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      "titulo" => "Comunicaciones orales : Cardiovasculares I"
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    "titulo" => "Comunicaciones orales :"
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    "textoCompleto" => "<p class="elsevierStylePara"> Jueves 2 de Octubre &#47; Thursday 2&#44; October<br></br> 11&#58;30&#58;00 a&#47;to 13&#58;30&#58;00</p><p class="elsevierStylePara"> Moderador&#47;Chairperson&#58;<br></br> Miquel Porta</p><p class="elsevierStylePara"><span class="elsevierStyleBold">041</span><span class="elsevierStyleBold">CANCER SURVIVAL IN PARENTS WHO LOST A CHILD&#58; A NATIONWIDE STUDY IN DENMARK</span></p><p class="elsevierStylePara"> Jiong Li&#42;&#44; Christoffer Johansen&#42;&#42;&#44; J&#248;rn Olsen&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Danish Epidemiology Science Centre&#44; Aarhus&#44; Denmark&#46; &#42;&#42;Department of Psychosocial Cancer Research&#44; Institute of Cancer Epidemiology&#47;Danish Cancer Society&#44; Copenhagen&#44; Denmark&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Psychological stress has been suggested to shorten cancer survival but only few studies have examined the effect of parental bereavement&#44; and the results have been inconsistent&#46; This study is to investigate the effect of the death of a child on the overall and specific cancer survival in parents who lost a child&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> We identified all 21&#44;062 parents who lost a child in Denmark from 1980 to 1996&#46; Among them&#44; 1630 parents had a subsequent incident cancer and they were recruited to the exposed cohort&#46; We recruited 6237 incident caner patients from a group of 293&#44;745 randomly selected unexposed parents matched on family structure at the same time as the bereaved parents&#46; All incident cancers in the two cohorts were followed to the end of 1997&#44; or until they died&#46; Cox&#39;s proportional-hazards regression models were used to evaluate the hazard ratio &#40;HR&#41; of dying in exposed parents with cancer&#46; We studied survival for&#58; All cancers&#44; site-specific cancers&#44; smoking-related cancers&#44; alcohol-related cancers&#44; virus&#47;immune-related cancers&#44; lymphatic&#47;haematopoietic cancers&#44; and hormone related cancers&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> The overall HR of dying from an incident cancer in exposed parents was 1&#46;23 &#40;95&#37; CI 1&#46;03-1&#46;47&#41;&#44; compared to parents with cancer who did not loose a child&#46; The HRs were nearly identical to those in the unexposed parents for site-specific cancers like lung cancer&#44; breast cancer and other groups of cancers like cancers in all digestive organs&#44; smoking related cancers&#44; alcohol related cancers&#44; hormone-related cancers and virus&#47;immune-related cancers&#44; and lymphatic&#47;haematopoietic cancers&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> Death of a child is not a strong prognostic factor for cancer survival among parents diagnosed with cancer after the bereavement&#46; However&#44; a small impairment in overall cancer survival cannot be ruled out&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">042</span><span class="elsevierStyleBold">CLINICAL VALUE OF SEROLOGICAL MARKERS&#44; INMUNOHISTOCHEMICAL MARKERS AND TOBACCO CONSUMPTION PREDICTING RELAPSE&#44; METASTASIS AND DEATH IN NON-SMALL CELL LUNG CANCER</span></p><p class="elsevierStylePara"> Marina Poll&#225;n&#44; Nuria Aragon&#233;s&#44; Gonzalo L&#243;pez-Abente&#44; Beatriz P&#233;rez-G&#243;mez&#46; En nombre del Grupo&#58; Group&#58; Prognostic Factors in NSCLC</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Unidad de Epidemiolog&#237;a Ambiental y C&#225;ncer&#44; Centro Nacional de Epidemiolog&#237;a del ISCIII&#44; Madrid&#44; Spain&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Objective&#58;</span> To assess the prognostic value of p53 and c-erbB-2 immunostaining&#44; preoperative serum levels of CEA and CA125 and tobacco consumption in non-small cell lung cancer &#40;NSCLC&#41; patients with resectable tumours&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> A prospective cohort of 465 NSCLC patients who underwent complete surgical resection in 13 Spanish hospitals were followed-up for a minimum of two years until the end of the study&#46; Smoking information was obtained through a structured questionnaire applied by non medical trained interviewers once the patient had been discharged from the hospital&#46; The average consumption during the 5 years previous to diagnosis was considered as a possible prognostic factor&#46; Four end-points were considered&#58; lung cancer death&#44; relapse in general&#44; loco-regional relapse and metastasis development&#46; Standard statistical survival methods&#44; namely Kaplan-Meier and Cox regression&#44; were used&#46; For comparison porpouses&#44; the same multivariate model was fitted for each end-point&#46; To explore the discriminative power of the final model in early stages of lung cancer&#44; a score constructed using the linear predictor from the final model was applied to the more homogeneous group of patients in stage IB &#40;202 patients&#41;&#44; given there were very few cases in stage IA&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> Pathological T and N classifications continue to be the strongest predictors regarding either relapse or mortality&#46; However&#44; three of the studied markers seemed to add further useful information&#44; but in a more specific context&#46; For example&#44; increased CEA concentration defined a higher risk population among adenocarcinomas but not among people with squamous tumours&#59; and p53 overexpression implied a worse prognosis mainly in patients with well differentiated tumours&#46; The analysis of type of relapse proved to be very informative&#46; Thus&#44; CA125 level was associated with a worse prognosis mainly related with metastasis development&#46; Another interesting result was the influence of smoking&#44; which showed a clear dose-response relationship with the probability of metastasis&#46; Applying the score from the final models to patients in stage IB it was possible to identify a subgroup of patients with a three-fold increased risk of metastasis development and death&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusion&#58;</span> TNM is still the strongest predictor in NSCLC patients&#44; but easily obtained markers can help to devise the best therapeutic decision&#46; The role of tobacco seems to expand beyond etiology&#46; The multidimensional nature of prognosis has been underinvestigated&#46; As our results point out&#44; the inclusion of a broader spectrum of end- points can be more informative&#46;</p><p class="elsevierStylePara"> Other Members of the Study Group &#40;alphabetic order&#41;&#58; Aurelio Arnedillo&#44; Ricardo Arrabal&#44; Emilio Canal&#237;s&#44; Manuel D&#237;ez&#44; Jorge Freixenet&#44; Mauricio Garc&#237;a&#44; Javier Garc&#237;a-Tirado&#44; Ana G&#243;mez&#44; Guillermo G&#243;mez&#44; Rogelio Gonz&#225;lez-Sarmiento&#44; Dolores Lude&#241;a&#44; Joan Minguella&#44; Dolores Ortega&#44; Joaqu&#237;n Pac&#44; Juan Jos&#233; Rivas&#44; Jose Mar&#237;a Rojas&#44; Fernando Sebasti&#225;n&#44; Mercedes de la Torre&#44; Antonio Torres&#44; Gonzalo Varela&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">043</span><span class="elsevierStyleBold">BLADDER CANCER&#58; HIGHER RISK OF TUMOUR RECURRENCE IN WOMEN</span></p><p class="elsevierStylePara"> Diana Puente<span class="elsevierStyleSup">1</span>&#44; N&#250;ria Malats<span class="elsevierStyleSup">1</span>&#44; &#192;lex Amor&#243;s<span class="elsevierStyleSup">1</span>&#44; Adonina Tard&#243;n<span class="elsevierStyleSup">2</span>&#44; Reina Garc&#237;a-Closas<span class="elsevierStyleSup">3</span>&#44; Consol Serra<span class="elsevierStyleSup">4</span>&#44; Alfredo Carrato<span class="elsevierStyleSup">5</span>&#44; Josep Lloreta<span class="elsevierStyleSup">6</span>&#44; Llu&#237;s Cecchini<span class="elsevierStyleSup">7</span>&#44; et al&#46; En nombre del Grupo&#58; for the EPICURO study group investigators</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>Unitat de Recerca en Respirat&#242;ria i Ambiental&#44; Instituto Municipal de Investigaci&#243;n M&#233;dica &#40;IMIM&#41;&#44; Barcelona&#44; Spain&#46; <span class="elsevierStyleSup">2</span>Universidad de Oviedo&#44; Oviedo&#44; Spain&#46; <span class="elsevierStyleSup">3</span>Hospital Universitario La Laguna&#44; Tenerife&#44; Spain&#46; <span class="elsevierStyleSup">4</span>Consorci Hospitalari Parc Taul&#237;&#44; Sabadell&#44; Spain&#46; <span class="elsevierStyleSup">5</span>Hospital General de Elche&#44; Alicante&#44; Spain&#46; <span class="elsevierStyleSup">6</span>Hospital del Mar&#44; Barcelona&#44; Spain&#46; <span