Trend analysis of gastrointestinal cancer incidences in Guilan province: comparing rates over 15 years

The effect of massage therapy on fatigue after chemotherapy in gastrointestinal cancer patients

INTRODUCTION

Gastrointestinal cancer patients undergoing chemotherapy usually suffer from fatigue, which may affect different aspects of their lives.

OBJECTIVE

The current study aimed to investigate the effect of massage therapy on fatigue after chemotherapy in gastrointestinal cancer patients.

METHOD

In this quasi-experimental study, 88 gastrointestinal cancer patients were randomly allocated into two groups of intervention and control. Patients received the chemotherapy for 3 h. The intervention group received four sessions of foot massage with an interval of 40 min during the chemotherapy. The massage duration was 7 min for each foot. Fatigue was measured using the visual analogue scale to evaluate fatigue severity just after and 24 h after the chemotherapy. Friedman and Mann-Whitney U tests were used to analyze the data.

RESULTS

The mean age of patients was 59/18 ± 9/35, and the most common type of cancer was gastric cancer (40%). There was a significant difference in the mean score of fatigue between the two groups immediately after (P > 0.001) and 24 h after chemotherapy (P < 0.001). In the intervention group, fatigue score decreased gradually (P = 0.031), while it increased in the control group (P = 0.001).

CONCLUSION

This study demonstrated that foot massage, as a simple method, could reduce chemotherapy-induced fatigue.

Trend of gastric cancer in a province in Western Iran: A population-based study during 2001-2014

BACKGROUND

There are no studies on the trend of gastric cancer (GC) incidence in Kurdistan, a province in the west of Iran. We aimed to estimate the trend, age-standardized incidence rate (ASR), and annual percentage change (APC) of GC in this province during 2001-2014.

MATERIALS AND METHODS

The data of newly diagnosed GC patients were obtained from the regional Cancer Registering Database. The ASRs were calculated per 100,000 population during 2001-2014. Direct standardization and 95% confidence intervals (CI) were calculated by an efficient method. The temporary changes in ASRs were determined based on the APC by the joinpoint regression model.

RESULTS

Overall, 2225 newly diagnosed GC patients were identified. The ASRs ranged from 13.5 (95% CI: 10.4-17.3) to 29.0 (95% CI: 24.5-34.0). The highest ASRs were related to the men and women lived in Divandareh as 32.26 and 13.66, respectively. The respective APC value of GC incidence in women demonstrated a nonsignificant increase during 2001-2008 and a nonsignificant decrease during 2008-2014 (P = 0.1). Accordingly, the incidence of GC in men increased during 2001-2004 (P = 0.1) and decreased during 2004-2014 (P = 0.001).

CONCLUSION

The incidence of GC showed nonsignificant and significant decreasing trends in women and men in Kurdistan province, respectively. Despite such decreasing trends, the Kurdistan province is still considered as one of the regions with high incidence of GC in Iran. Therefore, it is necessary to implement screening programs in the province to early diagnose GC.

Prevalence of pre-cancerous colon lesions in referred patients under patronage of a local relief foundation in Guilan province

Colon cancer is the most commonly diagnosed gastrointestinal cancers in developed countries with varied incidence and the onset age of disease worldwide. Overall, 161 participants who were under patronage of a local relief foundation and referred to the endoscopy ward of Razi Hospital affiliated to the Guilan University of Medical Sciences. These patients have been aged more than 50 or more than 40 years with history of colorectal cancer in their first-degree family were enrolled from March 2016–March 2017. Demographic information were collected. Colonoscopy was performed and histopathological evaluation of observed lesions and polyps was done. Most of participants were female (113 individuals, 70.2%) and aged 50–60 years (83 individuals, 51.6%). Seventy-four (46%) had certain lesions. Most of colonoscopy findings were observed in the ascending colon in which depressed polyps and diverticulum were most frequent. However, rectum showed the most histological findings. All polyps of descending and ascending colons were neoplastic, while most of rectal polyps were non-neoplastic. Male patients, who were aged more than 60 years and smokers had significant higher percentage of both lesions and polyps in their colon (p<0.05). Moreover, significant positive association was detected between exposure to harmful industries and having polyps (p=0.01). We found male gender, higher age, smoking, and exposure to harmful industries as important risk factors for having colorectal lesions, which must be confirmed in further studies.

