Survivorship with mouth and pharynx cancer and their association with cirrhosis of the liver, marital status, and residence

Use of the liver maximum function capacity test (LiMAx) for the management of liver resection in cirrhosis - A case of hypopharyngeal cancer liver metastasis

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A patient with a liver metastasis of pharyngeal cancer and aspect of severe cirrhosis is presented.

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Conventional laboratory tests are surrogate parameters and might underestimate cirrhosis.

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The LiMAx test provides a direct measurement of the liver function capacity even in cirrhosis.

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Safe resection was performed after LiMAx test proved operability.

Introduction

The presence of liver cirrhosis goes along with a higher chance for the need of liver resection. As established laboratory parameters often underestimate the degree of cirrhosis this is associated with an increased risk for postoperative liver failure due to the preoperatively impaired liver function. Known liver function tests are unlikely to be performed in daily use because of high cost or expenditure of time. Liver maximum function capacity test (LiMAx) provides a novel tool for measurement of liver function and references for the safety of liver resection.

Presentation of case

A 63-year old patient presented at our hospital with a large, solitary liver metastasis from hypopharyngeal cancer in segments VII/VIII with infiltration of the diaphragm. Liver resection was unsuccessful in a peripheral hospital 10 months before due to considerable macroscopic liver cirrhosis (CHILD B). Upon presentation conventional laboratory parameters revealed sufficient liver function. LiMAx was performed and showed regular liver function (354 μg/kg/h; at norm >315 μg/kg/h). Consequently, atypical liver resection (R0) was performed resulting in a postoperative LiMAx value of 281 μg/h/kg (>150 μg/kg/h). The patient was discharged from hospital 37 days after surgery without any signs of postoperative liver failure.

Conclusion

The LiMAx-test enables determination of liver function at a so far unavailable level (metabolism via cytochrome P450 1A2) and hence might provide crucial additional diagnostic information to allow for safe liver resection even in cirrhotic patients.

Widowhood and mortality: a meta-analysis and meta-regression

The study of spousal bereavement and mortality has long been a major topic of interest for social scientists, but much remains unknown with respect to important moderating factors, such as age, follow-up duration, and geographic region. The present study examines these factors using meta-analysis. Keyword searches were conducted in multiple electronic databases, supplemented by extensive iterative hand searches. We extracted 1,377 mortality risk estimates from 123 publications, providing data on more than 500 million persons. Compared with married people, widowers had a mean hazard ratio (HR) of 1.23 (95% confidence interval (CI), 1.19-1.28) among HRs adjusted for age and additional covariates and a high subjective quality score. The mean HR was higher for men (HR, 1.27; 95% CI, 1.19-1.35) than for women (HR, 1.15; 95% CI, 1.08-1.22). A significant interaction effect was found between gender and mean age, with HRs decreasing more rapidly for men than for women as age increased. Other significant predictors of HR magnitude included sample size, geographic region, level of statistical adjustment, and study quality.

Meta-analysis of marital dissolution and mortality: reevaluating the intersection of gender and age

The study of marital dissolution (i.e. divorce and separation) and mortality has long been a major topic of interest for social scientists. We conducted meta-analyses and meta-regressions on 625 mortality risk estimates from 104 studies, published between 1955 and 2011, covering 24 countries, and providing data on more than 600 million persons. The mean hazard ratio (HR) for mortality in our meta-analysis was 1.30 (95% confidence interval [CI], 1.23-1.37) among HRs adjusted for age and additional covariates. The mean HR was higher for men (HR, 1.37; 95% CI, 1.27-1.49) than for women (HR, 1.22; 95% CI: 1.13-1.32), but the difference between men and women decreases as the mean age increases. Other significant moderators of HR magnitude included sample size; being from Western Europe, Israel, the United Kingdom and former Commonwealth nations; and statistical adjustment for general health status.

Determinants of head and neck cancer survival by race

BACKGROUND

Several factors contribute to the documented racial disparity in head and neck cancer, among which are socioeconomic status, access to care, and biologic factors.

