$1186

A Multivariate Analysis of Risk Factors for Colorectat Adenomas: Results from Screening Colonoscopy in 3,114 Japanese Yutaka Yamali , Hirotsugu Watabe, Goichi Togo, Makoto Okamoto, Haruhiko Yoshida, Takao Kawabe, Ryoichi Wada, Toru Mitsushima, Masao Omata

[Introduction] Colorectal adenomas have been increasing during years in Japan. They are well known to be associated with male gender and aging. However, the association with the change of life style has also been suspected. We tried to evaluate the effect of the factors independent of gender and age in a cross-sectional study on the basis of screening colonoscopy in a large population. [Methods] We consecutively conducted total colonoscopy to 3,114 asymptomatic Japanese with no experience of colonoscopy (male/female = 2,147/967, mean age = 47.4) during our general health appraisal. Blood laboratory tests and questionnaire for life habits were conducted at the same time. We evaluated 16 parameters associated with obesity, liver and renal function, glucose tolerance, hyperfipidemia, alcohol intake and smoking habit. To adjust gender and age, multivariate analyses by using logistic regression models were utilized. [Results] A total of 556 cases with colorectal adenomas were found. Out of 16 parameters, 6 parameters including body weight, ALT (alanine aminotransferase), �9 y-GTP ("/-glutamyltransferase), TG (trigfyceride), alcohol, and smoking were screened as risk factors independent of gender and age. The multivariate analysis including all the 6 parameters together with gender and age revealed 3 parameters of't-GTP, TG, and smoking were statistically significant. The prevalence of colorectal adenomas in the high level and low level of each parameter was 25.6% in the subjects with ~'-GTP over 50IU/1 and 16.2% below it, 24.t% in the subjects with TG over 150mg/dl and 15.8% below it, 25.1% in the subjects with smoking over 10 cigarettes per day and 14.6% below it, respectively. [Conclu- sionl The association of life style such as smoking, alcohol and fat intake with colorectal adenomas were suggested.

$1187

Proximal Location of Colorectal Cancer is a Risk Factor for the Development of Second Primary Cancers : a Population Based Study Pascal Crervaz, Olivier Huber, Gilles Mentha, Philippe Morel

Aim : Microsateflite instability (MSI) has been recently identified as a molecular marker for multiple colorectal cancer (CRC). MSl-positive sporadic CRC is predominantly located in the proximal colon. This study was undertaken to assess : 1) the incidence of multiple primary CRC ; and 2) the incidence of extracoloinc cancers, in relation with the location (proximal or distal to the splenic flexure) of the initial CRC Method : Population-based study, using a cancer registry database to identify patients diagnosed with colorecraI adenocarcinoma between 1970 and 1999. FAP and HNPCC cases were excluded, as well as non-epithehal tumors. Location of the first tumor was established according to [CD-02 classification. The registry covers a population of 400,000 residents. Results : 5,126 patients presented with a first sporadic adenocarcinoma of the colon or rectum during this period of time. 1,762 cancers (33%) were located proximal to the splenic flexure. 120 second primary CRC were observed in this population (2.3%). The risk for developing a second primary CRC was significantly higher in patients having their initial tumor located in the proximal colon (3.3% vs. 1.8%, p<0.001). The risk for each segment of the colon was as follows: caecum 3.3% ; right colon 3.0% ; transverse 3.7% ; left colon 2.8% ; sigmoid 1.7% ; and rectum 1.8%. In addition, the risk for developing a second, extracolic cancer was also higher for patients with proximal tumors (12.7% Vs. 10.0%, p =0.004). Conclusion : Patients presenting with a first cancer of the proximal colon are at higher risk for developing multiple CRC. The risk for developing subsequent extra-colic tumors is also increased. These epidemiological data, along with the well.established increasing incidence of proximal tumors in various populations, justify the separate reporting of colon cancer according to location proximal or distal to the splenic flexure

51188

Does Alcohol Consumption Protect Against Colon Polyps ? Rajeev Jayadevan, Pramod Joseph, Tanaya Nayak, Ajit Kokkat, Mario Ricci, Nejat Ktyici, Edward Norkus, Hifary Hertan, Cs Pitchumoni

Recent publications have suggested a link between alcohol consumption and colon polyps. We are examining this possibility in an ongoing prospective study of colonoscopy outcomes in the endoscopy unit ofa Uinverstiy-affiliated city hospital. This report presents the findings from the initial 217 patients. Data were collected on demographics, co-morbidity, BMI, medications, alcohol use and smoking behavior, plus the size, number and location of polyps. Our sample continued 135 females and 82 males with a mean age of 56.8 +/- 14.1 years (range of 18 - 88 )'Is), a mean BMt of 29.0 +/- 6.4 and a racial distribution of 68% Hispanic, 23% African American, 7% Caucasian, and 2% other races. Polyps were seen in 30% of the patients. Logistic regression analysis was used to identify models to predict the occurrence of polyps. These models examined the effects of all variables listed above. We observed a significant model to predict the occurrence of polyps (P=O.0041) using age, sex, race, alcohol use, and smoking behavior as explanatory variable. This model identified a 3% increased risk of polyps for every year of age (P=0.023). The model also found an 80% decreased risk of polyps in patients who used alcohol (P<0.0005). When grams of alcohol consumed per week was substituted in the model, a 15% decreased risk of polyps was identified for every 10 grams of alcohol consumed per week (P=0.001) When years 0f alcohol use was substituted into the model, a 5% decreased risk of polyps was identified f0r each year of alcohol consumption (p=0.00l ) with the influence of age remaining at 3% per year (P = 0.007). No other explanatory variables (BMI, sex, race, smoking) influenced the occurrence of polyps, in this study of 217 patients, 32% consumed alcohol. Alcohol cortsumption and polyp occurrence was as shown in table 1. Conclusion: Alcohol had an apparent protective effect against polyp occurrence both with the amount of alcohol con- sumed per week and with the duration of alcohol use. The relationship remained consistent despite the age-related increase in polyp occurrence