class="elsevierStyleSup">7</span>Hospital Germans Trias i Pujol&#44; Badalona&#44; Spain&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Contrarily to other cancers&#44; the risk of dying is higher in women with bladder cancer than in men&#46; Little is known about the risk of intermediate events &#40;tumour recurrences and progression&#41; in relationship to gender&#46; Among the established prognostic factors for bladder cancer are invasiveness&#44; nuclear grade&#44; tumour size&#44; multiplicity and the presence of carcinoma in situ&#44; though it is not known whether these factors have the same effects in men and women&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Objective&#58;</span> The aim of the study is to assess whether the risk of bladder cancer recurrence is different for men and women&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methodology&#58;</span> Patients &#40;n&#61;498&#41; with superficial tumours newly diagnosed and recruited in 17 Spanish hospitals between May 1997 and April 2001 were included&#46; Information on sociodemographics was collected through personal computer-assisted questionnaires&#46; Clinical data related to diagnostic procedures&#44; treatment and tumoral characteristics were collected from hospital records&#46; Pathological characteristics of tumours were reviewed and reclassified according to WHO-ISUP&#39;98 by an expert pathologist&#46; Follow up information on tumour recurrence&#44; progression&#44; change of management and survival was gathered through hospital records and through direct personal telephone interviews&#46; The Kaplan-Meier method and multivariate Cox regression were applied&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> Out of 498 cases&#44; 108 developed tumoral recurrences &#40;21&#37; of men and 29&#37; of women&#44; p&#61;0&#46;133&#41;&#46; Kaplan-Meier analysis showed that women tended to present more recurrences than men &#40;p&#61;0&#46;100&#41;&#46; The difference was statistically significant for a major subgroup of superficial tumours &#40;TaGII&#41; when the analysis was adjusted for potential confounders such as morphology and treatment &#40;OR&#58; 3&#46;39 95&#37;CI 1&#46;23-9&#46;39&#41;&#46; A total of 42 cases presented tumoral progressions &#40;8&#37; in men and 10&#46;6&#37; in women&#44; p&#61;0&#46;495&#41;&#46; Women were not at a higher risk of progression than men after adjusting for confounding factors nor in any strata of the prognostic variables&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> Overall&#44; women presented a slightly increased risk of bladder tumour recurrence in comparison to men&#46; The higher risk of recurrences in women was confined to TaGII tumours&#46; Further investigation is needed to confirm this finding&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Partially funded by Fondo de Investigaci&#243;n Sanitaria 00&#47;0745&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">044</span><span class="elsevierStyleBold">POOLED ANALYSIS OF CASE-CONTROL STUDIES ON FLUID INTAKE AND BLADDER CANCER</span></p><p class="elsevierStylePara"> Cristina M&#46; Villanueva Belmonte<span class="elsevierStyleSup">1</span>&#44; Kenneth P&#46; Cantor<span class="elsevierStyleSup">2</span>&#44; Sylvaine Cordier <span class="elsevierStyleSup">3</span>&#44; Jouni JK Jaakkola<span class="elsevierStyleSup">4</span>&#44; Will D King<span class="elsevierStyleSup">5</span>&#44; Charles F Lynch<span class="elsevierStyleSup">6</span>&#44; Stefano Porru<span class="elsevierStyleSup">7</span>&#44; Manolis Kogevinas<span class="elsevierStyleSup">1</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>Respiratory and Environmental Research Unit&#44; Institut Municipal d&#39;Investigacio Medica&#44; Barcelona&#44; Spain&#46; <span class="elsevierStyleSup"> 2</span>Occupational Epidemiology Branch&#44; US National Cancer Institute&#44; Bethesda&#44; USA&#46; <span class="elsevierStyleSup">3</span>U435&#44; INSERM&#44; Rennes&#44; France&#46; <span class="elsevierStyleSup">4</span>Department of Public Health&#44; University of Helsinki&#44; Helsinki&#44; Finland&#46; <span class="elsevierStyleSup">5</span>Deparment of Community Health and Epidemiology&#44; Queen&#39;s University&#44; Ontario&#44; Canada&#46; <span class="elsevierStyleSup"> 6</span>Department of Epidemiology&#44; University of Iowa&#44; Iowa&#44; USA&#46; <span class="elsevierStyleSup">7</span>Institute of Occupational Health&#44; University of Brescia&#44; Brescia&#44; Italy&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> Prolonged exposure of the bladder urothelium to carcinogens in the urine has been suggested to affect the development of bladder cancer&#46; In an attempt to clarify this hypothesis&#44; epidemiological studies have evaluated the risk for bladder cancer in relation to quantity of fluid intake&#46; Contrary to expectation&#44; many studies found a slight excess risk in subjects with high total fluid intake&#44; although results have not been consistent&#46; We pooled and jointly analysed the data of the case-control studies of bladder cancer with detailed information on fluid intake and on contaminants of tap water&#44; particularly disinfection by-products&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> The pooled database includes two studies from USA&#44; and one each from Canada&#44; France&#44; Italy and Finland&#44; accounting for 3790 cases and 6075 controls&#46; Inclusion criteria were availability of detailed exposure data and accessibility to original data&#46; Primary data were combined using common definitions and coding schemes&#46; Subjects under 30 and over 80 years old&#44; and those with more than 2 years between diagnosis and interview were excluded&#46; Total fluids&#44; total tap water and total coffee intake were calculated&#46; Average exposure to disinfection by-products &#40;THMs-trihalomethanes&#41; was estimated for 40 years prior to interview&#46; Unconditional logistic regression was used and all odds ratios &#40;OR&#41; and 95&#37; confidence intervals &#40;95&#37;CI&#41; were adjusted for age&#44; sex&#44; centre&#44; smoking status and ever worked in high-risk occupations&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> The average total fluid intake in the study population was 2&#46;6 litres per day&#44; with 1&#46;5 litres from tap water&#46; We found an overall increased risk for total fluid intake &#40;OR per litre per day&#61;1&#46;08&#44; 95&#37;CI&#61;1&#46;03-1&#46;12&#41; and a dose-response pattern &#40;OR for highest quartile&#61;1&#46;33&#44; 1&#46;16-1&#46;53&#41;&#46; OR were higher for total tap water intake &#40;OR&#61;1&#46;16&#44; 1&#46;03-1&#46;31&#41; and a dose response pattern was also observed &#40;OR for highest quartile&#61;1&#46;33&#44; 1&#46;13-1&#46;57&#41;&#46; Drinking more than 5 cups of coffee per day was associated with an increased risk &#40;OR&#61;1&#46;28&#44; 1&#46;12-1&#46;46&#41;&#46; ORs increased with increasing levels of average THM exposure &#40;OR for highest quartile 1&#46;33&#44; 1&#46;15-1&#46;53&#41;&#46; Subjects in the highest quartile of tap water fluid intake and at the highest quartile of THMs had an OR of 2&#46;3 relative to those in the lowest quartile at both&#46; Exposure to disinfection by-products did not confound the ORs for fluid intake&#46; ORs for total fluid and tap water were highest in men&#46; All six studies found an excess risk for total fluid intake&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> Our results strengthen the hypothesis that total fluid intake is associated with an increased risk of bladder cancer&#46; There are no strong biological hypotheses explaining how high total fluid intake could increase the risk&#46; The positive associations found in most epidemiological studies may be&#44; in part&#44; attributed to the types of fluid intake&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">045</span><span class="elsevierStyleBold">ROLE OF HEPATITIS C VIRUS INFECTION IN MALIGNANT LYMPHOMA IN SPAIN</span></p><p class="elsevierStylePara"> Silvia de Sanjose<span class="elsevierStyleSup">1</span>&#44; Alexandra Nieters<span class="elsevierStyleSup">2</span>&#44; Jim J Goedert<span class="elsevierStyleSup">3</span>&#44; Yolanda Benavente<span class="elsevierStyleSup">4</span>&#44; Eva Domingo-Domench<span class="elsevierStyleSup">4</span>&#44; Alberto Fernadez de Sevilla<span class="elsevierStyleSup">5</span>&#44; Ramon Bosch<span class="elsevierStyleSup">6</span>&#44; Pilar Herrera<span class="elsevierStyleSup">7</span>&#44; Birgit Kalinowski<span class="elsevierStyleSup">8</span>&#44; et al</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>Epidemiologia i Registre del Cancer&#47; Viral Epidemiology&#44; ICO&#47;NCI&#44; Barcelona&#47;Spain&#44; Rockville&#47;USA&#46; <span class="elsevierStyleSup"> 2</span>Clinical Epidemiology German Cancer Research