Only serum pepsinogen I and pepsinogen I/II ratio are specific and sensitive biomarkers for screening of gastric cancer

Purpose We aimed to determine optimal cut-off points of plasma levels of ghrelin and serum levels of pepsinogen I, II, and their ratio for screening of gastric cancer (GC). Methods Blood samples were taken from 41 patients with confirmed gastric cancer along with 82 patients without malignancy. Serum levels of pepsinogen I and II, plus plasma levels of acylated ghrelin were measured using commercial ELISA kits. Results The case group had significant lower plasma levels of ghrelin, pepsinogen I, and pepsinogen I/II ratio in comparison to the control group (P<0.001). In the control group, there was significant higher serum pepsinogen I (P=0.028) and pepsinogen II (P=0.003) and lower pepsinogen I/II ratio (P=0.020) in males versus females; significantly higher serum pepsinogen II (P=0.047) and lower pepsinogen I/II ratio (P=0.030) in overweight compared to normal weight patients; and significantly lower pepsinogen I/II ratio (P=0.030) in smokers versus non-smoker. In the case group, there was only significantly lower pepsinogen I (P=0.006) in males versus females, and significantly lower plasma ghrelin (P=0.017) in overweight compared to normal weight patients. The characteristic curve analysis indicated that pepsinogen I at a cut-off of 70.95 μg/L and pepsinogen I/II ratio at cut-off of 2.99, had good sensitivity and specificity. Conclusions Just serums levels of pepsinogen I and the ratio of pepsinogen I/II can be used as biomarker to screen GC.

Bayesian adjustment for over-estimation and under-estimation of gastric cancer incidence across Iranian provinces

AIM

To correct the misclassification in registered gastric cancer incidence across Iranian provinces in cancer registry data.

METHODS

Gastric cancer data is extracted from Iranian annual of national cancer registration report 2008. A Bayesian method with beta prior is implemented to estimate the rate of misclassification in registering patient's permanent residence in neighboring province. Each time two neighboring provinces with lower and higher than 100% expected coverage of cancer cases are selected to be entered in the model. The expected coverage of cancerous patient is reported by medical university of each province. It is assumed that some cancer cases from a province with a lower than 100% expected coverage are registered in their neighboring province with more than 100% expected coverage.

RESULTS

The condition was true for 21 provinces from a total of 30 provinces of Iran. It was estimated that 43% of gastric cancer cases of North and South Khorasan provinces in north-east of Iran was registered in Razavi Khorasan as the neighboring facilitate province; also 72% misclassification was estimated between Sistan and balochestan province and Razavi Khorasan. The misclassification rate was estimated to be 36% between West Azerbaijan province and East Azerbaijan province, 21% between Ardebil province and East Azerbaijan, 63% between Hormozgan province and Fars province, 8% between Chaharmahal and bakhtyari province and Isfahan province, 8% between Kogiloye and boyerahmad province and Isfahan, 43% Golestan province and Mazandaran province, 54% between Bushehr province and Khozestan province, 26% between Ilam province and Khuzestan province, 32% between Qazvin province and Tehran province (capital of Iran), 43% between Markazi province and Tehran, and 37% between Qom province and Tehran.

CONCLUSION

Policy makers should consider the regional misclassification in the time of programming for cancer control, prevention and resource allocation.

Soluble IL-1 decoy receptor is associated with gastric adenocarcinoma

Background:

In recent years, studies on gastric cancer include changes in cancer associated immune system activation and the levels of immune system markers. It has been demonstrated that TNF-α (tumor necrosis factor-alpha) and IL-6 (interleukin-6) play a role in inflammatory associated carcinogenesis.

Objective:

Our aim was to investigate serum soluble IL-1 decoy receptor (sIL- 1RII), TNF-α and IL-6 levels in gastric adenocarcinoma patients.

Materials and methods:

Male gastric adenocarcinoma patients and dyspeptic participants, in total 55 cases were included. Serum sIL-1RII, TNF-α and IL-6 concentrations were measured.