METHODS

Clinical characteristics of 87 African-American patients with head and neck cancer and a random sample of 261 white patients matched on age and smoking dose were associated with outcome.

RESULTS

Black patients with cancers of the oral cavity and larynx were more likely diagnosed with advanced stages than whites, after adjusting for socioeconomic and insurance status and other confounding factors. There was a significant difference in relapse-free survival between blacks and whites with tumors of the larynx (hazard ratio [HR] = 3.36, 95% confidence interval [CI]: 1.62-7.00), but not with tumors of the oral cavity or pharynx.

CONCLUSIONS

Differences in disease outcome may be attributed to a combination of tumor stage, socioeconomic status, and access to health care. The inclusion of biologic markers such as human papillomavirus (HPV) status is needed in future studies to further evaluate racial disparities in head and neck cancer outcomes.

Gender disparity in the rate of partner abandonment in patients with serious medical illness

BACKGROUND

Life-threatening illness creates severe stress that may result in marital discord, separation, or divorce and may adversely impact treatment, quality of life, and survival. The few studies that are available to date have suggested that the risk of divorce is not higher in cancer patients, but to the authors' knowledge, no data exist to date that have examined the effect of gender on this rate.

METHODS

A total of 515 patients were prospectively identified as having either a malignant primary brain tumor (N = 214), a solid tumor with no nervous system involvement (N = 193), or multiple sclerosis (N = 108) who were married at the time of diagnosis. Basic demographic information and data regarding marital status were compiled. Patients were followed prospectively from enrollment until death or study termination.

RESULTS

Women composed 53% of the patient population. Divorce or separation occurred at a rate similar to that reported in the literature (11.6%). There was, however, a greater than 6-fold increase in risk after diagnosis when the affected spouse was the woman (20.8% vs 2.9%; P < .001). Female gender was found to be the strongest predictor of separation or divorce in each cohort. Marriage duration at the time of illness was also correlated with separation among brain tumor patients (P = .0001). Patients with brain tumors who were divorced or separated were more likely to be hospitalized, and less likely to participate in a clinical trial, receive multiple treatment regimens, complete cranial irradiation, or die at home (P < .0001).

CONCLUSIONS

Female gender was found to be a strong predictor of partner abandonment in patients with serious medical illness. When divorce or separation occurred, quality of care and quality of life were adversely affected.

Long-term all-cause mortality in cancer patients with preexisting diabetes mellitus: a systematic review and meta-analysis

CONTEXT

Diabetes mellitus appears to be a risk factor for some cancers, but the effect of preexisting diabetes on all-cause mortality in newly diagnosed cancer patients is less clear.

OBJECTIVE

To perform a systematic review and meta-analysis comparing overall survival in cancer patients with and without preexisting diabetes.

DATA SOURCES

We searched MEDLINE and EMBASE through May 15, 2008, including references of qualifying articles.

STUDY SELECTION

English-language, original investigations in humans with at least 3 months of follow-up were included. Titles, abstracts, and articles were reviewed by at least 2 independent readers. Of 7858 titles identified in our original search, 48 articles met our criteria.

DATA EXTRACTION

One reviewer performed a full abstraction and other reviewers verified accuracy. We contacted authors and obtained additional information for 3 articles with insufficient reported data.

RESULTS

Studies reporting cumulative survival rates were summarized qualitatively. Studies reporting Cox proportional hazard ratios (HRs) or Poisson relative risks were combined in a meta-analysis. A random-effects model meta-analysis of 23 articles showed that diabetes was associated with an increased mortality HR of 1.41 (95% confidence interval [CI], 1.28-1.55) compared with normoglycemic individuals across all cancer types. Subgroup analyses by type of cancer showed increased risk for cancers of the endometrium (HR, 1.76; 95% CI, 1.34-2.31), breast (HR, 1.61; 95% CI, 1.46-1.78), and colorectum (HR, 1.32; 95% CI, 1.24-1.41).