Center&#44; Heilderberg&#44; Germany&#46; <span class="elsevierStyleSup">3</span>Viral Epidemiology Branch&#44; NCI&#44; Rockville&#44; USA&#46; <span class="elsevierStyleSup">4</span>Epidemiologia i Registre del Cancer&#44; ICO&#44; Barcelona&#44; Spain&#46; <span class="elsevierStyleSup">5</span>Hematologia Oncologica&#44; ICO&#44; Barcelona&#44; Spain&#46; <span class="elsevierStyleSup">6</span>Patologia&#44; Hospital Verge de la Cinta&#44; Tortosa&#44; Spain&#46; <span class="elsevierStyleSup">7</span>Patologia&#44; Ramon y Cajal&#44; Madrid&#44; Spain&#46; <span class="elsevierStyleSup">8</span>Internal Medicine IV&#44; University Hospital of Heilderberg&#44; Germany&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> Hepatitis C virus &#40;HCV&#41; has been implicated in the etiology of malignant lymphomas&#46; We estimated the risk of lymphoma associated with detection of HCV infection&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> Cases &#40;N&#61; 532&#41; were consecutive patients newly diagnosed with a lymphoid malignancy between 1998 and 2002 in four centers in Spain&#46; Lymphomas were diagnosed and classified using the WHO Classification&#46; Controls &#40;N&#61;600&#41; were hospitalized patients matched to the cases by 5-year age group&#44; gender and study center&#46; Several medical conditions associated with severe immunosuppression precluded the eligibility of controls&#46; Patients underwent a personal interview and blood sampling&#46; HCV positive subjects were considered those with antibody response to third generation ELISA and&#47;or detection of HCV RNA with Amplicor 2&#46;0&#46; Cases were systematically tested for HIV antibodies&#46; Chi-square test and unconditional logistic regression were used to estimate the odds ratio &#40;OR&#41; and 95 percent confidence interval &#40;95&#37; CI&#41; for lymphoma associated with HCV&#46; All statistical tests were two-sided&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> HCV infection was detected in 40 cases &#40;7&#46;5&#37;&#41; and 23 &#40;3&#46;8&#37;&#41; control subjects&#46; HCV in sera was present in six of 16 patients with HIV-related lymphomas and in four of eight organ-recipient-related lymphomas&#46; HCV was associated with a two-fold increased risk for lymphoma &#91;odds ratio &#40;OR&#41;&#61; 2&#46;06 95&#37;CI&#61; 1&#46;21-3&#46;50&#93; as compared to HCV negative subjects&#44; with nearly identical results &#91;OR&#61;2&#46;04 &#40;95&#37;CI&#61;1&#46;42-3&#46;66&#41;&#93; with HCV status defined by HCV viremia&#46; Among non-HIV subjects the OR for all lymphomas was 1&#46;82 &#40;95&#37;CI &#61;1&#46;05-3&#46;17&#41; and among non-organ recipients the OR was 1&#46;85 &#40;95&#37;CI&#61;1&#46;08-3&#46;18&#41;&#46; Among all lymphoma categories&#44; HCV was most strongly associated with diffuse large-cell lymphoma &#40;OR&#61;4&#46;08&#44; 95&#37;CI&#61;1&#46;91-8&#46;71&#41;&#46; This risk was reduced when HIV or organ allograft transplant status was controlled for &#40;OR&#61;2&#46;20 95&#37;CI&#61; 0&#46;84-5&#46;73&#41;&#46; Among non-immunocompromised subjects&#44; a two-fold increased risk associated with HCV was also observed for marginal B-cell lymphomas and Hodgkin&#39;s lymphomas&#44; but the associations were not statistically significant&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> HCV infection is associated with an increased risk of lymphoma&#44; although the mechanism of this association has not been well defined&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">046</span><span class="elsevierStyleBold">ASSOCIATION OF TUMOURS OF THE GALLBLADDER AND THE BILIARY TRACT WITH MEDICAL CONDITIONS AND LIFESTYLE IN MEN - FIRST RESULTS OF O EUROPEAN MULTI-CENTRIC CASE-CONTROL STUDY</span></p><p class="elsevierStylePara"> Wolfgang Ahrens<span class="elsevierStyleSup">1</span>&#44; Antje Timmer<span class="elsevierStyleSup">2</span>&#44; Mogens Vyberg<span class="elsevierStyleSup">3</span>&#44; J&#248;rn Olsen<span class="elsevierStyleSup">4</span>&#46; En nombre del Grupo&#58; Rare Cancers Study Group</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>Bremen Institute for Prevention Research &#38; Social Medicine&#44; University Bremen&#44; Bremen&#44; Germany&#46; <span class="elsevierStyleSup"> 2</span>University Clinics&#44; Regensburg&#44; Germany&#46; <span class="elsevierStyleSup"> 3</span>Institute of Pathology&#44; Aalborg Hospital&#44; Aalborg&#44; Denmark&#46; <span class="elsevierStyleSup">4</span>Department of Epidemiology and Social Medicine&#44; Aarhus University&#44; Aarhus&#44; Denmark&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> This study was designed to identify yet unknown and possibly rare causes of cancer of the gallbladder and the extrahepatic biliary tract that could be amenable to preventive measures&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> Newly diagnosed male cases in the age-group 35 to 70 years were recruited between 1995 and 1997 in a population-based multi-centric case-control study involving six European countries &#40;Denmark&#44; Sweden&#44; France&#44; Germany&#44; Italy&#44; and Spain&#41;&#44;&#46; A central reference pathologist confirmed a tumour of the extrahepatic bile ducts &#40;EBD&#41;&#44; the gallbladder &#40;GB&#41;&#44; or of the Papilla Vateri &#40;PV&#41; included in the analysis&#46; Randomly selected controls from the general population were frequency-matched by age and study region to the cases&#46; Hospital controls were drawn in two study centres&#46; All participants were interviewed in person using a standardised questionnaire&#46; If a case was too ill or had died a surrogate person was interviewed&#46; Medical conditions were assessed as being confirmed by a physician and being present at least three years prior to diagnosis and interview&#46; The statistical analysis was performed by chi-square-tests and logistic regression using the SAS programme package&#46; Odds Ratios &#40;OR&#41; were adjusted for age &#40;5-year age groups&#41; and region of residence&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> 253 cases &#40;83 EBD&#44; 79 GB&#44; 80 PV&#44; 11 overlapping&#41; fulfilled the inclusion criteria &#40;97&#37; adeno-carcinoma&#41;&#46; There was no age difference between these localisations&#46; The analysis included 186 cases and 1969 controls for whom interviews were available&#46; The interview-response was 74&#37; and 66&#37; for cases and controls respectively&#46; Gallstones were confirmed as a risk factor for GB &#40;OR 2&#46;2&#59; 95&#37; confidence interval &#91;CI&#93; 0&#46;91-5&#46;36&#41;&#44; EBD &#40;OR 2&#46;6&#59; 95&#37; CI 1&#46;06-6&#46;32&#41; and PV &#40;OR 1&#46;5&#59; 95&#37; CI 0&#46;52-4&#46;25&#41;&#46; Cholecystectomy &#40;CCE&#41; was associated with all biliary tumours combined &#40;OR 1&#46;5&#59; 95&#37; CI 0&#46;51-4&#46;39&#41;&#46; Due to the low prevalence of CCE &#40;5&#37;&#41; we were unable to investigate differences by localisation&#46; Diabetes was associated with GB &#40;OR 2&#44;6&#59; 95&#37; CI 1&#46;12-5&#46;95&#41;&#46; For a body-mass-index &#91;BMI&#93; &#62;30 at the age of 35 an excess risk was observed relative to a normal BMI &#40;BMI 18&#46;5-25&#41; &#40;OR 1&#46;74&#59; 95&#37; CI 0&#46;88-3&#46;43&#41;&#46; This relationship was more pronounced for the BMI based on the smallest weight during adult life&#44; while this was not the case for a BMI &#62;30 one to five years prior to diagnosis &#40;OR 0&#46;96&#59; 95&#37; CI 0&#46;56-1&#46;64&#41;&#46; There was no convincing evidence for an association between biliary cancer and a history of diabetes mellitus&#44; hepatitis or typhus abdominalis&#46; Also smoking&#44; alcohol consumption&#44; and education showed no association with this cancer&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> Gallstones were confirmed as the most important risk factor for biliary cancer&#46; Apart from overweight we did not find any factors related to lifestyle that were associated with this cancer&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">047</span><span class="elsevierStyleBold">EUROCHIP&#58; AN EUROPEAN PROJECT FOR THE CANCER SURVEILLANCE&#46; THE ROLE OF SPAIN</span></p><p class="elsevierStylePara"> Andrea Micheli<span class="elsevierStyleSup">1</span>&#44; Carmen Navarro<span class="elsevierStyleSup">2</span>&#44; Paolo Baili<span class="elsevierStyleSup">1</span>&#44; Marina Pollan<span class="elsevierStyleSup">3</span>&#44; Isabel Izarzugaza<span class="elsevierStyleSup">4</span>&#44; Isabel Garau<span class="elsevierStyleSup">5</span>&#44; Nieves Ascunce Elizaga<span class="elsevierStyleSup">6</span>&#44; Carmen Martinez<span class="elsevierStyleSup">7</span>&#46; Eurochip&#58; An European Project for the Cancer Surveillance</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>Unit of Epidemiology&#44; Istituto Nazionale per lo Studio e la Cura dei