Association between waist circumference and risk of colorectal neoplasia in normal-weight adults

BACKGROUND AND AIM

Abdominal obesity, measured using waist circumference (WC), is associated with the colorectal neoplasia (CRN) risk. We examined whether WC is associated with the CRN risk even in normal-weight individuals.

METHODS

A cross-sectional study was performed on asymptomatic normal-weight (body mass index 18.5-23 kg/m² ) individuals who underwent colonoscopy as health checkups.

RESULTS

Of 63 057 examinees, 30 498 were men (mean age, 41.1 years) and 32 559 were women (mean age, 41.7 years). The prevalence of overall CRN in WC quartiles 1, 2, 3, and 4 was 14.2%, 15.5%, 15.5%, and 18.7%, respectively, in men and 7.4%, 8.9%, 9.4%, and 11.5%, respectively, in women. The prevalence of advanced CRN (ACRN) in WC quartiles 1, 2, 3, and 4 was 1.5%, 1.3%, 1.6%, and 2.1%, respectively, in men and 1.0%, 1.3%, 1.2%, and 1.3%, respectively, in women. Among men, the overall CRN risk in quartile 4 (> 82 cm) was higher than that in quartiles 1, 2, and 3 (adjusted odds ratio, OR [95% confidence interval, CI], 1.22 [1.11-1.34], 1.12 [1.05-1.23], and 1.18 [1.07-1.29], respectively); the ACRN risk in quartile 4 was also higher than that in quartiles 1, 2, and 3 (adjusted OR [95% CI], 1.41 [1.09-1.81], 1.56 [1.19-2.03], and 1.50 [1.16-1.94], respectively). Among women, the overall CRN risk in quartile 4 (> 77 cm) was higher than that in quartiles 1 and 3; the ACRN risk was not different among all groups.

CONCLUSIONS

Even with a normal weight, a large WC was associated with the CRN risk, especially with the ACRN risk in men.

Evaluation of Waning Immunity at 6 Months after Both Trivalent and Quadrivalent Influenza Vaccination in Korean Children Aged 6-35 Months

BACKGROUND

The titer of influenza vaccine-induced antibodies declines over time, and younger children have lower immunogenicity and shorter duration of immunity. This study aimed to compare persistence of antibody at 6 months after influenza vaccination according to influenza virus strains, vaccine type, antigen dose, and primed status in children aged 6 to 35 months.

METHODS

A total 124 healthy children aged 6 to 35 months were enrolled from September to December 2016 at 10 hospitals in Korea and randomly assigned to either a full dose of quadrivalent influenza vaccine or a half dose of trivalent influenza vaccine with Victoria B strain group. Hemagglutination inhibition antibody titers (that measure the seroprotection rates) were assessed for the recommended influenza strains at 6 months post vaccination.

RESULTS

The seroprotection rates at 6 months for strains A (H1N1), A (H3N2), B/Yamagata, and B/Victoria were 88.7%, 97.4%, 36.6%, and 27.6%, respectively. The seroprotection rates for A (H1N1), A (H3N2) and B (Victoria) were 91.4%, 98.7% and 27.5% in a full dose of quadrivalent vaccine vs. 83.7%, 94.6% and 27.9% in a half dose trivalent vaccine, respectively. The seroprotection rate for the B (Yamagata) strain was 23.8% in the quadrivalent group and 14.0% in the trivalent group.

CONCLUSION

Persistence of antibodies at 6 months was more favorable against the influenza A strains than against the B strains. Persistence of antibodies to additional B strain at 6 months was superior in the quadrivalent vaccine group. The immunity of primed children with different B strains was not superior to that of the unprimed group with another B strain.

Social provision partially mediates the complex associations among posttraumatic stress, obsessive-compulsive and depressive symptoms in traumatized patients

AIM

To identify the associations among posttraumatic stress, depressive and obsessive-compulsive symptoms (OCS) in outpatients with psychological trauma and to examine the mediating effect of social provision.

BACKGROUND

Psychologically traumatized patients simultaneously experience depressive and OCS. Social provision may mediate multiple symptoms differently compared with social support.

DESIGN

Cross-sectional and correlational study.

METHODS

Data were collected between August 2016-May 2017. Psychiatric outpatients (N = 151) completed a structured questionnaire consisting of the Korean versions of the Social Provision Scale, Beck Depression Inventory-II, Maudsley Obsessional-Compulsive Inventory and Impact of Event Scale-Revised. Structural equation modelling was used to examine the recursive association among the three symptoms and the mediation of social provision.

