Prediagnosis smoking, obesity, insulin resistance, and second primary cancer risk in male cancer survivors: National Health Insurance Corporation Study.

PURPOSE: Smoking, obesity, and insulin resistance are well-known risk factors for cancer, yet few epidemiology studies evaluate their role as risk factors for a second primary cancer (SPC). PATIENTS AND METHODS: We identified 14,181 men with a first cancer from the National Health Insurance Corporation Study cohort. We obtained data on fasting glucose level, body mass index (BMI), and smoking history from an enrollment interview (1996). We obtained SPC incidence data for 1996 through 2002 from the Korean Central Cancer Registry. We used the standard Poisson regression model to estimate the age- and multivariate-adjusted relative risk (RR) for SPCs in relation to smoking history, BMI, and insulin resistance before diagnosis. RESULTS: We observed 204 patients with SPC. The overall age-standardized incidence rate of SPC was 603.2 occurrences per 100,000 person-years, which was about 2.3 times higher than that of first cancer in the general male population. Multivariate regression revealed that lung (RR, 3.69; 95% CI, 1.35 to 10.09) and smoking-related (RR, 2.02; 95% CI, 1.02 to 4.03) SPCs were significantly associated with smoking. Obese patients (BMI > or = 25 kg/m2) had significantly elevated RRs for colorectal (RR, 3.45; 95% CI, 1.50 to 7.93) and genitourinary (RR, 3.61; 95% CI, 1.36 to 9.54) SPCs. Patients with a fasting serum glucose concentration > or = 126 mg/dL had a higher RR for hepatopancreatobiliary (RR, 3.33; 95% CI, 1.33 to 8.37) and smoking-related (1.93; 95% CI, 1.01 to 3.68) SPCs. CONCLUSION: Prediagnosis smoking history, obesity, and insulin resistance were risk factors for several SPCs. These findings suggest that more thorough surveillance and screening for SPCs is needed for the cancer survivors with these risk factors.

Postbiopsy arterioportal fistula in patients with hepatocellular carcinoma: clinical significance in transarterial chemoembolization.

OBJECTIVE: The purpose of this study was to determine, retrospectively, the frequency of postbiopsy arterioportal fistula in hepatocellular carcinoma and its significance in transarterial chemoembolization (TACE). MATERIALS AND METHODS: Forty-one patients who underwent percutaneous liver biopsy for diagnosis of hepatocellular carcinoma were referred for TACE. The control population comprised 161 patients referred during the same period who underwent TACE without biopsy. We determined that an arterioportal fistula was present by opacification of the portal vein during the arterial phase of angiography or by opacification with iodized oil during TACE. We considered hepatocellular carcinoma to be responsive to TACE when the sum of iodized oil retention in the tumor and a low-attenuation area on CT was greater than 50% of tumor size. We compared the frequency of arterioportal fistula and the rate of tumor response to TACE in both groups and also evaluated possible factors associated with postbiopsy arterioportal fistula, such as age, sex, Child-Pugh score, tumor size, average number of needle passes, average distance that the needle traversed normal liver before reaching the mass, and average interval between biopsy and TACE. RESULTS: Twenty-three (56.1%) of 41 patients in the biopsy group and 19 (11.8%) of 161 patients in the control group had an arterioportal fistula (p < 0.001). The rate of tumor response to TACE was 87.8% (36/41) in the biopsy group and 87.0% (140/161) in the control group (p = 0.5932). Of the possible related factors, only tumor size correlated negatively with the occurrence of arterioportal fistula. CONCLUSION: Percutaneous liver biopsy in hepatocellular carcinoma patients apparently increases the rate of arterioportal fistula but does not seem to affect the rate of tumor response to TACE.