Tumori&#44; Milan&#44; Italy&#46; <span class="elsevierStyleSup"> 2</span>Consejer&#237;a de Sanidad Murcia&#44; Spain&#46; <span class="elsevierStyleSup"> 3</span>National Center for Epidemiology Carlos III&#44; Madrid Spain&#46; <span class="elsevierStyleSup">4</span>Basque Country Cancer Registry&#44; Spain&#46; <span class="elsevierStyleSup"> 5</span>Mallorca Cancer Registry&#44; Spain&#46; <span class="elsevierStyleSup">6</span>European Breast Cancer Network&#44; Spain&#46; <span class="elsevierStyleSup">7</span>Granada Cancer Registry&#44; Spain&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#47;background&#58;</span> Despite the concern on cancer&#44; a monitoring system covering all European Union &#40;EU&#41; countries did not yet exist&#46; EUROCHIP &#40;European Cancer Health Indicator Project&#41; thus aimed to produce a comprehensive list of cancer health indicators pertaining to cancer&#44; with variables describing the natural history of the disease&#58; occurrence&#44; clinical follow-up&#44; recurrences&#44; patient survival&#44; diagnostic and therapeutic procedures&#44; effectiveness of care&#44; outcome and care prevalence&#46; The project was conceived as part of a large-scale Health Monitoring Programme &#40;HMP&#41;&#44; supported by the European Commission&#44; that has been implemented to set EU health indicators&#46; It was mainly intended as an intellectual work organised to reach the maximum consensus on a list of indicators&#46; EUROCHIP chose variables according to criteria of easy collection&#44; comparability and grade of each country&#39;s representation and hence proposed standardised methods for collection&#46; Final aim of the project is to improve cancer surveillance and promote actions in all European countries to reduce inequalities in controlling tumours&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> A complex organisation was set up&#46; Each indicator was discussed in several meetings at both national and international levels&#46; International meetings on different domains &#40;prevention&#44; epidemiology and cancer registration&#44; screening&#44; treatment and clinical aspects&#44; and social and macro-economic variables&#41; was organised&#46; We aimed to achieve a general consensus for several aspects of the indicators&#58; i&#46;e&#46; description&#44; operational definition&#44; meaning&#44; possible use&#44; caveat&#44; modalities of classification&#44; possible sources&#44; standardisation and validity&#46; The final list was obtained from discussions on priorities which&#44; as a whole&#44; added value to the indicator&#44; highlighted problems on comparability among European countries&#44; on data collection and on the relative costs&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> More than 130 cancer specialists of 15 countries belonging to different fields were involved in the various phases of the project&#46; EUROCHIP produced a list of indicators collectable in the next years in each European country for the development of a large European health database&#46; A European set of data is presently being constructed&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> This presentation aims to present the results EUROCHIP to the Spanish epidemiological audience&#46; The meaning of the indicators will be given&#46; However&#44; a new phase is now in progress&#46; It is our intention to organise a group of cancer specialists in different countries to discuss the available data to monitor cancer control&#46; The goal will be to reduce disparities&#44; fight inequalities and increase the capability of the national health system in cancer surveillance&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">047</span><span class="elsevierStyleBold">SERUM CONCENTRATIONS OF HIGHLY PREVALENT ORGANOCHLORINE COMPOUNDS AND RISK OF EXOCRINE PANCREATIC CANCER&#58; A CASE-CONTROL ANALYSIS</span></p><p class="elsevierStylePara"> Miquel Porta<span class="elsevierStyleSup">1</span>&#44; Ekhine Zumeta<span class="elsevierStyleSup">1</span>&#44; Laura Ruiz<span class="elsevierStyleSup">1</span>&#44; Manuel Jariod<span class="elsevierStyleSup">1</span>&#44; N&#250;ria Malats<span class="elsevierStyleSup">2</span>&#44; Joan Alguacil<span class="elsevierStyleSup">3</span>&#44; Alfredo Carrato<span class="elsevierStyleSup">4</span>&#44; Francisco X&#46; Real<span class="elsevierStyleSup">5</span>&#44; Joan O&#46; Grimalt<span class="elsevierStyleSup">6</span>&#46; En nombre del Grupo&#58; PANKRAS II Study Group</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>GRECMC&#44; IMIM&#44; Barcelona&#44; Spain&#46; <span class="elsevierStyleSup">2</span>URRA&#44; IMIM&#44; Barcelona&#44; Spain&#46; <span class="elsevierStyleSup">3</span>Occupational &#38; Environmental Epidemiology Branch&#44; NCI&#44; Bethesda&#44; USA&#46; <span class="elsevierStyleSup"> 4</span>Hospital General d&#39;Elx&#44; Universitat Miguel Hern&#225;ndez&#44; Alacant&#44; Spain&#46; <span class="elsevierStyleSup">5</span>URBCM&#44; IMIM&#44; Barcelona&#44; Spain&#46; <span class="elsevierStyleSup"> 6</span>Environmental Chemistry&#44; CSIC&#44; Barcelona&#44; Spain&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Whilst knowledge on the etiology of exocrine pancreatic cancer &#40;EPC&#41; is limited&#44; organochlorine compounds &#40;OCs&#41; as DDT&#44; DDE and polychlorinated biphenyls &#40;PCBs&#41; may increase the risk &#91;1&#44;2&#93;&#44; and several mechanistic scenarios have been proposed &#91;1-3&#93;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> All EPC cases newly diagnosed at 5 general hospitals were prospectively included &#40;n&#61;185&#41;&#46; Over 88&#37; were personally interviewed in-hospital&#46; Serum concentrations of OCs were measured by high-resolution gas chromatography with electron-capture detection in 144 patients&#44; thus increasing by 182&#37; the sample size of our previous&#44; early report &#91;1&#93;&#46; Cases were compared with 27 conventional hospital controls recruited in one of the study hospitals among subjects admitted for benign&#44; non-digestive disorders&#46; Multivariate-adjusted odds ratios &#40;OR&#41; and their 95&#37; confidence limits &#40;CL&#41; were computed by unconditional logistic regression&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> Serum levels of p&#44;p&#39;-DDT and p&#44;p&#39;-DDE were significantly higher in cases than in controls&#58; the respective medians &#40;mcg&#47;g lipid&#41; were&#44; for DDT&#44; 0&#46;42 and 0&#46;20 &#40;p &#61; 0&#46;04&#41;&#44; and for DDE&#44; 2&#46;70 and 1&#46;26 &#40;p &#60;0&#46;01&#41;&#46; The OR for the upper &#40;&#62;0&#46;574 mcg&#47;g&#41; vs&#46; lower &#40;&#60;0&#46;205 mcg&#47;g&#41; tertile of p&#44;p&#39;-DDT&#44; adjusted by age&#44; sex&#44; tobacco&#44; alcohol and coffee consumption &#40;ORa&#41; was 4&#46;52 &#40;CL&#58; 1&#46;36 and 14&#46;97&#59; p for trend &#61; 0&#46;012&#41;&#46; The ORa was similar for p&#44;p&#39;-DDE &#40;p-trend &#61; 0&#46;006&#41;&#46; These estimates held when adjusting by other OCs&#59; e&#46;g&#46;&#44; the ORa for the mid &#40;1&#46;441-3&#46;970 mcg&#47;g&#41; vs&#46; lower &#40;&#60;1&#46;441&#41; tertile of p&#44;p&#39;-DDE&#44; further adjusted by PCBs 138&#44; 153 and 180&#44; hexachlorobenzene &#40;HCB&#41; and &#226;-hexachlorocyclohexane &#40;&#226;-HCH&#41; was 5&#46;22 &#40;CL&#58; 1&#46;37 and 19&#46;96&#41;&#59; the corresponding figure for the upper tertile &#40;&#62;3&#46;970&#41; was 7&#46;57 &#40;CL&#58; 1&#46;53 and 37&#46;40&#41; &#40;p for trend &#61; 0&#46;009&#41;&#46; Most ORa for PCBs&#44; HCB and &#226;-HCH were in the range 1&#46;49 to 1&#46;87&#44; and none was statistically significant&#46; Thus&#44; the association between levels of OCs and risk of EPC was not indiscriminate with all OCs&#58; concentrations of HCB and &#226;-HCH in cases were high &#40;median of 1&#46;46 and 0&#46;86 mcg&#47;g&#44; respectively&#41;&#44; and yet these two compounds were not associated with an increased risk&#46; Concentrations of DDE were twice as high in our cases than in cases from San Francisco&#44; USA &#91;2&#93;&#44; while those of HCB were over 66 times higher in our study&#46; Concentrations of PCBs are hard to compare because different congeners were analysed in each study &#91;1&#44;2&#93;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusion&#58;</span> Organochlorine compounds as p&#44;p&#39;-DDT and p&#44;p&#39;-DDE may increase the risk of exocrine pancreatic cancer&#46; The results truly need to be refuted or replicated by new studies&#44; which should also assess interactions among OCs&#44; and of OCs with other environmental exposures and with genetic factors&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">References&#58;</span></p><p class="elsevierStylePara"> 1&#46; Porta M et al&#46; Lancet 1999&#46;<br></br> 2&#46; Hoppin JA et al&#46; Cancer Epidemiol Biomarkers Prev 2000&#46;<br></br> 3&#46; Porta M et al&#46; Molec Carcinogenesis 2003&#46;</p>"