RESULTS

There was a recursive association between posttraumatic stress symptoms (PTSS) and depressive symptoms, which were simultaneously associated with OCS with a one-way direction. OCS and social provision partially mediated these identified associations among three symptoms.

CONCLUSIONS

Our findings provide insight into the complex associations of multiple symptoms experienced by traumatized outpatients and the partial mediation of social provision. Psychiatric and mental health professionals may enhance social functioning and interpersonal interactions based on social provision components used for helping traumatized patients with obsessive-compulsive and depressive symptoms.

IMPACT

There was a recursive association between PTSS and depressive symptoms that were simultaneously associated with OCS with a one-way direction. Social provision functions as a partial mediator when working with OCS. Mental health nurses can develop social provision interventions for depressive symptoms for traumatized outpatients with OCS.

P3671Selexipag dosing and titration in the first 500 patients enrolled in SPHERE (SelexiPag: tHe UsErs dRug rEgistry)

Introduction

SPHERE is an ongoing US-based, multicentre, prospective, registry collecting data on use of the oral selective IP prostacyclin receptor agonist selexipag in real-world settings. Here, we report selexipag dosing and titration in the first 500 patients.

Methods

SPHERE, initiated in November 2016, will enrol 800 patients newly initiated on or already treated with selexipag at enrolment who have a documented titration regimen. Patients are followed for up to 18 months. Patients were considered “newly initiated” on selexipag if they were enrolled in SPHERE ≤60 days after starting selexipag and were considered “previously initiated” if they enrolled >60 days after starting selexipag. The highest dose is the maximum dose reached during up-titration within 6 months since initiation. Selexipag “maintenance dose” is defined as the first dose received for ≥14 days without interruption or change; “titration speed” is defined as the highest dose reached within the first 6 months after initiation divided by the time (in weeks) to reach it.

Results

The data cut-off for this analysis was December 20, 2018. Most patients had Group 1 pulmonary hypertension (PH) (95.4%), which was primarily idiopathic (49.6%) or connective tissue disease associated (26.0%). At selexipag initiation 49.8% of patients had functional class III symptoms. At the time of selexipag initiation, 19.2% of patients were on PH therapy containing a prostacyclin pathway agent (PPA) (8.5% with a parenteral PPA). The median maintenance dose of selexipag was 1200 μg BID (IQR: 800–1600 μg BID) and the median time to reach it was 8.1 wks (IQR: 5.3–11.0 wks). Low (≤400 μg BID), medium (600–1000 μg BID), and high (≥1200 μg BID) maintenance doses were attained by 15.1%, 30.8%, and 49.5% of patients, respectively (and in 23.2%, 31.2%, and 36.2%, respectively, in GRIPHON). The median titration speed was 175 μg BID/wk (IQR: 110.5–195.3 μg BID/wk), slower than the protocol-outlined 200 μg BID/wk in GRIPHON. In SPHERE, most patients titrated at speeds <200 μg BID/wk, regardless of whether they were newly (175 μg BID/wk; IQR 118.6, 195.3) or previously (175 μg BID/wk; IQR 109.8, 195.3) initiated. As expected, more patients discontinued due to adverse events in the newly (29.0%) versus previously (14.1%) initiated groups. The most common adverse events leading to selexipag discontinuation were worsening pulmonary hypertension (2.2%), headache (2.0%), myalgia (1.4%), and nausea (1.0%).

Conclusion

The median maintenance selexipag dose in SPHERE was 1200 μg BID. While the median titration speed was 175 μg BID/wk, there was marked variation and the vast majority of patients titrated slower than 200 μg BID/wk. No new safety signals were observed.

Acknowledgement/Funding

Actelion Pharmaceuticals US, Inc.

P2540Sex-specific differences in the clinical presentation, surgical complications, and course of chronic thromboembolic pulmonary hypertension

Background

Women are more susceptible to develop several forms of pulmonary hypertension, but they may have better survival rates than men. Sparse data are available concerning sex-specific differences in chronic thromboembolic pulmonary hypertension (CTEPH).

Purpose and methods

We investigated sex-specific differences in the clinical presentation of CTEPH, functional parameters, exposure to pulmonary endarterectomy (PEA), and survival.

