Risk Of Carcinoma In Patients Research Articles

Genetic variation near interleukin 28B and the risk of hepatocellular carcinoma in patients with chronic hepatitis C

We aimed to clarify the association between single nucleotide polymorphism (SNP) located near interleukin 28B and hepatocellular carcinoma (HCC). A cohort comprising 792 patients treated with interferon for chronic hepatitis C was investigated. SNPs at rs8099917 and rs12979860 were determined. Cumulative incidence and HCC risk were analyzed by Kaplan-Meier and Cox proportional hazard analyses for a mean follow-up period of 4.9 years. Fibrosis progression rate (FPR) was determined in these patients with a known time of infection (n = 294). Cumulative HCC incidence was significantly higher in rs8099917 nonTT (minor homozygote or heterozygote) patients than in rs8099917 TT (major homozygote) patients (20.8 vs. 10.5% over 10 years, logrank test, p = 0.002). This difference was notable in patients infected with genotype 1 and those treated with pegylated interferon and ribavirin. Among nonSVRs, interferon had a limited effect in suppressing alanine aminotransferase (ALT) and/or α-fetoprotein (AFP) levels in nonTT patients. The suppression of these values after interferon therapy was associated with a lower incidence of HCC. FPR were similar in TT and nonTT patients. rs8099917 nonTT is related to higher HCC development in patients with HCV genotype 1 and those treated with pegylated interferon and ribavirin. Higher HCC incidence observed in nonTT patients partly results from the limited suppression of ALT and/or AFP by interferon in these patients.

612 Effect of Hepatitis C Viral Factors and Overall Immune Suppression on the Risk of Hepatocellular Carcinoma in Patients With HCV-HIV Coinfection

612 Effect of Hepatitis C Viral Factors and Overall Immune Suppression on the Risk of Hepatocellular Carcinoma in Patients With HCV-HIV Coinfection

IL17Agene polymorphisms, serum IL-17A and IgE levels, and hepatocellular carcinoma risk in patients with chronic hepatitis B virus infection

Interleukin (IL)-17A plays important roles in hepatitis B virus (HBV)-induced liver diseases. This study aims to investigate IL17A single nucleotide polymorphisms (SNPs) and the predispositions to chronic HBV infection and hepatocellular carcinoma (HCC) risk and the correlations to IL-17A and IgE levels. Three hundred ninety-five chronic HBV patients, 75 HBV infection resolvers, and 174 healthy controls were included. IL17A SNPs rs8193036 (C/T) and rs2275913 (A/G) and serum IL-17A and IgE levels were determined. HBV infection resolvers had higher rs8193036 allele T and allele T-containing genotypes than HBV patients or controls. Compared with chronic hepatitis, HCC patients had more frequent rs2275913 genotype GG (odds ratios [OR] 3.317, 95% confidence interval [CI] 1.663-6.617, P = 0.001) and allele G (OR 1.844, 95% CI 1.311-2.595, P < 0.001), and more frequent haplotypes CG (OR 1.868, 95% CI 1.256-2.778, P = 0.002) and TG (OR 1.788, 95% CI 1.031-3.101, P = 0.037) of rs8193036 and rs2275913. Comparison of HCC patients with cirrhosis yielded similar findings. Apart from male gender and older ages, IL-17A level (OR 1.020, 95% CI 1.003-1.036, P = 0.019) and rs2275913 genotypes AG and GG (OR 1.704, 95% CI 1.214-2.390, P = 0.006) were factors significantly associated with HCC risk in multivariate analysis in comparison with HBV patients without HCC. These factors remained significant in multivariate analysis in relation to cirrhosis. IL17A rs2275913 genotype GG was associated with significantly increased IL-17A and IgE levels. IL17A polymorphisms may influence HCC risk in chronic HBV infection via regulating IL-17A production.

