Calcium and Colorectal Cancer Risk
High intake of dietary calcium in women is significantly associated with reduction in the risk of colorectal cancer in a dose-response fashion, reported Andrew Flood, Ph.D., of the University of Minnesota, Minneapolis, and his colleagues.
In a prospective cohort of 45,354 women who completed dietary questionnaires over an average of 8.5 years, those in the highest quintile of calcium consumption (median of 985 mg /day) had a significant, 26% reduction in risk of colorectal cancer, compared with women in the lowest quintile (median of 337 mg/day), after adjustment for age. Supplemental calcium alone did not show the same dose-response relationship with colorectal cancer risk.
But women who had high intakes of calcium from their diet and supplements had a significant, 46% reduction in the risk of colorectal cancer after an adjustment was performed for age.
None of the associations changed after adjustment for other confounding factors (Cancer Epidemiol. Biomarkers Prev. 2005;14:126-32).
Predicting Fatal Alcoholic Hepatitis
The model for end-stage liver disease may offer a more practical method of predicting mortality from alcoholic hepatitis than the Maddrey discriminant function, despite similar accuracy between the two models, reported Winston Dunn, M.D., and his colleagues at the Mayo Clinic, Rochester, Minn.
With the optimal cut points for both models in a retrospective study of 73 patients with alcoholic hepatitis, the model for end-stage liver disease (MELD) had 75% sensitivity and specificity for both 30- and 90-day mortality. The discriminant function (DF) had 75% sensitivity and 69% specificity in predicting mortality at 30 days, and 88% sensitivity and 65% specificity at 90 days (Hepatology 2005;41:353-8).
MELD uses serum creatinine, serum bilirubin, and the international normalized ratio for prothrombin time, whereas DF uses prothrombin time in seconds and serum bilirubin. The investigators suggested that MELD may be more practical than DF because prothrombin time expressed as the international normalized ratio is comparable across all laboratories, unlike prothrombin time expressed in seconds. MELD also has been prospectively and retrospectively validated in heterogeneous cohorts of patients.
Lymph Nodes Missed in Colorectal Ca
Most patients with colorectal cancer who underwent radical surgery with no preoperative radiation during 1988-2001 did not receive adequate lymph node evaluation, according to findings from a population-based study of the National Cancer Institute's Surveillance, Epidemiology, and End Results cancer registry.
Of 116,995 patients, only 37% received adequate lymph node evaluation (at least 12 nodes), reported Nancy N. Baxter, M.D., of the University of Minnesota, Minneapolis, and her associates. The percentage of patients who received adequate lymph node evaluation was significantly higher among those who had stage II (41%) or III (46%) disease, compared with stage I (25%).
Patients with left-sided colon or rectal cancer had a significant, 50% lower likelihood of receiving adequate lymph node evaluation than those with right-sided colon cancer. Age of 71 years or older significantly reduced by 55% the likelihood of receiving adequate evaluation, compared with age of 50 years or younger (J. Natl. Cancer Inst. 2005;97:219-25). The investigators noted that a variety of factors influences the number of lymph nodes evaluated: number of nodes present in the patient, obesity, size of nodes and thickness of tumor penetration into the bowel, and underlying surgical and pathologic practice patterns.
Hepatitis B: Mono vs. Combo Therapy
In patients with hepatitis B e antigen-positive chronic hepatitis B, sustained viral response rates after discontinuing treatment were similar to those treated with pegylated interferon alfa-2b alone and those who received the interferon in combination with lamivudine, reported Harry L.A. Janssen, M.D., of Erasmus MC, Rotterdam (Netherlands), and his colleagues.
At the end of 52 weeks of treatment, hepatitis B e antigen was undetectable in significantly more patients in the combination therapy group (44%, 57 of 130) than in the monotherapy group (29%, 40 of 136). But 26 weeks after the end of treatment in the randomized, double-blind trial, the rate of sustained virologic response was similar in the monotherapy and combination-therapy patients (36% vs. 35%). The same trend in outcomes occurred when the investigators assessed hepatitis B virus DNA concentrations or alanine aminotransferase levels at the end of treatment and after follow-up (Lancet 2005;365:123-9).