Diabetes Medication Use in Association with Survival among Patients of Breast, Colorectal, Lung, or Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Studies suggest that regular use of metformin may decrease cancer mortality. We investigated the association between diabetes medication use and cancer survival. MATERIALS AND METHODS: The current study includes 633 breast, 890 colorectal, 824 lung, and 543 gastric cancer cases identified from participants of two population-based cohort studies in Shanghai. Information on diabetes medication use was obtained by linking to electronic medical records. The associations between diabetes medication use (metformin, sulfonylureas, and insulin) and overall and cancer-specific survival were evaluated using time-dependent Cox proportional hazards models. RESULTS: After adjustment for clinical characteristics and treatment factors, use of metformin was associated with better overall survival among colorectal cancer patients (hazards ratio [HR], 0.55; 95% confidence interval [CI], 0.34 to 0.88) and for all four types of cancer combined (HR, 0.75; 95% CI, 0.57 to 0.98). Ever use of insulin was associated with worse survival for all cancer types combined (HR, 1.89; 95% CI, 1.57 to 2.29) and for the four cancer types individually. Similar associations were seen for diabetic patients. Sulfonylureas use was associated with worse overall survival for breast or gastric cancer (HR, 2.87; 95% CI, 1.22 to 6.80 and HR, 2.05; 95% CI, 1.09 to 3.84, respectively) among diabetic patients. Similar association patterns were observed between diabetes medication use and cancer-specific survival. CONCLUSION: Metformin was associated with improved survival among colorectal cancer cases, while insulin use was associated with worse survival among patients of four major cancers. Further investigation on the topic is needed given the potential translational impact of these findings.

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

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.

Total fluid intake, urination frequency and risk of bladder cancer: a population-based case-control study in urban Shanghai / 中华流行病学杂志

Objective To evaluate the association between total fluid intake and the time of urination per day and the risk of bladder cancer. Methods A population-based case-control study was conducted in urban Shanghai, China, during January 1996 to December 1998. The study included 608 incident cases of bladder cancer and 607 age- and sex-matched controls. Unconditional logistic regression models were used to estimate the odds ratios(ORs)and their corresponding 95%confidence intervals(95%CIs)for bladder cancer associated with frequency of urination, after adjusted for age, gender, smoking status, history of occupation with high risk, history of bladder infections, body mass index and other confounding factors. The level of statistical significance was set at 0.05(two-sided). Results No significant trend was observed for the association between total fluid intake, time of nighttime urination and the risk of bladder cancer. Increasing time of urination during daytime was associated with decreased risk of bladder cancer(P for trend=0.014). ORs(95%CIs)for subjects who voided 4 times, 5 times and 6 or more times per day[0.72(0.49-1.05),0.60(0.41-0.87)and 0.62(0.43-0.90), respectively], when compared with those with less than 4times per day after adjustment of confounding factors. Data showed that smokers and nonsmokers who voided at least 6 times per day had the ORs of 0.72(95%CI: 0.45-1.15)and 0.46(95%CI:0.25-0.87)when compared to their counterparts who voided 3 times or less per day during the daytime. Subjects who urinated at least 6 times per day and consumed more than 1500 ml of total fluid per day experienced a significant 57% reduction in risk compared to subjects who urinated 3 times or less and consumed less than 750 ml of total daily fluid intake. Conclusion Increased urination frequency and total fluid intake, especially among those who never smoked might be associated with a reduced risk of bladder cancer.