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    "textoCompleto" => "<p class="elsevierStylePara"> Jueves 2 de Octubre &#47; Thursday 2&#44; October<br></br> 11&#58;30&#58;00 a&#47;to 13&#58;30&#58;00</p><p class="elsevierStylePara"> Moderador&#47;Chairperson&#58;<br></br> Miquel Porta</p><p class="elsevierStylePara"><span class="elsevierStyleBold">041</span><span class="elsevierStyleBold">CANCER SURVIVAL IN PARENTS WHO LOST A CHILD&#58; A NATIONWIDE STUDY IN DENMARK</span></p><p class="elsevierStylePara"> Jiong Li&#42;&#44; Christoffer Johansen&#42;&#42;&#44; J&#248;rn Olsen&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Danish Epidemiology Science Centre&#44; Aarhus&#44; Denmark&#46; &#42;&#42;Department of Psychosocial Cancer Research&#44; Institute of Cancer Epidemiology&#47;Danish Cancer Society&#44; Copenhagen&#44; Denmark&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Psychological stress has been suggested to shorten cancer survival but only few studies have examined the effect of parental bereavement&#44; and the results have been inconsistent&#46; This study is to investigate the effect of the death of a child on the overall and specific cancer survival in parents who lost a child&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> We identified all 21&#44;062 parents who lost a child in Denmark from 1980 to 1996&#46; Among them&#44; 1630 parents had a subsequent incident cancer and they were recruited to the exposed cohort&#46; We recruited 6237 incident caner patients from a group of 293&#44;745 randomly selected unexposed parents matched on family structure at the same time as the bereaved parents&#46; All incident cancers in the two cohorts were followed to the end of 1997&#44; or until they died&#46; Cox&#39;s proportional-hazards regression models were used to evaluate the hazard ratio &#40;HR&#41; of dying in exposed parents with cancer&#46; We studied survival for&#58; All cancers&#44; site-specific cancers&#44; smoking-related cancers&#44; alcohol-related cancers&#44; virus&#47;immune-related cancers&#44; lymphatic&#47;haematopoietic cancers&#44; and hormone related cancers&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> The overall HR of dying from an incident cancer in exposed parents was 1&#46;23 &#40;95&#37; CI 1&#46;03-1&#46;47&#41;&#44; compared to parents with cancer who did not loose a child&#46; The HRs were nearly identical to those in the unexposed parents for site-specific cancers like lung cancer&#44; breast cancer and other groups of cancers like cancers in all digestive organs&#44; smoking related cancers&#44; alcohol related cancers&#44; hormone-related cancers and virus&#47;immune-related cancers&#44; and lymphatic&#47;haematopoietic cancers&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> Death of a child is not a strong prognostic factor for cancer survival among parents diagnosed with cancer after the bereavement&#46; However&#44; a small impairment in overall cancer survival cannot be ruled out&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">042</span><span class="elsevierStyleBold">CLINICAL VALUE OF SEROLOGICAL MARKERS&#44; INMUNOHISTOCHEMICAL MARKERS AND TOBACCO CONSUMPTION PREDICTING RELAPSE&#44; METASTASIS AND DEATH IN NON-SMALL CELL LUNG CANCER</span></p><p class="elsevierStylePara"> Marina Poll&#225;n&#44; Nuria Aragon&#233;s&#44; Gonzalo L&#243;pez-Abente&#44; Beatriz P&#233;rez-G&#243;mez&#46; En nombre del Grupo&#58; Group&#58; Prognostic Factors in NSCLC</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Unidad de Epidemiolog&#237;a Ambiental y C&#225;ncer&#44; Centro Nacional de Epidemiolog&#237;a del ISCIII&#44; Madrid&#44; Spain&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Objective&#58;</span> To assess the prognostic value of p53 and c-erbB-2 immunostaining&#44; preoperative serum levels of CEA and CA125 and tobacco consumption in non-small cell lung cancer &#40;NSCLC&#41; patients with resectable tumours&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> A prospective cohort of 465 NSCLC patients who underwent complete surgical resection in 13 Spanish hospitals were followed-up for a minimum of two years until the end of the study&#46; Smoking information was obtained through a structured questionnaire applied by non medical trained interviewers once the patient had been discharged from the hospital&#46; The average consumption during the 5 years previous to diagnosis was considered as a possible prognostic factor&#46; Four end-points were considered&#58; lung cancer death&#44; relapse in general&#44; loco-regional relapse and metastasis development&#46; Standard statistical survival methods&#44; namely Kaplan-Meier and Cox regression&#44; were used&#46; For comparison porpouses&#44; the same multivariate model was fitted for each end-point&#46; To explore the discriminative power of the final model in early stages of lung cancer&#44; a score constructed using the linear predictor from the final model was applied to the more homogeneous group of patients in stage IB &#40;202 patients&#41;&#44; given there were very few cases in stage IA&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> Pathological T and N classifications continue to be the strongest predictors regarding either relapse or mortality&#46; However&#44; three of the studied markers seemed to add further useful information&#44; but in a more specific context&#46; For example&#44; increased CEA concentration defined a higher risk population among adenocarcinomas but not among people with squamous tumours&#59; and p53 overexpression implied a worse prognosis mainly in patients with well differentiated tumours&#46; The analysis of type of relapse proved to be very informative&#46; Thus&#44; CA125 level was associated with a worse prognosis mainly related with metastasis development&#46; Another interesting result was the influence of smoking&#44; which showed a clear dose-response relationship with the probability of metastasis&#46; Applying the score from the final models to patients in stage IB it was possible to identify a subgroup of patients with a three-fold increased risk of metastasis development and death&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusion&#58;</span> TNM is still the strongest predictor in NSCLC patients&#44; but easily obtained markers can help to devise the best therapeutic decision&#46; The role of tobacco seems to expand beyond etiology&#46; The multidimensional nature of prognosis has been underinvestigated&#46; As our results point out&#44; the inclusion of a broader spectrum of end- points can be more informative&#46;</p><p class="elsevierStylePara"> Other Members of the Study Group &#40;alphabetic order&#41;&#58; Aurelio Arnedillo&#44; Ricardo Arrabal&#44; Emilio Canal&#237;s&#44; Manuel D&#237;ez&#44; Jorge Freixenet&#44; Mauricio Garc&#237;a&#44; Javier Garc&#237;a-Tirado&#44; Ana G&#243;mez&#44; Guillermo G&#243;mez&#44; Rogelio Gonz&#225;lez-Sarmiento&#44; Dolores Lude&#241;a&#44; Joan Minguella&#44; Dolores Ortega&#44; Joaqu&#237;n Pac&#44; Juan Jos&#233; Rivas&#44; Jose Mar&#237;a Rojas&#44; Fernando Sebasti&#225;n&#44; Mercedes de la Torre&#44; Antonio Torres&#44; Gonzalo Varela&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">043</span><span class="elsevierStyleBold">BLADDER CANCER&#58; HIGHER RISK OF TUMOUR RECURRENCE IN WOMEN</span></p><p class="elsevierStylePara"> Diana Puente<span class="elsevierStyleSup">1</span>&#44; N&#250;ria Malats<span class="elsevierStyleSup">1</span>&#44; &#192;lex Amor&#243;s<span class="elsevierStyleSup">1</span>&#44; Adonina Tard&#243;n<span class="elsevierStyleSup">2</span>&#44; Reina Garc&#237;a-Closas<span class="elsevierStyleSup">3</span>&#44; Consol Serra<span class="elsevierStyleSup">4</span>&#44; Alfredo Carrato<span class="elsevierStyleSup">5</span>&#44; Josep Lloreta<span class="elsevierStyleSup">6</span>&#44; Llu&#237;s Cecchini<span class="elsevierStyleSup">7</span>&#44; et al&#46; En nombre del Grupo&#58; for the EPICURO study group investigators</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>Unitat de Recerca en Respirat&#242;ria i Ambiental&#44; Instituto Municipal de Investigaci&#243;n M&#233;dica &#40;IMIM&#41;&#44; Barcelona&#44; Spain&#46; <span class="elsevierStyleSup">2</span>Universidad de Oviedo&#44; Oviedo&#44; Spain&#46; <span class="elsevierStyleSup">3</span>Hospital Universitario La Laguna&#44; Tenerife&#44; Spain&#46; <span class="elsevierStyleSup">4</span>Consorci Hospitalari Parc Taul&#237;&#44; Sabadell&#44; Spain&#46; <span class="elsevierStyleSup">5</span>Hospital General de Elche&#44; Alicante&#44; Spain&#46; <span class="elsevierStyleSup">6</span>Hospital del Mar&#44; Barcelona&#44; Spain&#46; <span class="elsevierStyleSup">7</span>Hospital Germans Trias i Pujol&#44; Badalona&#44; Spain&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Contrarily