Complex Atypical Hyperplasia of the Uterus: Characteristics and Prediction of Underlying Carcinoma Risk

Objective The objective of the study was to identify additional factors that may improve the ability to predict underlying carcinoma risk in patients with complex atypical hyperplasia (CAH) of the uterus. Study Design All subjects diagnosed with CAH of the uterus on endometrial sampling from March 1994 to May 2008 were identified. CAH was classified as CAH suspicious, CAH polypoid, CAH focal, or CAH not otherwise specified (NOS). Subjects were then exclusively assigned to 1 of 3 categories: CAH suspicious, CAH NOS, or CAH focal and/or polypoid. Results We identified 197 cases of CAH diagnosed on preoperative endometrial sampling. Carcinoma was subsequently diagnosed in the hysterectomy specimen in 67 subjects (34%). The risk of underlying carcinoma if assigning subjects as CAH suspicious, CAH NOS, or CAH polypoid and/or focal was 56%, 36%, and 20%, respectively ( P Conclusion The risk of underlying carcinoma in patients with CAH on preoperative endometrial sampling is associated with the method of sampling and age and can be significantly modified by the nature of pathologic assessment.

The Mutations in the Enhancer I/X Promoter and X Gene Region Increased Risk for Hepatocellular Carcinoma in Patients With Chronic Hepatitis B Infection

BACKGROUND/AIM: Several reports have suggested that the number of amino acid (aa) mutations in the interferon sensitivity determining region (ISDR, aa 2209 2248) of the nonstructural protein 5A (NS5A) affects the response to IFN-based therapy in patients with chronic hepatitis C (CHC) with genotype 1 and high viral load. The aim of the present study was to clarify whether host immunity is influenced by the number of aa mutations in the ISDR. PATIENTS AND METHODS: Subjects included 44 consecutive patients with biopsy-proven CHC who were infected with genotype 1b (27 men and 17 women; age range, 29 to 70 (median: 58) years; baseline serum HCV-RNA levels, 100 to 850 (median: 480) KIU/ml, quantified by Amplicor Monitor Version 2.0 test). The number of aa mutations in the ISDR was retrospectively determined using stored serum samples taken immediately before starting therapy. All patients received interferon (IFN)-alpha 2b or pegylated-IFNalpha 2b and ribavirin. When serum HCV-RNA was negative at 12 weeks, the patient was defined as having early viral response (EVR). When serum HCV-RNA was negative at 24 weeks after the end of therapy, the patient was defined as having sustained viral response (SVR). Baseline liver test, and CD4-positive T cell subsets such as IFN-gamma (+)/IL-4 (−) (Th1) or IFN-gamma (−)/IL-4 (+) (Th2) cells in peripheral blood (PB) before and at 3, 7, 14, 28 and 56 days after starting therapy were analyzed. RESULTS: Rates of EVR and SVR were 14% (3/21) and 14% (3/21), respectively, in patients with one or fewer aa mutations in the ISDR (ISDR0-1), and 70% (17/23) and 53% (10/23), respectively, with two or more aa mutations in the ISDR (ISDR>2). Although the percentage of PB Th1 cells did not differ between the 2 groups during the study period, the percentage of PB Th2 cells was significantly lower in the ISDR0-1 group than in the ISDR>2 group at baseline and on days 3, 7, 14 and 28 of treatment. DISCUSSION: The number of aa mutations in the ISDR influenced PB Th2 cells before and at 3, 7, 14 and 28 days after the start of therapy, and was associated with higher EVR and SVR rates.

Complex atypical hyperplasia of the uterus: characteristics and prediction of underlying carcinoma risk

The objective of the study was to identify additional factors that may improve the ability to predict underlying carcinoma risk in patients with complex atypical hyperplasia (CAH) of the uterus. All subjects diagnosed with CAH of the uterus on endometrial sampling from March 1994 to May 2008 were identified. CAH was classified as CAH suspicious, CAH polypoid, CAH focal, or CAH not otherwise specified (NOS). Subjects were then exclusively assigned to 1 of 3 categories: CAH suspicious, CAH NOS, or CAH focal and/or polypoid. We identified 197 cases of CAH diagnosed on preoperative endometrial sampling. Carcinoma was subsequently diagnosed in the hysterectomy specimen in 67 subjects (34%). The risk of underlying carcinoma if assigning subjects as CAH suspicious, CAH NOS, or CAH polypoid and/or focal was 56%, 36%, and 20%, respectively (P < .001). The risk of underlying carcinoma in patients with CAH on preoperative endometrial sampling is associated with the method of sampling and age and can be significantly modified by the nature of pathologic assessment.