Results:

The median sIL-1RII levels of the patients were statistically significantly lower than the median of the control group (3111 ng/mL; 3601 ng/mL, respectively) (p=0.003). But the median TNF-α and IL-6 levels (58.17 ng/mL; 10.22 ng/mL, respectively) were both numerically higher than those of control group levels (16.62 ng/mL; 5.74 ng/mL, respectively). Also, patients’ median TNF-α levels were found statistically significantly higher (p=0.034).

Conclusion:

This study showed the increase of TNF-α, IL-6 levels and for the first time the decrease of sIL-1RII in gastric cancer patients. We propose that negative regulation of gastric cancer using sIL-1RII could be a new anti-cancer strategy.

General significance:

Our study provides target pathways for further studies in the pathophysiology of gastric cancer.

Risk Factors and Epidemiology of Gastric Cancer in Pakistan

Gastric cancer is the 2nd most common cause of death among all cancers and is the 4th most common cancer in the world. The number of deaths due to gastric cancer is about 800,000 annually. Gastric cancer is more common in men as compared to women and is 3rd most common cancer after colorectal and breast cancers in women. A progressive rise in the incidence rate has been observed in females over the last 5 years. The highest incidence of stomach cancer is in China, South America and Eastern Europe. The incidence of gastric cancer has 20 fold variation worldwide. Global variation is linked by two factors which play important role in developing gastric cancer. One is infection with Helicobacter pylori and the 2nd is diet. South Asia is a region with low risk, despite a high prevalence of H.pylori. Gastric carcinoma is common in southern region of India. Gastric cancer is more readily treated if diagnosed early. This study aims to provide awareness about gastric cancer as well as an updated knowledge about risk factors and epidemiology of gastric cancer in Pakistan.

Histopathologic Prolife of Primary Gastrointestinal Malignancies in Uyo City (Niger-Delta Region of Nigeria)

Incidence of gastrointestinal malignancy is gradually increasing. The aim of the study is to investigate age, sex and relative frequencies of various gastrointestinal malignancies diagnosed between January 2007 and December 2014 in the University of Uyo Teaching Hospital, and in a Private Specialist Laboratory, Uyo, Akwa Ibom State, Nigeria. All histological-diagnosed cases of gastrointestinal malignancies seen during the study period were recruited noting their bio-data and histopathological characteristics. A total of 67 patients aged 6-77 years (mean 58.0, SD 7.4) were enrolled; a male to female ratio of 1.3:1 was recorded. The most common age group and anatomical site affected with gastrointestinal malignancy were 61-70 years (23 cases, 34.3%) and colo-rectum cancers (36 cases, 53.7%). The small intestine and stomach were second and third leading anatomic sites involved in gastrointestinal malignancies, accounting for 13 (19.4%) and 8 (11.9%) cases respectively. Adenocarcinoma accounted for the majority of gastrointestinal malignancies (57 cases, 85.1%). Lymphoma and carcinoid tumor were also common, accounting for 3 (4.5%) cases each. Colorectal carcinoma was the most common type of gastrointestinal malignancies (53.7%) with adenocarcinoma being the predominant histological subtype of gastrointestinal malignancies.

Clustering asian and north african countries according to trend of colon and rectum cancer mortality rates: an application of growth mixture models

BACKGROUND

Colorectal cancer is the second most common cause of cancer death with half a million deaths per year. Incidence and mortality rates have demonstrated notable changes in Asian and African countries during the last few decades. In this study, we first aimed to determine the trend of colorectal cancer mortality rate in each Institute for Health Metrics and Evaluation (IHME) region, and then re-classify them to find more homogenous classes.

MATERIALS AND METHODS

Our study population consisted of 52 countries of Asia and North Africa in six IHME pre-defined regions for both genders and age-standardized groups from 1990 to 2010.We first applied simple growth models for pre-defined IHME regions to estimate the intercepts and slopes of mortality rate trends. Then, we clustered the 52 described countries using the latent growth mixture modeling approach for classifying them based on their colorectal mortality rates over time.