to other cancers&#44; the risk of dying is higher in women with bladder cancer than in men&#46; Little is known about the risk of intermediate events &#40;tumour recurrences and progression&#41; in relationship to gender&#46; Among the established prognostic factors for bladder cancer are invasiveness&#44; nuclear grade&#44; tumour size&#44; multiplicity and the presence of carcinoma in situ&#44; though it is not known whether these factors have the same effects in men and women&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Objective&#58;</span> The aim of the study is to assess whether the risk of bladder cancer recurrence is different for men and women&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methodology&#58;</span> Patients &#40;n&#61;498&#41; with superficial tumours newly diagnosed and recruited in 17 Spanish hospitals between May 1997 and April 2001 were included&#46; Information on sociodemographics was collected through personal computer-assisted questionnaires&#46; Clinical data related to diagnostic procedures&#44; treatment and tumoral characteristics were collected from hospital records&#46; Pathological characteristics of tumours were reviewed and reclassified according to WHO-ISUP&#39;98 by an expert pathologist&#46; Follow up information on tumour recurrence&#44; progression&#44; change of management and survival was gathered through hospital records and through direct personal telephone interviews&#46; The Kaplan-Meier method and multivariate Cox regression were applied&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> Out of 498 cases&#44; 108 developed tumoral recurrences &#40;21&#37; of men and 29&#37; of women&#44; p&#61;0&#46;133&#41;&#46; Kaplan-Meier analysis showed that women tended to present more recurrences than men &#40;p&#61;0&#46;100&#41;&#46; The difference was statistically significant for a major subgroup of superficial tumours &#40;TaGII&#41; when the analysis was adjusted for potential confounders such as morphology and treatment &#40;OR&#58; 3&#46;39 95&#37;CI 1&#46;23-9&#46;39&#41;&#46; A total of 42 cases presented tumoral progressions &#40;8&#37; in men and 10&#46;6&#37; in women&#44; p&#61;0&#46;495&#41;&#46; Women were not at a higher risk of progression than men after adjusting for confounding factors nor in any strata of the prognostic variables&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> Overall&#44; women presented a slightly increased risk of bladder tumour recurrence in comparison to men&#46; The higher risk of recurrences in women was confined to TaGII tumours&#46; Further investigation is needed to confirm this finding&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Partially funded by Fondo de Investigaci&#243;n Sanitaria 00&#47;0745&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">044</span><span class="elsevierStyleBold">POOLED ANALYSIS OF CASE-CONTROL STUDIES ON FLUID INTAKE AND BLADDER CANCER</span></p><p class="elsevierStylePara"> Cristina M&#46; Villanueva Belmonte<span class="elsevierStyleSup">1</span>&#44; Kenneth P&#46; Cantor<span class="elsevierStyleSup">2</span>&#44; Sylvaine Cordier <span class="elsevierStyleSup">3</span>&#44; Jouni JK Jaakkola<span class="elsevierStyleSup">4</span>&#44; Will D King<span class="elsevierStyleSup">5</span>&#44; Charles F Lynch<span class="elsevierStyleSup">6</span>&#44; Stefano Porru<span class="elsevierStyleSup">7</span>&#44; Manolis Kogevinas<span class="elsevierStyleSup">1</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>Respiratory and Environmental Research Unit&#44; Institut Municipal d&#39;Investigacio Medica&#44; Barcelona&#44; Spain&#46; <span class="elsevierStyleSup"> 2</span>Occupational Epidemiology Branch&#44; US National Cancer Institute&#44; Bethesda&#44; USA&#46; <span class="elsevierStyleSup">3</span>U435&#44; INSERM&#44; Rennes&#44; France&#46; <span class="elsevierStyleSup">4</span>Department of Public Health&#44; University of Helsinki&#44; Helsinki&#44; Finland&#46; <span class="elsevierStyleSup">5</span>Deparment of Community Health and Epidemiology&#44; Queen&#39;s University&#44; Ontario&#44; Canada&#46; <span class="elsevierStyleSup"> 6</span>Department of Epidemiology&#44; University of Iowa&#44; Iowa&#44; USA&#46; <span class="elsevierStyleSup">7</span>Institute of Occupational Health&#44; University of Brescia&#44; Brescia&#44; Italy&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> Prolonged exposure of the bladder urothelium to carcinogens in the urine has been suggested to affect the development of bladder cancer&#46; In an attempt to clarify this hypothesis&#44; epidemiological studies have evaluated the risk for bladder cancer in relation to quantity of fluid intake&#46; Contrary to expectation&#44; many studies found a slight excess risk in subjects with high total fluid intake&#44; although results have not been consistent&#46; We pooled and jointly analysed the data of the case-control studies of bladder cancer with detailed information on fluid intake and on contaminants of tap water&#44; particularly disinfection by-products&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> The pooled database includes two studies from USA&#44; and one each from Canada&#44; France&#44; Italy and Finland&#44; accounting for 3790 cases and 6075 controls&#46; Inclusion criteria were availability of detailed exposure data and accessibility to original data&#46; Primary data were combined using common definitions and coding schemes&#46; Subjects under 30 and over 80 years old&#44; and those with more than 2 years between diagnosis and interview were excluded&#46; Total fluids&#44; total tap water and total coffee intake were calculated&#46; Average exposure to disinfection by-products &#40;THMs-trihalomethanes&#41; was estimated for 40 years prior to interview&#46; Unconditional logistic regression was used and all odds ratios &#40;OR&#41; and 95&#37; confidence intervals &#40;95&#37;CI&#41; were adjusted for age&#44; sex&#44; centre&#44; smoking status and ever worked in high-risk occupations&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> The average total fluid intake in the study population was 2&#46;6 litres per day&#44; with 1&#46;5 litres from tap water&#46; We found an overall increased risk for total fluid intake &#40;OR per litre per day&#61;1&#46;08&#44; 95&#37;CI&#61;1&#46;03-1&#46;12&#41; and a dose-response pattern &#40;OR for highest quartile&#61;1&#46;33&#44; 1&#46;16-1&#46;53&#41;&#46; OR were higher for total tap water intake &#40;OR&#61;1&#46;16&#44; 1&#46;03-1&#46;31&#41; and a dose response pattern was also observed &#40;OR for highest quartile&#61;1&#46;33&#44; 1&#46;13-1&#46;57&#41;&#46; Drinking more than 5 cups of coffee per day was associated with an increased risk &#40;OR&#61;1&#46;28&#44; 1&#46;12-1&#46;46&#41;&#46; ORs increased with increasing levels of average THM exposure &#40;OR for highest quartile 1&#46;33&#44; 1&#46;15-1&#46;53&#41;&#46; Subjects in the highest quartile of tap water fluid intake and at the highest quartile of THMs had an OR of 2&#46;3 relative to those in the lowest quartile at both&#46; Exposure to disinfection by-products did not confound the ORs for fluid intake&#46; ORs for total fluid and tap water were highest in men&#46; All six studies found an excess risk for total fluid intake&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> Our results strengthen the hypothesis that total fluid intake is associated with an increased risk of bladder cancer&#46; There are no strong biological hypotheses explaining how high total fluid intake could increase the risk&#46; The positive associations found in most epidemiological studies may be&#44; in part&#44; attributed to the types of fluid intake&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">045</span><span class="elsevierStyleBold">ROLE OF HEPATITIS C VIRUS INFECTION IN MALIGNANT LYMPHOMA IN SPAIN</span></p><p class="elsevierStylePara"> Silvia de Sanjose<span class="elsevierStyleSup">1</span>&#44; Alexandra Nieters<span class="elsevierStyleSup">2</span>&#44; Jim J Goedert<span class="elsevierStyleSup">3</span>&#44; Yolanda Benavente<span class="elsevierStyleSup">4</span>&#44; Eva Domingo-Domench<span class="elsevierStyleSup">4</span>&#44; Alberto Fernadez de Sevilla<span class="elsevierStyleSup">5</span>&#44; Ramon Bosch<span class="elsevierStyleSup">6</span>&#44; Pilar Herrera<span class="elsevierStyleSup">7</span>&#44; Birgit Kalinowski<span class="elsevierStyleSup">8</span>&#44; et al</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>Epidemiologia i Registre del Cancer&#47; Viral Epidemiology&#44; ICO&#47;NCI&#44; Barcelona&#47;Spain&#44; Rockville&#47;USA&#46; <span class="elsevierStyleSup"> 2</span>Clinical Epidemiology German Cancer Research Center&#44; Heilderberg&#44; Germany&#46; <span class="elsevierStyleSup">3</span>Viral Epidemiology Branch&#44; NCI&#44; Rockville&#44; USA&#46; <span