Results

Women constituted half of the study population (N=679 treatment-naïve patients from the European CTEPH registry) and were characterized by a lower prevalence of some cardiovascular risk factors (e.g. prior acute coronary syndrome, smoking habit, chronic obstructive pulmonary disease), but more prevalent obesity, cancer, and thyroid diseases. Median age was 62 (IQR 50–73) years in women and 63 (IQR 53–70) in men. Women underwent PEA less often than men (54% vs 65%; Figure 1, Panel A) and were exposed to fewer additional cardiac procedures, notably coronary artery bypass graft surgery (0.5% vs. 9.5%). The prevalence of specific reasons for not being operated, including the patient's refusal and the proportion of proximal vs. distal lesions, did not differ between sexes. A total of 57 (17.0%) deaths in women and 70 (20.7%) in men were recorded over long-term follow-up. Female sex was positively associated with long-term survival (adjusted Hazard Ratio 0.66; 95% Confidence Interval 0.46–0.94). Short-term mortality was identical in the two groups (Figure 1, Panel B).

Conclusions

Women with CTEPH had a lower prevalence of cardiovascular risk factors and underwent PEA less frequently than men, who, in turn, were more often exposed to additional major cardiac surgery procedures. Women had more favorable long-term survival.

Acknowledgement/Funding

The CTEPH registry is supported by a research grant from Actelion Pharmaceuticals Ltd.

Age at menarche and risk of colorectal adenoma

BACKGROUND/AIMS

Limited data are available regarding the association between age at menarche and the risk of colorectal adenoma. Therefore, we aimed to evaluate the relationship between reproductive factors including age at menarche and the risk of colorectal adenoma.

METHODS

A cross-sectional study was performed on asymptomatic female subjects who underwent colonoscopy between 2010 and 2014 as part of a comprehensive health screening program in Korea. The association between reproductive factors including age at menarche and the presence of adenomas was assessed using multivariate logistic regression analysis.

RESULTS

Among 32,620 asymptomatic female subjects, the proportion of patients with menarche at 10 to 11, 12 to 13, 14 to 15, 16 to 17, and 18 to 19 years of age was 4.1%, 31.7%, 45.4%, 14.9%, and 4.0%, respectively. Age at menarche was not significantly associated with the risk of any adenoma (adjusted odds ratio [AOR], 0.99; 95% confidence interval [CI], 0.97 to 1.02; p = 0.500) or advanced adenoma (AOR, 0.98; 95% CI, 0.91 to 1.04; p = 0.468) after adjusting for confounding factors. Age at menarche was not significantly associated with the risk of adenoma even among similar age groups. In addition, parity, use of female hormones, and menopause were not associated with the risk of adenoma.

CONCLUSION

Age at menarche, parity, use of female hormones, and menopause were not significantly associated with the risk of colorectal adenoma. Our findings indicate that reproductive factors including age at menarche do not affect the development of colorectal adenoma.

Long-term efficacy and safety of CT-P13, a biosimilar of infliximab, in patients with inflammatory bowel disease: A retrospective multicenter study

BACKGROUND AND AIM

A biosimilar of infliximab, CT-P13 (Remsima®) has the potential to reduce treatment costs and enhance access to biological therapy for inflammatory bowel disease (IBD) patients. However, long-term clinical data on its use for IBD treatment are currently sparse. We aimed to investigate the long-term efficacy and safety of CT-P13 therapy in a large, real-life IBD cohort.

METHODS

A total of 368 IBD patients (227 with Crohn's disease [CD] and 141 with ulcerative colitis [UC]) treated with CT-P13 at 16 referral hospitals in Korea between July 2012 and December 2017 were retrospectively analyzed.

RESULTS

The cumulative retention rates at years 1, 3, and 5 were 86.1%, 68.5%, and 58.7% and 69.7%, 46.0%, and 26.7% in anti-tumor necrosis factor (TNF)-naïve CD and UC patients, respectively. The clinical response and remission rates at week 14 and at years 1, 3, and 5 were 94.3%, 92.7%, 76.8%, and 17.6% and 78.6%, 82.4%, 72.2%, and 17.6% in anti-TNF-naïve CD and 85.6%, 80.0%, 55.2%, and 6.7% and 42.6%, 59.8%, 44.2%, and 6.7% in anti-TNF-naïve UC patients, respectively. Among patients who switched from the biologic originator to CT-P13, the cumulative retention rates at years 1, 3, and 5 were 88.5%, 66.1%, and 44.8% in CD, and 73.9%, 42.5%, and 42.5% in UC patients, respectively. Significant improvements in disease activity scores were accompanied by marked reductions in inflammatory marker levels, and no unexpected adverse events including death or malignancy occurred during the study period.