RESULTS

Statistical analysis revealed that males and people in high income Asia pacific and East Asia countries were at greater risk of death from colon and rectum cancer. In addition, South Asia region had the lowest rates of mortality due to this cancer. Simple growth modeling showed that majority of IHME regions had decreasing trend in mortality rate of colorectal cancer. However, re-classification these countries based on their mortality trend using the latent growth mixture model resulted in more homogeneous classes according to colorectal mortality trend.

CONCLUSIONS

In general, our statistical analyses showed that most Asian and North African countries had upward trend in their colorectal cancer mortality. We therefore urge the health policy makers in these countries to evaluate the causes of growing mortality and study the interventional programs of successful countries in managing the consequences of this cancer.

Spatial analysis of common gastrointestinal tract cancers in counties of Iran

BACKGROUND

Gastrointestinal tract cancers are among the most common cancers in Iran and comprise approximately 38% of all the reported cases of cancer. This study aimed to describe the epidemiology and to investigate spatial clustering of common cancers of the gastrointestinal tract across the counties of Iran using full Bayesian smoothing and Moran I Index statistics.

MATERIALS AND METHODS

The data of the national registry cancer were used in this study. Besides, indirect standardized rates were calculated for 371 counties of Iranand smoothed using Winbug 1.4 software with a full Bayesian method. Global Moran I and local Moran I were also used to investigate clustering.

RESULTS

According to the results, 75,644 new cases of cancer were nationally registered in Iran among which 18,019 cases (23.8%) were esophagus, gastric, colorectal, and liver cancers. The results of Global Moran's I test were 0.60 (P=0.001), 0.47 (P=0.001), 0.29 (P=0.001), and 0.40 (P=0.001) for esophagus, gastric, colorectal, and liver cancers, respectively. This shows clustering of the four studied cancers in Iran at the national level.

CONCLUSIONS

High level clustering of the cases was seen in northern, northwestern, western, and northeastern areas for esophagus, gastric, and colorectal cancers. Considering liver cancer, high clustering was observed in some counties in central, northeastern, and southern areas.

Effect of Age on Survival Outcome in Operated and Non-Operated Patients with Colon Cancer: A Population-Based Study

OBJECTIVE

To know the effect of age on survival outcome in operated and non-operated patients with colon cancer.

METHODS

From the Surveillance, Epidemiology, and End Results database, we identified 123,356 patients with colon cancer who were diagnosed between 1996 and 2005, grouped them as older or younger than 40 years and analyzed their 5-year cancer-specific survival (CSS) data, along with some risk factors, using Kaplan-Meier methods and multivariable Cox regression models.

RESULTS

The younger group had significantly higher pathological grades (P<0.001), more mucinous and signet-ring histology (P<0.001), advanced AJCC stage (P<0.001), and were more likely to undergo surgery (P<0.001). For surgically treated patients, age did not significantly affect 5-year CSS (younger: 66.7%; older: 67.3%; P = 0.86). Further analysis showed that age was an independent prognostic factor in stage I-IV disease (stage I: P = 0.001; P<0.001 for stages II-IV, in both uni- and multivariate analyses), but not for patients with unknown disease stage (P = 0.52). For non-surgically treated patients, age significantly affected 5-year CSS (younger: 16.2%; older: 12.9%; P<0.001) in univariate analysis; and was an independent prognostic factor (P<0.001) in multivariate analysis.

CONCLUSION

The CSS rate for younger CC patients was at least as high as for older patients, although they presented with higher proportions of unfavorable factors and more advanced disease.

Demographic survey of four thousand patients with 10 common cancers in North Eastern Iran over the past three decades

BACKGROUND

Cancer is a major cause of mortality in developing countries and correct and valid information about the epidemiology of this disease is the first step in the planning of health care in each region. The aim of this study was to determine the relative frequency, mean age and sex ratio of the most 10 common non-skin cancers in the world and Iran, among patients referred to an oncology clinic.

MATERIALS AND METHODS

This descriptive study was conducted in Mashhad, north east of Iran. The data obtained from the records of patients referred to the private oncology center between the years of 1985-2012." According to the latest report of GLOBOCAN study commonest malignancies included were lung, breast, colorectal, prostate, stomach, liver, cervix, esophageal, bladder cancers and Non-Hodgkin lymphoma.

