosis of colorectal adenocarcinoma. Matched controls were randomly chosen from the same source population. Paired univariate analysis was performed to develop an odds ratio (OR) for each exposure. RESULTS: Twenty-seven patients were found to have Crohn's colitis and CRC. Colonoscopy performed for screening or surveillance was associated with an OR of 0.21 (95% CI 0.04-0.77; P=0.02). Nonsignificant trends for a protective effect included prior appendectomy (OR 0.30; 95% CI 0.05-1.17; P=0.10) and regular 5-aminosalicylate use (OR 0.30; 95% CI 0.05-1.17; P=0.10). Smoking history was associated with a 4-fold-increased risk for CRC, but this was not statistically significant (OR 4.00; 95% CI 0.80-38.67; P=0.11). CONCLUSIONS: We found that having a colonoscopy for an indication of surveillance or screening is associated with decreased risk of CRC in the setting of Crohn's colitis. These data underscore the importance of CRC surveillance for Crohn's colitis in addition to ulcerative colitis and should prompt further study in this area.     

Risk of colorectal adenomas in patients with a family history of colorectal cancer: some implications for screening programmes.

BACKGROUND AND AIMS: Most colorectal cancers (CRC) arise in colorectal adenomas. A case-control study was conducted to see whether a family history of CRC is associated with a higher prevalence of colorectal adenomas. SUBJECTS: Subjects were drawn from all patients who underwent colonoscopy at the Royal Brisbane Hospital between 1980-1982 and 1985, and included 141 cases with colorectal adenomas diagnosed at colonoscopy and 882 controls who were free of polyps at colonoscopy. METHODS: The prevalence of family history of CRC was compared between patients with adenomas and negative colonoscopy controls. RESULTS: Overall, patients with one first degree relative with CRC were at no greater risk for adenomas at colonoscopy than patients with no family history (odds ratio (OR) = 0.8, 95% confidence intervals (CI) = 0.4, 1.5). Patients with two or more affected first degree relatives had a more than doubled risk for adenomas (OR = 2.3, 95% CI = 0.5, 8.2), and were also more likely to carry moderately or severely dysplastic adenomas (OR = 14.1, 95% CI = 2.0, 62.9). CONCLUSIONS: These findings are consistent with the hypothesis that some families, in addition to those with familial adenomatous polyposis, have an increased susceptibility to develop colorectal adenomas, and that adenomas in such families may have a greater tendency to undergo malignant transformation.     

Risk factors for lung cancer in patients with scleroderma: a nested case-control study

OBJECTIVES: To study potential risk factors for the development of lung cancer in patients with scleroderma and explore the chronological relationship between onset of scleroderma symptoms and subtypes of lung cancer. METHOD: Linkage of two population-based registers to identify lung cancer cases and gender-matched controls with scleroderma, followed by retrospective case note review for clinical details. RESULTS: Patients with scleroderma who smoke are seven times more likely to develop lung cancer than non-smokers (p=0.008). Smokers with scleroderma and cancer smoke more than smokers with scleroderma without cancer (p=0.019). Pulmonary fibrosis and anti-topoisomerase antibody do not increase the risk of lung cancer. Peripheral lung tumours occur earlier after the onset of scleroderma symptoms than bronchogenic tumours (p=0.05). CONCLUSIONS: Smokers with scleroderma should be monitored for the presence of lung cancer and counselled to quit smoking. The earlier development of peripheral lung tumours is not consistent, with pulmonary fibrosis being an aetiological factor.     

