Risk factors for endometrial cancer at different ages

The importance of the major risk factors for endometrial cancer in women of different ages was evaluated with the use of data from a hospital-based case-control study conducted in Milan, Italy, on 283 women with endometrial cancer and 566 age-matched controls. Current weight was related strongly to the risk of endometrial cancer both in younger (premenopausal) and in older women (with risk estimates for the heaviest categories of 20.3 and 7.7, respectively), thus confirming that obesity is the major cause of endometrial cancer in Northern Italy. Endometrial cancer risk appeared to be approximately proportional to the second power of body mass index. Early menarche and nulliparity were associated with an increased risk of endometrial cancer in premenopausal women, the point estimate for nulliparity rising to 35.1 (with lower confidence limit of 10.2) after adjustment for marital status. However, no association with these factors was evident in postmenopausal women. Combination oral contraceptives were used by 2 cases and 19 controls only [relative risk (RR) = 0.2, with 95% confidence interval = 0.1-0.8]. The use of noncontraceptive estrogens was associated with an elevated risk, which was greater in perimenopausal women (RR = 5.1 for greater than 2 yr of use), and decreased progressively with increasing time after menopause. Late menopause was also related to endometrial cancer. However, the risk estimates for late menopause apparently were more elevated in older women (greater than or equal to 65 yr) than in perimenopausal women. Most of the risk factors identified (excluding late menopause) apparently act on one of the later stages of the process of carcinogenesis, because the excess risk drops after cessation of exposure.     

Anthropometric measures at different ages and endometrial cancer risk

Background:

Endometrial cancer is strongly associated with body mass index (BMI), but the influence of BMI history and of different types of obesity is uncertain.

Ethods:

M A case–control study was carried out in Italy including 454 cases and 908 controls admitted to hospital for acute non-hormone-related conditions. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using multivariate logistic and spline regression models.

Results:

The OR for BMI >30 at diagnosis compared with 20 to <25 kg m⁻² was 4.08 (95% CI: 2.90–5.74). The association for BMI was monotonic with a possible steeper increase for BMI above 28. Conversely, waist-to-hip ratio (WHR) showed a bell shaped curve with increased OR (2.10; 95% CI: 1.43–3.09) in the intermediate tertile only. After stratification by BMI at diagnosis, history of weight loss and BMI at age 30 did not influence endometrial cancer risk. History of obesity in middle age had a weak and not significant adverse effect among obese women (OR=1.60; 95% CI: 0.52–4.96).

Conclusion:

The predominant importance of recent weight compared to lifetime history, justifies encouraging weight reduction in women at any age.     

Prostate cancer and body size at different ages: an Italian multicentre case-control study

We investigated the influence of anthropometric measures at diagnosis and at different ages on prostate cancer risk using an Italian multicentre case-control study conducted between 1991 and 2002 of 1294 histologically confirmed cases and 1451 controls admitted to the same network of hospitals for acute non-neoplastic conditions. Height, weight, body mass index (BMI), waist-to-hip ratio, lean body mass 1 year before diagnosis/interview were not significantly associated with risk. However, a positive association with high BMI at age 30 years was found (odds ratio=1.2 for BMI> or =24.7 vs <22.7) and: for less differentiated prostate cancer, with BMI 1 year before diagnosis/interview. This study supports possible relationships between high body mass in young adulthood, and a tendency to high weight throughout adult life, and the risk of prostate cancer.     

The use of radiotherapy for early breast cancer in woman at different ages

Age is an important feature at the time of early breast cancer diagnosis. Radiotherapy is a mandatory component of treatment for breast-conserving strategies in early disease stages. Breast radiotherapy has rapidly evolved in the last 20 years. A tendency to less treatment volume (partial-breast irradiation) and less treatment time (hypofractionation) is consolidated in modern radiation oncology practice. Age and risk for local recurrence guide the decision-making process to electro-optimal treatment. Radiotherapy technological versatility offers multiple options for individualized (risk–age adapted) recommendations.     

Body size indices at different ages and epithelial ovarian cancer risk

The relationship between body mass measures at diagnosis and/or at different ages and ovarian cancer risk was investigated using an Italian multicentre case-control study. The study, conducted between 1992 and 1999, included 1031 cases of incident, histologically-confirmed epithelial ovarian cancer and 2411 controls admitted to the same network of hospitals for acute non-neoplastic conditions. Odds ratios (OR) and 95% confidence intervals (CI) were obtained using unconditional multiple logistic regression analyses. Weight and body mass index (BMI, kg/m(2)) 1 year prior to diagnosis/interview were not associated with ovarian cancer risk. A direct association emerged with waist-to-hip ratio (W/H) (OR=1.45 in the highest category), particularly among women with stage I-II cancers. Cases also had a higher BMI at age 30 years (OR=1.22). Conversely, cases had lower weight gain between age 30 years and the year prior to diagnosis/interview, both for cases with stage I-II and those with stage III-IV cancers.     