Incidence trends of colorectal cancer in urban Shanghai, 1973 - 2005 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the time trends of colorectal cancer incidence rates in urban Shanghai from 1973 to 2005.</p><p><b>METHODS</b>Data on the incidence rates of colorectal cancer were obtained from a population-based cancer registry in Shanghai. A total of 32 962 colon cancer patients and 24 662 rectal cancer patients were registered. Population estimation were based on periodic censuses, with age- and sex-specific annual estimates derived for the remaining years. The rates were adjusted to the world standard population by using the direct method. Annul percent changes (APCs) in rates were estimated by means of a linear regression of the logarithm of the respective rates on calendar, weighted by the number of incidence cases.</p><p><b>RESULTS</b>The incidence rates of colorectal cancer increased steadily during 1973 to 2005, the age-adjusted incidence rates of colon cancer increased from 6.09 and 5.70 to 14.70 and 14.35 per 100 000 in male and female respectively. The APCs were 3.03% (t = 14.77, P < 0.01) and 3.21% (t = 22.15, P < 0.01). The rates of rectal cancer increased from 7.68 and 6.51 to 11.45 and 8.28 per 100 000 in male and female respectively. The APCs were 1.34% (t = 7.28, P < 0.01) and 0.93% (t = 7.34, P < 0.01). The top APCs for colon and rectal cancer in female were 5.86% and 2.79% at age above 85 and in male those were 4.64% and 2.38% at age of 80-. The APCs of colon cancer were greater than those of rectal cancer at the groups above 45 years old. The average ages when diagnosed were delayed from 57 - 60 to 66 - 70 during these 33 years. The average diagnosed ages of colon cancer were later than those of rectal cancer slightly (from 2003 to 2005, the onset age of male colon cancer: 68.61 +/- 12.17, male rectal cancer: 66.81 +/- 12.62, t = 4.90, P < 0.01; female colon cancer: 69.20 +/- 12.13, female rectal cancer: 67.75 +/- 12.54, t = 3.81, P < 0.01).</p><p><b>CONCLUSION</b>The incidence rates of colorectal cancer increased steadily during 1973 to 2005, especially for colon cancer. Further research is needed to identify the causes resulting in these changes.</p>

Cigarette smoking and primary liver cancer risk: a nested case-control study in Shanghai / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the association between cigarette smoking and risk of primary liver cancer (PLC) among middle-aged and elderly men in urban Shanghai.</p><p><b>METHODS</b>A nested case-control study was conducted based on a cohort of 18,244 men who were 45-64 years of age in 1986-1989 and had no history of cancer at recruitment in Shanghai. As of 31 Dec 2000, a total of 213 incident cases of PLC were identified. 1094 matched controls were randomly selected among the cohort subjects who were free of cancer and alive at the time of cancer diagnosis of the index case. The matching criteria were date of birth (within 2 years), date of biospsy specimen collection (within 1 month), and neighborhood of residence at recruitment. Conditional logistic regression models were used to estimate adjusted odds ratios (ORs) and their corresponding 95% confidence intervals (CIs).</p><p><b>RESULTS</b>After controlling for potential confounders, cigarette smoking (ever vs. never) was associated with risk of PLC (OR = 1.91; 95% CI: 1.28-2.86). Risk of PLC increased with increasing number of cigarettes smoked per day, as well as duration of cigarette smoking, pack-years of cigarettes consumed over lifetime and earlier age started smoking. The ORs were 2.16 (95% CI = 1.37-3.40), 2.14 (95% CI = 1.18-3.87), 2.12 (95% CI = 1.21-3.74) and 2.57 (95% CI = 1.50-4.40) for men who smoked 20 cigarettes or more daily, smoked for 40 or more years, consumed more than 37 pack-years of cigarettes, and began smoking before 20 years of age, respectively.</p><p><b>CONCLUSION</b>This study confirms that cigarette smoking is an independent risk factor for primary liver cancer among males in Shanghai.</p>