Nomograms for Risk of Hepatocellular Carcinoma in Patients With Chronic Hepatitis B Virus Infection

Counseling patients with chronic hepatitis B virus (HBV) on their individual risk of liver disease progression is challenging. This study aimed to develop nomograms for predicting hepatocellular carcinoma risk in patients with chronic hepatitis B. Two thirds of the Risk Evaluation of Viral Load Elevation and Associated Liver Disease/Cancer-Hepatitis B Virus (REVEAL-HBV) study cohort was allocated for model derivation (n = 2,435), and the remaining third was allocated for model validation (n = 1,218). Previously confirmed independent risk predictors included in three Cox proportional hazards regression models were sex, age, family history of hepatocellular carcinoma, alcohol consumption habit, serum ALT level, hepatitis B envelope antigen (HBeAg) serostatus, serum HBV DNA level, and HBV genotype. Regression coefficients were rounded into integer risk scores, and predicted risk over 5- and 10-year periods for each risk score was calculated and depicted in nomograms. The predictive accuracy was evaluated using the area under the receiver operating characteristic curve (AUROC) and the correlation between predicted and observed hepatocellular carcinoma risk. All selected risk predictors were statistically significant in all models. In each model, either HBeAg seropositivity or HBeAg seronegativity with high viral load (HBV DNA level >or= 100,000 copies/mL) and genotype C infection had the highest risk scores. All AUROCs for risk prediction nomogram were >or= 0.82 in both model derivation and validation sets. The correlation coefficients between the observed hepatocellular carcinoma risk and the nomogram-predicted risk were greater than 0.90 in all model derivation and validation sets. These easy-to-use nomograms based on noninvasive clinical characteristics can accurately predict the risk of hepatocellular carcinoma in patients with chronic hepatitis B. They may facilitate risk communication between patients and clinicians.

Vulvar Lichen Sclerosus in the Elderly

Lichen sclerosus is a chronic skin condition that most commonly affects the anogenital skin of postmenopausal women. The aetiology of the condition is multifactorial. The most common presenting symptom is itching. Lichen sclerosus has a characteristic appearance. Diagnosis is made with vulvar biopsy. Treatment is important and the regimen most often includes topical corticosteroid ointments. Lifetime surveillance of the skin is imperative because of the increased risk of squamous cell carcinoma in patients with lichen sclerosus.

835 Insulin Treatment and the Risk of Hepatocellular Carcinoma in Patients with Diabetes

835 Insulin Treatment and the Risk of Hepatocellular Carcinoma in Patients with Diabetes

W1007 Mean Liver Stiffness Value Is Not Associated with Risk of Hepatocellular Carcinoma in Patients with Compensated Cirrhosis: Preliminary Results

W1007 Mean Liver Stiffness Value Is Not Associated with Risk of Hepatocellular Carcinoma in Patients with Compensated Cirrhosis: Preliminary Results

I-28 Association between epidermal growth factor gene polymorphisms and the risk of hepatocellular carcinoma in patients with hepatitis B virus chronic infection

I-28 Association between epidermal growth factor gene polymorphisms and the risk of hepatocellular carcinoma in patients with hepatitis B virus chronic infection

Risk of breast cancer associated with papilloma

Objective The purpose of this study was to investigate the risk of carcinoma in patients with a diagnosis of papilloma of the breast made on ultrasound large core biopsy or stereotactic vacuum-assisted biopsies. Material and methods This retrospective database review (2000–2007) included 130 patients with a papilloma diagnosed on preoperative biopsies or excisional surgery specimen. The mean patient age was 52 years (range, 20–80 years). The examinations included mammography and ultrasonography in all 130 patients. The final surgical histology was compared to preoperative biopsy diagnosis, and then factors associated with underestimation of malignancy were evaluated in univariate and multivariate analyses. Results The preoperative histology was available for 63 patients. Benign papilloma had been identified by ductography in 34 patients and by preoperative biopsy in 48 patients. Mammography showed microcalcifications in 25 cases and nipple discharge was present in 59 patients. Malignancy was found on final histology in 8% of patients with initial diagnosis of benign papilloma. In this study group, age of more than 50 years, presence of nipple discharge and microcalcifications were found to be significantly related to the risk of malignancy ( p = 0.001, 0.05 and 0.02, respectively). Conclusion Since benign papilloma can be associated to malignancy at excisional biopsy, we still recommend surgical excision for papilloma especially when associated to identified risk factors of malignancy.

