Diabetes mellitus and risk of pancreatic cancer: A meta-analysis of cohort studies

Background

Diabetes mellitus (DM) is widely considered to be associated with risk of pancreatic cancer (PaC), however, whether DM is a cause or a consequence of PaC is still controversial. We examined this association by conducting a detailed meta-analysis of cohort studies.

Methods

Studies were identified by searching Medline and Embase through November 30, 2010. Summary relative risks (RRs) with their corresponding 95% confidence intervals (CIs) were calculated using a random-effects model.

Results

A total of thirty-five cohort studies were included in this meta-analysis. DM was associated with an increased risk of PaC (the summary RRs = 1.94; 95% CI, 1.66-2.27), with significant evidence of heterogeneity among these studies (p < 0.001, I² = 93.6%). Subgroup analyses revealed that the increased risk of PaC was independent of geographic locations, sex, study design, alcohol consumption, body mass index (BMI) and smoking status. In addition, the relative risk of PaC was correlated negatively with the duration of DM, with the highest risk of PaC found among patients diagnosed within less than 1 year. There was no significant publication bias (p = 0.136 for Egger’s regression asymmetry test).

Conclusions

Findings from this meta-analysis strongly support that diabetes is associated with an increased risk of PaC in both males and females and that DM is both an early manifestation and an etiologic factor of pancreatic cancer.     

既往疾病史与胰腺癌关系的流行病学研究

目的探讨既往疾病史与胰腺癌的关系。方法采用全人群病例-对照研究,研究对象为1990年10月~1993年6月期间确诊的、年龄在35~74岁的上海市区451例胰腺癌新发病例以及按性别、年龄(5岁1组)频数配对的1552例人群对照。采用非条件logistic回归模型分析既往疾病史与胰腺癌的关系。结果男性中,糖尿病患者(OR=4.49,95%CI2.21~9.12)、慢性胰腺炎患者(OR=7.05,95%CI1.93~25.75)、胆囊切除者(OR=4.02,95%CI1.75~9.26)以及肝硬化者(OR=4.22,95%CI1.68~10.59)发生胰腺癌的危险性显著增加;女性糖尿病患者(OR=3.58,95%CI1.89~6.76)、慢性胰腺炎患者(OR=6.15,95%CI1.88~20.06)、胆囊切除者(OR=2.91,95%CI1.54~5.48)以及肝硬化者(OR=6.92,95%CI1.08~44.49)。去除胰腺癌诊断前或调查前5年内出现上述疾病史的研究对象后,男性糖尿病患者胰腺癌危险性仍显著增加(OR=3.47,95%CI1.09~11.06),其余结果虽多数危险性也升高,但均未达显著水平。结论糖尿病、慢性胰腺炎、胆囊切除以及肝硬化病史可能会增加胰腺癌的发病风险,上述疾病史可能在胰腺癌病因学中起一定的作用。     

胰腺癌与糖尿病关联的探讨

背景与目的:在十九世纪早期,人们即认识到胰腺癌与糖尿病(DM)的关系,但至今两者的因果关系仍有争论,本文探讨两者的关联,从而提高胰腺癌早期诊断水平。方法:对2003年12月-2005年2月收住我院的胰腺癌合并DM患者及非合并DM患者共83例进行回顾性分析,并将其中13例以DM为首发症状或DM病情加重胰腺癌患者与另外20例病程匹配的2型糖尿病(T2DM)进行年龄、体重指数、DM家族史及实验室指标的比较。结果:①83例胰腺癌中,35例(42.17%)合并DM,其中24(68.57%)例DM病程小于2年(其中14(40%)例与胰腺癌同时发现),8(22.86%)例DM病程大于2年,3例DM病程不详。胰腺癌合并DM患者高血压的患病率高于非DM患者(45.71%vs25%,P<0.05)。②胰腺癌合并DM患者腹痛(χ2=5.332,P<0.01)、纳差(χ2=3.867,P<0.01)的发生率低于非DM患者。③胰腺癌合并DM患者直接胆红素(DB)(χ2=23.46,P<0.01)升高发生率较低。④两组患者在肿瘤的部位、转移、手术情况和生存期差异无统计学意义。⑤13例以DM为首发症状或DM病情加重胰腺癌患者与20例T2DM进行比较,胰腺癌患者发病年龄较大(68.93±10.62vs55.6±11.14岁,P<0.01)且体型更消瘦(BMI21.51±1.98vs23.87±3.04kg/m2,P<0.01)。结论:胰腺癌为进展较快的肿瘤,即使合并DM,也不影响胰腺癌临床表现及预后。对于高龄且消瘦初发DM患者及血糖短期恶化DM患者,要警惕胰腺癌的发生。     