A case-control study on genetic polymorphism of CYP17 MspA(1)I and its association with endometrial cancer risk / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To assess whether the polymorphisms of CYP17 MspA(1)I are associated with the susceptibility of endometrial cancer.</p><p><b>METHODS</b>The allelic discrimination of the CYP17A1 gene polymorphisms were assessed with the ABI PRISM 7900 Sequence Detection Systems using TaqMan genotyping assay. Unconditional logistic regression was applied to assess odds ratio and 95% CI and evaluate the association between different genotypes and endometrial cancer development.</p><p><b>RESULTS</b>The frequencies of wild-type, heterozygote and homozygote for the CYP17 MspA(1)I in control women in Shanghai were 17.8%, 49.3% and 32.9%, respectively. No significant difference was found in the distribution of various genotypes of CYP17 MspA(1)I between patients and controls. Pregnancy was associated with reduced risk of endometrial cancer in pre-menopausal women with A2 allele, OR = 0.66, 95% CI: 0.44 approximately 0.99. In post-menopausal women with A2 allele, more pregnancies ( > 2) and shorter time of menstruation ( < or = 32 yrs) were associated with reduced risk of endometrial cancer.</p><p><b>CONCLUSION</b>No significant relationship was found between CYP17 MspA(1)I genotypes and endometrial cancer risk.</p>

Anthropometry and female breast cancer: a prospective cohort study in urban Shanghai / 中华流行病学杂志

<p><b>OBJECTIVE</b>To investigate the association between anthropometry and risk of breast cancer among pre-and post-menopausal women in urban Shanghai.</p><p><b>METHODS</b>A total of 73 461 female residents aged 40 to 70 years in urban Shanghai were recruited in a prospective cohort study (the Shanghai women's health study) during 1997 through 2000, and were actively followed up biennially. During mean follow-up period of 5.66 years, 432 incident cases of breast cancer were identified in the cohort. Cox regression model was used to estimate the adjusted relative risks (RRs) and 95% confidence intervals (CIs).</p><p><b>RESULTS</b>After adjustment for some potential confounding factors, baseline weight, body mass index(BMI), waist-to-hip ratio(WHR) and weight gain since age 20 were positively associated with the increased risk of breast cancer among postmenopausal women. The positive association between height and breast cancer was found among premenopausal women. Among them, those with height taller than 161 cm at age 20 experienced 1.84 fold increased risk (95% CI: 1.30-2.61) of breast cancer compared to their counterpart with height shorter than 157.1 cm. Women who were either much heavier or lighter than average at age 20 were at reduced risk. Further analyses mutually adjusted for BMI and WHR did not substantially alter the positive association for both BMI and WHR. After further adjustment for BMI, weight gain since age 20 was significantly associated to an increased risk for postmenopausal breast cancer (RR = 1.61, 95% CI: 1.09-2.37).</p><p><b>CONCLUSIONS</b>Weight gain and central obesity seemed to be strong predictors for the risk of breast cancer among postmenopausal women. Controlling weight and decreasing fat around waist were effective means to prevent postmenopausal breast cancer and height might serve as a risk factor for premenopausal breast cancer.</p>

Green tea consumption and the risk of endometrial cancer: a population-based case-control study in urban Shanghai / 中华流行病学杂志

<p><b>OBJECTIVE</b>To assess the effect of tea consumption on the risk of endometrial cancer.</p><p><b>METHODS</b>In a population based case-control study conducted in urban Shanghai, face-to-face interviews were completed for 995 incidence cases aged 30 - 69 from January 1997 to December 2002 and 1087 controls that frequency-matched to cases on age. Unconditional logistic model was used for analysis.</p><p><b>RESULTS</b>An inverse association was observed in tea drinking and endometrial cancer risk. Compared to non-tea drinkers, regular tea drinkers had reduced risk of endometrial cancer (OR = 0.74; 95% CI: 0.54 - 1.01) in premenopausal women. Green tea had a protective effect on endometrial cancer among non-smoking or non-alcohol drinking women (OR = 0.77, P = 0.0199) and the ORs reduced with the increasing concentration of tea being served (P for trend = 0.0493). The multivariate ORs for drinking green tea < 7 times/week and >or= 7 times/week were 0.90 (95% CI: 0.53 - 1.54) and 0.76 (95% CI: 0.60 - 0.95) with the trend test of P = 0.0163.</p><p><b>CONCLUSION</b>Tea drinking, with green tea in particurlar, seemed to have weak but inverse association with endometrial cancer risk, but this effect of protection might only limit to premenopausal women.</p>