T1929 Alcohol Consumption and Not Metabolic Abnormalities Is Associated with Increased Hepatocellular Carcinoma Risk in Patients with END-Stage Liver Disease

T1929 Alcohol Consumption and Not Metabolic Abnormalities Is Associated with Increased Hepatocellular Carcinoma Risk in Patients with END-Stage Liver Disease

531 Increased Risk of Esophageal Squamous Cell Carcinoma in Patients with Gastric Atrophy: Independent of the Severity of Atrophic Changes

531 Increased Risk of Esophageal Squamous Cell Carcinoma in Patients with Gastric Atrophy: Independent of the Severity of Atrophic Changes

The Risk of Hepatocellular Carcinoma in Patients with Previous Malignancy

Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world, with an incidence worldwide of 564,000 new cases per year ([1]). The age-adjusted incidence rates in the United S...

The risk of medullary thyroid carcinoma in patients with Hirschsprung's disease

Hirschsprung's disease (HD) can be associated with the development of neuroendocrine tumours such as medullary thyroid carcinoma (MTC). The RET proto-oncogene is the major gene responsible for both HD and MTC. Mutations in exon 10 (codons 609, 611, 618, 620) were found in patients with co-occurrence of HD and MTC. The aim of the study was to screen the MTC risk in patients with HD. The prospective and retrospective genetic analyses comprised 56 HD patients (41 males, 15 females, aged 0-47). The prospective subgroup of patients consisted of 34 patients (25 boys, 9 girls) operated on between June 2003 and December 2005. The retrospective subgroup comprised 22 patients (16 boys, 6 girls) of 194 patients who were operated on between December 1979 and May 2003, non-systematically chosen preferably for total colonic aganglionosis (TCA). DNAs were isolated from blood and resected segments of aganglionic bowel. The HD patients and nine available family members (2 HD) were tested for RET mutations in exons 10, 11, 13, 14, 15 and 16. Direct double-stranded fluorescent sequencing revealed typical germline heterozygous MTC risk RET mutations in 3/56 (5.4%) female HD patients: Cys609Tyr, Cys620Arg (both exon 10) and Tyr791Phe (exon 13). Two of these patients had TCA and one patient had classical type of HD. One TCA patient developed clinical stage of MTC and underwent total thyroidectomy (TTE). The other two RET positive HD patients (aged 7 and 25 years) are screened for calcitonin level and they are without TTE till now. Two family members (mothers of TCA patients) with detected RET mutation underwent prophylactic TTE with MTC finding. Results showed the benefit of systematic RET mutation screening in HD patients in order to identify the risk of MTC in preclinical stage of the disease in patients with HD and their family members. We recommend to investigate not only exon 10 but also exon 13.

244 Does transjugular intrahepatic portosystemic shunt increase hepatocellular carcinoma risk in patients with cirrhosis? pathological study from explanted livers

244 Does transjugular intrahepatic portosystemic shunt increase hepatocellular carcinoma risk in patients with cirrhosis? pathological study from explanted livers

Biliary Carcinoma Risk in Patients with Pancreaticobiliary Maljunction and the Degree of Extrahepatic Bile Duct Dilatation