CONCLUSIONS

Long-term treatment with CT-P13 is effective in inducing and maintaining disease improvement and is well-tolerated in patients with IBD. CT-P13 may be a promising treatment option for IBD.

Impact of obesity and metabolic abnormalities on the risk of metachronous colorectal neoplasia after polypectomy in men

BACKGROUND AND AIM

Obesity and metabolic syndrome are well-known risk factors for the development of metachronous colorectal neoplasia (CRN). However, data on the risks of metachronous CRN among subgroups according to obesity and metabolic status are scarce. Therefore, we aimed to compare the risk of metachronous CRN among men with different obesity and metabolic status.

METHODS

In total, 8059 asymptomatic men who underwent ≥ 1 adenoma removal between 2010 and 2014 and follow-up colonoscopic surveillance until 2017 were categorized into four groups according to obesity and metabolic status: metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO).

RESULTS

Of the 8059 men, 2389 (29.6%), 351 (4.4%), 1986 (24.6%), and 3333 (41.4%) subjects were assigned to the MHNO, MHO, MUNO, and MUO groups, respectively. The mean surveillance interval was 3.5 ± 1.4 years. Compared to the MHNO group, the risk of metachronous advanced CRN was significantly increased in the MUO group (adjusted hazard ratio [HR] = 1.50; 95% confidence interval [CI]: 1.02-2.19), but not in the MHO and MUNO groups, while the risk of metachronous overall CRN significantly increased in the MUNO (adjusted HR = 1.12; 95% CI: 1.01-1.24) and MUO groups (adjusted HR = 1.17; 95% CI: 1.07-1.29), but not in the MHO group.

CONCLUSIONS

Men who had both obesity and poor metabolic health were found to be at an increased risk of metachronous advanced CRN, suggesting that MUO men may need to undergo more intensive surveillance colonoscopy after polypectomy.

Long-Term Efficacy and Safety of Partial Splenic Embolization in Hepatocellular Carcinoma Patients with Thrombocytopenia Who Underwent Transarterial Chemoembolization

BACKGROUND

Performing transarterial chemoembolization (TACE) is difficult with the occurrence of thrombocytopenia in cirrhotic patients with hepatocellular carcinoma (HCC). We aimed to evaluate the long-term efficacy and safety of partial splenic embolization (PSE) combined with TACE in patients with HCC with severe thrombocytopenia related to splenomegaly.

METHODS

We conducted a case-control study consisting of 18 HCC patients with severe thrombocytopenia (< 50 × 10⁹/L) who underwent PSE concurrently with TACE (PSE group) and 72 controls who underwent TACE alone (non-PSE group).

RESULTS

Mean platelet counts at 1 month and 1, 3, and 5 years after concurrent PSE and TACE significantly increased compared with baseline (all P < 0.05), whereas the platelet count did not significantly increase after TACE alone. In addition, the platelet count at several time points after treatment in the PSE group was significantly higher than that in the non-PSE group, although the baseline platelet count in the PSE group was significantly lower than that in the non-PSE group. The platelet increase after PSE significantly reduced the need for platelet transfusions (P = 0.040) and enabled the subsequent TACE procedures in time (P = 0.046). The leukocyte counts and hemoglobin concentrations after concurrent PSE and TACE were also significantly increased, without deterioration of Child-Turcotte-Pugh score and unexpected side effects.

CONCLUSION

PSE combined with TACE is effective in inducing and maintaining long-term thrombocytopenia improvement which reduces the need for the platelet transfusion and helps to perform initial and serial TACE, and is well-tolerated in patients with HCC and thrombocytopenia. PSE may be a promising treatment option for HCC patients with severe thrombocytopenia associated with splenomegaly who will undergo TACE.

