Quantitative risk of positive family history in developing colorectal cancer: A meta-analysis

BACKGROUND Positive family history is a risk factor for development of colorectal cancer.Despite numerous studies on the topic,the absolute risk in patients with a positive family history remains unclear and therefore studies are lacking to validate non-invasive screening methods in individuals with positive family history.AIM To quantify the risk of colorectal cancer in individuals with a positive family history.METHODS A comprehensive electronic literature search was performed using PubMed from January 1955 until November 2017,EMBASE from 1947 until 2018,and Cochrane Library without date restrictions.Two independent reviewers conducted study selection,data extraction and quality assessment.A meta-analysis of Mantel-Haenzel relative risks was performed using the random effects model.Newcastle-Ottawa scale was used to score the quality of selected papers.Funnel plot and Egger’s regression test was performed to detect publication bias.Subgroup analysis was performed comparing Asian and non-Asian studies.Sensitivity analyses were performed to rule out the effect of the timing of the study,overall quality,the main outcome and the effect of each individual study in overall result.RESULTS Forty-six out of 3390 studies,including 906981 patients were included in the final analysis.41 of the included studies were case-control and 5 were cohort.A positive family history of colorectal cancer in first-degree relatives was associated with significantly increased risk of colorectal cancer with a relative risk of 1.87(95%CI:1.68-2.09;P<0.00001).Cochrane Q test was significant(P<0.00001,I2=90%).Egger’s regression test showed asymmetry in the funnel plot and therefore the Trim and Fill method was used which confirmed the validity of the results.There was no difference between Asian versus non-Asian studies.Results remained robust in sensitivity analyses.CONCLUSION Individuals with a positive family history of colorectal cancer are 1.87 times more likely to develop colorectal cancer.Screening guidelines should pay specific attention to individuals with positive family history and further studies need to be done on validating current screening methods or developing new modalities in this high-risk population.     

Risk factors for tuberculosis after gastrectomy in gastric cancer

AIM: To examine incidence of tuberculosis(TB) in gastrectomy patients and investigate the risk factors for developing TB after gastrectomy in patients with gastric cancer.METHODS: A retrospective cohort study of gastrectomy patients with gastric cancer was performed at a university-affiliated hospital in Seoul, South Korea between January 2007 and December 2009. We reviewed patient medical records and collected data associated with the risk of TB, surgery, and gastric cancer. Standardized incidence ratios(SIRs) of TB were calculated to compare the incidence of TB in gastrectomy patients with that in the general Korean population, and risk factors for TB after gastrectomies were analyzed.RESULTS: Among the 1776 gastrectomy patients, 0.9%(16/1776) developed post-gastrectomy TB, with an incidence of 223.7 cases per 100000 patients per year. The overall incidence of TB in gastrectomy patients, adjusted by sex and age, was significantly higher thanthat in the general population(SIR = 2.22, 95%CI: 1.27-3.60). Previous TB infection [odds ratio(OR) = 7.1, P < 0.001], lower body mass index(BMI)(kg/m2; OR = 1.21, P = 0.043) and gastrectomy extent(total gastrectomy vs subtotal gastrectomy)(OR = 3.48, P = 0.017) were significant risk factors for TB after gastrectomy in a multivariate analysis.CONCLUSION: TB incidence after gastrectomy is higher than that in the general population. Previous TB infection, lower BMI, and total gastrectomy are risk factors for TB after gastrectomy in patients with gastric cancer.     

Family history of colorectal cancer

PURPOSE: A family history of colorectal cancer is an important risk factor for the disease. A positive family history means that endoscopic screening should be recommended and a strongly positive family history raises the possibility of a dominantly inherited syndrome. This study was performed to find how often and how accurately a family history of colorectal cancer was recorded in the charts of patients on a colorectal surgical ward. A second aim was to see whether family history-taking could be improved. METHODS: The charts of 100 inpatients on a colorectal surgical floor were reviewed for the presence of a family history of colorectal cancer. Any chart documentation was compared with a family history obtained by a detailed interview. The chart review was repeated four years later. RESULTS: In the initial review, we found that a family history was recorded in 45 of 100 charts. It was accurate for colorectal cancer in 36 charts. Four years later, the rate of family history recording increased to 61 of 96, whereas the accuracy rate (45/61) did not change. Responses to a simple screening question asking about a family history of colorectal cancer were accurate in 77 percent of patients. CONCLUSIONS: Not all colorectal surgical patients have their family histories recorded, and even when it is recorded, it is not always correct. Despite improvement during a four-year period, there is still room for further improvement in the recording of a family history of colorectal cancer. Physicians should make an effort to ask this question and document the response in the hospital chart.     

