Faecal neutral sterols and bile acids in patients with adenomas and large bowel cancer: an ECP case-control study. European cancer prevention.

It is unclear whether neutral steroids and bile acids are involved in large bowel carcinogenesis. This study was conducted to compare the concentration of these faecal constituents at the different stages of the adenoma-carcinoma sequence. Neutral sterols and free bile acid concentrations were determined from stool samples collected form patients with large bowel cancer (n = 47), large adenoma > or = 1 cm (n = 42), small adenoma (n = 24), and controls (n = 104). The distribution of tertiles between cases and controls was analysed using odds ratio (OR), with 95% confidence interval (CI), comparing (two-sided tests) the second tertile (OR2) and the third tertile (OR3) to the first one. Persistence of primary bile acids appeared as a protective factor against cancer: (OR = 0.09, 95% CI 0.02-0.54). High values of cholesterol were associated with cancer risk (OR2 = 5.8, 95% CI 1.3-26.6; OR3 6.4, 95% CI 1.3-31.4). High values of cholesterol were more frequently observed in patients with large adenomas than in controls (OR2 = 8.5, 95% CI 1.9-37.5; OR3 = 4.3, 95% CI 0.9-20.9). Neutral sterols, cholesterol especially, may play a role in adenoma growth and adenoma transformation into carcinoma. Persistence of primary bile acids may afford protection.

[Cronkhite-Canada syndrome and arsenic poisoning: fortuitous association or new etiological hypothesis?]. / Syndrome de Cronkhite-Canada et intoxication à l'arsenic: association fortuite ou nouvelle hypothèse étiologique?

We report a case of Cronkhite-Canada syndrome in a 66 year-old man, particular by an association with arsenism. Both arsenism and the Cronkhite-Canada syndrome are a cause of ectodermal and mucosal lesions. The persistence of physical, biological and endoscopic manifestations associated with disappearance of arsenic intoxication signs allowed us to make the diagnosis. The search of arsenic in blood, nail and hair must complete the investigations in case of acquired pseudopolyposis and ectodermal changes.

Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation.

BACKGROUND: Polyethylene glycol (PEG) 3350 is a non-absorbable, non-metabolised osmotic agent used in lavage solutions for gut cleansing. AIMS: To compare the efficacy of PEG and lactulose in chronic constipation. METHODS: A total of 115 patients with chronic constipation entered a multicentre, randomised, comparative trial. They initially received two sachets containing either PEG (13 g/sachet) or lactulose (10 g/sachet) and were given an option to change the dose to one or three sachets/day, depending on response. RESULTS: Ninety nine patients completed the trial. After four weeks, patients in the PEG group (n=50) had a higher number of stools and a lower median daily score for straining at stool than patients in the lactulose group (n=49). Overall improvement was greater in the PEG group. Clinical tolerance was similar in the two groups, but flatus was less frequently reported in the PEG group. The mean number of liquid stools was higher in the PEG group but the difference was significant only for the first two weeks. There were no serious adverse events and no significant change in laboratory tests in either group. At the end of the study, the number of sachets used by the patients was 1.6 (0.7)/day in the PEG group and 2.1 (0.7)/day in the lactulose group. Sixty one patients completed a further two months open study of one to three sachets PEG daily; there was no loss of efficacy and no serious toxicity. CONCLUSION: Low dose PEG 3350 was more effective than lactulose and better tolerated.

A 15-year series of gastrointestinal non-Hodgkin's lymphomas: a population-based study.

Data from the Registry of Digestive tumours of the Département of Côte d'Or (France) were used to study the characteristics of gastrointestinal non-Hodgkin's lymphomas in the 1976-90 period. The mean annual age-standardized incidence rate was 0.94 per 100,000 for men, and 0.54 per 100,000 for women. Incidence varied little during the study period. Overall 5-year survival rate was 34.3 +/- 5.6%.

Environmental and familial risk factors in relation to the colorectal adenoma--carcinoma sequence: results of a case-control study in Burgundy (France).