Impact of temperature and humidity on performance of the fecal immunochemical test for advanced colorectal neoplasia

Although it is known that ambient temperature can affect the diagnostic performance of the fecal immunochemical test (FIT), the impact of other weather parameters, including humidity, on the sensitivity of FIT remains to be further investigated. We aimed to evaluate the impact of ambient temperature and humidity on the performance of FIT for screening for advanced colorectal neoplasia (ACRN). We included asymptomatic individuals who had undergone both screening colonoscopy and FIT. The diagnostic performance of FIT, including its sensitivity, was analyzed according to the ambient temperature and humidity on the day that FIT was performed. Temperature and humidity were divided into five levels. Among 35,461 participants, 589 (1.7%) had ACRN. The positivity rate of FIT was lower at ≥24 °C (3.1%) than at <0 °C (3.9%), 0–8 °C (4.3%), and 8–16 °C (3.9%). It was also lower at 80–90% humidity (3.1%) than at < 60% humidity (3.9%). Multivariable analysis showed that high ambient temperature (≥24 °C) with high ambient humidity (≥80%) was associated with a low positivity rate of FIT (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.44–0.86). Sensitivity tended to decrease at high ambient temperature (<24 °C vs. ≥24 °C; 20.8% vs. 14.6%, P = 0.110) and was significantly lower at high ambient humidity (<80% vs. ≥80%; 21.0% vs. 12.5%, P = 0.044). The multivariable analysis also showed that high ambient humidity was independently associated with low sensitivity of FIT (OR 0.54, 95% CI 0.28–0.96). In conclusion, high ambient humidity decreased the sensitivity, while high ambient temperature along with high ambient humidity decreased the positivity rate of FIT.

Erratum: Addition of a Co-Author: Etiology of Invasive Bacterial Infections in Immunocompetent Children in Korea (2006-2010): a Retrospective Multicenter Study

This corrects the article on e45 in vol. 33, PMID: 29349940.

Regular dental scaling associated with decreased tooth loss in the middle-aged and elderly in Korea: A 3-year prospective longitudinal study

Context

Tooth loss exacerbates the deterioration of physical function and induces illness. Numerous studies have identified the risk factors for tooth loss, and several have identified an association of tooth loss with sociodemographic factors, general health status, and lifestyle.

Aims

The objective of the present cohort study was to elucidate the relationship between regular dental scaling and tooth loss in middle-aged and elderly individuals in Korea.

Settings and Design

The study was 3-year prospective longitudinal study and conducted in Wonju-si of South Korea.

Methods

In total, 557 subjects (219 men, 338 women; 40-75 years) were included in our 3-year follow-up survey (2010-2014). Data from the Korean Genome and Epidemiology Study on Atherosclerosis Risk of Rural Areas in the Korean General Population (KOGES-ARIRANG) were used. All subjects underwent an oral examination and face-to-face interview for taking oral health behavior, sociodemographic status, and the utilization of dental service.

Statistical Analysis Used

Logistic regression analysis was used to determine the effects of regular dental scaling on tooth loss after adjusting for history of oral examinations and dental visits, oral health behavior, and sociodemographic status.

Results

In total, 263 subjects (47.2%) experienced a loss of one or more teeth during the 3-year period, and lost a mean of 1.54 ± 2.53 teeth. The incidence of tooth loss was 1.87 (1.03-3.38) times higher in participants who did not undergo dental scaling during the 3-year period than in those who regularly received dental scaling.

Conclusions

This study showed the potential causal relationship between tooth loss and regular dental scaling for preventing oral disease. Further study is needed to consolidate the evidence that regular dental scaling is effective in preventing tooth loss.

Associations of Metabolic Syndrome with Total Testosterone and Homocysteine Levels in Male Korean Workers

BACKGROUND

Low testosterone is associated with metabolic syndrome (MetS), and homocysteine (Hcy) is elevated in individuals with MetS. We investigated the relationships of total testosterone (TT) and serum Hcy levels with MetS in male Korean workers.

METHODS

We conducted a cross-sectional study including 8,606 male workers, aged 20 to 58 years, who underwent a physical examination in 2015. MetS was diagnosed based on the criteria of the 2009 harmonized definition, while the Korean standard for waist circumference (WC) was used. Participants' biochemical parameters, including TT and serum Hcy, were measured, and participants were divided into quartiles. Multiple logistic regression models were used to estimate the association of MetS and its individual components depending on TT and serum Hcy quartiles.

RESULTS

The prevalence of MetS in the study population was 16%. TT was lower in participants with MetS than in those without MetS (P<0.001). By contrast, Hcy level was similar between groups (P=0.694). In multiple logistic regression analysis, the odds ratio for the lowest TT quartile was 1.29 (95% confidence interval, 1.06 to 1.57) after adjusting for potential confounders. Participants with lower TT were more likely to have high WC, hypertriglyceridemia, and low high density lipoprotein levels. Serum Hcy levels were not significantly associated with MetS. Of the five components of MetS, only WC was significantly associated with serum Hcy.