Familial risk of colorectal cancer in subjects attending an organised screening programme

Background

First degree relatives of colorectal cancer patients are at increased risk for the same disease.

Aims

To evaluate the prevalence of familial risk and its association with the occurrence of pathological significant lesions in subjects with positive faecal occult blood testing leading to colonoscopy.

Methods

Faecal occult blood testing is offered biennially to subjects aged 50-70. Subjects with a positive faecal test are invited to undergo colonoscopy. Familial history for colorectal cancer in subjects undergoing colonoscopy was routinely recorded.

Results

From 1995 to 2009, 4833 screenees with positive faecal occult blood test undergoing colonoscopy were enrolled. Twelve percent reported a positive first degree family history. Multivariate analysis evidenced that the probability of detecting pathological significant lesions was statistically associated with age, gender, type of test, repeated or first screening, and having at least 1 first degree relative with colorectal cancer.

Conclusions

Subjects attending colonoscopy reporting a positive first degree family history are at increased risk for pathologically significant lesions.     

Cyclooxygenase 2 polymorphism and colorectal cancer： -765G〉C variant modifies risk associated with smoking and body mass index

AIM： To explore whether cyclooxygenase 2 （COX-2） -765G〉C polymorphism is associated with susceptibility of colorectal cancer （CRC） and to evaluate the risk of colorectal cancer in relation to environmental exposures and polymorphism. METHODS： We conducted a case-control study of 137 patients with colorectal cancer and 199 cancerfree controls in northeast China. Multivariate logistic regression analysis was performed to calculate the adjusted odds ratio （OR） and 95% confidence interval （95% CI）. RESULTS： The -765G〉C polymorphism was not independently associated with CRC risk. However, risk associated with the polymorphism differed by smoking and body mass index （BMI）. Smoking and BMI associated risks were stronger among those with -765GG genotype, showing that smokers had a 2.682-fold greater risk of CRC than nonsmokers （51/43 vs 68/126, P = 0.006）. Compared to those with a normal body mass index （BMI 18.5-22.9）, those with overweight （BMI 23-24.9） had a 3.909-fold higher risk of CRC （OR = 3.909, 95% CI = 2.081-7.344; P 〈 0.001）, while those with obesity （BMI 〉 25） had a 2.031- fold higher risk of CRC （OR = 1.107, 95% CI = 1.107-3.726; P = 0.022）. is not associated with an increased risk of CRC, -765GG genotype appears to be related to an increased risk in the presence of smoking and higher BMI.     

身体体质指数与结直肠癌的相关性研究

目的探讨身体体质量（body mass index,BMI）与结直肠癌发病的关系,为结直肠癌的预防提供参考。方法用病例对照研究法分析202例首次确诊的结直肠癌患者和202例非癌症患者的BMI情况,比较两组人群BMI的情况。结果首次确诊的结肠癌患者平均BMI为（25．122±3．4642）kg／m2,对照组人群平均BMI为（21．175±3．0507）kg／m2,结直肠癌患者的BMI明显高于健康对照人群（P〈0．05）。根据性别、年龄和按胆囊炎或胆囊切除的不同进行分组后,可以看出结肠癌患者的BMI比健康对照组高。Logistic回归分析,BMI与是否有胆囊病、性别、是否结直肠癌呈显著正相关关系,年龄与是否结直肠癌不相关。结论结直肠癌的发生与BMI有关。     