Body mass at different ages and subsequent endometrial cancer risk.

The relationship between body mass index (BMI) at different ages and subsequent endometrial-cancer risk was investigated in a multicentre case-control study conducted between 1988 and 1991 in Vaud, Switzerland, and Northern Italy on 272 histologically confirmed incident cases of endometrial cancer and 571 controls admitted to hospital for acute, non-neoplastic conditions, unrelated to known or potential risk factors for endometrial cancer. The risk of endometrial cancer increased with increasing BMI in the 3rd decade of age (20 to 29 years), in the 5th decade (40 to 49 years) and in the 7th decade (60 to 69 years), although the risk estimates tended to be substantially higher at older ages: compared with women whose BMI (kg m-2) was less than 20, the relative risks (RR) were 1.8 for BMI greater than or equal to 25 at age 20 to 29, 2.7 for BMI greater than or equal to 30 at age 40 to 49 and 3.8 at age 60 to 69. All the trends in risk were significant, except that for BMI at age 25 after allowance for current BMI. When data were examined in separate strata of current BMI, among women of normal body mass at diagnosis no significant effect of past overweight was observed. In contrast, among subjects over-weight at diagnosis, there were significant direct relationships with BMI at ages 20 to 29 and 40 to 49. To reduce endometrial cancer risk, it is therefore important to avoid obesity in later middle and older age, and the benefit can be even greater for women who were overweight at younger age.     

Invasive lobular breast cancer. Prognostic significance of histological malignancy grading

Invasive lobular carcinoma (ILC) is the second most reported type of breast cancer in the Danish Breast Cancer Cooperative Group (DBCG). Several histological subtypes exist, with reports of different prognosis. The aim was to present the incidence of ILC in DBCG from 1977-2004, and evaluate tumours regarding diagnosis, histological subtype and grade, and relate to prognosis. Eight hundred and sixty tumours from patients with a diagnosis of ILC or ILC/non-ILC, who underwent breast cancer surgery in the period of 1990-1998, were evaluated. The impact of histological malignancy grade on disease-free survival and overall survival was analysed using a multivariate analysis adjusting for tumour size, hormone receptor status, axillary lymph node status and patient age. The incidence of pure ILC has risen from 5 to 12%, the ILC/non-ILC is constant at 2% of all reported breast cancers in DBCG. Most of the tumours were classical ILC grade II. The majority of the grade III tumours were among the non-classical subtypes, showing a statistically significant worse disease-free and overall survival compared to grade II, regardless of type. The prognosis was the same for grade I and grade II tumours. The number of positive axillary lymph nodes and hormone receptor negative tumours increased among grade III tumours. We conclude that histological malignancy grade has an independent significant impact on the prognosis of ILC, and it should be taken into consideration when planning the postoperative treatment in this group of patients.     

The ultrastructural characteristics of different histological types of bronchiolar-alveolar cancer

Morphological study of bronchioloalveolar carcinoma (BAC) was performed by light or electron microscopy in 100 and 33 patients, respectively. BAC-1, 2 and 3 histologic subtypes were established basing on ultrastructural peculiarities which betrayed different cytogenetic origins. Electron microscopic signs of goblet cells were found in cells constituting BAC-1 tumors. BAC-2 tumor cells exhibited ultrastructural characteristics of Clara cells and/or type-II pneumocytes. BAC-3 tumors appeared less differentiated and contained mainly undifferentiated cells and cell clusters displaying various combinations of electron microscopic markers of goblet and Clara cells and type-II pneumocytes.     

Correlation between estrogen receptor status and histological malignancy in human breast cancer

Sixty-two breast carcinoma patients underwent mastectomy and were analyzed for correlations between estrogen receptor (ER) status of the tumor and the histological findings of tumor, age, nodal status, and tumor size. An immunocytochemical assay for the detection of ER in breast carcinomas was used to evaluate the staining intensity index (SII) of the ER level of the tumors, which was calculated from the staining intensity of cancer cells and the percentage of ER-positive cancer cells. The histological differentiation of carcinomas showed a strong correlation with the SII. A statistically significant (F = 10.580, P less than 0.0005) negative correlation was found between the grade of malignancy and the SII. Patients under 50 years of age tended to have a lower SII, whereas patients over 49 years of age tended to have a higher SII. The tumor size, and nodal status showed no correlations with the SII in any of the patients. The histological differentiation of the tumor cells showed a strong correlation with the heterogeneity of the distribution of ER-positive cells in breast cancers.     