RESULTS

A total of 4,606 cases were analyzed. The mean age was 55.5±13.8years (male: 59.5±13.9, female: 52.6±12.9). Overall, breast cancer (1,264 cases, relative frequency of 27.4%) was the most prevalent cancer; however the mean ages of diagnosis were not significantly different between 5-year time period divisions (p=0.290). The most common cancer in men was esophageal cancer (26.3%).The lowest mean age was related to women diagnosed with breast cancer (48.5±11.8) and men with non-Hodgkins lymphoma (48.4±17.8). There were statistically significant differences between the mean age of men and women with gastric (p=0.003) and esophageal cancers (p<0.001). Male to female sex ratios in our study for bladder, lung and stomach cancers were 6.57, 2.60 and 2.50 respectively.

CONCLUSIONS

The results showed that breast cancer tends to be found in younger female patients and bladder cancer appears more often in men. Screening in target population in addition to early diagnosis may reduce death and disability.

Incidence of cancers in Kuzestan province of iran: trend from 2004 to 2008

BACKGROUND

Cancer is an increasing cause of mortality and morbidity worldwide. Incidences of common cancers has been growing in different provinces of Iran in recent years but trends in Khuzestan which shares a border with Iraq and is located in south west of Iran have not been investigated. This study aimed to assess secular changes in incidences of common cancers in Khuzestan province from 2004 to 2008.

MATERIALS AND METHODS

Data were collected from Khuzestan cancer registry which is a branch of Iranian Ministry of Health Cancer Registry (http://ircancer.ir) for the period 2004-2008. Data were presented as incidence rates by site, sex, age, using the crude rate and age-standardized rate (ASR) per 105 persons. A direct method of standardization was applied according to the WHO guideline and data analysis was performed using the SPSS package.

RESULTS

During the 2004-2008 period, 14,893 new cases of cancer were registered in Khuzestan cancer registry. The age- standardized incidence rate of all cancers was 153.7 per 105 in males and 156.4 per 105 in females. The incidence was increased over the period of five years. The most incident cancers among males were skin cancer (ASR =18.7/105), stomach cancer (ASR13.8/105), lung cancer (ASR12.9/105), leukemia (ASR=12.6/105) and prostate cancer (ASR=12.4/105). In females, the most incident cancers were breast cancer (ASR=41/105), skin cancer (ASR=16.4/105), colorectal cancer (ASR=10.0/105), leukemia (ASR=8.1/105) and lung cancer (ASR=6.9/105).

CONCLUSIONS

Incidences of various cancers are rising in Khuzestan. It is necessary to develop and implement comprehensive cancer control programs in this region which could be monitored and evaluated by the future trend data from cancer registry.

Pemetrexed is mildly active with good tolerability in treating patients with gastric cancer

BACKGROUND

This systemic analysis was conducted to evaluate the efficacy and safety of pemetrexed based chemotherapy in treating patients with metastatic gastric cancer (MGC) as a salvage chemotherapy.

METHODS

Clinical studies evaluating the efficacy and safety of pemetrexed based regimens on response and safety for patients with gastric cancer were identified by using a predefined search strategy. Pooled response rates (RRs) of treatment were calculated.

RESULTS

In pemetrexed based regimens, 4 clinical studies including 171 patients with advanced gastric cancer were considered eligible for inclusion. Systemic analysis suggested that, in all patients, pooled RR was 25.1% (43/171) in pemetrexed based regimens. Major adverse effects were neutropenia, anorexia, fatigue, and anemia. No treatment related death occurred in pemetrexed based treatment.

CONCLUSION

This systemic analysis suggests that pemetrexed based regimens are associated with mild activity with good tolerability in treating patients with MGC.