体质量指数与结直肠癌相关性的研究现状

结直肠癌(colorectal cancer,CRC)是消化系统常见的严重危害人们健康的杀手,全球每年约有120万新发病例,其中中国约有13万.随着我国社会经济发展和饮食结构的改变,CRC的发病率和死亡率呈逐年上升趋势,且平均发病年龄低于西方国家约20岁,居所有恶性肿瘤中的第2位,在中国发达地区已经接近西方发达国家.CRC的发病是多种因素综合作用的结果,近四分之一的CRC患者可以通过良好的生活习惯来避免患病.目前全球有2/3的成年人正在与超重和肥胖做斗争.近期大量研究表明,高体质量指数(body mass index,BMI)与结直肠癌的发病具有一定关系.本文就BMI与CRC相关性的研究现状作一综述.     

Association of smoking, alcohol drinking and dietary factors with esophageal cancer in high- and low-risk areas of Jiangsu Province, China

AIM: To study the main environmental and lifestyle factors that account for the regional differences in esophageal cancer (EC) risk in low- and high-risk areas of Jiangsu Province, China. METHODS: Since 2003, a population-based case-control study has been conducted simultaneously in low-risk (Ganyu County) and high-risk (Dafeng County) areas of Jiangsu Province, China. Using identical protocols and pre-tested standardized questionnaire, following written informed consent, eligible subjects were inquired about their detail information on potential determinants of EC, including demographic information, socio-economic status, living conditions, disease history, family cancer history, smoking, alcohol drinking, dietary habits, frequency, amount of food intake, etc. Conditional logistic regression with maximum likelihood estimation was used to obtain Odds ratio (OR) and 95 % confidence interval (95% CI), after adjustment for potential confounders. RESULTS: In the preliminary analysis of the ongoing study, we recruited 291 pairs of cases and controls in Dafeng and 240 pairs of cases and controls in Ganyu, respectively. In both low-risk and high-risk areas, EC was inversely associated with socio-economic status, such as level of education, past economic status and body mass index. However, this disease was more frequent among those who had a family history of cancer or encountered misfortune in the past 10 years. EC was also more frequent among smokers, alcohol drinkers and fast eaters. Furthermore, there was a geographic variation of the associations between smoking, alcohol drinking and EC risk despite the similar prevalence of these risk factors in both low-risk and high-risk areas. The dose-response relationship of smoking and smoking related variables, such as age of the first smoking, duration and amount were apparent only in high-risk areas. On the contrary, a dose-response relationship on the effect of alcohol drinking on EC was observed only in low-risk areas. CONCLUSION: The environmental risk factors, together with genetic factors and gene-environmental interactions might be the main reason for this high-risk gradient in Jiangsu Province, China.     

大肠癌危险因素分析

目的研究广东省惠州市大肠癌的患病相关危险因素，为制订本地区大肠癌的监测与筛查方案提供科学依据。方法采用基于结肠镜检查的病例对照研究，应用Logistic回归对大肠癌相关变量进行单因素和多因素分析。把可能的危险因素先行单因素分析，发现某些有意义的因素后，纳入Logistic回归模型进行多因素分析。结果有统计学意义的危险因素有年龄≥45岁、排血便或黏液血便、排便次数增多（≥2～3次，天），摄食水果少。结论惠州地区大肠癌的发病与年龄、进食水果、排便性状及次数有关。     