不同年龄段女性三阴性乳腺癌化疗患者的认知功能水平分析

目的:探究不同年龄段女性三阴性乳腺癌化疗患者的认知功能水平。方法:收集2016年5月至2017年8月期间在我院接受化学治疗的三阴性乳腺癌患者96例,作为实验组,另收集同时间段内在我院进行治疗的非三阴性乳腺癌患者96例,作为对照组。将实验组及对照组患者按照年龄分为A组(≤40岁),B组(41~65岁),C组(>65岁),A组、B组、C组的例数分别为53例、62例、77例。比较实验组患者与对照组患者的MMSE量表、PM问卷、RM问卷得分,并采用SPSS 19.0统计学软件进行数据分析。结果:实验组患者与对照组患者的年龄、教育程度资料比较差异不具有统计学意义（P>0.05）;实验组患者的MMSE量表得分低于对照组,PM量表、RM量表得分高于对照组,数据差异具有统计学意义（P<0.05）。在A组中,实验组患者的PM量表、MMSE量表、RM量表得分与对照组比较差异具有统计学意义（P<0.05）,两组的教育程度比较差异不具有统计学意义（P>0.05）;B组、C组中,实验组患者的PM量表、MMSE量表、RM量表得分与对照组比较差异不具有统计学意义（P>0.05）。Logistic回归分析结果显示,患者年龄、三阴性乳腺癌均是影响乳腺癌患者发生认知障碍的独立危险因素(P<0.05)。结论:乳腺癌化疗能够使患者的认知障碍呈现异质性;三阴性乳腺癌患者认知障碍的严重程度高于非三阴性乳腺癌患者;患者年龄是影响三阴性乳腺癌发生认知障碍的独立危险因素。     

不同年龄段非小细胞肺癌的外科临床特点及预后

背景与目的随着社会工业化的不断发展和社会人口老龄化,肺癌的发病年龄也出现了年轻化和老龄化的趋势,因此对不同年龄肺癌患者的治疗方式也应有所不同。本研究结合临床资料对非小细胞肺癌手术后不同年龄段患者的临床特点及预后进行评价及分析。方法回顾分析自1996年1月至2003年1月我科手术治疗1380例非小细胞肺癌患者资料,按年龄分组,第一组(青年组)(年龄≤40岁),第二组(中年组)(年龄在41~69岁),第三组(老年组)(年龄≥70岁),对各组的临床特点及预后进行分析。结果全组平均年龄(58.16±0.26)岁,其中青年组为35.76±0.57(范围12~40),中年组为58.00±0.22(范围41~69),老年组为72.30±0.21(范围70~80)。女性在青年组与老年组中所占比例有明显差异(P=0.024)。老年组患者伴有其他系统疾病的比例明显高于其他两组(P=0.000)。鳞癌为主要的组织细胞类型,三组所占的比例为41.79%(28/67)、54.12%(644/1190)和58.54%(72/123),无统计学差异(P=0.080),但腺癌在青年组的比例则高于其他两组,分别为43.28%(29/67)、29.50%(351/1190)和26.82%(33/123)(P=0.036)。肺叶和全肺切除是主要的手术方式,分别占各组的58.21%、65.29%、78.86%(P=0.004)和34.33%、26.22%、12.20%(P=0.001)。术后病理分期Ⅲ期肺癌在各组所占比例分别为43.28%(29/67)、38.82%(462/1190)和26.02%(32/123),青年组高于其他组(P=0.015)。各组接受术后化疗的比例分别为55.22%(37/67),47.48%(565/1190)和29.27%(36/123)(P=0.000)。全组5年生存率为38.96%,青年组29.99%,中年组39.61%,老年组37.99%(P=0.494)。结论青年非小细胞肺癌的特点主要为女性多见,肺腺癌所占比例较大,且分期较晚,接受辅助化疗的比例大。而老年肺癌则肺鳞癌所占比例大,伴有其他系统疾病多见,术后出现并发症的机会大。但三组预后无明显差异。     

Risk of a new primary cancer among patients with lung cancer of different histological types