A case-control study in the Cote-d'Or area (Burgundy, France) investigated the relationship between environmental and familial risk factors and the different steps of the adenoma-carcinoma sequence. Two adenoma groups (< 10 mm and > or = 10 mm), a polyp-free control group, a colorectal cancer group and a general population control group were recruited. Tobacco was associated with the risk of adenomas, and alcohol with the risk of large adenomas. They proved to be independently related to large adenoma formation when compared with controls. There was no association with cancer risk. Refined cereals, delicatessen, offal and fats appear to be risk factors along the adenoma-carcinoma sequence. This data does not support an increased risk with high consumption of fresh meat, or a protective effect of dairy products and calcium. A high consumption of vegetables was a protective factor for cancer, mainly in men. Excess weight and body mass index influenced the earlier step of the adenoma carcinoma sequence and excess calorie intake was risk factor for cancer. The decision to study precancerous lesions as well as cancer appears fruitful. Results suggest that the three stages of large bowel carcinogenesis are partly related to diet in different ways. They are concordant with risk factors recorded for colorectal cancer, but suggest some local specificities.

Colon cancer in the elderly: evidence for major improvements in health care and survival.

Time trends in therapeutic approaches and in the prognosis of colon cancer for patients aged 75 years and above have been investigated in comparison with corresponding trends for younger patients using a population-based series of 2089 colon cancer patients diagnosed between 1976 and 1990 in the Côte-d'Or area (478,000 inhabitants), Burgundy, France. Significant progress has been achieved in the management of patients with colon cancer in both age groups, but trends have been more noticeable in patients aged 75 years and above. In the elderly, the proportion of cancers limited to the digestive tract wall showed a 3-year average increase of 2.8% (P = 0.02) and the frequency of curative surgery an average increase of 8.6% (P < 0.001), so that it was performed in 80% of cases in the last 3-year period. Operative mortality decreased by 2.5% between 3-year periods (P < 0.004). Crude 5-year survival rates in elderly patients increased from 15% in the 1976-78 period to 29% in the 1985-87 period (P < 0.001), the corresponding figures being 36% and 44% (P > 0.10) in younger patients.

Calcium, phosphorus, vitamin D, dairy products and colorectal carcinogenesis: a French case--control study.

A protective effect of calcium against colorectal cancer has been described in Anglo-Saxon but not in Latin communities, and no such effect has been observed regarding adenomas. We investigated the relationship between calcium, dairy products and the adenoma-carcinoma sequence in a French region by comparing small adenoma ( < 10 mm, n = 154), large adenoma (n = 208) and polyp-free (n = 426) subjects, and cancer cases (n = 171) with population controls (n = 309). There was no protective effect of calcium against colorectal tumours except for low fat calcium and large adenomas in men (OR for highest quintile = 0.3, P for trend = 0.06). There was even a trend towards an increased risk of cancer with dairy calcium in men and non-dairy calcium in women. Vitamin D was inversely related to the risk of small adenomas in women (OR for highest quintile = 0.4, P for trend = 0.04). Regarding dairy products, only consumption of yoghurt displayed an inverse relationship with risk of large adenomas, in both men and women. These data failed to demonstrate a protective effect of calcium against colorectal carcinogenesis. They suggest that the type of dairy product might be the important factor with regard to prevention of colorectal tumours.

Family history of colorectal tumours and implications for the adenoma-carcinoma sequence: a case control study.

Family history of colorectal cancer is a risk factor for sporadic colorectal cancer, but it is not known which step of the adenoma-carcinoma pathway it influences. This case control study investigated the relation between family history of cancer and colorectal adenomas and cancers. Family history of colorectal cancer (FHCRC) was as frequent in small (< 10 mm) adenoma patients (11.7%, n = 154) as in polyp free patients (10.6%, n = 426), whereas it was more frequent in patients with large adenoma(s) (18.8%, n = 208; p < 0.01). Odds ratios for FHCRC were 1.2 (p > 0.10) for small adenomas and 2.1 (p < 0.01) for large adenomas. Family history of other (non-colorectal) cancers (FHOC) was similar in the three groups. Patients with a colorectal cancer (n = 171) had more frequently a family history of cancer, both colorectal (15.8%; p < 0.01) and other cancers (35.7%; p < 0.001) than general population controls (n = 309; FHCRC: 8.1%; FHOC: 21.7%). In a logistic model, both factors were independently related to colorectal cancers (odds ratios: 1.9 (p < 0.05) for FHCRC and 2.1 (p < 0.001) for FHOC). These data suggest that family history of colorectal cancer influences only the growth of adenomas or their malignant transformation. The finding of a further predisposition to any type of cancer needs to be confirmed.