结直肠癌患者术后吻合口漏的危险因素分析

目的探讨结直肠癌术后发生吻合口漏（AL）的危险因素。 方法回顾性分析2010年12月~2014年4月在上海长征医院普外科接受手术治疗的926例结直肠癌患者的病例资料,通过病例对照分析和χ²检验,在临床病理分类的变量中筛选AL的危险因素,通过Logistic回归进行多因素分析,筛选独立的危险因素。 结果高血压病史、腹腔镜手术、未预防性造口是AL的独立危险因素（OR=1.907,2.252,5.556;P=0.016,0.006,0.001）。亚组分析显示：结肠癌亚组中,左半结肠是AL的危险因素（OR=2.519,P=0.032）;直肠癌亚组中,高血压病史、腹腔镜手术和未预防性造口是AL的独立危险因素（OR=2.597,7.609,9.346;P=0.012,0.007,<0.001）;腹腔镜手术亚组中,高血压病史、未预防性造口、术中出血≥ 400 mL是AL的独立危险因素（OR=2.407,5.376,3.922;P=0.006,0.002,0.001）;未预防性造口亚组中,高血压病史、腹腔镜手术和直肠癌是AL的独立危险因素（OR=1.969,1.859,1.716;P=0.015,0.046,0.059）;直肠癌未预防性造瘘亚组中,高血压、腹腔镜和手术时间≥ 3 h是AL的独立危险因素（OR=2.796,7.346,2.287;P=0.012,0.008,0.046）;开腹手术亚组和预防性造口亚组无AL的危险因素。 结论对于存在高血压病史、腹腔镜手术且未预防性造口的直肠癌患者,需要密切关注、针对性预防,以期减少术后AL的发生。     

The melbourne colorectal cancer study

The characteristics of 702 colorectal cancer patients are described in relation to the presence or absence of a family history of colorectal cancer in near relatives. No statistically significant associations were found between those with a family history of colorectal cancer and age at detection, sex, country of birth, religion, number of cancers (single, synchronous, or metachronous), previously removed benign colorectal polyps, and adenomatous polyps found in the resection specimen. The family history rate of colorectal cancer for colon cancer cases was statistically significantly higher than for rectal cancer cases (χ ₁ ² =3.8,P=0.5) and there was a gradient of decreasing risk from colon to rectum. The family history rate of colorectal cancer in parents of those who were less than 50 years old was twice that of those 50 or older (P=.07), consistent with the view that earlier age of onset is a characteristic of those with a family history of colorectal cancer. There was a statistically significantly higher family history rate of colorectal cancer in respondents who knew of the disease compared with those who did not (χ ₁ ² =5.5,P<.05). It is unclear if this effect represents recall bias or self-selection bias. In contrast, the rates for a family history of heart disease and stroke were similar, irrespective of the respondent's knowledge of their colorectal cancer status. Thus in the Melbourne study, the family history rate of colorectal cancer was higher in colon cancer than in rectal cancer, there was a decreasing gradient of risk from colon to rectum, and a tendency for earlier age of onset of colorectal cancer in those with a history of this cancer in a parent. This part of the “Melbourne Colorectal Cancer Study” was generously supported by the Nicholas and Elizabeth Slezak Cancer Research Fund and by a University of Melbourne Cancer Research Grant.     

结直肠癌患者术后感染的危险因素及防治

术后感染是结直肠癌术后患者最常见的并发症之一,主要包括以下几种类型：手术部位感染、腹腔感染、盆腔感染、泌尿系统感染、呼吸系统感染、膈下脓肿、菌血症等,不仅给患者带来痛苦,还增加医疗成本。目前国内外对于结直肠手术围术期感染的危险因素和预防措施进行大量的研究,不仅涉及到外科医生、手术室护士,麻醉医生也起到重要作用。本文将对结直肠癌患者术后感染的危险因素及防治进行综述。     

Molecular evaluation of glutathione S transferase family genes in patients with sporadic colorectal cancer