Background and Aim: In patients with pancreaticobiliary maljunction (PBM), pancreatic juice frequently refluxes into the bile duct. This results in a high risk of biliary carcinoma. No consensus has been reached on whether preventive resection of the extrahepatic bile duct is necessary in PBM cases without dilatation of the extrahepatic duct. The aim of this study is to examine the biliary complications of patients with PBM in relation to the degree of extrahepatic bile duct dilatation and thus to determine appropriate management. Patients and Methods: We have treated 98 patients (21 males and 77 females, average = 48.0) with PBM. The PBM cases could be divided into 5 groups according to the maximum diameter of the extrahepatic bile duct:≤10, 11-15, 16-20, 21-30, ≥31mm. The clinicopathological findings of biliary carcinomas associated with PBM were examined and compared with 232 cases of gallbladder carcinoma and 159 cases of bile duct carcinoma that were not associated with PBM. Results: Gallbladder carcinoma occurred in 36 of 65 patients (55%) with PBM whose maximum diameter of the extrahepatic bile duct was ≤30 mm, but no gall bladder carcinoma occurred in patients with PBM whose maximum diameter of the extrahepatic bile duct was ≥31 mm. Bile duct carcinoma occurred in 6 of 52 patients (12%) with PBM whose maximum diameter of the extrahepatic bile duct was ≥21 mm, but no bile duct carcinoma occurred in patient with PBM whose maximum diameter of extrahepatic bile duct was ≤20 mm. The age at diagnosis of the patients with gall bladder (58.9 ± 8.8 vs. 69.4 ± 8.7 years old, p < 0.01) or bile duct carcinoma (54.8 ± 14.3 vs. 68.8 ± 9.1 years old, p < 0.01) associated with PBM was significantly younger than those without PBM. Gallstones were rarely detected in patients with gallbladder carcinoma associated with PBM (8% vs. 62%, p < 0.01). There were no significant differences between cases of gallbladder carcinoma associated with and without PBM in the location and histology, incidence of multiple biliary carcinoma. Multiple biliary carcinomas frequently occurred in the patients with bile duct carcinoma associated with PBM (50% vs. 4%, p < 0.01). Conclusion: PBM with an extrahepatic bile duct diameter ≤30 mm is associated with a high risk of gallbladder carcinoma. Furthermore, PBM with an extrahepatic bile duct diameter ≥21 mm is associated with a high risk of bile duct carcinoma. The treatment of choices for PBM with biliary dilatation is excision of extrahepatic bile duct and gallbladder with Roux-en-Y reconstruction of the biliary tree. However, given the present study, only cholecystectomy should be recommended as prophylactic treatment for patients with PBM without biliary dilatation.

Interdependence of radial scar and proliferative disease with respect to invasive breast carcinoma risk in patients with benign breast biopsies

Radial scars (RS) are benign breast lesions that have been implicated as independent risk factors for invasive breast carcinoma (IBC). A retrospective cohort study of 9556 women who underwent biopsy between 1950-1986 and enrolled in the Nashville Breast Cohort was performed to investigate the association between RS in a benign breast biopsy and the risk of IBC. The risk associated with RS and coexistent proliferative disease (PD) was assessed adjusting for age at biopsy using a Cox hazards regression analysis with time-dependent covariates. RS were identified in 880 women (9.2%). The average follow-up time was 20.4 years. Sixty-two women (7.0%) with RS developed IBC compared with 5.5% of controls. The relative risk of IBC associated with RS was 1.82 (95% confidence interval [95% CI], 1.2-2.7) at 10 years. Restricting the analysis to women age > 49 years increased the risk to 2.14 (95% CI, 0.6-2.8). These risks decreased with increasing years of follow-up. Approximately 92% of women with RS also had PD, but RS were present in only 1.3% of biopsies without PD. Analyses stratifying relative risk with regard to PD found RS to minimally elevate the relative risk of subsequent IBC. RS in the absence of PD is uncommon. Although the presence of RS in a benign breast biopsy mildly elevates the risk of IBC risk, the current analysis indicated that this risk can be largely attributed to the category of coexistent PD. In women with both RS and atypical hyperplasia, recommendations for interventions beyond biopsy should be based on the extent of atypical hyperplasia.

No Evidence for Increased Risk of Cutaneous Squamous Cell Carcinoma in Patients With Rheumatoid Arthritis Receiving Etanercept for Up to 5 Years

No Evidence for Increased Risk of Cutaneous Squamous Cell Carcinoma in Patients With Rheumatoid Arthritis Receiving Etanercept for Up to 5 Years