Tobacco, alcohol, and colorectal tumors: a multistep process.

A case-control study in the Côte d'Or area of France used the multistep concept of colorectal carcinogenesis to compare lifetime tobacco consumption and present alcohol consumption in patients with small adenomas (less than 1 cm, n = 154) or large adenomas (n = 208) and in polyp-free controls (n = 427). Cancer patients (n = 171) were compared with population controls (n = 309). In men, smoking was associated with the risk of adenomas (odds ratio = 3.6 over 20 pack-years vs. nonsmokers, p < 0.001). Alcohol was a risk factor for large adenomas only, with relative risks of 4.2 (p < 0.01), 3.0 (p < 0.05), and 4.4 (p < 0.01) for consumptions of 20-39, 40-59, and 60 g/day compared with less than 10 g/day. When patients with large adenomas were compared with polyp-free controls, both alcohol and tobacco were independently related to the risk of tumor. There was no association between tobacco or alcohol intakes and cancer risk. In women, consumption was much lower in all groups, and no significant association with either risk factor was observed. These data suggest for the first time that there is an independent effect of alcohol and tobacco in men at different early steps of the adenoma-carcinoma sequence. They demonstrate the usefulness of such a model for etiologic studies on cancer.

Increase in the incidence of non-Hodgkin's lymphomas: evidence for a recent sharp increase in France independent of AIDS.

An increasing incidence of non-Hodgkin's lymphoma (NHL) has been reported in several areas of the world and often correlated with the occurrence of AIDS-related lymphomas. A registry specialised in haematopoietic malignancies enabled us to report detailed time trends in the incidence of NHL over the period 1980-89. There was an overall significant increase in incidence of + 10.9% per year (P < 0.001). Such a trend was observed both in men and in women (+ 11.2% and + 10.5%, respectively) and in all age groups. It was slightly more marked in the case of high-grade tumours than for low- or intermediate-grade tumours (+ 20.0%, + 12.6% and + 12.6% respectively) and in rural than in urban areas (+ 19.6% and + 8.1% respectively). In this series, only one case was associated with an HIV infection. These data indicate that, although a significant increase in NHL incidence related to the AIDS epidemic might be expected in the near future, there is an independent dramatic trend which started earlier than the AIDS problem and the causes of which should be investigated.

Effect of different doses of dietary calcium on murine colonic cell proliferation.

One-hundred and twenty 6-week-old 257BL/65 mice were fed for 2 or 7 weeks with diets supplemented with different combinations of bile acids and calcium. The effect of calcium, bile acids and the duration of these treatments on proliferative indices of the colonic mucosa was studied with a multiway analysis of variance. In mice not treated with bile acids, a low level (0.1%) of calcium in the diet was related to a significantly higher number of cells in each compartment of the crypt, compared with diets supplemented with 0.5 and 1% calcium (P < 0.01). There was no difference between the groups fed with normal and high calcium diets. Bile acids significantly increased proliferative indices in all animal groups whatever the duration of the treatment; however, this effect was significantly lower in the mice fed with 0.5% and 1% calcium than in those fed with 0.1% calcium (P < 0.01). There was a significant interaction between the effect of bile acids and the effect of calcium regarding the number of labeled cells and the labeling indices. Duration of the treatment had little effect on these indices. The effect of bile acids on colonic proliferative activity could be significantly reduced by calcium supplementation, and this effect was stable with time. Although there was no toxic effect of the highest calcium diet, there was no advantage in increasing the calcium dose beyond 0.5%.

[Prognostic factors in colorectal adenocarcinoma of Dukes stage B. Study of a series of population]. / Facteurs pronostiques des adénocarcinomes colorectaux de stade B de Dukes. Etude d'une série de population.