Is diabetes mellitus a risk factor for ovarian cancer? A case-control study in Utah and Washington (United States)

Insulin resistance characterizes non-insulin dependent diabetes (NIDDM). Insulin resistance may coexist in clinical syndromes with hyperestrogenism and hyperandrogenism, suggesting that the ovary may be sensitive to effects of insulin. In addition, insulin-like growth factor-I receptors, which are capable of binding insulin, have been identified in ovarian cancer tissue and are proposed to regulate cell growth. We evaluated the association between a history of diabetes mellitus and ovarian cancer in a case-control study in seven counties in Washington and in Utah (United States) during the years 1975–87. Cases included women newly diagnosed with ovarian cancer over a five-year period who were identified through population-based cancer reporting. Controls similar to cases with regard to age and county of residence were identified via household surveys or random digit dialing. The study included 595 cases and 1,587 controls. Twenty-seven cases (4.5 percent) and 72 controls (4.5 percent) reported a history of diabetes. Logistic regression analysis of the association between diabetes and ovarian cancer controlling for age, body mass index, and race resulted in an odds ratio (OR) of 0.9 (95 percent confidence interval [CI]=0.6–1.5). The OR was not changed with further controlling for prior oral contraceptive use or prior pregnancy. None of the 20 women with nonepithelial tumors (15 of which were stromal tumors) had a history of diabetes (upper CI=4.0). These results, together with findings of two earlier cohort studies, do not support the hypothesis that diabetes is a risk factor for epithelial ovarian cancer.This research was supported in part by grants R35-CA-39779 and 2T32-CA-09168 from the US National Cancer Institute.     

Chronic hepatitis B virus infection and pancreatic cancer: a case-control study in southern China

Background: The association of hepatitis B virus (HBV) infection and pancreatic cancer is still controversial. The purpose of this study is to determine whether chronic HBV infection increases the risk. Methods: In this case-control study, there were 1,066 patients recruited, with 533 in the study group and 533 controls, frequencymatched for age and sex. Blood samples were collected to detect hepatitis viral infection. Results: Compared to 77 patients (14.4%) in the control group, 80 pancreatic cancer patients (15.0%) were seropositive for HBV surface antigen (not statistically significant, P=0.8). The prevalence of HBV e antigen was higher in study group than that of control group ( P=0.03). Further analysis indicated that HBeAg was a risk factor for pancreatic cancer (OR=2.935, 95% CI: 1.048-8.220). Conclusions: In HBV endemic area of China, there appears to be no significant association between chronic HBV infection and pancreatic cancer, but the role of HBeAg needs further exploration.     

普通感冒与肿瘤发病关系的病例对照研究

目的:观察普通感冒对肿瘤发病风险的影响。方法:2021年1月至2021年5月,连续收集综合医院和社区医院就诊的532例肿瘤患者作为病例组,按年龄、性别、长期居住地进行1∶1匹配,收集同期同地点532名未患肿瘤者作为对照组。通过问卷调查、查阅门诊或住院病历的方式获取患者的临床资料。采用条件logistic回归进行单因素和多因素分析感冒对肿瘤发病风险的影响。结果:单因素分析显示,感冒的频率在病例组和对照组中有统计学差异(P＜0.05)。多因素分析显示,与每年感冒次数少于1次相比,每年患1次感冒（OR=0.461,95%CI:0.327~0.649）,患2次感冒（OR=0.224,95%CI:0.145~0.347）,患3次及以上感冒（OR=0.092,95%CI:0.046~0.182）肿瘤的发病风险降低。结论:一定频率的普通感冒可能与肿瘤发病风险降低有关。     