AIM To evaluate the association between polymorphismsin glutathione S transferases(GSTs) and the risk of sporadic colorectal cancer(SCRC), tumor progression and the survival of patients.METHODS A case-control study of 970 individuals from the Brazilian population was conducted(232 individuals from the case group with colorectal cancer and 738 individuals from the control group without a history of cancer). PCR multiplex and PCR-RFLP techniques were used to genotype the GST polymorphisms. The tumors were categorized according to the TNM classification: tumor extension(T), affected lymph nodes(N), and presence of metastasis(M). Logistic regression, multiple logistic regression and survival analysis were used to analyze the data. The results are presented in terms of odds ratio(OR) and 95% confidence interval(CI). The level of significance was set at 5%(P ≤ 0.05).RESULTS Age equal to or over 62 years(OR = 8.79; 95%CI: 5.90-13.09, P 0.01) and female gender(OR = 2.91; 95%CI: 1.74-4.37; P 0.01) were associated with increased risk of SCRC. Analysis of the polymorphisms revealed an association between the GSTM1 polymorphisms and a risk of SCRC(OR = 1.45; 95%CI: 1.06-2.00; P = 0.02), as well as between GSTT1 and a reduced risk of the disease(OR = 0.65; 95%CI: 0.43-0.98; P = 0.04). An interaction between the presence of the wild-type allele of GSTP1 Ile105 Val polymorphism and tobacco consumption on risk of SCRC(OR = 2.33; 95%CI: 1.34-4.05; P = 0.05) was observed. There was an association between the GSTM1 null genotype and the presence of advanced tumors(OR = 2.33; 95%CI: 1.23-4.41; P = 0.009), as well as increased risk of SCRC in the presence of a combination of GSTT1 non-null/GSTM1 null genotypes(OR = 1.50; 95%CI: 1.03-2.19; P = 0.03) and GSTT1 non-null/GSTM1 null/GSTP1 Val~*(OR = 1.85; 95%CI: 1.01-3.36, P = 0.04). Combined GSTT1 non-null/GSTM1 null genotypes(OR = 2.40; 95%CI: 1.19-4.85; P = 0.01) and GSTT1 non-null/GSTM1 null/GSTP1 Val~*(OR = 2.92; 95%CI: 1.05-8.12; P = 0.04) were associated with tumor progression. Polymorphisms were not associated with the survival of patients with SCRC.CONCLUSION Females aged 62 years or older are more susceptible to SCRC. Polymorphisms of GSTT1 and GSTM1 null genotypes modulated the susceptibility to SCRC in the population studied.     

Risk factors for Barrett＇s oesophagus and oesophageal adenocarcinoma： Results from the FINBAR study

AIM:To investigate risk factors associated with Barrett's oesophagus and oesophageal adenocarcinoma.METHODS:This all-Ireland population-based case-control study recruited 224 Barrett's oesophagus patients,227 oesophageal adenocarcinoma patients and 260 controls.All participants underwent a structured interview with information obtained about potential lifestyle and environmental risk factors.RESULTS:Gastro-oesophageal reflux was associated with Barrett's [OR 12.0(95% CI 7.64-18.7)] and oesophageal adenocarcinoma [OR 3.48(95% CI 2.25-5.41)].Oesophageal adenocarcinoma patients were more likely than controls to be ex-or current smokers [OR 1.72(95% CI 1.06-2.81)and OR 4.84(95% CI 2.72-8.61)respectively] and to have a high body mass index [OR 2.69(95% CI 1.62-4.46)].No significant associations were observed between these risk factors and Barrett's oesophagus.Fruit but not vegetables were negatively associated with oesophageal adenocarcinoma [OR 0.50(95% CI 0.30-0.86)].CONCLUSION:A high body mass index,a diet low in fruit and cigarette smoking may be involved in the progression from Barrett's oesophagus to oesophageal adenocarcinoma.     

Risk for colorectal cancer in ulcerative colitis： Changes, causes and management strategies

The risk of colorectal cancer for any patient with ulcerative colitis is known to be elevated, and is estimated to be 2% after 10 years, 8% after 20 years and 18% after 30 years of disease. Risk factors for cancer include extent and duration of ulcerative colitis, primary sclerosing cholangitis, a family history of sporadic colorectal cancer, severity of histologic bowel inflammation, and in some studies, young age at onset of colitis. In this review, the authors discuss recent epidemiological trends and causes for the observed changes. Population-based studies published within the past 5 years suggest that this risk has decreased over time, despite the low frequency of colectomies. The crude annual incidence rate of colorectal cancer in ulcerative colitis ranges from approximately 0.06% to 0.16% with a relative risk of 1.0-2.75. The exact mechanism for this change is unknown; it may partly be explained by the more widespread use of maintenance therapy and surveillance colonoscopy.     