Risk factors for pancreatic cancer: case-control study

OBJECTIVES: Although cigarette smoking is the most well-established environmental risk factor for pancreatic cancer, the interaction between smoking and other risk factors has not been assessed. We evaluated the independent effects of multiple risk factors for pancreatic cancer and determined whether the magnitude of cigarette smoking was modified by other risk factors in men and women. METHODS: We conducted a hospital-based case-control study involving 808 patients with pathologically diagnosed pancreatic cancer and 808 healthy frequency-matched controls. Information on risk factors was collected by personal interview, and unconditional logistic regression was used to determine adjusted odds ratios (AORs) by the maximum-likelihood method. RESULTS: Cigarette smoking, family history of pancreatic cancer, heavy alcohol consumption (>60 mL ethanol/day), diabetes mellitus, and history of pancreatitis were significant risk factors for pancreatic cancer. We found synergistic interactions between cigarette smoking and family history of pancreatic cancer (AOR 12.8, 95% confidence interval [CI] 1.6-108.9) and diabetes mellitus (AOR 9.3, 95% CI 2.0-44.1) in women, according to an additive model. Approximately 23%, 9%, 3%, and 5% of pancreatic cancer cases in this study were related to cigarette smoking, diabetes mellitus, heavy alcohol consumption, and family history of pancreatic cancer, respectively. CONCLUSIONS: The significant synergy between these risk factors suggests a common pathway for carcinogenesis of the pancreas. Determining the underlying mechanisms for such synergies may lead to the development of pancreatic cancer prevention strategies for high-risk individuals.     

Increased prevalence of colorectal neoplasia in korean patients with sporadic duodenal adenomas: a case-control study

Background/Aims

Recent data from Western populations have suggested that patients with sporadic duodenal adenomas are at a higher risk for the development of colorectal neoplasia. In this study, we compared the frequency of colorectal neoplasia in patients with sporadic duodenal adenomas to healthy control subjects.

Methods

This retrospective case-control study used the databases of 3 teaching hospitals in Gyeonggi-do Province, South Korea. The colonoscopy findings of patients with sporadic duodenal adenomas were compared with those of age- and gender-matched healthy individuals who had undergone gastroduodenoscopies and colonoscopies during general screening examinations.

Results

Between 2001 and 2008, 45 patients were diagnosed endoscopically with sporadic duodenal adenomas; 26 (58%) of these patients received colonoscopies. Colorectal neoplasia (42% vs 21%; odds ratio [OR], 2.8; 95% confidence interval [CI], 1.1 to 7.4) and advanced colorectal adenoma (19% vs 3%; OR, 9.0; 95% CI, 1.6 to 50.0) were significantly more common in patients with sporadic duodenal adenomas than in healthy control subjects.

Conclusions

Compared with healthy individuals, patients with sporadic duodenal adenomas were at a significantly higher risk for developing colorectal neoplasia. Such at-risk patients should undergo routine screening colonoscopies.     

Risk factors for symptomatic gallstones in patients with liver cirrhosis: a case-control study

OBJECTIVES: Liver cirrhosis is a well-documented risk factor for the formation of gallstones. In cirrhotic patients, gallstones are almost always "silent," and surgery is rarely required. When indicated (symptoms or complications), cholecystectomy implies a high morbidity risk in these patients, especially in the advanced stages of cirrhosis. The aim of this study was to estimate the risk factors for symptom development in cirrhotic patients with gallstones to identify the subgroup of patients at risk of undergoing surgery. METHODS: A total of 140 patients with liver cirrhosis and gallstones were studied: 97 with asymptomatic and 43 with symptomatic gallstone disease. The risk factors for gallstone formation (age, gender, family history, parity, obesity, diabetes mellitus, hyperlipoproteinemia) and the characteristics of liver cirrhosis (etiology, duration, Child class, hypersplenism), gallstones (duration, number, size), and gallbladder (size, wall thickness) were assessed in all patients. In 12 patients (four symptomatic, eight asymptomatic), gallbladder emptying was also evaluated by ultrasound. The association of asymptomatic and symptomatic gallstones with all these parameters was statistically evaluated by Student's t, Mann-Whitney, and chi(2) tests, as well as by means of multiple logistic regression. The causal relationship between these characteristics and gallstone symptoms was also examined by means of the KDD (knowledge discovery from databases) method, with an algorithm for learning Bayesian networks. RESULTS: Advanced age, female gender, viral etiology of cirrhosis, family history of gallstones, and duration of gallstone disease were significantly associated with symptomatic gallstone disease. The number or size of gallstones and the size or emptying of the gallbladder did not differ in symptomatic versus asymptomatic patients. Male gender and alcoholic cirrhosis were inversely correlated with symptom presence. In the multivariate analysis, family history (p = 0.0098) and advanced age (p = 0.0422) were positively correlated and male gender (p = 0.0049) and alcoholic etiology of cirrhosis (p = 0.0116) negatively correlated with symptom presence. These relationships (except for age) were also evidenced by the KDD method. CONCLUSIONS: The risk of gallstones becoming symptomatic is significantly lower in men and in alcoholic cirrhosis. In cirrhotic women, and especially in the presence of a positive family history and of advanced age, the risk of developing symptoms and undergoing surgery was significantly greater.     