Effects of p53 codon 72 and MDM2 SNP309 polymorphisms on gastric cancer risk among the Iranian population

BACKGROUND

Development of gastric cancer (GC) is a multistep process that requires alterations in the expression of oncogenes and tumor suppressor genes, occurring over several decades. The p53 tumor suppressor protein is involved in cell-cycle control, apoptosis and DNA repair. One of the most important regulators of p53 is MDM2, which acts as a negative regulator in the p53 pathway. Based on the key role of p53 and MDM2 in tumor suppression, polymorphisms that cause change in their function might affect cancer risk. We therefore elevated associations of the polymorphisms of p53 (R72P) and MDM2 (SNP309) with GC in Iran.

MATERIALS AND METHODS

A total of 104 patients with gastric cancer and 100 controls were recruited. Genomic DNA was extracted from fresh gastric samples. Genotyping of the p53 and MDM2 genes was performed using allele specific PCR (AS-PCR).

RESULTS

There was no significant difference between the p53 codon 72 polymorphism distribution in control and patient groups (p=0.54), but the G allele of MDM2 was found to be over-represented in patients (p=0. 01, Odds Ratio=2. 08, 95% Confidence Interval= 1.37-4.34).

CONCLUSIONS

The p53 R72P seems not to be a potential risk factor for development of GC among Iranian patients, but our data suggest that MDM2 SNP309 might modify the risk related to GC.

Down-regulated MYH11 expression correlates with poor prognosis in stage II and III colorectal cancer

The MYH11 gene may be related to cell migration and adhesion, intracellular transport, and signal transduction. However, its relationship with prognosis is still uncertain. The aim of this study was to investigate correlations between MYH11 gene expression and prognosis in 58 patients with stage II and III colorectal cancer. Quantitative real-time polymerase chain reaction was performed in fresh CRC tissues to examine mRNA expression, and immunohistochemistry was performed with paraffin-embedded specimens for protein expression. On univariate analysis, MYH11 expression at both mRNA and protein levels, perineural invasion and lymphovascular invasion were related to disease-free survival (p<0.05; log-rank test). Cancers with lower MYH11 expression were more likely to have a poor prognosis. Otherwise, MYH11 expression was unrelated to patient clinicopathological features. On multivariate analysis, low MYH11 expression proved to be an independent adverse prognosticator (p<0.05). These findings show that MYH11 can contribute to predicting prognosis in stage II and III colorectal cancers.

Does treatment of Helicobacter pylori infection reduce gastric precancerous lesions?

BACKGROUND

Treatment of Helicobacter pylori (H. pylori) decreases the prevalence of gastric cancer, and may inhibit gastric precancerous lesions progression into gastric cancer. The aim of this study was to determine the effect of treatment on subsequent gastric precancerous lesion development.

MATERIALS AND METHODS

We prospectively studied 27 patients who had low grade dysplasia at the time of enrollment, in addition to dysplasia atrophic gastritis and intestinal metaplasia observed in all patients. All were prescribed quadruple therapy to treat H. Pylori infection for 10 days. Patients underwent endoscopy with biopsy at enrollment and then at follow up two years later. Biopsy samples included five biopsies from the antrum of lesser curvature, antrum of greater curvature, angularis, body of stomach and fundus. RESULTS of these biopsies were compared before and after treatment.

RESULTS

Overall, the successful eradication rate after two years was 15/27 (55.6%). After antibiotic therapy, the number of patients with low grade dysplasia decreased significantly (p=0.03), also with reduction of the atrophic lesions (p=0.01), but not metaplasia.

CONCLUSIONS

Treatment of H. pylori likely is an effective therapy in preventing the development of subsequent gastric premalignant lesions.

Cancer notification at a referral hospital of Kermanshah, Western Iran (2006-2009)

BACKGROUND

Cancer is a major public health problem and the leading cause of mortality in both males and females in developed and developing countries. The incidence of cancer is gender dependent. Among Iranians, it is the third cause of death.

MATERIALS AND METHODS

The information recorded in the files of all patients (7,695 individuals) pathologically diagnosed with cancer in Imam Reza referral hospital of Kermanshah University of Medical Sciences during the four year period of 2006-2009 were reviewed and analyzed using SPSS statistical software package version 16.0.