The risk of a new primary cancer (NPC) among 77548 Finnish lung cancer patients from 1953 to 1995 was analysed by the histological type of the lung cancer. The relative risks were expressed as standardised incidence ratios (SIR, ratio of the observed and expected numbers of cases). During the follow-up, 1148 NPCs were observed among men and 152 among women. After exclusion of lung cancers, the risk of NPC was elevated in both males (SIR 1.07; 95% confidence interval (CI) 1.00-1.14) and females (SIR 1.21; 95% CI 1.02-1.42). The excess was larger among lung cancer patients with small-cell carcinoma and adenocarcinoma than those with squamous-cell carcinoma. In all major histological groups of lung cancer, significant excess risks were found for cancers of the larynx (SIRs 2.94-4.25), and bladder (SIRs 2.16-2.86). Significantly elevated SIRs were also found for cancers of the stomach (SIR 1.42; 95% CI 1.12-1.76) and kidney (SIR 2.18; 95% CI 1.56-2.97) in squamous-cell carcinoma; for brain tumours (SIR 3.26; 95% CI 1.20-7.09) in small-cell carcinoma; and for cancers of the prostate (SIR 1.68; 95% CI 1.21-2.27) and thyroid (SIR 3.79; 95% CI 1.23-8.85), and brain tumours (SIR 2.34; 95% CI 1.07-4.43) in adenocarcinoma. The risk of contracting NPC at sites where the majority of tumours are adenocarcinomas was elevated among patients with adenocarcinoma of the lung, but not among squamous-cell or small-cell carcinoma patients. In adenocarcinoma, the excess risks of several smoking-related cancers tended to be somewhat lower than those in the other two histological categories. The relative risk of a NPC among patients diagnosed with lung cancer in 1985-1995 was higher than that of patients from earlier periods in all comparable follow-up categories (up to 10 years), possibly suggesting that the increased use of cytostatic drugs had increased the risk of NPC.     

The severity of duodeno‐esophageal reflux influences the development of different histological types of esophageal cancer in a rat model

The mechanism through which each histological type of carcinoma arises from the esophageal mucosa remains unknown. This study was designed to investigate whether there is an association between the severity of duodeno‐esophageal reflux and the histological type of esophageal cancer. A series of 120 male Fischer rats, weighing ～180 g, were randomized to receive one of the following procedures: duodeno‐forestomach reflux (DFR) with reduced exposure to duodenal contents, duodeno‐esophageal reflux (DER) with increased exposure to duodenal contents and three control operations (DFR, DER control and sham). The reflux of bile was estimated with ^99mTc‐PMT scintigraphy. All animals were fed a standard diet without carcinogen. The esophageal mucosa was assessed 50 weeks after surgery for carcinoma. The median scanned fraction rate of duodeno‐esophageal reflux was significantly lower for the rodents in the DFR group than those in the DER group. Five of 28 rodents in the DFR group and 17 of the 22 rodents in the DER group developed esophageal carcinoma. None of the controls developed carcinoma. The five rodents in the DFR group developed SCC. Of 22 esophageal carcinomas for the DER group, nine were SCC, 12 ADC and one was adenosquamous carcinoma. The fraction of esophageal SCC for the DFR group was significantly higher than that for the DER group, while the fraction of esophageal ADC for the DFR group was significantly lower than that for the DER group. These observations suggest that the severity of duodeno‐esophageal reflux in rodents is related to the development of different histological types of esophageal carcinoma.     

Risk factors for breast cancer at young ages in twins: an international population-based study

BACKGROUND: Breast cancer etiology in women may relate to exposures early in life as well as in adulthood, but it has been difficult to gain information on childhood variables, and evidence on their effects is very limited. Comparison of risk factor levels between affected probands and unaffected twins in twin pairs can provide a unique method to investigate risk factors that act in early life. METHODS: We conducted four population-based case-control studies of breast cancer risk in twins in Denmark, England and Wales, Finland, and Sweden and pooled the data from these studies. The case patients were 400 women with incident breast cancer before the age of 50 years, and the control subjects were their twin sisters who had not had breast cancer by that time. Data on risk factors (e.g., demographic and anthropomorphic variables, reproductive history, and family history) were collected by interview and by a mailed questionnaire and were analyzed by calculating matched odds ratios [ORs]. All statistical tests were two-sided. RESULTS: The risk of breast cancer was increased for women who were less obese (OR = 1.44, 95% confidence interval [CI] = 1.08 to 1.91) or taller (OR = 1.27, 95% CI = 0.95 to 1.70) than their co-twin at age 10 years, for women who developed breasts earlier than their co-twin (OR = 1.53, 95% CI = 1.14 to 2.06), and for women who had a smaller waist-to-hip ratio at age 20 years than their co-twin (OR = 1.79, 95% CI = 1.00 to 3.21). Analysis according to family history of breast cancer showed that the associations of childhood height and weight with risk of breast cancer were only apparent in women without a family history of breast cancer. CONCLUSIONS: Childhood growth before puberty may affect the risk of premenopausal breast cancer, at least in women without a family history of breast cancer. The distribution of body fat in young adulthood may also be related to breast cancer risk.     