结直肠癌支架置入术后并发症危险因素及预防

结直肠癌患者常伴结肠梗阻症状,急诊手术多因无法行肠道准备及患者一般情况较差,死亡率及术后并发症的发病率较高。支架置入治疗可以作为手术的桥梁治疗,同时也可作为晚期转移性结直肠癌患者的姑息治疗手段,与手术治疗比较,支架置入治疗的死亡率及术后并发症发生率均较低,且可避免瘘口形成,患者住院时间短、术后恢复快。但支架置入常伴穿孔、支架移位、再梗阻等并发症,严重时危及患者生命。本文对支架置入术后相关并发症相关的危险因素及预防措施作一概述。     

CYP2E1 Rsa Ⅰ polymorphism impacts on risk of colorectal cancer association with smoking and alcohol drinking

AIM: To investigate associations between the Rsa Ⅰpolymorphism of CYP2E1 and risk of colorectal cancer.METHODS: A case-control study was conducted with 315 colorectal cancer cases (105 colon, 210 rectal)and 439 population-based controls in Jiangsu Province of China. Genomic DNA samples were assayed for restriction fragment length polymorphisms in CYP2E1by PCR amplification followed by digestion with Rsa Ⅰ. Information on smoking and alcohol drinking was collected using a questionnaire. Odds ratios (ORs) were estimated with an unconditional logistic model.RESULTS: The proportional distribution of the CYP2E1 Rsa Ⅰ c1/c1, c1/c2 and c2/c2 genotypes were 61.4%,35.6% and 3.0% in controls, 60.6%, 33.7% and 5.8%in colon cancer cases, and 58.4%, 34.0% and 7.7% in rectal cancer cases, respectively. A significant difference was noted between controls and rectal cancer cases (P = 0.029), the c2/c2 genotype being associated with elevated OR (adjusted age, sex and status of the smoking and alcohol drinking) for rectal cancer (1.64,95% CI, 1.12-2.41, vs c1 allele carriers), but not for colon cancer. In interaction analysis between the CYP2E1Rsa Ⅰ genotype and smoking and drinking habits, we found a significant cooperative action between the c2/c2 genotype and alcohol drinking in the sex-, age-adjusted ORs for both colon (4.74, 95% CI, 1.10-20.40) and rectal (5.75, 95% CI, 1.65-20.05) cancers. Among nonsmokers, the CYP2E1 Rsa Ⅰ c2/c2 genotype was also associated with elevated ORs in the two sites (1.95, 95%CI, 0.99-3.86 and 2.30, 95% CI, 1.32-3.99).CONCLUSION: The results of the present study suggest that the CYP2E1 c2/c2 genotype increases susceptibility to rectal cancer and the gene-environmental interactions between the CYP2E1 polymorphism and smoking or alcohol drinking exist for colorectal neoplasia in general.     

CYP2E1 Rsa Ⅰ polymorphism impacts on risk of colorectal cancer association with smoking and alcohol drinking

AIM： To investigate associations between the Rsa I polymorphism of CYP2E1 and risk of colorectal cancer. METHODS： A case-control study was conducted with 315 colorectal cancer cases （105 colon, 210 rectal） and 439 population-based controls in Jiangsu Province of China. Genomic DNA samples were assayed for restriction fragment length polymorphisms in CYP2E1 by PCR amplification followed by digestion with Rsa I. Information on smoking and alcohol drinking was collected using a questionnaire. Odds ratios （ORs） were estimated with an unconditional logistic model. RESULTS： The proportional distribution of the CYP2E1 Rsa I c1/c1, c1/c2 and c2/c2 genotypes were 61.4%, 35.6% and 3.0% in controls, 60.6%, 33.7% and 5.8% in colon cancer cases, and 58.4%, 34.0% and 7.7% in rectal cancer cases, respectively. A significant differencewas noted between controls and rectal cancer cases （P = 0.029）, the c2/c2 genotype being associated with elevated OR （adjusted age, sex and status of the smoking and alcohol drinking） for rectal cancer （1.64, 95% CI, 1.12-2.41, vs cl allele carriers）, but not for colon cancer. In interaction analysis between the CYP2E1 Rsa I genotype and smoking and drinking habits, we found a significant cooperative action between the c2/c2 genotype and alcohol drinking in the sex-, age-adjusted ORs for both colon （4.74, 95% CI, 1.10-20.40） and rectal （5.75, 95% CI, 1.65-20.05） cancers. Among nonsmokers, the CYP2E1 Rsa I c2/c2 genotype was also associated with elevated ORs in the two sites （1.95, 95% CI, 0.99-3.86 and 2.30, 95% CI, 1.32-3.99）. CONCLUSION： The results of the present study suggest that the CYP2E1 c2/c2 genotype increases susceptibility to rectal cancer and the gene-environmental interactions between the CYP2E1 polymorphism and smoking or alcohol drinking exist for colorectal neoplasia in general.     