A prospective cohort study on body mass index and mortality among middle-aged and elderly men in urban Shanghai / 中华流行病学杂志

<p><b>OBJECTIVE</b>To examine the association between body mass index (BMI) and mortality as well as the effect of age on it among middle-aged and elderly men in urban area of Shanghai.</p><p><b>METHODS</b>A total of 18,244 male subjects aged 45-64 years resided in urban area of Shanghai were enrolled in the study during January 1, 1986 through September 30, 1989, and were actively followed under annual visits. 'Cox proportional hazards model' was used to estimate the relative risks (RR).</p><p><b>RESULTS</b>By the end of the follow-up process in 2002, a total number of 235,762 person-years was accumulated in the cohort, with an average of 12.9 years per subject. A total number of 3365 deaths including 1381 from cancer and 1165 from cardio- and cerebro-vascular diseases (CVD), was identified during the follow-up period. Compared with those under normal BMI (BMI 18.5-23.9), the RRs of death for all causes of death among groups at low BMI (BMI < 18.5), overweight (BMI 24-27.9) and obesity (BMI > or = 28) were 1.20, 1.12 and 1.61, respectively, among non-smokers after adjustment for age, alcohol consumption and level of education. After excluding the numbers observed during the first 5 years of follow-up, the corresponding RRs became 1.01, 1.12, and 1.75, respectively. The risk of deaths from colon cancer or CVD increased along with the increase of BMI, while the risk of non-cancer and non-CVD deaths, mostly deaths from infectious diseases, increased significantly in the group of low BMI. Among those aged > or = 55 years at baseline survey, the risk for all causes of death increased more significantly with those having obesity. However, among those who were younger than 55 years of age, no significant correlation between BMI and overall mortality was noticed.</p><p><b>CONCLUSION</b>A positive relationship between obesity and total mortality was observed in the middle-aged and elderly men in urban Shanghai. The association was more obvious among the elderly while the risk of deaths from colon cancer or CVD rose along with the increase of BMI. The risk of death from infectious disease increased significantly in the group with low BMI.</p>

Tea consumption and risk of biliary tract cancers and gallstone disease: a population-based case-control study in Shanghai, China / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the relationship between tea consumption, biliary tract cancers and gallstone disease.</p><p><b>METHODS</b>A population-based case-control study was conducted in urban Shanghai from 1 June 1997 to 31 May 2001 involving interviews with 627 new cases of biliary tract cancers (including 368 cases of gallbladder cancer, 191 cases of extrahepatic bile duct cancer and 68 cases of cancer of the ampulla of Vater) aged 35 to 74 years and 959 population controls frequency-matched to cases by gender and age in five-year group. 1037 patients of gallstone disease were selected from the same hospital. All subjects were interviewed in person by trained interviewers by use of a structured questionnaire. Unconditional logistic regression analysis was used to calculate adjusted odds ratio (OR) and 95% confidence interval (CI).</p><p><b>RESULTS</b>Compared with tea non-drinkers, current tea consumption was inversely associated with risk of gallbladder cancer, extrahepatic bile duct cancer and gallstone disease among females with OR of 0.57 (95% CI: 0.34-0.96), 0.53 (95% CI: 0.27-1.03) and 0.71 (95% CI: 0.51-0.99), respectively. OR declined with younger age at initiation of tea drinking and with longer duration of tea consumption (P for trend < 0.05). Among males, the corresponding OR were mostly below one, although not statistically significant.</p><p><b>CONCLUSION</b>Tea consumption may decrease the risk of cancers of the gallbladder and extrahepatic bile duct among females. The protective effect appears to be independent of gallstone disease.</p>

A survey on the diagnosis and treatment of biliary tract cancers in Shanghai / 中华外科杂志