CONCLUSIONS

Patients diagnosed with cancer who have preexisting diabetes are at increased risk for long-term, all-cause mortality compared with those without diabetes.

Is there a religious factor in health?

This paper reviews epidemiologic studies employing religion as an independent construct, and finds that most epidemiologists have an extremely limited appreciation of religion. After a historical overview of empirical religion and health research, some theoretical considerations are offered, followed by clarification of several operational and methodological issues. Next, well over 200 studies are reviewed from nine health-related areas: cardiovascular disease, hypertension and stroke, colitis and enteritis, general health status, general mortality, cancer of the uterine corpus and cervix, all other non-uterine cancers, morbidity and mortality in the clergy, and cancer in India. Finally, an agenda for further research is proposed.

Squamous cell carcinoma of the oral mucosa: a review of 244 cases in Australia

In an attempt to extend and update information relating to oral cancer in Australia and to provide a basis for international comparison a group of 244 patients suffering from oral cancer have been studied in detail. These patients were all diagnosed in one Oral Pathology Biopsy Service used almost exclusively by oral surgeons and dentists, and although this introduced bias into the sample it had the advantage of standardising documentation. The male: female ratio (1.3 : 1) of patients with oral cancer was lower than that previously reported in Australia, but the average age of patients (60 years) was comparable with many previous reports. The floor of the mouth was the most common site of cancer. There was a significant over-representation of tobacco and alcohol consumers amongst the patients, but a group of elderly females who had never used tobacco or alcohol, yet developed oral cancer, was identified. It was of particular interest that these elderly females had significantly lower haemoglobin and serum iron levels than a sex- and age-matched control group.

Reassessing the epidemiology of lip cancer

The risk factors associated with carcinoma of the lip are reviewed with an aim toward reassessing the epidemiology of the disease. Descriptive studies show lip cancer to occur most commonly in aging white men. The geographic distribution of the disease varies widely, both nationally and internationally; recent studies show that at the national level there is not a uniformly high risk of lip cancer across the sunny states, as has been believed. Secular disease trends show a decline in both morbidity and mortality while survival rates have remained stable. The risk factors consistently associated with lip cancer are rural residence and outdoor occupation, but the latter does not apply to all outdoor workers. In addition, both actinic radiation and tobacco smoking have long been considered to be causally related to lip cancer. An extensive review of the literature, however, reveals that the studies evaluating the association between these exposure variables and the disease do not yield consistent results; in addition, many recent, well-designed studies fail to support independent causal hypotheses. We conclude that (1) any risk factors considered to be causally related to lip cancer must be congruent with the descriptive factors (geographic distribution, secular disease trends, etc.) and (2) although sunlight and smoking are highly likely risk factors, their interrelationship as well as their interaction with other factors, such as genetic predisposition, needs reassessment.

Selected factors in the risks of upper alimentary cancers

This study investigates whether liver cirrhosis, alcoholic beverages, smoked tobaccos, age, occupations, and multiple primary cancers are significant risk factors for malignancies of the upper alimentary tract. It utilizes maximum likelihood estimates of logistic parameters in multivariate analyses of these factors to assess risks of upper alimentary cancers (UAC) among 529 cancer patients, 204 with liver cirrhosis and 325 without liver cirrhosis. All patients are black males, discharged from U.S. Veterans Administration Hospitals from 1969 to 1975 with newly diagnosed and histologically confirmed primary cancers. In comparison with cirrhotics without UAC, cirrhotics with UAC have similar frequencies of liver cirrhosis by type, severity, and histological confirmation but are notably younger and have liver cirrhosis before cancer at a significantly higher frequency and over a significantly longer period. When there is simultaneous adjustment for all six factors, only liver cirrhosis, age, and multiple primaries (mainly at floor of mouth, soft palate, and esophageal sites) are significantly associated with increased cancer risk at upper alimentary sites where such processes as glycogen storage in some squamous cells, as obtains in the liver, may contribute to further elucidation of the implication of liver cirrhosis as a major pathway in cancer risk at upper alimentary sites.