不同年龄胃肠胰神经内分泌肿瘤患者预后分析

  目的  本研究旨在描述中国不同诊断年龄胃肠胰神经内分泌肿瘤（gastroenteropancreatic neuroendocrine neoplasms,GEP-NENs）患者的临床病理特征和治疗信息,探讨诊断年龄与术后5年生存率之间的关系。  方法  作为一项以医院为基础的全国多中心临床流行病学研究,本研究回顾性收集了2001年1月至2010年12月在研究医院就诊的GEP-NENs患者的病历信息和术后生存情况。采用Cox风险比例回归模型估计研究对象的术后死亡风险比和95%可信区间（95%CI）。  结果  共2 002例患者被纳入最终分析。患者按照诊断年龄分为≤50岁组和>50岁组。术后5年生存数据分析显示,与年龄≤50岁的患者相比,年龄>50岁的患者术后死亡风险显著增加（HR=2.83,95%CI:1.87～4.28）。在调整了原发部位、功能状态、TNM分期、分级、肿瘤浸润和转移情况、放化疗、靶向治疗和生物治疗情况后,不同年龄组之间的死亡风险差异无统计学意义（HR=1.63,95%CI:0.98～2.72）。对性别亚组进行多因素分析结果显示,在男性患者中,年龄>50岁组患者术后死亡风险显著增加（HR=2.65,95%CI:1.28～5.47）。  结论  不同年龄组GEP-NENs患者的临床病理特征和治疗方式选择存在差异,但年龄不是GEP-NENs患者预后的独立影响因素,提示对于诊断年龄不同的患者,临床医生应根据现有临床实践指南及患者个体情况,选择精准治疗方案。      

Menopausal hormone therapy and other breast cancer risk factors in relation to the risk of different histological subtypes of breast cancer: a case-control study

Introduction

Breast cancers of different histology have different clinical and prognostic features. There are also indications of differences in aetiology. We therefore evaluated the risk of the three most common histological subtypes in relation to menopausal hormone therapy and other breast cancer risk factors.

Methods

We used a population-based case-control study of breast cancer to evaluate menopausal hormone therapy and other breast cancer risk factors for risk by histological subtype. Women aged 50 to 74 years, diagnosed with invasive ductal (n = 1,888), lobular (n = 308) or tubular (n = 93) breast cancer in Sweden in 1993 to 1995 were compared with 3,065 age-frequency matched controls randomly selected from the population. Unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for ductal, lobular, and tubular cancer.

Results

Women who had used medium potency estrogen alone were at increased risks of both ductal and lobular cancer. Medium potency estrogen-progestin was associated with increased risks for all subtypes, but the estimates for lobular and tubular cancer were higher compared with ductal cancer. We found OR 5.6 (95% CI 3.2–9.7) for lobular cancer, OR 6.5 (95% CI 2.8–14.9) for tubular cancer and OR 2.3 (95% CI 1.6–3.3) for ductal cancer with ≥5 years use of medium potency estrogen-progestin therapy. Low potency oral estrogen (mainly estriol) appeared to be associated with an increased risk for lobular cancer, but the association was strongest for short-term use. Reproductive and anthropometric factors, smoking, and past use of oral contraceptives were mostly similarly related to the risks of the three breast cancer subtypes. Recent alcohol consumption of > 10 g alcohol/day was associated with increased risk only for tubular cancer (OR 3.1, 95% CI 1.4–6.8).

Conclusion

Menopausal hormone therapy was associated with increased risks for breast cancer of both ductal and lobular subtype, and medium potency estrogen-progestin therapy was more strongly associated with lobular compared with ductal cancer. We also found medium potency estrogen-progestin therapy and alcohol to be strongly associated with tubular cancer. With some exceptions, most other risk factors seemed to be similarly associated with the three subtypes of breast cancer.     

Lower breast cancer survival in mothers of children with a malignancy: a national study

As it is unclear if hereditary factors affect breast cancer survival, this was compared using fertility and cancer registry data, among all women so diagnosed during 1961-1999 in Sweden, having a child with childhood cancer (相似文献