Nutrients and pancreatic cancer: a population-based case-control study

A case-control study was conducted in the Minneapolis-St Paul (Minnesota, United States) area to assess the role of dietary factors in the etiology of pancreatic cancer. Cases were White males aged 40 to 84 whose death certificate listed pancreatic cancer (exocrine only). White male controls were ascertained through random-digit dialing. Family members were interviewed about the subject's dietary usage in the two years prior to death (cases, n=212) or prior to interview (controls, n=220). Energy-adjusted,nutrient-intake, risk estimates were calculated. Among all respondents, negative trends were observed for polyunsaturated fat, linoleic acid, vitamin C, and -carotene. Positive trends were observed for riboflavin and retinol. Point estimates were, in general, comparable between the analyses of all respondents and spouse-only respondents. The nutrients associated with a decreased risk for pancreatic cancer occur primarily in vegetables and fruits, of which the consumption of cruciferous and -carotene-rich vegetables and citrus fruits provided the greatest reduction in risk.Authors are at the University of Minnesota. Drs Olsen and Schuman are at the School of Public Health, Division of Epidemiology, Minneapolis, MN, USA. Dr Mandel is with the Division of Environmental and Occupational Health, School of Public Health. Dr Gibson is at the School of Medicine, Department of Behavioral Sciences. Dr Wattenberg is at the School of Medicine, Department of Laboratory Medicine and Pathology. Address correspondence to Dr Olsen, The Dow Chemical Company, Health and Environmental Sciences, Epidemiology, 1803 Building, Midland, MI 48674, USA. This study was supported by grant SIG5 from the American Cancer Society.     

上海市区胃癌危险因素探讨

目的 探索上海市区胃癌的危险因素，为采取有效的预防措施提供科学依据。方法 采用全人群病例对照研究，共调查1999年4月～1999年10月期间诊断的30～74岁的上海市区新发胃癌病例311例(男性198例，女性113例)，对照1579例，获得环境暴露等资料。采用非条件logistic模型控制混杂因素计算各个因素的调整比值比(OR)和95％可信限(95％CI)。结果 男性中吸烟、热烫饮食、油炸面食、患病前精神压抑和自我调节能力差、慢性胃炎及一级亲属胃癌史等因素可增加患胃癌的危险性；女性胃癌则与腌制食品(尤其是腌制蔬菜)、油炸食品、酒精摄人、患病前精神压抑和自我调节能力差、溃疡病史、慢性胃炎史及一级亲属胃癌史等关系密切。新鲜蔬菜、水果，新鲜豆类，豆制品，植物油和蛋及蛋制品等对胃癌有保护作用。调整可能的混杂因素后，分析结果均达到显著水平。结论 上海市区胃癌近十年危险因素没有明显改变，吸烟、腌制食品和油炸食品、慢性胃炎史和胃癌家族史等可能是主要的危险因素，而多食新鲜蔬菜和水果、豆及豆制品等对胃癌有保护作用。     

沈阳市子宫颈癌发病危险因素的病例对照研究

目的通过沈阳市子宫颈癌患者与沈阳市地区居民的病例对照研究,探讨子宫颈癌发病的危险因素。方法 以在辽宁省肿瘤医院住院的沈阳市子宫颈癌患者100例为病例,以沈阳市大东区二台子街道随机抽取的1000名子宫颈癌及癌前病变筛查的城市居民中非癌对象为对照,进行流行病学调查,采集HPV标本及宫颈脱落上皮液基细胞学检测标本,对获得的数据采用SPSS 13.0统计软件进行单因素卡方分析、logistic回归分析以及多因素logistic回归分析。结果 HPV感染(OR=221.62,95%CI:28.53~1721.51)、初次性生活年龄小于21岁(OR=6.65,95%CI:1.88~23.51)是子宫颈癌发病的危险因素,使用避孕套(OR=0.05,95%CI:0.01~0.18)是避免患宫颈癌的保护性因素。结论 清除HPV感染、倡导使用避孕套、树立科学的性生活观念、避免过早性体验,对降低沈阳地区子宫颈癌的发病具有重要意义。     

A multi-institute case-control study on the risk factors of developing pancreatic cancer.

