77 RISK FACTORS FOR RENAL CELL CARCINOMA IN THE VITAL STUDY

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analyzed presenting symptoms, stage, grade, and number of lesions. A questionnaire regarding current and past profession, years of work and daily habits were applied in all patients. Patients included in group 1 were those with no professions previously related to bladder cancer risk. Group 2 represented patients at risk due to professions or activities that exposes workers to chemicals known as bladder carcinogens, such as in rubber and chemical industries. Statistical analysis was performed using chi-square and Fisher tests with SPSS v13. RESULTS: Patients in group 2 presented significantly higher incidence of disuria as a presenting symptom (p⫽0.001). Patients in group 2 had a higher incidence of T1 disease at diagnosis (36% vs 18%), although not statistically significant (p⫽0.059). There was no difference among other variables between groups 1 and 2, such as rate of recurrence (21% vs 22%), 3 or more lesions (22% vs 19%), or grade. Also, other presenting symptoms (hematuria, urinary retention, frequency and urgency) had similar rates between the two groups. CONCLUSIONS: Irritative urinary symptoms are more frequently encountered among patients with bladder cancer who are exposed to bladder carcinogens due to professional activities than with no occupational risks. Therefore, presenting symptoms may help in the initial bladder cancer diagnosis in patients with a history of occupational exposure. Source of Funding: None

75 ARSENIC EXPOSURE IS ASSOCIATED WITH SIGNIFICANT UPPER UROTHELIAL TRACT CANCER HEALTH CARE NEEDS AND ELEVATED MORTALITY RATES Francisco Lopez, Mario Fernandez*, Fernando Coz, Santiago, Chile INTRODUCTION AND OBJECTIVES: Upper tract urothelial cancer (UTUC) is a rare malignant disease with few known environmental risk factors. In particular, arsenic has not been clearly associated to higher UTUC incidence or mortality rates. Antofagasta is a well-known arsenic-exposed region in Northern Chile, with a significant impact of this geologic factor on public health, even two decades after having controlled arsenic concentrations in drinking-water. The aim of the study was to assess UTUC health care needs and mortality rates in this affected region during the last decades, comparing them to those of the rest of the country. METHODS: Arsenic levels of drinking water of the affected region were obtained for the last 60 years and correlated with UTUC hospital discharges and mortality rates. Incident rate ratios and trends in mortality and hospital admission rates were estimated using a Poisson regression model, being the response variable the number of observed deaths in each age group for each year for Antofagasta and the rest of Chile. Separate calculations were made for men and women. RESULTS: UTUC hospital discharges were significantly higher in the affected region (peak RR 5.5; 95%CI: 4.1 - 7.3). There were 220 UTUC-specific deaths in Chile between 1983 and 2009; 74 (34%) of them occurred in Antofagasta, where only 3.5% of the Chilean population lives. Mortality rates for UTUC were higher in this region during the analyzed period, reaching peak mortality rates of 79.2/100,000 in men and 33.2/100,000 in women. Poisson regression models showed increased mortality risk in the studied region compared to the rest of the country until present time for men (IRR 21.7; 95%CI: 15.4 - 30.7) and women (IRR 16.9; 95%CI: 10.4 - 27.5). Age at time of cancer-specific death was significantly lower in the exposed region than in the rest of the country (mean age 61.5; 95%CI: 58.9 - 63.9 vs. mean age 69.5; 95% CI: 67.7- 71.2; p⬍0.001). CONCLUSIONS: Similar to bladder cancer, exposure to arsenic is clearly related to a significant need for UTUC health care and high mortality rates, even twenty years after having controlled arsenic levels in drinking-water. Affected populations should be aware of the significant impact of this ecologic factor and urologists should play an important role in defining strategies for early detection and management of UTUC in these exposed individuals. Source of Funding: None