CONCLUSION

In male Korean workers, TT may be an independent predictor of MetS, and serum Hcy levels could be a marker of abdominal obesity. However, future prospective studies are needed.

Usefulness of risk stratification models for colorectal cancer based on fecal hemoglobin concentration and clinical risk factors

BACKGROUND AND AIMS

We aimed to develop risk stratification models for advanced colorectal neoplasia (ACRN) and colorectal cancer (CRC) based on fecal hemoglobin (f-Hb) concentration and clinical risk factors.

METHODS

We reviewed screenees aged ≥50 years who underwent fecal immunochemical test (FIT) and colonoscopy and developed risk-scoring models for ACRN and CRC using logistic regression analysis. Participants were classified into low- (risk lower than that in FIT-negative individuals), intermediate- (risk higher than that in FIT-negative but lower than that in FIT-positive individuals), high- (risk similar to that in FIT-positive individuals), and very-high- (risk higher than that in FIT-positive individuals) risk groups.

RESULTS

Of 3733 participants, 367 (9.8%) and 70 (1.9%) had ACRN and CRC, respectively. On multivariable analysis, age (ß = .043/y), former smoker (ß = .401), current smoker (ß = .841), diabetes (ß = .097), and square root of f-Hb concentration (ß = .071) were significantly associated with ACRN. In terms of CRC, age (ß = .035/y) and square root of f-Hb concentration (ß = .004) were associated factors. After point assignments based on the regression coefficient, we could classify screenees as low-, intermediate-, high-, and very-high-risk groups. ACRN was identified in 2.9%, 5.3%, 16.2%, and 35.7% of screenees in the low-, intermediate-, high-, and very-high-risk groups, respectively. CRC was identified in .1%, .5%, 3.9%, and 11.1% of screenees in the low-, intermediate-, high-, and very-high-risk groups, respectively.

CONCLUSIONS

The proposed models can effectively stratify the risk for ACRN and CRC and provide accurate information on this risk in individuals who undergo FIT.

Yield of repeat colonoscopy in asymptomatic individuals with a positive fecal immunochemical test and recent colonoscopy

BACKGROUND AND AIMS

A fecal immunochemical test (FIT) is often repeated annually, even after a recent colonoscopy. However, there are no published data on the proper approach to FIT-positive patients after a recent colonoscopy. We compared colorectal cancer (CRC) and advanced colorectal neoplasia (ACRN) prevalence based on the interval since the last colonoscopy.

METHODS

We reviewed asymptomatic screenees aged ≥50 years who underwent FIT and colonoscopy.

RESULTS

Of 2228 FIT-positive participants, 514 had a colonoscopy less than 3 years before (group 1), 427 had a colonoscopy had a colonoscopy 3 to 10 years before (group 2), and 1287 had a colonoscopy >10 years before or no colonoscopy (group 3). The prevalence of CRC in groups 1, 2, and 3 was 2.1%, 1.6%, and 7.2%, respectively, and that for ACRN was 10.9%, 12.6%, and 26.0%, respectively. Even after adjusting for confounders, CRC and ACRN detection rates in group 1 were lower than those in group 3 but not lower than those in group 2. Among 6135 FIT-negative participants, the prevalence of CRC in the 3 groups was .7%, .4%, and 3.4%, respectively, and that for ACRN was 6.0%, 6.1%, and 14.7%, respectively. CRC and ACRN detection rates were significantly higher in FIT-positive participants than in FIT-negative participants in all 3 groups.

CONCLUSIONS

In FIT-positive patients who underwent colonoscopy within the prior 3 years, CRC and ACRN prevalence was not low. Our findings support the U.S. Multi-Society Task Force on the CRC screening recommendation that repeat colonoscopy be offered to patients with positive FIT results and recent colonoscopy.