A multi-institute, hospital-based, case-control study on pancreatic cancer was carried out to examine its association with preceding diseases, cigarette smoking, alcohol drinking and dietary factors. Analyses were based on 124 newly diagnosed exocrine pancreatic cancer cases and sex-, age- and institute-matched hospital controls in seven hospitals in Japan. Cigarette smoking showed a positive association with the risk of developing pancreatic cancer. Especially among smokers, a risk enhancing effect of involuntary/passive smoking prior to twenty years of age was observed (P < 0.05). No consistent associations were found with coffee, black tea or alcohol consumption. Among dietary factors, favoring food of a salty taste and drinking green tea five cups per day or more were positively associated with the risk. Drinking milk and eating fish everyday were inversely associated with the risk.     

胰腺癌合并糖尿病患者放疗后血糖变化及相关因素分析

目的 探讨胰腺癌合并糖尿病患者放疗后血糖变化情况及其相关因素.方法 回顾性分析了69例Ⅰ～Ⅲ期胰腺癌合并糖尿病患者的临床资料,根据糖尿病病程分组,分析各组的临床特征及经过立体定向放疗以后各组患者血糖变化的情况,并分析血糖与肿瘤标志物变化的相关性.结果 糖尿病程＜12个月的胰腺癌患者占39.1％,远高于其他病程的患者.经有效治疗后,糖尿病病程＜12个月与病程12 ～24个月患者的血糖改善情况比较,差异无统计学意义(P=0.519);而与病程25 ～36个月和病程＞36个月的患者比较,血糖的改善率差异均有统计学意义(均P＜0.05).经有效治疗后,糖尿病病程＜12个月、病程12～24个月的患者随着CA199或癌胚抗原(CEA)水平的降低,血糖亦有相应的改善,两者呈正相关(r分别为0.834和0.660,均P＜0.01).糖尿病病程25 ～ 36个月、病程＞ 36个月的患者血糖改善比例与CA199或CEA水平降低比例无关(r分别为0.319和0.439,均P＞0.05).结论 糖尿病病程＜24个月的胰腺癌患者的高血糖可能是继发于胰腺癌的—种临床表现,对于新发糖尿病患者需要密切随访以早期诊断胰腺癌.     

A case-control study of diabetes mellitus and cancer risk.

The relationship between diabetes mellitus and cancer risk was investigated using data from an integrated series of case-control studies conducted in Northern Italy between 1983 and 1992. Cases were 9,991 patients with incident, histologically confirmed neoplasms below age 75, including 181 cancers of the oral cavity and pharynx, 316 of the oesophagus, 723 of the stomach, 828 of the colon, 498 of the rectum, 320 of the liver, 58 of the gall bladder, 362 of the pancreas, 242 of the larynx, 3,415 of the breast, 726 of the endometrium, 971 of the ovary, 125 of the prostate, 431 of the bladder, 187 of the kidney, 208 of the thyroid, 80 Hodgkin''s lymphomas, 200 non-Hodgkin''s lymphomas and 120 multiple myelomas. Controls were 7,834 subjects in hospital for acute, non-neoplastic, non-metabolic, non-hormone-related disorders. A history of diabetes was reported by 5.1% of male and 5.4% of female controls. Significantly elevated relative risks (RRs) among subjects with diabetes were observed for cancers of the liver [RR = 2.8, 95% confidence interval (CI) 2.0-3.9], pancreas (RR = 2.1, 95% CI 1.5-2.9) and endometrium (RR 3.4, 95% CI 2.7-4.3). After allowance for obesity and education as well as age and sex, the RRs were 3.0 for liver, 2.3 for pancreas, and 2.8 for endometrium. Diabetic subjects had no elevated risk for any of the other cancer sites considered. For liver and endometrial cancer the RRs remained elevated up to 10 years after diagnosis of diabetes (RR 2.6 and 2.0 respectively), while the RR for pancreatic cancer declined from 3.2 in the first 5 years after diagnosis of diabetes to 2.3 from 5 to 9 years and to 1.3 (95% CI 0.7-2.3) 10 or more years since diagnosis. This suggests that the relationship between diabetes mellitus and liver and endometrial cancer is probably real, while that with pancreatic cancer is compatible with diabetes being an early symptom of the disease, or at least of preneoplastic lesions.     