Risk factors for stroke in patients with nonrheumatic atrial fibrillation: a case-control study

PURPOSE: Randomized controlled trials have demonstrated that anticoagulant therapy is very effective at preventing stroke among patients with nonrheumatic atrial fibrillation. However, these trials have reported too few strokes for powerful risk factor analysis. Observational studies may provide additional information. The purpose of this study was to identify risk factors in a larger number of patients with stroke and nonrheumatic atrial fibrillation, using case-control methodology. PATIENTS AND METHODS: We identified all patients discharged from one hospital over an 8-year period who met our case definition of nonrheumatic atrial fibrillation and ischemic stroke (n = 134), and compared them with contemporaneous control subjects who were discharged with nonrheumatic atrial fibrillation without stroke (n = 131). RESULTS: Cases and controls were similar in terms of duration of atrial fibrillation; proportion with paroxysmal atrial fibrillation; percentage with a past medical history of angina, myocardial infarction, congestive heart failure, diabetes, or smoking; and mean left atrial size. In contrast, cases were significantly older than controls (78.5 versus 74.8 years, p = 0.002) and more likely to have a history of hypertension (55% versus 38%, p = 0.0093). The relative odds for stroke was 1.91 for patients with hypertension, 1.73 for patients older than 75 years, and 3.26 for patients with both factors. CONCLUSIONS: Our analysis suggests that age and hypertension should be considered when deciding upon long-term anticoagulant therapy to prevent stroke in patients with nonrheumatic atrial fibrillation.     

Risk factors associated with hepatitis C among patients co-infected with human immunodeficiency virus: a case-control study

A case-control study was carried out to assess the risk factors associated with hepatitis C in patients infected with human immunodeficiency virus. One hundred eighteen patients tested positive for hepatitis C virus (HCV) and were included as cases, and 117 tested negative for HCV and were included as controls. Information was collected through a questionnaire. The risk factors that showed a significant association with co-infection by multivariate analysis were an age of 30-39 years (odds ratio [OR] = 4.65, 95% confidence interval [CI] = 1.31-16.43), an age of 40-49 years (OR = 6.48, 95% CI = 1.70-24.78), an age > 50 years (OR = 7.50, 95% CI = 1.54-36.68), use of intravenous drugs (OR = 25.46, 95% CI = 4.91-131.88), use of inhaled illicit drugs (OR = 3.56, 95% CI = 1.22-10.44), anal intercourse (OR = 3.93, 95% CI = 1.27-12.13), a sexual partner with a history of liver disease (OR = 5.45, 95% CI = 1.33-22.32), a sexual partner with a history of blood transfusions (OR = 4.79, 95% CI = 0.95-24.19), and sexual partner with a history of intravenous drug use (OR = 3.46, 95% CI = 1.24-9.65).     

Risk factors of intrahepatic cholangiocarcinoma in patients with hepatolithiasis:a case-control study

BACKGROUND:Why 3.3% to 10% of all patients with hepatolithiasis develop intrahepatic cholangiocarcinoma (ICC) remains unknown.We carried out a hospital-based case-control study to identify risk factors for the development of ICC in patients with hepatolithiasis in China.METHODS:Eighty-seven patients with pathologically diagnosed hepatolithiasis associated with ICC and 228 with hepatolithiasis alone matched by sex,age (±2 years),hospital admittance and place of residence were interviewed during the period of...     