Reverse Chemical Proteomics Identifies an Unanticipated Human Target of the Antimalarial Artesunate

Artemisinins are the most potent and safe antimalarials available. Despite their clinical potential, no human target for the artemisinins is known. The unbiased interrogation of several human cDNA libraries, displayed on bacteriophage T7, revealed a single human target of artesunate; the intrinsically disordered Bcl-2 antagonist of cell death promoter (BAD). We show that artesunate inhibits the phosphorylation of BAD, thereby promoting the formation of the proapoptotic BAD/Bcl-xL complex and the subsequent intrinsic apoptotic cascade involving cytochrome c release, PARP cleavage, caspase activation, and ultimately cell death. This unanticipated role of BAD as a possible drug target of artesunate points to direct clinical exploitation of artemisinins in the Bcl-xL life/death switch and that artesunate's anticancer activity is, at least in part, independent of reactive oxygen species.

Appropriate Surveillance Interval after Colonoscopic Polypectomy in Patients Younger than 50 Years

BACKGROUND

Current postpolypectomy surveillance guidelines are based on studies in patients aged ≥50 years. Equal application of the guidelines in patients aged < 50 years may be unreasonable. We aimed to determine an appropriate surveillance interval after adenoma removal in patients aged < 50 years.

METHODS

We studied 10,013 patients who underwent ≥ 1 adenoma removal and follow-up colonoscopy. The cumulative risk of metachronous advanced colorectal neoplasia (ACRN) was compared among the eight groups based on age (30-39, 40-44, 45-49 and ≥ 50 years) and baseline adenoma characteristics (low- [LRA] and high-risk adenoma [HRA]).

RESULTS

The risk of metachronous ACRN in patients aged 30-39 and 40-44 years with HRA was comparable to that in those aged ≥ 50 years with LRA (P = 0.839 and P = 0.381, respectively). However, the risk in those aged 45-49 years with HRA was higher than in those aged ≥ 50 years with LRA (P = 0.003), and the risk was not significantly different from that in those aged ≥ 50 years with HRA (P = 0.092). Additionally, the 5-year cumulative risk in those aged 45-49 years with LRA was not significantly different from that in those aged ≥ 50 years with LRA.

CONCLUSION

The postpolypectomy surveillance interval can be extended up to 5 years in patients aged 30-44 years with HRA, similar to those aged ≥ 50 years with LRA. However, the interval in patients aged 45-49 years with HRA and LRA should be 3 and 5 years, respectively, similar to those aged ≥ 50 years.

Impact of family history of colorectal cancer on age-specific prevalence of colorectal neoplasia

BACKGROUND AND AIM

There are no established guidelines on screening strategies for persons with a family history of colorectal cancer (CRC) in Korea. We aimed to evaluate the age-specific risk of colorectal neoplasia according to family history of CRC.

METHODS

Participants who underwent screening colonoscopy were included. Age-specific prevalence of non-advanced adenoma (NAA) and advanced colorectal neoplasia (ACRN) was calculated according to family history of CRC.

RESULTS

Among 35 997 participants, 1339 (3.7%) had a family history of CRC in first-degree relatives. A family history of CRC was an independent risk factor for NAA (adjusted odds ratio [AOR] 1.33, 95% confidence interval [CI] 1.16-1.52). In the subgroup analysis by age, family history of CRC was a risk factor for NAA in the 50-59 and ≥ 60 years groups (AOR [95% CI]: 1.42 [1.04-1.91] and 2.33 [1.34-4.09], respectively), but not in the 30-39 and 40-49 years groups. In the curve of age-specific prevalence of NAA, the gap of the prevalence between the family history and non-family history groups began to widen after the mid-50s. In cases of ACRN, a family history of CRC was not a risk factor in the entire age group (AOR 1.16, 95% CI 0.75-1.70). In the curve of age-specific prevalence of ACRN, however, the gap of the prevalence between the family history and non-family history groups began to widen after the early 60s.

CONCLUSION

Although a family history of CRC is a risk factor for NAA, it may affect NAA development from the mid-50s and ACRN development from the early 60s.

Abstract P1-08-21: Association of depression and anxiety disorder with the risk of mortality in breast cancer: A national health insurance service study in South Korea

PURPOSE: To examine whether depression, anxiety disorder and their co-occurrence would increase the risk of mortality in patients with breast cancer, and whether antidepressant treatment would reduce the same.

PATIENTS AND METHODS: Data were retrieved from the database of the Korean National Health Insurance Service. Of 145,251 patients diagnosed with breast cancer between 2007 and 2014, 20,870 patients diagnosed with depression or anxiety disorder one year before breast cancer diagnosis were excluded. Thus, data of 124,381 patients were included in this study.