Vol. 187, No. 4S, Supplement, Saturday, May 19, 2012

76 PERSISTENTLY HIGH TESTICULAR CANCER MORTALITY RATES DURING THE LAST DECADES: THE CHILEAN CASE Francisco Lopez, Mario Fernandez*, Fernando Coz, Santiago, Chile INTRODUCTION AND OBJECTIVES: Testicular cancer incidence has doubled in the last 40 years, presenting a wide range of rates worldwide. The latter is mainly attributed to racial factors, being far more frequent in young, white Caucasian men. However, since the introduction of platinum-based chemotherapy, mortality has decreased, becoming one of the least important causes of death from cancer. The aim of this study was to assess mortality rates and trends in Chile, comparing them to those of other countries worldwide. METHODS: Mortality rates adjusted for age were constructed for the period 1983-2009 using data from the National Statistics Institute, including cases coded for testicular cancer according to the ICD-10 classification. Time trends were analyzed by joinpoint regression. Geographical distribution was assessed using a Poisson regression model. Mortality rates were compared by means of the World Health Organization (WHO) and the International Agency for Research in Cancer (IARC) databases. RESULTS: During the studied period, a mean number of 100 deaths were annually observed in our country. Trend analysis showed a constant 1.6% annual decreasement in mortality rates, reaching 1.4/100,000 habitants in 2009. Deaths where homogeneously distributed throughout the country. According to the IARC database, Chile has the second most important testicular cancer mortality rate worldwide. Meanwhile, according to the WHO data, Chile presents the highest mortality rate because of testicular cancer worldwide. CONCLUSIONS: Although mortality is decreasing, Chile is one of the leading countries in testicular cancer mortality. Measures in order to decrease this rate cannot be proposed at this point, because no particular factor has been associated to this high mortality in our population so far. A study exploring tumoral as well as social factors is needed in order to identify possible causes of this phenomenon. Source of Funding: None

77 RISK FACTORS FOR RENAL CELL CARCINOMA IN THE VITAL STUDY Liam C. Macleod, MD MPH*, James M. Hotaling, MD MS, Jonathan L. Wright, MD MS, Michael L. Davenport, BA, John L. Gore, MD, Jonathan D. Harper, MD, Emily White, PhD, Seattle, WA INTRODUCTION AND OBJECTIVES: The incidence of renal cell carcinoma (RCC) is increasing worldwide. Although several risk factors have been identified including modifiable risk factors such as smoking, hypertension and obesity, few have been confirmed by prospective studies. Given this, we used a prospective cohort study to confirm known and screen for new modifiable risk factors for incident RCC. METHODS: 76,339 residents of Washington aged 50-76 years completed a questionnaire between 2000-2002 on lifestyle, health and demographic data. Incident RCC cases were determined through annual linkage to the regional cancer registry through Dec 31, 2009. Multivariate Cox proportional hazard regression was performed to analyze the association between RCC and demographic (gender, race), health (hypertension, diabetes, kidney disease, viral hepatitis), and lifestyle (body mass index [BMI], smoking and alcohol use) risk factors. RESULTS: There were 249 incident cases of RCC. Table 1 shows the results of the multivariate model. Hypertension, kidney disease, BMI, smoking and male gender were independently associated with an increased risk of RCC. Diabetes and viral hepatitis were both associated with RCC in a base model adjusting for age and gender, but failed to remain significant in the multivariate model. We found no association between alcohol intake and risk of RCC.

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CONCLUSIONS: In this contemporary, population-based cohort, we confirmed the association of several factors with risk of RCC. Considering the changing demographics and health status of the US population, identification of modifiable risk factors offers an opportunity for targeted education and intervention in those with multiple high risk features. Table 1. Multivariate model of RCC risk factors HR* Male (referent) 1.0 Female

0.6

95% CI (0.4, 0.7)

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in PSA values (p⫽0.001). Linear regression models stratified by attained BMI also revealed an inverse relationship between weighted mean HbA1c and PSA for subjects who were overweight (p⫽0.001) and obese (p⫽0.06). CONCLUSIONS: PSA decreases as HbA1c increases in men with type 1 DM. This relationship appears most robustly in overweight and obese men and suggests that factors related to obesity may be affecting PSA levels used to detect early-stage prostate cancer. Characteristics Overall

Year 17 PSA Levels [Mean (SD)] 0.93 (0.96)

Non smoker (referent)

1.0

⬎ 0 to 7.5 pack years

1.1

(0.7, 1.6)

⬍40

0.56 (0.24)

⬎ 7.5 to 22.5 pack years

1.1

(0.7, 1.7)

40-49

0.76 (0.65)

⬎ 22.5 to 37.5 pack years

1.6

(1.1, 2.3)

50-59

1.00 (1.03)

⬎ 37.5 pack years

1.6

(1.1, 2.3)

⬎60

1.38 (1.47)

White (referent)

1.0

Black

0.6

(0.2, 2.5)

Other Race

0.5

(0.2, 1.1)

BMI ⬍ 25 (referent)