class="elsevierStyleSup">4</span>Epidemiologia i Registre del Cancer&#44; ICO&#44; Barcelona&#44; Spain&#46; <span class="elsevierStyleSup">5</span>Hematologia Oncologica&#44; ICO&#44; Barcelona&#44; Spain&#46; <span class="elsevierStyleSup">6</span>Patologia&#44; Hospital Verge de la Cinta&#44; Tortosa&#44; Spain&#46; <span class="elsevierStyleSup">7</span>Patologia&#44; Ramon y Cajal&#44; Madrid&#44; Spain&#46; <span class="elsevierStyleSup">8</span>Internal Medicine IV&#44; University Hospital of Heilderberg&#44; Germany&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> Hepatitis C virus &#40;HCV&#41; has been implicated in the etiology of malignant lymphomas&#46; We estimated the risk of lymphoma associated with detection of HCV infection&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> Cases &#40;N&#61; 532&#41; were consecutive patients newly diagnosed with a lymphoid malignancy between 1998 and 2002 in four centers in Spain&#46; Lymphomas were diagnosed and classified using the WHO Classification&#46; Controls &#40;N&#61;600&#41; were hospitalized patients matched to the cases by 5-year age group&#44; gender and study center&#46; Several medical conditions associated with severe immunosuppression precluded the eligibility of controls&#46; Patients underwent a personal interview and blood sampling&#46; HCV positive subjects were considered those with antibody response to third generation ELISA and&#47;or detection of HCV RNA with Amplicor 2&#46;0&#46; Cases were systematically tested for HIV antibodies&#46; Chi-square test and unconditional logistic regression were used to estimate the odds ratio &#40;OR&#41; and 95 percent confidence interval &#40;95&#37; CI&#41; for lymphoma associated with HCV&#46; All statistical tests were two-sided&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> HCV infection was detected in 40 cases &#40;7&#46;5&#37;&#41; and 23 &#40;3&#46;8&#37;&#41; control subjects&#46; HCV in sera was present in six of 16 patients with HIV-related lymphomas and in four of eight organ-recipient-related lymphomas&#46; HCV was associated with a two-fold increased risk for lymphoma &#91;odds ratio &#40;OR&#41;&#61; 2&#46;06 95&#37;CI&#61; 1&#46;21-3&#46;50&#93; as compared to HCV negative subjects&#44; with nearly identical results &#91;OR&#61;2&#46;04 &#40;95&#37;CI&#61;1&#46;42-3&#46;66&#41;&#93; with HCV status defined by HCV viremia&#46; Among non-HIV subjects the OR for all lymphomas was 1&#46;82 &#40;95&#37;CI &#61;1&#46;05-3&#46;17&#41; and among non-organ recipients the OR was 1&#46;85 &#40;95&#37;CI&#61;1&#46;08-3&#46;18&#41;&#46; Among all lymphoma categories&#44; HCV was most strongly associated with diffuse large-cell lymphoma &#40;OR&#61;4&#46;08&#44; 95&#37;CI&#61;1&#46;91-8&#46;71&#41;&#46; This risk was reduced when HIV or organ allograft transplant status was controlled for &#40;OR&#61;2&#46;20 95&#37;CI&#61; 0&#46;84-5&#46;73&#41;&#46; Among non-immunocompromised subjects&#44; a two-fold increased risk associated with HCV was also observed for marginal B-cell lymphomas and Hodgkin&#39;s lymphomas&#44; but the associations were not statistically significant&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> HCV infection is associated with an increased risk of lymphoma&#44; although the mechanism of this association has not been well defined&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">046</span><span class="elsevierStyleBold">ASSOCIATION OF TUMOURS OF THE GALLBLADDER AND THE BILIARY TRACT WITH MEDICAL CONDITIONS AND LIFESTYLE IN MEN - FIRST RESULTS OF O EUROPEAN MULTI-CENTRIC CASE-CONTROL STUDY</span></p><p class="elsevierStylePara"> Wolfgang Ahrens<span class="elsevierStyleSup">1</span>&#44; Antje Timmer<span class="elsevierStyleSup">2</span>&#44; Mogens Vyberg<span class="elsevierStyleSup">3</span>&#44; J&#248;rn Olsen<span class="elsevierStyleSup">4</span>&#46; En nombre del Grupo&#58; Rare Cancers Study Group</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>Bremen Institute for Prevention Research &#38; Social Medicine&#44; University Bremen&#44; Bremen&#44; Germany&#46; <span class="elsevierStyleSup"> 2</span>University Clinics&#44; Regensburg&#44; Germany&#46; <span class="elsevierStyleSup"> 3</span>Institute of Pathology&#44; Aalborg Hospital&#44; Aalborg&#44; Denmark&#46; <span class="elsevierStyleSup">4</span>Department of Epidemiology and Social Medicine&#44; Aarhus University&#44; Aarhus&#44; Denmark&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> This study was designed to identify yet unknown and possibly rare causes of cancer of the gallbladder and the extrahepatic biliary tract that could be amenable to preventive measures&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> Newly diagnosed male cases in the age-group 35 to 70 years were recruited between 1995 and 1997 in a population-based multi-centric case-control study involving six European countries &#40;Denmark&#44; Sweden&#44; France&#44; Germany&#44; Italy&#44; and Spain&#41;&#44;&#46; A central reference pathologist confirmed a tumour of the extrahepatic bile ducts &#40;EBD&#41;&#44; the gallbladder &#40;GB&#41;&#44; or of the Papilla Vateri &#40;PV&#41; included in the analysis&#46; Randomly selected controls from the general population were frequency-matched by age and study region to the cases&#46; Hospital controls were drawn in two study centres&#46; All participants were interviewed in person using a standardised questionnaire&#46; If a case was too ill or had died a surrogate person was interviewed&#46; Medical conditions were assessed as being confirmed by a physician and being present at least three years prior to diagnosis and interview&#46; The statistical analysis was performed by chi-square-tests and logistic regression using the SAS programme package&#46; Odds Ratios &#40;OR&#41; were adjusted for age &#40;5-year age groups&#41; and region of residence&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> 253 cases &#40;83 EBD&#44; 79 GB&#44; 80 PV&#44; 11 overlapping&#41; fulfilled the inclusion criteria &#40;97&#37; adeno-carcinoma&#41;&#46; There was no age difference between these localisations&#46; The analysis included 186 cases and 1969 controls for whom interviews were available&#46; The interview-response was 74&#37; and 66&#37; for cases and controls respectively&#46; Gallstones were confirmed as a risk factor for GB &#40;OR 2&#46;2&#59; 95&#37; confidence interval &#91;CI&#93; 0&#46;91-5&#46;36&#41;&#44; EBD &#40;OR 2&#46;6&#59; 95&#37; CI 1&#46;06-6&#46;32&#41; and PV &#40;OR 1&#46;5&#59; 95&#37; CI 0&#46;52-4&#46;25&#41;&#46; Cholecystectomy &#40;CCE&#41; was associated with all biliary tumours combined &#40;OR 1&#46;5&#59; 95&#37; CI 0&#46;51-4&#46;39&#41;&#46; Due to the low prevalence of CCE &#40;5&#37;&#41; we were unable to investigate differences by localisation&#46; Diabetes was associated with GB &#40;OR 2&#44;6&#59; 95&#37; CI 1&#46;12-5&#46;95&#41;&#46; For a body-mass-index &#91;BMI&#93; &#62;30 at the age of 35 an excess risk was observed relative to a normal BMI &#40;BMI 18&#46;5-25&#41; &#40;OR 1&#46;74&#59; 95&#37; CI 0&#46;88-3&#46;43&#41;&#46; This relationship was more pronounced for the BMI based on the smallest weight during adult life&#44; while this was not the case for a BMI &#62;30 one to five years prior to diagnosis &#40;OR 0&#46;96&#59; 95&#37; CI 0&#46;56-1&#46;64&#41;&#46; There was no convincing evidence for an association between biliary cancer and a history of diabetes mellitus&#44; hepatitis or typhus abdominalis&#46; Also smoking&#44; alcohol consumption&#44; and education showed no association with this cancer&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> Gallstones were confirmed as the most important risk factor for biliary cancer&#46; Apart from overweight we did not find any factors related to lifestyle that were associated with this cancer&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">047</span><span class="elsevierStyleBold">EUROCHIP&#58; AN EUROPEAN PROJECT FOR THE CANCER SURVEILLANCE&#46; THE ROLE OF SPAIN</span></p><p class="elsevierStylePara"> Andrea Micheli<span class="elsevierStyleSup">1</span>&#44; Carmen Navarro<span class="elsevierStyleSup">2</span>&#44; Paolo Baili<span class="elsevierStyleSup">1</span>&#44; Marina Pollan<span class="elsevierStyleSup">3</span>&#44; Isabel Izarzugaza<span class="elsevierStyleSup">4</span>&#44; Isabel Garau<span class="elsevierStyleSup">5</span>&#44; Nieves Ascunce Elizaga<span class="elsevierStyleSup">6</span>&#44; Carmen Martinez<span class="elsevierStyleSup">7</span>&#46; Eurochip&#58; An European Project for the Cancer Surveillance</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>Unit of Epidemiology&#44; Istituto Nazionale per lo Studio e la Cura dei Tumori&#44; Milan&#44; Italy&#46; <span class="elsevierStyleSup"> 2</span>Consejer&#237;a de Sanidad Murcia&#44; Spain&#46; <span class="elsevierStyleSup"> 