RESULTS: Anxiety disorder was more prevalent than depression in patients with breast cancer, and similar factors were associated with both depression and anxiety disorder. Overall, female sex, older age, residence in metropolitan areas, lower income, higher comorbidity, carcinoma in situ, and the receipt of any type of cancer therapies were associated with an increased risk of depression or anxiety disorder. Depression and anxiety disorder were associated with an increased risk of mortality (Hazard Ratio (HR) = 1.26, 95% CI=1.18–1.36; HR=1.14, 95% CI=1.08–1.22, respectively) and their co-occurrence further increased the risk (HR=1.38, 95% CI=1.24–1.54). Antidepressant treatment was related to a reduced risk of mortality. Compared to patients with no depression, among those with depression, the risk of mortality was 2.18 times higher (95% CI=1.69–2.81) in patients who did not receive antidepressant treatment and 1.25 times higher (95% CI =1.17–1.32) in those who received antidepressant treatment.

CONCLUSION: The current findings suggest that psychiatric comorbidities are markers of increased mortality risk in patients with breast cancer. This underscores the need for screening and treating depression and anxiety disorders to improve survival in breast cancer.

Citation Format: Kim YS, Shim E-J, Lee JW, Cho J, Jung HK, Kim NH, Lee JE, Min J, Noh WC, Park S-H. Association of depression and anxiety disorder with the risk of mortality in breast cancer: A national health insurance service study in South Korea [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-21.

Association between family history of colorectal cancer and the risk of metachronous colorectal neoplasia following polypectomy in patients aged < 50 years

BACKGROUND AND AIM

The relationship between a family history of colorectal cancer (CRC) and the risk of metachronous colorectal neoplasia (CRN) following polypectomy remains unknown. We aimed to compare the risk of metachronous CRN according to CRC family history in groups of patients aged < 50 and ≥ 50 years.

METHODS

We studied patients who underwent ≥ 1 adenoma removal between 2010 and 2014 and follow-up surveillance colonoscopic examinations until 2017.

RESULTS

Among the 9866 patients studied, 544 (5.5%) had ≥ 1 first-degree relatives (FDRs) affected by CRC. In patients aged < 50 years (n = 7787), as compared with having no family history of CRC, a positive family history in any FDR (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.16-1.62), a father (HR 1.35, 95% CI 1.09-1.68), or a mother (HR 1.32, 95% CI 1.005-1.74) was associated with an increased risk of metachronous CRN after adjusting for confounding factors. However, in patients aged ≥ 50 years (n = 2079), there was no significant association between having an FDR with CRC and the risk of metachronous CRN. For metachronous advanced CRN, the association between its risk and family history of CRC was not observed in either the < 50 years or ≥ 50 years of age group.

CONCLUSIONS

Having an FDR with CRC at a young age (< 50 years) appears to be closely related to the risk of metachronous CRN. However, considering that the risk of metachronous advanced CRN did not depend on CRC family history, the interval of post-polypectomy surveillance colonoscopy may not need to be adjusted depending on CRC family history.

Loss of SLC25A11 causes suppression of NSCLC and melanoma tumor formation

Background

Fast growing cancer cells require greater amounts of ATP than normal cells. Although glycolysis was suggested as a source of anabolic metabolism based on lactate production, the main source of ATP to support cancer cell metabolism remains unidentified.

Methods

We have proposed that the oxoglutarate carrier SLC25A11 is important for ATP production in cancer by NADH transportation from the cytosol to mitochondria as a malate. We have examined not only changes of ATP and NADH but also changes of metabolites after SLC25A11 knock down in cancer cells.

Findings

The mitochondrial electron transport chain was functionally active in cancer cells. The cytosolic to mitochondrial NADH ratio was higher in non-small cell lung cancer (NSCLC) and melanoma cells than in normal cells. This was consistent with higher levels of the oxoglutarate carrier SLC25A11. Blocking malate transport by knockdown of SLC25A11 significantly impaired ATP production and inhibited the growth of cancer cells, which was not observed in normal cells. In in vivo experiments, heterozygote of SLC25A11 knock out mice suppressed KRAS^LA2 lung tumor formation by cross breeding.

Interpretation

Cancer cells critically depended on the oxoglutarate carrier SLC25A11 for transporting NADH from cytosol to mitochondria as a malate form for the purpose of ATP production. Therefore blocking SLC25A11 may have an advantage in stopping cancer growth by reducing ATP production.

Fund

The Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science and ICT to SYK (NRF-2017R1A2B2003428).