RESULTS

Around 61.6% of reported cancer cases were males and 38.4% were females. The most prevalent reported malignant tumors occurred at the age group of 70-79 years in males and in females these tumors were presented in the ages of 60-69 years. The most prevalent cancers among studied patients were gastrointestinal (GI) cancers with a frequency of 22.9% [gastric 10.7%, colorectal 6.9%, and esophageal 6%]. The second, third and forth prevalent cancers were blood at 16.4%, lung 13.5% and bladder 12.8%, respectively. In males the cancers of GI (25.6%) were the most prevalent followed in order of frequency by bladder (18%), blood (17.6%), lung (17.4%) and prostate (6.8%) . In females the most frequent recorded cancer was breast (24.1%) followed in order of frequency by GI (20.5%), blood (14.4%), lung (7.3%), uterus (6.2%) and ovary (5.1%) . Breast cancer was the most prevalent cancer (27%) in the age group of 40-49 years.

CONCLUSIONS

The present study provides frequency data for various types of cancers in both males and females from a referral hospital of Kermanshah that are comparable with some reports from other areas of the country.

Epidemiology and trend of cancers in the province of Kerman: southeast of Iran

BACKGROUND

According to increase in elderly populations, and change in lifestyle and cancer-causing behavior, the global burden of cancer is increasing. For prevention and control of disease, knowledge of population statistics of cancers and their trends is essential. This study aimed to investigate the epidemiology and trends of cancer in the province of Kerman: southeast of Iran.

MATERIALS AND METHODS

This analytical and cross-sectional study was carried out based on cancer registry data at the Disease Management Center of the Health Ministry from 2004 to 2009 in the province of Kerman in Iran. Common cancers were defined as the number of reported cases and standardized incidence rates. To compute the annual percentage change (APC), joinpoint 4.1.1.1 software was applied.

RESULTS

Of 10,595 registered cases, 45.3% (4802 cases) were in women and 56.7% (5,793 cases) occurred in men. The standardized incidence rates for both females and males were increasing during the six years studied. The most common cancers in both sexes during six years of studied were skin (13.4%), breast (9.35%), bladder (7.8%), stomach (7.45%), leukemia (7.05%), colorectal(5.57%), lung(4.92%), trachea(3.51%) and prostate(2.48%).

CONCLUSIONS

Our findings revealed that the cancer incidence is demonstrating increasing trends in both sexes in the province of Kerman. This may be because of changes in lifestyle, increasing exposure to risk factors for cancer and increase of life expectancy. If this is the case, increasing public awareness of cancer risk factors is a high priority, together with introduction of large-scale screening techniques.

The clinicopathologic importance of serum lactic dehydrogenase in patients with gastric cancer

Background. To explore possible correlation between serum lactate dehydrogenase (SLDH) levels and gastric cancer. Materials and Methods. We retrospectively reviewed 365 patients with gastric cancer. The correlation of SLDH levels with clinicopathologic features and survival rate was studied. Results. SLDH levels were closely associated with the pathological (p) T stage (P = 0.011), metastasis (P = 0.012), pTNM stage (P = 0.001), and recurrence (P = 0.012). Moreover, we found a significant SLDH level difference among Borrmann type (P = 0.027), pT stage (P = 0.004), lymph node metastasis (P = 0.027), metastasis (P < 0.001), pTNM stage (P = 0.006), and recurrence (P = 0.002). In addition, we detected a significant SLDH level difference between alive and dead subgroups (P = 0.001). In addition, both univariate analysis and multivariate analysis showed that high SLDH levels were independent prognostic factor. For the subgroup with normal LDH (median point of 157.0 U/L), we detected that the subset with SLDH levels ≥157 U/L (158–245 U/L) showed poorer OS (P = 0.005) and DFS (P = 0.01) than that of ≤157 subgroup. Conclusions. Our results suggest that high SLDH level could be an independent poor prognostic biomarker. Gastric cancer patients with relative high SLDH level (158–245 U/L) were prone to develop a shorter OS and DFS.