3</span>National Center for Epidemiology Carlos III&#44; Madrid Spain&#46; <span class="elsevierStyleSup">4</span>Basque Country Cancer Registry&#44; Spain&#46; <span class="elsevierStyleSup"> 5</span>Mallorca Cancer Registry&#44; Spain&#46; <span class="elsevierStyleSup">6</span>European Breast Cancer Network&#44; Spain&#46; <span class="elsevierStyleSup">7</span>Granada Cancer Registry&#44; Spain&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#47;background&#58;</span> Despite the concern on cancer&#44; a monitoring system covering all European Union &#40;EU&#41; countries did not yet exist&#46; EUROCHIP &#40;European Cancer Health Indicator Project&#41; thus aimed to produce a comprehensive list of cancer health indicators pertaining to cancer&#44; with variables describing the natural history of the disease&#58; occurrence&#44; clinical follow-up&#44; recurrences&#44; patient survival&#44; diagnostic and therapeutic procedures&#44; effectiveness of care&#44; outcome and care prevalence&#46; The project was conceived as part of a large-scale Health Monitoring Programme &#40;HMP&#41;&#44; supported by the European Commission&#44; that has been implemented to set EU health indicators&#46; It was mainly intended as an intellectual work organised to reach the maximum consensus on a list of indicators&#46; EUROCHIP chose variables according to criteria of easy collection&#44; comparability and grade of each country&#39;s representation and hence proposed standardised methods for collection&#46; Final aim of the project is to improve cancer surveillance and promote actions in all European countries to reduce inequalities in controlling tumours&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> A complex organisation was set up&#46; Each indicator was discussed in several meetings at both national and international levels&#46; International meetings on different domains &#40;prevention&#44; epidemiology and cancer registration&#44; screening&#44; treatment and clinical aspects&#44; and social and macro-economic variables&#41; was organised&#46; We aimed to achieve a general consensus for several aspects of the indicators&#58; i&#46;e&#46; description&#44; operational definition&#44; meaning&#44; possible use&#44; caveat&#44; modalities of classification&#44; possible sources&#44; standardisation and validity&#46; The final list was obtained from discussions on priorities which&#44; as a whole&#44; added value to the indicator&#44; highlighted problems on comparability among European countries&#44; on data collection and on the relative costs&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> More than 130 cancer specialists of 15 countries belonging to different fields were involved in the various phases of the project&#46; EUROCHIP produced a list of indicators collectable in the next years in each European country for the development of a large European health database&#46; A European set of data is presently being constructed&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> This presentation aims to present the results EUROCHIP to the Spanish epidemiological audience&#46; The meaning of the indicators will be given&#46; However&#44; a new phase is now in progress&#46; It is our intention to organise a group of cancer specialists in different countries to discuss the available data to monitor cancer control&#46; The goal will be to reduce disparities&#44; fight inequalities and increase the capability of the national health system in cancer surveillance&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">047</span><span class="elsevierStyleBold">SERUM CONCENTRATIONS OF HIGHLY PREVALENT ORGANOCHLORINE COMPOUNDS AND RISK OF EXOCRINE PANCREATIC CANCER&#58; A CASE-CONTROL ANALYSIS</span></p><p class="elsevierStylePara"> Miquel Porta<span class="elsevierStyleSup">1</span>&#44; Ekhine Zumeta<span class="elsevierStyleSup">1</span>&#44; Laura Ruiz<span class="elsevierStyleSup">1</span>&#44; Manuel Jariod<span class="elsevierStyleSup">1</span>&#44; N&#250;ria Malats<span class="elsevierStyleSup">2</span>&#44; Joan Alguacil<span class="elsevierStyleSup">3</span>&#44; Alfredo Carrato<span class="elsevierStyleSup">4</span>&#44; Francisco X&#46; Real<span class="elsevierStyleSup">5</span>&#44; Joan O&#46; Grimalt<span class="elsevierStyleSup">6</span>&#46; En nombre del Grupo&#58; PANKRAS II Study Group</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>GRECMC&#44; IMIM&#44; Barcelona&#44; Spain&#46; <span class="elsevierStyleSup">2</span>URRA&#44; IMIM&#44; Barcelona&#44; Spain&#46; <span class="elsevierStyleSup">3</span>Occupational &#38; Environmental Epidemiology Branch&#44; NCI&#44; Bethesda&#44; USA&#46; <span class="elsevierStyleSup"> 4</span>Hospital General d&#39;Elx&#44; Universitat Miguel Hern&#225;ndez&#44; Alacant&#44; Spain&#46; <span class="elsevierStyleSup">5</span>URBCM&#44; IMIM&#44; Barcelona&#44; Spain&#46; <span class="elsevierStyleSup"> 6</span>Environmental Chemistry&#44; CSIC&#44; Barcelona&#44; Spain&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Whilst knowledge on the etiology of exocrine pancreatic cancer &#40;EPC&#41; is limited&#44; organochlorine compounds &#40;OCs&#41; as DDT&#44; DDE and polychlorinated biphenyls &#40;PCBs&#41; may increase the risk &#91;1&#44;2&#93;&#44; and several mechanistic scenarios have been proposed &#91;1-3&#93;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> All EPC cases newly diagnosed at 5 general hospitals were prospectively included &#40;n&#61;185&#41;&#46; Over 88&#37; were personally interviewed in-hospital&#46; Serum concentrations of OCs were measured by high-resolution gas chromatography with electron-capture detection in 144 patients&#44; thus increasing by 182&#37; the sample size of our previous&#44; early report &#91;1&#93;&#46; Cases were compared with 27 conventional hospital controls recruited in one of the study hospitals among subjects admitted for benign&#44; non-digestive disorders&#46; Multivariate-adjusted odds ratios &#40;OR&#41; and their 95&#37; confidence limits &#40;CL&#41; were computed by unconditional logistic regression&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> Serum levels of p&#44;p&#39;-DDT and p&#44;p&#39;-DDE were significantly higher in cases than in controls&#58; the respective medians &#40;mcg&#47;g lipid&#41; were&#44; for DDT&#44; 0&#46;42 and 0&#46;20 &#40;p &#61; 0&#46;04&#41;&#44; and for DDE&#44; 2&#46;70 and 1&#46;26 &#40;p &#60;0&#46;01&#41;&#46; The OR for the upper &#40;&#62;0&#46;574 mcg&#47;g&#41; vs&#46; lower &#40;&#60;0&#46;205 mcg&#47;g&#41; tertile of p&#44;p&#39;-DDT&#44; adjusted by age&#44; sex&#44; tobacco&#44; alcohol and coffee consumption &#40;ORa&#41; was 4&#46;52 &#40;CL&#58; 1&#46;36 and 14&#46;97&#59; p for trend &#61; 0&#46;012&#41;&#46; The ORa was similar for p&#44;p&#39;-DDE &#40;p-trend &#61; 0&#46;006&#41;&#46; These estimates held when adjusting by other OCs&#59; e&#46;g&#46;&#44; the ORa for the mid &#40;1&#46;441-3&#46;970 mcg&#47;g&#41; vs&#46; lower &#40;&#60;1&#46;441&#41; tertile of p&#44;p&#39;-DDE&#44; further adjusted by PCBs 138&#44; 153 and 180&#44; hexachlorobenzene &#40;HCB&#41; and &#226;-hexachlorocyclohexane &#40;&#226;-HCH&#41; was 5&#46;22 &#40;CL&#58; 1&#46;37 and 19&#46;96&#41;&#59; the corresponding figure for the upper tertile &#40;&#62;3&#46;970&#41; was 7&#46;57 &#40;CL&#58; 1&#46;53 and 37&#46;40&#41; &#40;p for trend &#61; 0&#46;009&#41;&#46; Most ORa for PCBs&#44; HCB and &#226;-HCH were in the range 1&#46;49 to 1&#46;87&#44; and none was statistically significant&#46; Thus&#44; the association between levels of OCs and risk of EPC was not indiscriminate with all OCs&#58; concentrations of HCB and &#226;-HCH in cases were high &#40;median of 1&#46;46 and 0&#46;86 mcg&#47;g&#44; respectively&#41;&#44; and yet these two compounds were not associated with an increased risk&#46; Concentrations of DDE were twice as high in our cases than in cases from San Francisco&#44; USA &#91;2&#93;&#44; while those of HCB were over 66 times higher in our study&#46; Concentrations of PCBs are hard to compare because different congeners were analysed in each study &#91;1&#44;2&#93;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusion&#58;</span> Organochlorine compounds as p&#44;p&#39;-DDT and p&#44;p&#39;-DDE may increase the risk of exocrine pancreatic cancer&#46; The results truly need to be refuted or replicated by new studies&#44; which should also assess interactions among OCs&#44; and of OCs with other environmental exposures and with genetic factors&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">References&#58;</span></p><p class="elsevierStylePara"> 1&#46; Porta M et al&#46; Lancet 1999&#46;<br></br> 2&#46; Hoppin JA et al&#46; Cancer Epidemiol Biomarkers Prev 2000&#46;<br></br> 3&#46; Porta M et al&#46; Molec Carcinogenesis 2003&#46;</p>"
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