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Mo1126 Cholangitis and Subsequent Risk of Cancer: A Danish Nationwide Cohort Study
polymorphism. [Results] The mean age, male/female ratio and Helicobacter pylori (HP) positive ratio in GC group were significantly higher than those in non-GC group. The NFKB1 genotype distribution in non-GC group was 253ins/ins, 357ins/del and 81del/del, whereas the distribution in GC group was 112ins/ins, 170ins/del and 48del/del. The frequencies of rs28362491 minor allele in non-GC group and GC group were 37.6% and 40.3%, respectively. Overall, rs28362491 del/del homozygous had a significant risk for the development of gastric cancer by logistic regression analysis after adjustment for gender, age and HP infection status (OR, 1.52; 95%CI, 1.01-2.28; p=0.046). On the other hand, the distribution of genotype in the subjects with diffuse type gastric cancer was 45ins/ins, 62ins/del and 26del/del (del/del homozygous ratio; p=0.023 vs. non-GC group). The rs28362491 del/del homozygous had a significantly increased risk for the development of diffuse type gastric cancer by the logistic regression analysis (OR, 2.01, 95%CI, 1.21-3.31; p=0.0066). In the subjects younger than 60 years old, the adjusted risk for gastric cancer among individuals who were del/del homozygous was 2.06 (range, 1.11-3.83; p=0.022) compared with ins/ ins + ins/del genotype. In the gastric cancer cases, invaded beyond mp layer and had lymph node metastasis, del/del homozygote was a significant risk factor (OR, 1.93; 95%CI, 1.193.14; p=0.0081, and OR, 1.86; 95%CI, 1.10-3.14; p=0.020, respectively). [Conclusions] Our results suggest that rs28362491 del/del homozygous of NFKB1 gene is associated with the susceptibility to gastric cancer, especially diffuse type of cancer.
Mo1128
Purpose: To date, data on the relative risk of colorectal adenomas (CRAs) in Hispanic versus non-Hispanic populations are sparse and inconclusive. In this retrospective study, we aimed to better characterize the ethnic differences in the prevalence of CRA, and to understand the possible interactions among known risk factors for CRA. Methods: We conducted a retrospective review of colonoscopy patients (n=1656) at a single tertiary-care community hospital from 2007 to 2011, to evaluate the association of self-reported race/ethnicity status with CRA prevalence and location. Further analysis was performed to assess the interactions between vitamin D, smoking and ethnicity in a relationship to CRA among 233 subjects with serum 25-hydroxyvitamin D level available. Results: Overall, the CRA prevalence was found 33% lower in Hispanic subjects than non-Hispanic subjects. Conversely, no difference in CRA prevalence was observed between non-Hispanic white and black subjects. Smoking was associated with increased risk of adenomas in overall population [OR 1.55 (1.12-2.15); P = 0.008)], whites [OR, 1.78 (0.98-3.24); P=0.05] and in blacks [OR, 1.91 (1.11-3.29); P=0.02]. However, no effect of smoking on the adenoma risk was found among Hispanics [OR, 1.00 (0.51-1.97); P = 0.999], which indicates an existence of other predominant but unmeasured protective factor(s) among these patients. In contrast, age, gender, BMI, alcohol consumption or metabolic disorders exhibited similar relationships with CRA across all ethnic subgroups (Table 1). Stratified analyses by adenoma location revealed 58% reduction in proximal CRA prevalence for Hispanics vs. non-Hispanics, while no differences in CRA in distal colon, rectum or multiple locations between ethnic subgroups (data table not shown). In a subset of 233 patients with winter serum 25-hydroxyvitamin D levels measured, we found that higher vitamin D status was associated with a slight reduction (6%) in the CRA risk for active smokers, but not for non-smokers (Table 2). Additionally, a negative correlation between smoking and CRA prevalence was again shown among non-Hispanics, but not among Hispanics irrespective of vitamin D status (data table not shown). Conclusions: Our data suggest a lower prevalence of proximal colonic adenoma in Hispanics versus nonHispanics. Interactions between smoking, vitamin D and ethnicity in the biologic levels could be possible mechanism for this location-specific ethnic difference in the CRA risk. Additional multi-center prospective studies are needed to confirm and understand this phenomenon in generalized population. Table 1. The Odds ratios from logistic regression for colonrectal adenoma by race/ethnicity in 1656 subjects