Analysis of laparoscopy-assisted gastric cancer operations performed by inexperienced junior surgeons

To clarify whether gastric cancer patients can benefit from laparoscopy-assisted surgery completed by junior surgeons under supervision of expert surgeons, data of 232 patients with gastric cancer underwent operation performed by inexperienced junior surgeons were reviewed. Of the 232 patients, 137 underwent laparoscopy- assisted resection and in 118 cases this approach was successful. All of these 118 patients were assigned to laparoscopic group in this study, 19 patients who were switched to open resection were excluded. All laparoscopic operations were performed under the supervision of expert laparoscopic surgeons. Some 95 patients receiving open resection were assigned to the open group. All open operations were completed independently by the same surgeons. Short-term outcomes including oncologic outcomes, operative time intra-operative blood loss, time to first flatus, time to first defecation, postoperative hospital stay and perioperative complication were compared between the two groups. The numbers of lymph nodes harvested in the laparoscopic and open groups were21.1±9.6 and 18.2±9.7 (p=0.029). There was no significant difference in the length of margins. The mean operative time was 215.9±32.2 min in laparoscopic group and 220.1±34.6min in the open group (p=0.866), and the mean blood loss in laparoscopic group was obviously less than that in open group (200.9±197.0ml vs 291.1±191.4ml; p=0.001). Time to first flatus in laparoscopic and open groups was 4.0±1.0 days and 4.3±1.2days respectively and the difference was not significant (p=0.135). Similarly no statically significant difference was noted for time to first defecation (4.7±1.6 vs 4.8±1.6, p=0.586). Eleven patients in the laparoscopic group and 19 in the open group suffered from peri-operative complications and the difference between the two groups was significant (9.3% vs 20.0%, p=0.026). The conversion rate for laparoscopic surgery was 13.9%. Patients with gastric cancer can benefit from laparoscopy-assisted operations completed by inexperienced junior surgeons under supervision of expert laparoscopic surgeons.

Screening of precancerous gastric lesions by serum pepsinogen, gastrin-17, anti-helicobacter pylori and anti- CagA antibodies in dyspeptic patients over 50 years old in Guilan Province, north of Iran

BACKGROUND

The aim of this study was to investigate the value of serum gastric markers to differentiate between patients with precancerous lesions and nonatrophic chronic gastritis.

MATERIALS AND METHODS

Serum samples of 128 patients with dyspepsia who were candidates for endoscopic examination were tested for pepsinogen (PG I and PG II), PG I/II ratio, gastrin 17(G-17), anti-Helicobacter pylori (anti-H pylori ) and anti- CagA antibodies. Two sample t-tests, chi-square tests and Pearson's correlation analyses were used for analysis using SPSS (version 20).

RESULTS

PGI, PG I/II ratio values were decreased significantly in the precancerous lesion group (0.05, 0.001 respectively). The frequency of H pylori infection was significantly (p=0.03) different between the two groups ofthe study.

CONCLUSIONS

We suggest PGI and the PG I/II ratio as valuable markers for screening of premalignant gastric lesions.

Outcome of rectal cancer in patients aged 30 years or less in the Pakistani population

BACKGROUND

The incidence of rectal cancer is increasing in younger age groups. Limited data is available regarding survival outcome in younger patients with conflicting results from western world. The goal of this study was to determine survival in patients with rectal cancer<30 years of age and compare it with their older counterparts in the Pakistani population.

MATERIALS AND METHODS

A retrospective chart review of patients operated for rectal adenocarcinoma between January 2005 and December 2010 was performed. Patients were divided into two groups, Group 1 aged ≤30 years and Group 2 aged >30 years. Patient characteristics, surgical procedure, histopathological details and number of loco-regional and distant failures were compared. Expected 5 year survival was calculated using Kaplan Meier curves and significance was determined using the Log rank test.

RESULTS

There were 38 patients in group 1 and 144 in group 2. A significantly high number of younger patients presented with poorly differentiated histology (44.7% vs 9.7%) (p=0.0001) and advanced pathological stage (63.1% vs 38.1%) (p=0.04). Predicted overall 5 year survival was 38% versus 57% in groups I and II, respectively (p=0.05). Disease free survival was 37% versus 52% and was significantly different (p=0.007).

CONCLUSIONS

Early onset rectal cancer is associated with poor pathological features and a worse outcome in Pakistani population.