Risk factors for paediatric cancer in the Gaza Strip: a case-control study

Background

Cancer is a serious health problem and the third leading cause of death in the occupied Palestinian territory, both in adults and children. For most children younger than 18 years who have cancer, there is no obvious cause. The aim of this study was to identify the main risk factors for paediatric cancer in the Gaza Strip.

Risk factors for tuberculosis in patients with AIDS in London: a case-control study.

OBJECTIVE: To identify risk factors for the acquired immune-deficiency syndrome (AIDS) associated with tuberculosis, in patients with AIDS attending 11 of the largest human immunodeficiency virus (HIV)/AIDS Units in London. DESIGN: Case-control study nested in a retrospective cohort of 2048 HIV-1 positive patients. Cases were defined as patients with a definitive diagnosis of tuberculosis, and controls as patients with AIDS and without tuberculosis during follow-up. RESULTS: Of 627 patients diagnosed with AIDS, 121 had a definitive diagnosis of tuberculosis. Significant risk factors for tuberculosis in the univariate analysis were sex, ethnicity, age, HIV exposure category and hospital attended, and in the multiple regression analysis ethnicity, age and hospital attended. African ethnicity was the strongest risk factor for tuberculosis (adjusted odds ratio [AOR] 5.9, 95% confidence interval 3.4-10.2). The risk of tuberculosis was higher in the younger age groups (test for trend P < 0.001). The hospital-associated risk of tuberculosis was more heterogeneous in the non-African group, and non-Africans attending Hospital 1 had an increased risk of tuberculosis which was statistically significant. CONCLUSIONS: The risk factors for AIDS-associated tuberculosis in London are sub-Saharan African origin, younger age group, and, among the non-Africans only, attending one hospital in east London. Different transmission patterns and mechanisms for the development of tuberculosis may operate in different settings depending on the background risk of tuberculous infection. Screening for tuberculosis infection and disease among HIV-positive individuals in London is important for the provision of preventive or curative therapy, and prophylaxis policies need to be designed in accordance with the transmission patterns and mechanisms of disease.     

Risk factors for death in patients with beta-thalassemia major: results of a case-control study

This retrospective one to one matched case-control study was aimed at evaluating risk factors for death in beta-thalassemic patients followed in Italian centers between 1997 and 2001. The mortality risk was lower in patients with good compliance to iron chelation therapy and in those treated with deferiprone.     

血脂异常患者结直肠早期癌发病的危险因素分析

探讨血脂异常患者结直肠早期癌发病的危险因素,以及他汀类药物在其中可能发挥的作用。回顾性分析2018年2月—2021年2月北京友谊医院消化科行内镜治疗合并血脂异常的结直肠肿物患者资料。根据结肠镜及病理结果将266例患者分为结直肠腺瘤组（n=174）和结直肠早期癌组（n=92）。分析两组患者临床资料的差异,采用Logistic回归分析血脂异常患者结直肠早期癌发病的危险因素。结果发现,与结直肠腺瘤组相比,结直肠早期癌组患者的男性比例（64.1%比25.9%）、吸烟比例（41.3%比14.4%）和饮酒比例（37.0% 比17.2%）更高,同时低密度脂蛋白胆固醇［（3.06±0.81） mmol/L比（2.60±0.74） mmol/L］和总胆固醇值更高［（5.27±1.22） mmol/L 比（4.61±1.06） mmol/L］,而他汀用药占比更低（27.2% 比52.9%）,差异均有统计学意义（P均<0.05）。多因素Logistic回归分析显示,男性（OR=3.641, 95%CI：1.694~7.826）、吸烟（OR=2.920, 95%CI：1.159~7.356）以及较高的低密度脂蛋白胆固醇（OR=2.203,95%CI：1.481~3.277）、较高的总胆固醇水平（OR=1.744,95%CI：1.329~2.289）是血脂异常患者结直肠早期癌发生的危险因素,而他汀用药史（OR=0.469,95%CI：0.236~0.932）对避免血脂异常患者结直肠早期癌的发生具有保护作用。应对血脂异常患者进行戒烟宣教,监测低密度脂蛋白胆固醇、总胆固醇水平,必要时使用他汀类药物促进血脂达标,同时积极进行结直肠癌的早期筛查。     