Mo1126 Cholangitis and Subsequent Risk of Cancer: A Danish Nationwide Cohort Study Kirstine K. Søgaard, Rune Erichsen, Jennifer Lund, Dóra Körmendiné Farkas, Henrik T. Sørensen Background: Cholangitis may be a harbinger of cancer. Patients with gastrointestinal cancer have an increased risk of cholangitis, but it is less clear whether cholangitis is also a marker for occult cancer. Undiagnosed gastrointestinal cancer may obstruct the bile duct system, and consequently lead to cholangitis. Furthermore an increased long term risk of cancer is conceivable due to chronic inflammatory processes. We assessed the risk of cancer subsequent to cholangitis. Methods: We conducted a population-based cohort study by linking Danish medical registries from 1978-2010. We calculated standardized incidence ratios (SIRs) by comparing observed cancer incidence after cholangitis with that expected based on national cancer incidence in the Danish population. Results: A total of 7,366 patients with cholangitis were followed for 45,666 person-years. During the follow-up period 1,441 cancers occurred (vs. 808 expected), corresponding to an overall SIR of 1.8 (95% CI: 1.7-1.9). Focusing on gastrointestinal cancers, 728 cancers occurred (vs. 173 expected), corresponding to a relative risk of 4.2 (95% CI 3.9-4.5). In site specific analyses for gastrointestinal cancers, SIRs varied from 1.2-26.6; stomach 1.9 (95% CI: 1.3-2.6), small intestine 6.0 (95% CI 2.9-11.1), colon 1.2 (95% CI: 0.9-1.4), rectum 1.2 (95% CI 0.9-1.7) liver 9.8 (95% CI: 7.6-12.3), gall bladder and biliary tract 26.6 (95% CI: 22.8-31.0), and pancreas 13.7 (95% CI: 12.1-15.3). There were 352 patients diagnosed with gastrointestinal cancer during the first 3 months of follow-up, corresponding to a SIR of 55.6 (95% CI: 50.1-61.9). Conclusions: Cholangitis may be a marker of prevalent cancer, particularly gastrointestinal cancer. Mo1127 Opium: An Emerging Risk Factor for Gastric Adenocarcinoma Arash Etemadi, Ramin Shakeri, Dariush Nasrollahzadeh, Masoud Sotoudeh, Farhad Islami, Paolo Boffetta, Sanford M. Dawsey, Christian C. Abnet, Farin Kamangar, Reza Malekzadeh Background: Opium use has been shown to be associated with higher risk of cancers of esophagus, bladder, larynx, and lung; however, no previous study has examined its association with gastric cancer. Opium and its derivatives are traditionally used in many SouthCentral Asian countries, as well as in South-East Asia. These are also areas with some of the highest rates of gastric cancer incidence and mortality in the world. In many of these areas, hookah (water-pipe) use is also a widely practiced social habit. Numerous studies have examined the association between cigarette smoking and gastric cancer, but much less is known about the associations of other types of tobacco use, such as smoking hookah or chewing tobacco, and this malignancy. Methods: In a case-control study in Golestan Province of Iran, we enrolled 309 incident cases of gastric adenocarcinoma (118 noncardia, 161 cardia, and 30 mixed-location adenocarcinomas) and 613 matched controls. Detailed information on long-term use of opium, tobacco products, and other covariates were collected using structured and validated lifestyle and food frequency questionnaires. Serum samples of cases and plasma samples of controls were used to determine seropositivity against CagA antigens of H. pylori. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were obtained using conditional logistic regression models. Results: Opium use was associated with increased risk of noncardia, cardia, and all gastric adenocarcinomas, with adjusted ORs (95% CIs) of 3.9 (1.6-9.4), 2.8 (1.4-5.7), and 3.1 (1.9 - 5.2), respectively. Patients may start opium use to alleviate pain; hence associations may be due to reverse causality. However, when we limited our analyses to those who had started opium use at least one year prior to diagnosis, opium still showed a strong increased risk. There was a dose-response effect, and individuals with the highest cumulative opium use had the strongest association (OR: 4.5; 95%CI: 2.38.5). Even in individuals who had never smoked cigarettes, opium strongly and significantly increased the risk of cardia and noncardia adenocarcinoma. We did not find a statistically significant association between the use of any of the tobacco products and risk of gastric adenocarcinoma, overall or by anatomic subsite. H. pylori CagA antigen was strongly associated with risk of noncardia cancer, but adjusting for it did not change the results. Conclusion: We showed, for the first time, an association between opium use and gastric adenocarcinoma. Several mechanisms have been proposed for the association between opium use and cancer, including the mutagenic effect of smoking opium and its alkaloid components (mainly morphine). Given that opium use is a traditional practice in many parts of the world, these results are of public health significance.