Re-evaluation of ABO gene polymorphisms detected in a genome-wide association study and risk of pancreatic ductal adenocarcinoma in a Chinese population

Pancreatic cancer is a fatal malignancy with an increasing incidence in Shanghai, China. A genome wide association study （GWAS） and other work have shown that ABO alleles are associated with pancreatic cancer risk. We conducted a population-based case-control study involving 256 patients with pathologically confirmed pancreatic ductal adenocarcinoma （PDAC） and 548 healthy controls in Shanghai, China, to assess the relationships between GWAS-identified ABO alleles and risk of PDAC. Carriers of the C allele of rs505922 had an increased cancer risk [adjusted odds ratio （OR） = 1.42, 95% confidence interval （CI）： 1.02-1.98] compared to TT carriers. The T alleles of rs495828 and rs657152 were also significantly associated with an elevated cancer risk （adjusted OR = 1.58, 95% CI： 1.17-2.14; adjusted OR = 1.51, 95% CI： 1.09-2.10）. The rs630014 variant was not associated with risk. We did not find any significant gene-environment interaction with cancer risk using a multifactor dimensionality reduction （MDR） method. Haplotype analysis also showed that the haplotype CTTC was associated with an increased risk of PDAC （adjusted OR = 1.46, 95% CI： 1.12-1.91） compared with haplotype TGGT. GWAS-identified ABO variants are thus also associated with risk of PDAC in the Chinese population.     

贲门癌发病危险因素的病例对照研究

目的 探讨贲门癌发病的危险因素.方法 选择食管癌高发区河北省磁县、河北省涉县、河南省林州市、山东省肥城市及胃癌高发区辽宁省庄河市,每个地区选择2008年1月以后发病的贲门癌50例.采用以人群为基础的1∶3配对病例对照研究,用专门设计的调查表,分别对250例患者和750例对照进行问卷调查.并采用SPSS 13.0软件COXREG命令拟合条件Logistic回归模型,对相关变量进行分析.结果 单因素分析显示,吸烟、饮酒、饮食不规律、就餐姿势不正确、饮食口味重、常吃干果干菜、腌制食品、油炸食品、热烫食品、消化系统疾病史、胃食管反流性疾病可增加贲门癌发病的危险性,多吃豆类食品、体质指数(BMI)≥25则为保护因素.多因素分析显示,消化系统疾病史、常吃干果干菜、饮食不规律、常吃烫热食品、常吃腌制食品、吸烟、胃食管反流性疾病是贲门癌发病的危险因素,比值比(OR)分别为42.889、5.932、4.911、4.144、3.287、2.355和1.930;常吃豆类食品、BMI≥25是贲门癌发病的保护性因素,OR值分别为0.254和0.492.结论 生活行为习惯是贲门癌发病的重要影响因素,在高发区人群中开展健康教育,干预其不良生活行为和饮食习惯,将有助于降低贲门癌的发病率.     

The risk factors of prostate cancer: a multicentric case-control study in Iran.

Prostate cancer (PC), in Iran, is the third most frequently diagnosed visceral cancer among men and the seventh most common underlying cause of cancer mortality. We evaluated the relation between speculated factors and PC risk using data from a multicentric case-control study conducted in Iran from 2005 to 2007 on 130 cases of incident, clinicopathologically confirmed PC, and 75 controls admitted to the same network of hospitals without any malignant disease. Odds ratios (OR) and corresponding 95% confidence intervals (CIs) were estimated using conditional logistic regression models. The risk of PC was increased with aging (OR: 5.35, 95% CI: 2.17-13.19; P<0.0001), and with the number of sexual intercourse >or=2 times/week (OR: 3.14, 95% CI: 1.2-8.2; P=0.02). One unit elevation in serum estradiol and testosterone concentration was related to increase (OR: 1.04, 95% CI: 1.01-1.06; P=0.006) and decrease (OR: 0.79; 95% CI: 0.64-0.96; P=0.02) of PC risk, respectively. Cases were less likely to have a history of diabetes (OR: 0.34, 95% CI: 0.12-0.98; P=0.04). Increasing in dietary consumption of lycopene and fat was associated with declined (OR: 0.45, 95% CI: 0.09-2.12) and increased (OR: 2.38, 95% CI: 0.29-19.4) PC development, respectively. Other factors including educational level, marriage status, dietary meat consumption, vasectomy and smoking have not been shown to affect PC risk in the Iranian population. Our study adds further information on the potential risk factors of PC and is the first epidemiologic report from Iran. However, justification of these results requires more well-designed studies with a larger number of participants.     