Variables associated with the risk of colorectal adenomas in asymptomatic patients with a family history of colorectal cancer.

The results of screening individuals referred to the Family Cancer Clinic at St Mark's Hospital from 1986 are presented. Colonoscopy was performed in 644 asymptomatic individuals (from 436 families) with a family history of colorectal cancer. Sixty nine (15.8%) of the families fulfilled the Amsterdam criteria for the hereditary non-polyposis colorectal cancer syndromes (HNPCC). Seven cases of colorectal cancer were diagnosed at an average age of 49 years; six at Dukes's stage A and one at stage C, four in subjects from Amsterdam criteria families. One hundred and forty four (22.4%) subjects had one or more adenomas. The prevalence of adenomas in the subjects from Amsterdam criteria families was 34 of 127 (26.8%) compared with 110 of 517 (21.3%) in those from other families; the age and sex adjusted odds ratio (OR) was 1.76 (p = 0.02). Factors influencing the prevalence of adenomas in screened individuals were evaluated. Multivariate analysis showed that independent variables significantly related to the risk of adenomas were: age (p < 0.0001), sex (p = 0.0002), and the number of generations (> or = 2 v 1) of relatives affected by either colorectal cancer or adenomas (p = 0.0006). The latter variable was more highly predictive of the probability of finding an adenoma at colonoscopy than a family history of two generations with cancer only (p = 0.056). The OR of having colorectal adenomas increased with age, by about twofold for each decade, and was twice as high in men than women, and in subjects with two or more generations relative to those with one generation affected by colorectal cancer or adenomas. Six of seven patients with cancer and 46 of 144 (31.9%) with adenomas had lesions proximal to the splenic flexure only. The proportion of individuals with proximal adenomas only was 47.1% in Amsterdam criteria families and 27.3% in the others (p=0.03). These findings support the view that colonoscopy rather than sigmoidoscopy is the method of choice for screening high risk groups.     

Risk factors for development of hepatocellular carcinoma among Australians with hepatitis C: a case-control study

Background: Older patients with cirrhosis due to hepatitis C are at risk of developing hepatocellular carcinoma (HCC), but additional risk factors may vary between countries. Aim: In the present study, we sought to identify additional risk factors for HCC among a cohort of Australian patients with chronic hepatitis C. Methods: Case-control study of patients with advanced fibrosis stage hepatitis C who developed HCC during five-year follow up at a referral liver clinic. Cases were compared to twice the number of age-matched patients with chronic hepatitis C of similar fibrotic severity who did not develop HCC over a similar interval, using conditional logistic regression analysis (CLRA) and multivariate analysis. The main outcome measures were demographic and disease-related variables at first presentation in relation to the development of HCC. Results: HCC developed in 17 cases, an annual incidence among those considered to be at risk of 2%. The duration of follow up since first assessment was comparable among the cases and 34 selected age-matched controls (4.1 and 5.2 years respectively, p=0.5). Cases were more often male (p=0.03), born in Asia (p=0.05), and had poorer liver function as indicated by serum albumin concentration (p=0.02). Anti-hepatitis B core antibody (anti-HBc) was detected in 59% (ten/17) of cases, compared to 21% (seven/34) of the controls (p=0.01). No patient with a sustained response to interferon developed HCC during follow up. There were no significant differences in the mode of HCV transmission, HCV genotype, alcohol exposure, serum bilirubin level or prothrombin time between the cases and the controls. Although the data set was small, multivariate CLR analysis identified serum albumin 35 g/L and anti-HBc positivity to be independent risk factors for development of HCC. Conclusions: Among older Australian patients (over the age of 40 years) with advanced fibrosis stage hepatitis C, the annual incidence of HCC is about 2%. Those who have low serum albumin and evidence of previous exposure to hepatitis B virus (anti-HBc positivity) appear to have the highest risk of developing HCC during follow up, but males and those born in Asia could also be at increased risk.     