A study of prognostic factors in Dukes B colorectal adenocarcinoma was performed on a population basis in order to determine subgroups with poor prognosis which could benefit from adjuvant therapy after surgery. The study considered the 746 cases of Dukes B colorectal carcinoma diagnosed during the 1976-1988 period among Côte-d'Or residents (Burgundy, France). The overall 5-year crude survival rate was 55.7%, the corresponding relative survival rate being 73%. In the final Cox model, age, tumour extension to adjacent organs, number of examined lymph nodes and tumour size were significant prognostic factors. The corresponding multivariate relative survival model considered only tumour extension and number of examined lymph nodes as having a prognostic value. The relative risk of death was 2.3 (range: 1.5-3.3) in case of a tumor extension and 2.5 (range: 1.5-4.4) when no lymph node was found compared to surgical samples with at least 6 lymph nodes. These data should be taken into account when conceiving or analyzing future therapeutic trials.

Influence of socioeconomic status on prognosis of colorectal cancer. A population-based study in Côte D'Or, France.

BACKGROUND: The prognostic significance of the socioeconomic status of patients treated for colorectal cancer, although stated in some studies, remains controversial. METHODS: The authors studied a population-based series of 771 patients with colorectal cancer diagnosed in Cote D'Or, France, between January 1976 and December 1980. Survival was studied for the first 5 years after diagnosis. The relationship between socioeconomic status, assessed by comfort of housing, and the main clinical prognostic factors was examined. The influence of comfort of housing on prognosis was studied with the Cox model, while controlling for these factors. Interactions between type of housing and other prognostic factors also were tested. RESULTS: Compared with patients living in a comfortable house, patients in the medium or no-comfort categories were more likely to receive diagnosis at an advanced stage (P = 0.03) and be treated by palliative therapy (P = 0.0005). After adjustment for these factors and age, sex, place of residence, and tumor site, patients living in no comfort had a twofold higher risk of dying during the follow-up period compared with patients living in comfortable housing, with the relative risk being 1.5 for the medium comfort category (95% confidence intervals, 1.3-3.2 and 1.2-1.7, respectively). This effect was more remarkable in patients with early-stage tumors than in patients with advanced tumors. CONCLUSIONS: Such findings should prompt public health measures for earlier access to care structures for people in a lower social class and research for a better understanding of the host-tumor relationship.

Plasma lipoproteins in cortical infarction versus transient ischaemic attacks: a case control study.

The authors investigated the relationship between plasma lipids and the risk for cortical infarction (61 cases) and transient ischaemic attacks (TIA) (35 cases) compared with matched controls. They observed a maximal increase of total cholesterol, of very low-density lipoprotein and low-density lipoprotein (LDL), triglycerides, total apolipoprotein (Apo), B,LDL-Apo B and Apo-A1, and small size high-density lipoprotein (HDL) and large size HDL whose separation was not possible. In contrast they observed a decrease of HDL-ApoE, a distribution of LDL in a single fraction and the presence of LDL of low weight in the group with cortical infarction with or without cardiac arrhythmias. For the first time, we describe a decrease of the HDL-ApoE/total ApoE ratio. TIA differed from the former group by a low level of HDL and the lack of abnormalities of Apo-A1, distribution of small and large size HDL, and in the distribution and the weight of LDL. These data suggest that previously demonstrated differences in LDL-cholesterol and HDL-cholesterol levels between patients with ischaemic stroke and control subjects may apply to patients with cortical infarction, and that in TIA there are changes in the distribution and the weight of LDL.

Age and prognosis of non-small cell lung cancer. Usefulness of a relative survival model.

The aim of our study was the comparative evaluation of a relative survival model and a Cox model to determine the prognostic factors of survival for patients with surgically cured non-small cell lung cancer (NSCLC). We focused particularly on the exact role of age in this survival. 156 patients treated between 1975 and 1988 were studied. Both univariate and multivariate analyses were performed, using the actuarial method and the Cox model for crude survival and the Hakulinen model for relative survival. This study confirmed the poor prognosis of NSCLC, even if a curative surgical procedure has been possible, with a 5-year survival of 48% for stage I tumours but only 6% for stage III tumours. The most significant prognostic factor was the postsurgical TNM staging. The relative survival method of Hakulinen dismissed age as a significant prognostic factor. Our study underlines the usefulness of relative survival methods which should be more frequently employed to allow comparisons between series of different origin and to set up multicentre therapeutic trials.