Past medical conditions and K-ras mutations in pancreatic ductal adenocarcinoma: a hypothesis-generating study

Background  In pancreatic ductal adenocarcinoma (PDA) evidence on the etiopathogenic role of past medical conditions in the occurrence and persistence of K-ras mutations is scant. Methods  Incident cases of PDA were interviewed face-to-face about past medical history and other factors. Logistic regression was used to compare PDA cases (n = 120) with wild-type and mutated K-ras tumors (case–case study). Results  Patients with wild-type K-ras tumors were more likely to have a prior diagnosis of pancreatitis (Odds ratio [OR] = 6.11, p = 0.041). Diabetes mellitus (DM) was non-significantly more common among cases with a K-ras wild-type tumor, and the OR for DM of >6 years of duration was 4.54 (p = 0.39). Patients with wild-type K-ras were significantly more likely to have had a surgically treated peptic ulcer (OR = 9.03, p = 0.027). The probability of having a K-ras wild-type tumor increased with the number of medical conditions (p for trend = 0.012); the corresponding OR for two or more medical conditions was 4.46 (95% CI: 1.37–14.50). Conclusions  Results raise the hypothesis that pancreatitis and possibly peptic ulcer might influence pancreatic carcinogenesis through pathways independent of K-ras mutation, perhaps related to growth factors or mediators of the inflammatory response. Large unselected studies should be conducted to refute or replicate our findings. PANKRAS II Study Group—Members of the Multicenter Prospective Study on the Role of K-ras and other Genetic Alterations in the Diagnosis, Prognosis and Etiology of Pancreatic and Biliary Diseases (PANKRAS II) Study Group are mentioned in previous publications.     

Association between a polymorphic variant in the CDKN2B-AS1/ANRIL gene and pancreatic cancer risk

Genes carrying high-penetrance germline mutations may also be associated with cancer susceptibility through common low-penetrance genetic variants. To increase the knowledge on genetic pancreatic ductal adenocarcinoma (PDAC) aetiology, the common genetic variability of PDAC familial genes was analysed in our study. We conducted a multiphase study analysing 7745 single nucleotide polymorphisms (SNPs) from 29 genes reported to harbour a high-penetrance PDAC-associated mutation in at least one published study. To assess the effect of the SNPs on PDAC risk, a total of 14 666 PDAC cases and 221 897 controls across five different studies were analysed. The T allele of the rs1412832 polymorphism, that is situated in the CDKN2B-AS1/ANRIL, showed a genome-wide significant association with increased risk of developing PDAC (OR = 1.11, 95% CI = 1.07-1.15, P = 5.25 × 10⁻⁹). CDKN2B-AS1/ANRIL is a long noncoding RNA, situated in 9p21.3, and regulates many target genes, among which CDKN2A (p16) that frequently shows deleterious somatic and germline mutations and deregulation in PDAC. Our results strongly support the role of the genetic variability of the 9p21.3 region in PDAC aetiopathogenesis and highlight the importance of secondary analysis as a tool for discovering new risk loci in complex human diseases.     