1.0

BMI 25 to 29

1.2

BMI 30 to 34

Attained Age

p-value

⬍0.0001

Weighted Mean HbA1c ⬍7.5%

1.05 (1.01)

7.5-8.0%

0.95 (0.79)

(0.9, 1.7)

8.0-8.5%

0.86 (0.68)

1.2

(0.8, 1.8)

⬎8.5%

0.76 (0.93)

BMI ⱖ 35

1.7

(1.1, 2.8)

p-value

⬍0.0001

Hypertension

1.7

(1.3, 2.2)

Diabetes

1.4

(0.9, 2.1)

History of kidney disease

2.9

(1.3, 6.1)

History of viral hepatitis

1.7

(0.96, 3.1)

Non drinker (referent)

1.0

⬎ 0 to ⬍ 1 drink/day

1.2

(0.5, 3.4)

1 to 2 drinks/day

1.2

(0.4, 3.4)

⬎ 2 drinks/day 0.9 *HR adjusted for all other variables in the table.

(0.3, 2.6)

Source of Funding: None

78 POOR GLYCEMIC CONTROL IS ASSOCIATED WITH REDUCED PROSTATE-SPECIFIC ANTIGEN CONCENTRATIONS IN MEN WITH TYPE 1 DIABETES Aruna Sarma*, Ann Arbor, MI; James Hotaling, Seattle, WA; Patricia Cleary, Barbara Braffett, Rockville, MD; Rodney Dunn, Ann Arbor, MI; Patricia Gatcomb, New Haven, CT; Catherine Martin, William Herman, Ann Arbor, MI; Hunter Wessells, Seattle, WA INTRODUCTION AND OBJECTIVES: Previous studies have demonstrated lower prostate-specific antigen (PSA) concentrations in men with type 2 diabetes mellitus (DM). This decrease in PSA parallels reported risk reduction of prostate cancer among diabetic men and has been hypothesized to be associated with the effects of altered steroid concentrations in overweight/obese diabetic men. However, data in men with type 1 DM is limited. The objectives of this study were to examine the distribution of PSA concentrations and the relationship between glycemic control and PSA concentrations in men with type 1 DM by BMI status. METHODS: Total PSA concentrations were measured in 627 men during Year 17 of the Epidemiology of Diabetes Interventions and Complication (EDIC) study, the observational follow up of participants of the Diabetes Control and Complications Trial (DCCT). The Wilcoxon rank-sum and Kruskal-Wallis tests were used to evaluate differences in PSA by various clinical characteristics. Separate linear regression models were used to assess the relationship between PSA levels and DCCT/EDIC weighted mean HbA1c, both overall and by BMI category (normal, overweight, and obese). RESULTS: The 627 DCCT/EDIC male subjects had a mean age of 52 years, mean PSA levels of 0.93, and weighted mean HbA1c of 7.95%. PSA levels increased significantly with age (p⬍0.001) and decreased with higher HbA1c levels (p⬍0.001) (Table). Each 10% increase in HbA1c levels was accompanied by a -1.3 ng/mL reduction

Source of Funding: NIH 5R01 DK083927

79 THE TRUE RISK OF BLOOD TRANSFUSION AFTER NEPHRECTOMY FOR RENAL MASSES Gino Vricella*, Cleveland, OH; Antonio Finelli, Shabbir Alibhai, Toronto, Canada; Lee Ponsky, Rabii Madi, Robert Abouassaly, Cleveland, OH INTRODUCTION AND OBJECTIVES: Perioperative blood transfusions are costly and have attendant risks and safety concerns. Reported blood transfusion rates after nephrectomy (radical and partial) demonstrate considerable variability, likely due to the referral patterns and selection biases that influence reports from tertiary academic centers. To our knowledge, the transfusion rate in general practice has not been previously reported. The aim of our study was to examine the actual transfusion rate and risk factors for blood transfusion after nephrectomy for renal masses on a population-level. METHODS: We performed a population-based, retrospective observational study using a national discharge abstract database. Our cohort consisted of 10,902 patients treated by radical (RN) or partial nephrectomy (PN) for a renal mass between April 1, 2003 and March 31, 2008. Patient demographics and treatment approach (i.e. open vs. laparoscopic) were available for all patients. Surgeon and institution volume quartiles for kidney surgery were created. Adjustment for comorbidity was performed using the Charlson-Deyo Index. The association between blood transfusion and various explanatory variables was examined using the Chi-square test, as well as with multivariable logistic regression.