Risk factors in progression from endometriosis to ovarian cancer: a cohort study based on medical insurance data / 부인종양

OBJECTIVE: The objective was to identify risk factors that were associated with the progression from endometriosis to ovarian cancer based on medical insurance data. METHODS: The study was performed on a dataset obtained from the National Health Insurance Research Database, which covered all the inpatient claim data from 2000 to 2013 in Taiwan. The International Classification of Diseases (ICD) code 617 was used to screen the dataset for the patients who were admitted to hospital due to endometriosis. They were then tracked for subsequent diagnosis of ovarian cancer, and available biological, socioeconomic and clinical information was also collected. Univariate and multivariate analyses were then performed based on the Cox regression model to identify risk factors. C-index was calculated and cross validated. RESULTS: A total of 229,617 patients who were admitted to hospital due to endometriosis from 2000 to 2013 were included in the study, out of whom 1,473 developed ovarian cancer by the end of 2013. A variety of factors, including age, residence, hospital stratification, premium range, and various comorbidities had significant impact on the progression (p < 0.05). Among them, age, urbanization of residence, hospital stratification, premium range, post-endometriosis childbearing, pelvic inflammation, and depression all had independent, significant impact (p < 0.05). The validated C-index was 0.69. CONCLUSION: For a woman diagnosed with endometriosis, increased age, residing in a highly urbanized area, low or high income, depression, pelvic inflammation, and absence of childbearing post-endometriosis all put her at high-risk to develop ovarian cancer. The findings may be of help to gynecologists to identify high-risk patients.

Do people from Taiwan have higher heavy metal levels than those from Western countries?

<p><b>INTRODUCTION</b>This study investigated whether heavy metal levels were higher in people from Taiwan as compared to those from Western countries.</p><p><b>METHODS</b>We measured the level of heavy metals (lead, mercury, arsenic and cadmium) in the blood of 40 apparently healthy adults. Since mercury does not respond to ethylenediaminetetraacetic acid (EDTA) infusion, only urine lead, arsenic and cadmium levels were determined by applying the body burden concept after calcium disodium EDTA infusion. These three heavy metals were extracted from daily urine samples for three consecutive days.</p><p><b>RESULTS</b>The mean blood lead, mercury and cadmium levels of the Taiwanese individuals (24.46 ± 9.69 µg/L, 9.64 ± 6.98 µg/L and 0.73 ± 0.27 µg/L, respectively) were greater than those of the Americans. The Taiwanese also had greater blood mercury and cadmium levels than the Germans. The first-day urine lead, arsenic and cadmium levels were 77.9%, 33.1% and 62.4%, respectively, of the total lead, arsenic and cadmium excretion during the three days. This indicates that the first-day urine lead and cadmium excretion represented most (> 60%) of the lead and cadmium excretion in those three days.</p><p><b>CONCLUSION</b>This study demonstrated that the Taiwanese population has higher blood mercury and cadmium levels than Western populations. To study the urine lead and cadmium body burden of patients, detection of first-day, rather than three-day, urine lead and cadmium levels can be done, as the former yields results that are fairly representative, and is more time- and cost-effective.</p>