Polymorphisms of alcohol dehydrogenase 2 and aldehyde dehydrogenase 2 and colorectal cancer risk in Chinese males

AIM： To evaluate the relationship between drinking and polymorphisms of alcohol dehydrogenase 2 （ADH2） and/or aldehyde dehydrogenase 2 （ALDH2） for risk of colorectal cancer （CRC） in Chinese males. METHODS： A case-control study was conducted in 190 cases and 223 population-based controls. ADH2 Arg47His （G-A） and ALDH2 Glu487Lys （G-A）genotypes were identified by PCR and denaturing high-performance liquid chromatography （DHPLC）. Information on smoking and drinking was collected and odds ratio （OR） was estimated. RESULTS= The ADH2 A/A and ALDH2 G/G genotypes showed moderately increased CRC risk. The age- and smoking-adjusted OR for ADH2 A/A relative to G/A and G/G was 1.60 （95% CI=1.08-2.36）, and the adjusted OR forALDH2 G/G relative to G/A and A/A was 1.79 （95% CI= 1.19-2.69）. Significant interactions between ADH2, ALDH2 and drinking were observed. As compared to the subjects with ADH2 G and ALDH2 A alleles, those with ADH2 A/A and ALDH2 G/G genotypes had a significantly increased OR （3.05, 95% CI= 1.67-5.57）. The OR for CRC among drinkers with the ADH2 A/A genotype was increased to 3.44 （95% CI= 1.84-6.42） compared with non-drinkers with the ADH2 G allele. The OR for CRC among drinkers with the ALDH2 G/G genotype was also increased to 2.70 （95% CI= 1.57-4.66） compared with non-drinkers with the ALDH2 A allele. CONCLUSION： Polymorphisms of the ADH2 and ALDH2 genes are significantly associated with CRC risk. There are also significant gene-gene and gene-environment interactions between drinking and ADH2 and ALDH2 polymorphisms regarding CRC risk in Chinese males.     

Risk factors for clinical anastomotic leakage and postoperative mortality in elective surgery for rectal cancer

Background and aims Clinical anastomotic leakage remains a major problem after anterior or low anterior resection for rectal cancer. The aim of this study was to assess the association between risk factors and anastomotic leakage and postoperative mortality. Materials and methods Two hundred seventy-six elective anterior or low anterior resections with anastomosis were performed and documented on-line from January 1995 to December 2004. Univariate and multivariate analyses with Bonferroni adjustment were carried out to identify relevant risk factors. Results The rate of anastomotic leakage was 14.9% (41 of 276 patients) with a mortality of 12.2% (5 of 41 patients). Overall mortality was 2.5% (7 of 276 patients). Multiple regression analysis showed that smokers had an increased risk of anastomotic leakage [odds ratio (OR), 6.42; 95% confidence interval (CI), 2.68–15.36] as well as patients with coronary heart disease (OR, 7.79; 95% CI, 2.52–24.08). Smokers (OR, 13.20; 95% CI, 2.48–7.24) and patients with coronary heart disease (OR, 23.46; 95% CI, 4.33–27.04) also had an increased risk of postoperative mortality in the univariate analysis as well as patients with anastomotic leakage (OR, 16.25; 95% CI, 3.04–16.92). Conclusions Smoking and coronary heart disease are important risk factors for anastomotic leakage and postoperative mortality after elective resection for rectal cancer.