<p><b>OBJECTIVE</b>To survey the status of diagnosis and treatment of biliary tract cancer in Shanghai.</p><p><b>METHODS</b>A clinical epidemiology investigation was carried out on 658 new cases of biliary duct cancers aged 35-74, that registered between June 1997 and May 2001 in urban Shanghai. Clinical findings were collected in 390 gallbladder cancer, 195 bile duct cancer and 73 ampullary cancer.</p><p><b>RESULTS</b>Biliary tract cancers mainly occurred in elderly patients. Ratio of males to female was 1:2.61 in gallbladder cancer, while bile duct cancer and ampullary cancer were slightly more common in men. Association with gallstones was 68.5%, 43.1% and 22.4% for gallbladder cancer, bile duct cancer and ampullary cancer, respectively. Diagnostic accuracy rate of B-ultrasonography was 63.1% in gallbladder cancer. Incidental gallbladder cancer accounted for 20%, while stage IVA and IVB patients reached up to 43.6%. Misdiagnosis rate was still high in bile duct cancer and ampullary cancer, it was 19.1% and 47.1% respectively. In addition, most patients presented jaundice at diagnosis. 69 cases (18.2%) of gallbladder cancer, 50 cases (25.6%) of bile duct cancer and 54 cases (74%) of ampullary cancer underwent radical resection, the 1-, 3- and 5-year survival rates were 58.5%, 42.8% and 40.7%, 58%, 28.3% and 11.1%, 81.5%, 39.2% and 26.9%, respectively. 79 patients with bile duct cancer underwent palliative drainage, and most cases died within 1 year. Metal endo-prostheses or plastic stents were placed into the biliary tract in 38 patients. The median survival was about 7 months.</p><p><b>CONCLUSIONS</b>It is difficult to make early diagnosis of biliary tract cancers. Standardization of the operation for gallbladder cancer must be respected. Surgical exploration should be undertaken when a bile duct cancer is suspected and there are no contraindications to surgery. Pancreatoduodenectomy should be recommended for ampullary cancer.</p>

Cigarette smoking and cancer mortality: a prospective cohort study in urban males in Shanghai / 中华流行病学杂志

<p><b>OBJECTIVE</b>To investigate the association between cigarette smoking and cancer mortality in urban men in Shanghai and its impact when smoking habit changed during the follow-up period.</p><p><b>METHODS</b>A total of 18 244 male residents aged 45 to 64 years in urban Shanghai were enrolled in the study during January 1, 1986 through September 30, 1989, and was actively followed up on annual visits. Cox proportional hazards model was used to estimate relative risks (RR).</p><p><b>RESULTS</b>By the end of follow-up program in 2002, 235 762 person-years, averaged 12.9 years per subject in the cohort was reached. 3365 deaths including 1381 cancer deaths were registered during the follow-up period. The mortality rates for cancers of lung, stomach, liver, pancreas, esophagus, head and neck etc. increased significantly among smokers. Compared with data of nonsmokers at the baseline survey, the adjusted RR was 1.49 for all-causes mortality among current smokers at the baseline survey. After excluding subjects who changed their smoking habit during the follow-up period, the RR became 1.78 compared with lifelong-nonsmokers. The corresponding RRs rose from 2.05 to 2.58 for all cancer deaths and from 6.40 to 8.77 for lung cancer deaths. The age-adjusted all-causes and cancer death rates among current smokers at the baseline survey were 1695.6 and 782.0 per 100 000 person-years, respectively. After exclusion of those with smoking habit changed during the follow-up period, the rates among persistent smokers were 2353.7 and 1144.6 per 100 000 person-years, respectively.</p><p><b>CONCLUSION</b>Cigarette smoking is an important predictor for risk of all-causes of death as well as for cancer deaths. The change of smoking habit during the follow-up period could result in underestimating the deleterious effect of cigarette smoking on health.</p>