Table 2. The association between colorectal adenoma and ethnicitiy and vitamin D status stratified by cigarette smoking in 233 subjects
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AGA Abstracts
AGA Abstracts
Interactive Effects of Smoking, Vitamin D and Ethnicity in the Prevalence of Colorectal Adenoma: A Retrosepctive Multiethnic Study Xi E. Zheng, Seth Lipka, Ting Li, Paul Mustacchia, Alan S. Multz, Vladimir Gotlieb
Mo1128
Purpose: To date, data on the relative risk of colorectal adenomas (CRAs) in Hispanic versus non-Hispanic populations are sparse and inconclusive. In this retrospective study, we aimed to better characterize the ethnic differences in the prevalence of CRA, and to understand the possible interactions among known risk factors for CRA. Methods: We conducted a retrospective review of colonoscopy patients (n=1656) at a single tertiary-care community hospital from 2007 to 2011, to evaluate the association of self-reported race/ethnicity status with CRA prevalence and location. Further analysis was performed to assess the interactions between vitamin D, smoking and ethnicity in a relationship to CRA among 233 subjects with serum 25-hydroxyvitamin D level available. Results: Overall, the CRA prevalence was found 33% lower in Hispanic subjects than non-Hispanic subjects. Conversely, no difference in CRA prevalence was observed between non-Hispanic white and black subjects. Smoking was associated with increased risk of adenomas in overall population [OR 1.55 (1.12-2.15); P = 0.008)], whites [OR, 1.78 (0.98-3.24); P=0.05] and in blacks [OR, 1.91 (1.11-3.29); P=0.02]. However, no effect of smoking on the adenoma risk was found among Hispanics [OR, 1.00 (0.51-1.97); P = 0.999], which indicates an existence of other predominant but unmeasured protective factor(s) among these patients. In contrast, age, gender, BMI, alcohol consumption or metabolic disorders exhibited similar relationships with CRA across all ethnic subgroups (Table 1). Stratified analyses by adenoma location revealed 58% reduction in proximal CRA prevalence for Hispanics vs. non-Hispanics, while no differences in CRA in distal colon, rectum or multiple locations between ethnic subgroups (data table not shown). In a subset of 233 patients with winter serum 25-hydroxyvitamin D levels measured, we found that higher vitamin D status was associated with a slight reduction (6%) in the CRA risk for active smokers, but not for non-smokers (Table 2). Additionally, a negative correlation between smoking and CRA prevalence was again shown among non-Hispanics, but not among Hispanics irrespective of vitamin D status (data table not shown). Conclusions: Our data suggest a lower prevalence of proximal colonic adenoma in Hispanics versus nonHispanics. Interactions between smoking, vitamin D and ethnicity in the biologic levels could be possible mechanism for this location-specific ethnic difference in the CRA risk. Additional multi-center prospective studies are needed to confirm and understand this phenomenon in generalized population. Table 1. The Odds ratios from logistic regression for colonrectal adenoma by race/ethnicity in 1656 subjects
Mo1126 Cholangitis and Subsequent Risk of Cancer: A Danish Nationwide Cohort Study Kirstine K. Søgaard, Rune Erichsen, Jennifer Lund, Dóra Körmendiné Farkas, Henrik T. Sørensen Background: Cholangitis may be a harbinger of cancer. Patients with gastrointestinal cancer have an increased risk of cholangitis, but it is less clear whether cholangitis is also a marker for occult cancer. Undiagnosed gastrointestinal cancer may obstruct the bile duct system, and consequently lead to cholangitis. Furthermore an increased long term risk of cancer is conceivable due to chronic inflammatory processes. We assessed the risk of cancer subsequent to cholangitis. Methods: We conducted a population-based cohort study by linking Danish medical registries from 1978-2010. We calculated standardized incidence ratios (SIRs) by comparing observed cancer incidence after cholangitis with that expected based on national cancer incidence in the Danish population. Results: A total of 7,366 patients with cholangitis were followed for 45,666 person-years. During the follow-up period 1,441 cancers occurred (vs. 808 expected), corresponding to an overall SIR of 1.8 (95% CI: 1.7-1.9). Focusing on gastrointestinal cancers, 728 cancers occurred (vs. 173 expected), corresponding to a relative risk of 4.2 (95% CI 3.9-4.5). In site specific analyses for gastrointestinal cancers, SIRs varied from 1.2-26.6; stomach 1.9 (95% CI: 1.3-2.6), small intestine 6.0 (95% CI 2.9-11.1), colon 1.2 (95% CI: 0.9-1.4), rectum 1.2 (95% CI 0.9-1.7) liver 9.8 (95% CI: 7.6-12.3), gall bladder and biliary tract 26.6 (95% CI: 22.8-31.0), and pancreas 13.7 (95% CI: 12.1-15.3). There were 352 patients diagnosed with gastrointestinal cancer during the first 3 months of follow-up, corresponding to a SIR of 55.6 (95% CI: 50.1-61.9). Conclusions: Cholangitis may be a marker of prevalent cancer, particularly gastrointestinal cancer. Mo1127 Opium: An Emerging Risk Factor for Gastric Adenocarcinoma Arash Etemadi, Ramin Shakeri, Dariush Nasrollahzadeh, Masoud Sotoudeh, Farhad Islami, Paolo Boffetta, Sanford M. Dawsey, Christian C. Abnet, Farin Kamangar, Reza Malekzadeh Background: Opium use has been shown to be associated with higher risk of cancers of esophagus, bladder, larynx, and lung; however, no previous study has examined its association with gastric cancer. Opium and its derivatives are traditionally used in many SouthCentral Asian countries, as well as in South-East Asia. These are also areas with some of the highest rates of gastric cancer incidence and mortality in the world. In many of these areas, hookah (water-pipe) use is also a widely practiced social habit. Numerous studies have examined the association between cigarette smoking and gastric cancer, but much less is known about the associations of other types of tobacco use, such as smoking hookah or chewing tobacco, and this malignancy. Methods: In a case-control study in Golestan Province of Iran, we enrolled 309 incident cases of gastric adenocarcinoma (118 noncardia, 161 cardia, and 30 mixed-location adenocarcinomas) and 613 matched controls. Detailed information on long-term use of opium, tobacco products, and other covariates were collected using structured and validated lifestyle and food frequency questionnaires. Serum samples of cases and plasma samples of controls were used to determine seropositivity against CagA antigens of H. pylori. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were obtained using conditional logistic regression models. Results: Opium use was associated with increased risk of noncardia, cardia, and all gastric adenocarcinomas, with adjusted ORs (95% CIs) of 3.9 (1.6-9.4), 2.8 (1.4-5.7), and 3.1 (1.9 - 5.2), respectively. Patients may start opium use to alleviate pain; hence associations may be due to reverse causality. However, when we limited our analyses to those who had started opium use at least one year prior to diagnosis, opium still showed a strong increased risk. There was a dose-response effect, and individuals with the highest cumulative opium use had the strongest association (OR: 4.5; 95%CI: 2.38.5). Even in individuals who had never smoked cigarettes, opium strongly and significantly increased the risk of cardia and noncardia adenocarcinoma. We did not find a statistically significant association between the use of any of the tobacco products and risk of gastric adenocarcinoma, overall or by anatomic subsite. H. pylori CagA antigen was strongly associated with risk of noncardia cancer, but adjusting for it did not change the results. Conclusion: We showed, for the first time, an association between opium use and gastric adenocarcinoma. Several mechanisms have been proposed for the association between opium use and cancer, including the mutagenic effect of smoking opium and its alkaloid components (mainly morphine). Given that opium use is a traditional practice in many parts of the world, these results are of public health significance.
Table 2. The association between colorectal adenoma and ethnicitiy and vitamin D status stratified by cigarette smoking in 233 subjects
S-585
AGA Abstracts
AGA Abstracts
Interactive Effects of Smoking, Vitamin D and Ethnicity in the Prevalence of Colorectal Adenoma: A Retrosepctive Multiethnic Study Xi E. Zheng, Seth Lipka, Ting Li, Paul Mustacchia, Alan S. Multz, Vladimir Gotlieb