Risk factors for the gastric cardia cancer： a case-control study in Fujian Province

AIM: The incidence of gastric cardia cancer has greatly increased in the past 2-3 decades, however, the risk factors for the disease are still not clearly understood. The investigations among Chinese population on the risk factors of gastric cardia cancer were also scarcely reported. We therefore conducted a case-control study in Fujian province, China, to investigate the potential risk and protective factors of this disease. METHODS: 191 cardia and 190 non-cardia gastric cancer cases, and a total of 222 control cases were included in this study. Standard questionnaires were used in collecting epidemiological factors and the data were then analyzed by the unconditional logistic regression model. RESULTS: As the factors such as age, gender, smoking, alcohol consumption, and family history of gastric cancer were controlled, a multivariable analysis was conducted, which revealed that there was a significant correlation between the dietary habits such as irregular meal, over and fast eating, and the gastric cardia cancer with the odds ratios (ORs) of 4.2 (95 % confidence interval: 2.3-7.7), 4.7 (2.1-10.8), and 2.7 (1.3-5.3) respectively. Other correlations were also observed between the gastric cardia cancer and the consumption of salty fish or pickled vegetable, smoking, and the family cancer history with the ORs of 5.5 (1.4-19.5), 1.8 (1.0-3.0), 2.1 (1.3-3.5), and 3.8 (2.3-6.2) respectively. In contrast, the negative correlations were found existing between the intake of fresh vegetables and fruits, the use of refrigerator, and the gastric cardia cancer, with the ORs of 0.4 (0.2-0.9), 0.2 (0.1-0.5), and 0.2 (0.1-0.4), respectively. However, dietary habits were associated less with non-cardia gastric cancer compared with its cardia counterpart. CONCLUSION: Dietary habits might be one of the risk factors for the cardia carcinogenesis among Chinese population.     

Risk factors for colorectal cancer: an epidemiologic descriptive study of a series of 333 patients

AIM: The purpose of the research was to evaluate several risk factors for colonic neoplasia and to institute a specialized colorectal cancer (CRC) registry in the 3rd Medical and Surgical Clinics Cluj-Napoca. MATERIAL AND METHODS: The study comprised 333 patients,155 women, mean age 61.32 +/- 12.42 years and 178 men, mean age 64.31 +/- 10.39 years, admitted to the 3rd Medical Clinic and 3rd Surgical Clinic Cluj-Napoca and diagnosed with CRC between January 2001 - September 2003. The diagnosis was made on the basis of clinical, endoscopical and histopathological findings. Age, geographical patterns, tumor location, family history, personal history and several lifestyle factors: dietary habits (intake of fat and red meat), long term smoking (more than 20 years), heavy alcohol consumption were analyzed. Evaluation was made using family history and epidemiologic lifestyle questionnaires. RESULTS: CRC occurred more frequently in the 7th decade. There was a strong correlation between age and CRC development. In the 5th decade, females developed CRC more frequently than males. The median age for developing right-sided tumors was significantly higher in males. Patients living in an urban area were dominant (69%). Family history was present in 1/3 of females and 1/4 of males. Personal history of colon polyps was more common in men, particularly among smokers for more than 20 years and among those with an excessive intake of fat. The cholecystectomized women had an increased frequency of sigmoidian tumors. All the patient's information was included in a specialized colon cancer registry. CONCLUSION: High fat intake and cigarette smoking favour colon polyp development. CRC development and location of the tumor are associated with an older age (in men) and personal history of cholecystectomy (in women). Inheritance was significant in our study group.