Alcohol consumptlon vs polyp occunmce

Alcohol rmmum ~ polyp= found Po~p= found Alcohol consunted per week (mean) 51 g 15 0 _Years as drinker (mean) 10 )'ears 4 years

$1189

Changing Trends in Gender, Race, and Site-Specific Gastrointestinal Carcinoid Tumor Incidence: The Latest Word Kevin D. Lye, ]rvin M Modlin, Mark Kidd

BACKGROUND: Carcinoid tumors represent an unusual and complex disease spectrum with protean clinical manifestations This compilation of several large United Srates-based databases comprising cases from 1950 to 1999 examines 13,715 cases of carcinoid tumor and provides epidemiologic information about the natural history and evolution of the detection and diagnosis of this entity. METHODS: The authors evaluated 10,878 carcinoid cases identified by the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI) from 1973 to 1999 in addition tO 2837 carcinoid cases previously registered by two earlier NCI programs. Case data were mined for tumor site and stage, year of diagnosis, and patient age, gender, and race. Specific trends in incidence for carcinoid tumors of certain sites were identified by comparing cases accrued between 1950-i971, 1973-199I, and 1992-1999. RESULTS: Among the most recently collected subset of data (1992-1999), sites demonstrating the greatest incidence of carcinoids were the gastrointestinal tract (67.5%). Most carcinoid tumors occurred in the small intestine (41.8%), rectum (27.4%), and stomach (8.7%). For all sites, age-adjusted incidence rates were highest in black males (4.48 per 100,000 population per year). Associated non-carcinoid tumors were frequent in conjunction with small intestinal (29.0%), gastric (20.5%), colonic (20.0%), and appendiceal (18.2%) carcinoids. The highest percentage of non-localized lesions were noted for cecal (81.5-83.2%) and pancreatic (71 9-81.3%) carcinoids, while the highest percentage of localized disease was found among rectal (81.7%) and gastric (67.5%) carci- noids. The best five-year survival rates were recorded for rectal (88.3%) and appendiceal (71.0%) carcinoids. In 129% of all carcinoid cases, distant metastases were evident at the time of diagnosis; the overall five-year survival rate for all carcinoid tumors, regardless of site, was 67.2%. CONCLUSIONS: Gastric and rectal carcinoids appear to have increased and appendiceal carcinoids have decreased over the past thirty years. The widely promulgated belief of the relative benignity of carcinoid disease is challenged by the findings of relatively low five-year survival rates irrespective of tumor type

S l190

The Incidence of Perforated Colonic Diverticular Disease and Risk Factors for Mortality in a UK Population Christopher Morris, lan Harvey, William Stebbmgs, Andrew Hart

Background: Perforated colonic diverticular disease (PCDD) is a serious condition with high associated morbidity and mortality Despite this, there are few studies that have directly measured the incidence of PCDD or investigated factors influencing outcome. The aims of this study were to measure the age and gender specific rates of perforation, and investigate pre-admission risk factors for mortality. Methods: The study population were people living within the counties of Norfolk and Suffolk, UK. Patients admitted to hospital with an abscess or peritonitis secondary to PCDD were included. They were identified by hospital coding departments using ICD-10 codes for a five-year period between April 1995 and April 2001. Hospital records were reviewed to confirm the diagnosis and to collect demographic and clinical data. Population statistics were obtained for the study area and used to calculate both crude and age and gender specific incidence rates. Risk factors for mortality were analysed using logistic regression Results: The study area covered a population of 1 2 million people. 179 cases were detected over the five year period consisting of 117 (65%) women and 61 men with a median age of 72 years (range 30 - 95 years). The crude incidence rate of PCDD for all ages was 3 0 cases/100 000/annum (95% confidence interval (CI) 2.6-3.4). The age standardised female: male ratio was 1.6 (CI: 1.4 - 20) and the age and gender specific rates are shown in the table. The case fatality rate for the disease was 26%. After multivariate analysis the following factors had a statistically significant association with mortality: Age>60 (Odds ratio(OR): 9B, CI: 1.2-75.5), high ASA (American Society of Anaesthesioiogists) score (OR: 3.8, CI: 2.2-6.7), and use of non-steroidal anti-inflammatory drugs (NSAIDs) (OR: 2.6, CI: 1 0-69) . Conclusion: The overall incidence of PCDD is greater in women and maximal in the population over 75 years. However, the higher incidence in men between the ages of 55 and 64 years suggest there may be an aetiological factor specific to this group. As expected, mortality" increases with age and in those with significant comorbidity. However, the use of NSAIDs appears to be an independent risk factor for death and clinicians should be aware of the poor outcome in patients taking these drugs.

Age and 0wder specll~r Inddence of PCDD

,,Gender Cases/100 0001 annum by age.bands. 0-r44years 45-54years 55-64years 65-?4years 75-84years 85+years

Male 0.5 2.2 5.3 4.5 7.3 6.9 Female 0.2 1.5 4,6 10.7 17.9 18,4

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