Relationship between mammographic density and the risk of breast cancer in japanese women: a case-control study

BACKGROUND: The relationship between mammographic density and the risk of breast cancer was examined in Japanese women. The study was a matched case-control study comparing the mammographic densities of both breast cancer cases and healthy controls. MATERIALS AND METHODS: We selected 237 women who were diagnosed with a histologically verified breast cancer, and who underwent surgery at Gihoku General Hospital in Gifu, from January, 1998 to December, 1999. During the time of this study, 3,650 people participated in breast cancer screening with mammography and ultrasound together. We selected 742 women as a control group from the screening participants and matched them by age and the number of deliveries with the cancer patients. The same mammography machine was used for both cases and controls. For evaluation, we used a visual method (Wolfe's classification) and a computer assisted method to classify the mammograms based on mammographic density. RESULTS: (1) According to Wolfe's classification, the DY group had a significantly increased breast cancer risk compared with the N1 group (Relative risk (RR)=2.20, 95% confidence interval (95%CI) (1.02-4.77). (2) The group showing a high mammographic density had a significantly increased risk of breast cancer compared with the group with low mammographic density (RR=2.83, 95%CI=1.33-5.98) as classified by the computer assisted method. CONCLUSION: It is suggested that women with high mammographic densities, classified visually or by computer, have an elevated risk of breast cancer compared with those with low mammographic densities.     

The yield of staging laparoscopy for resectable and borderline resectable pancreatic cancer in the PREOPANC randomized controlled trial

BackgroundThe necessity of the staging laparoscopy in patients with pancreatic cancer is still debated. The objective of this study was to assess the yield of staging laparoscopy for detecting occult metastases in patients with resectable or borderline resectable pancreatic cancer.MethodThis was a post-hoc analysis of the randomized controlled PREOPANC trial in which patients with resectable or borderline resectable pancreatic cancer were randomized between preoperative chemoradiotherapy or immediate surgery. Patients assigned to preoperative treatment underwent a staging laparoscopy prior to preoperative treatment according to protocol, to avoid unnecessary chemoradiotherapy in patients with occult metastatic disease.ResultsOf the 246 included patients, 7 did not undergo surgery. A staging laparoscopy was performed in 133 patients (55.6%) and explorative laparotomy in 106 patients (44.4%). At staging laparoscopy, occult metastases were detected in 13 patients (9.8%); 12 liver metastases and 1 peritoneal metastasis. At direct explorative laparotomy, occult metastases were found in 9 patients (8.5%); 6 with liver metastases, 1 with peritoneal metastases, and 2 with metastases at multiple sites. One patient had peritoneal metastases at exploration after a negative staging laparoscopy. Patients with occult metastases were more likely to receive palliative chemotherapy if found with staging laparoscopy compared to laparotomy (76.9% vs. 30.0%, p = 0.040).ConclusionsStaging laparoscopy detected occult metastases in about 10% of patients with resectable or borderline resectable pancreatic cancer. These patients were more likely to receive palliative systemic chemotherapy compared to patients in whom occult metastases were detected with laparotomy. A staging laparoscopy is recommended before planned resection.     

随访队列的结直肠癌危险因素的病例-对照研究

目的研究环境暴露因素与结直肠癌发病的联系,为采取有效的预防措施提供科学依据.方法以嘉善结直肠癌筛检队列为研究人群,采用单纯随机抽样方法选择正常人对照343例,以及随访至今发生的结直肠癌存活病例126例,进行结直肠癌流行病学调查,并以非条件logistic回归法分析各因素与结直肠癌发生的关系.结果同事吸烟、粘液血便史、服用导泻药史、肠息肉史、乙肝史、家族结直肠癌史和常食动物油是结肠癌的危险因素,OR值依次为:4.87、28.84、13.00、7.68、6.98、5.55和2.41,香蕉 (OR=0.66)是保护因素;粘液血便史(OR=112.04),腺瘤史(OR=31.92),肠息肉史(OR=8.07),腹部手术史(OR=2.40),食用炸肉(OR=12.88),红烧鱼(OR=1.77),均为直肠癌的危险因子,常饮深井水(OR=0.32),常吃白菜、蘑菇、西瓜和爱吃白糖能显著降低直肠癌的风险,OR依次为:0.32、0.60、0.51、0.67和0.55.结论同事吸烟、粘液血便史、服用导泻药史、肠息肉史、乙肝史、家族结直肠癌史、和动物油、炸肉、红烧鱼、香蕉、白菜、蘑菇、西瓜等饮食与结直肠癌的发生有一定影响.