The Cambridge Prognostic Groups for improved prediction of disease mortality at diagnosis in primary non-metastatic prostate cancer: a validation study.

Purpose: To validate a new 5-tier prognostic classification system to better discriminate cancer specific mortality in men diagnosed with primary non-metastatic prostate cancer. Patients and Methods: We applied a recently described 5 strata model (Cambridge Prognostic Groups-CPG) in 2 international cohorts and tested prognostic performance against the current standard 3 strata classification of low, intermediate or high-risk disease. Diagnostic clinico-pathological data of men from Prostate Cancer Data Base Sweden (PCBaSe) and the Singapore Health Study were used. The main outcome measure was prostate cancer mortality (PCM) stratified by age group and treatment modality. Results: The PCBaSe cohort included 72,337 men, of whom 7,162 died of prostate cancer. The CPG model successfully classified men with different risks of PCM with competing risk-regression confirming significant intergroup distinction (p<0.0001). The CPGs were significantly better at stratified prediction of PCM compared to the current 3-tier system (C-Index 0.81 vs. 0.77, p<0.0001). This superiority was maintained for every age group division (p<0.0001). Also in the ethnically different Singapore cohort of 2,550 men with 142 prostate cancer deaths, the CPG model outperformed the 3 strata categories (C-Index 0.79 vs. 0.76, p<0.0001). The model also retained superior prognostic discrimination in treatment sub-groups - Radical prostatectomy (n=20,586): C-Index 0.77 vs. 074, radiotherapy (n=11,872): C-Index 0.73 vs. 0.68, and conservative management (n=14,950): C-Index 0.74 vs. 0.73. The CPG groups that sub-divided the old intermediate (CPG2 vs. CPG3) and high-risk categories (CPG4 vs.CPG5) significantly discriminated PCM outcomes after radical therapy or conservative management (p<0.0001). Conclusion: This validation study of nearly 75,000 men, confirms that the CPG 5-tiered prognostic model has superior discrimination in predicting prostate cancer death over the 3-tier model across different age and treatment groups. Crucially, it identifies distinct sub-groups of men within the old intermediate-risk and high-risk criteria who have very different prognostic outcomes We therefore propose adoption of the CPG model as a simple to use but more accurate prognostic stratification tool to help guide management for men with newly diagnosed prostate cancer

Common founder effects of hereditary hemochromatosis, Wilson´s disease, the long QT syndrome and autosomal recessive deafness caused by two novel mutations in the WHRN and TMC1 genes.

BACKGROUND: Genealogy and molecular genetic studies of a Swedish river valley population resulted in a large pedigree, showing that the hereditary hemochromatosis (HH) HFE/p.C282Y mutation is inherited with other recessive disorders such as Wilson´s disease (WND), a rare recessive disorder of copper overload. The population also contain individuals with the Swedish long QT syndrome (LQTS1) founder mutation (KCNQ1/p.Y111C) which in homozygotes causes the Jervell & Lange Nielsen syndrome (JLNS) and hearing loss (HL).Aims of the study were to test whether the Swedish long QT founder mutation originated in an ancestral HFE family and if carriers had an increased risk for hemochromatosis (HH), a treatable disorder. We also aimed to identify the pathogenic mutation causing the hearing loss disorder segregating in the pedigree. METHODS: LQTS patients were asked about their ancestry and possible origin in a HH family. They were also offered a predictive testing for the HFE genotype. Church books were screened for families with hearing loss. One HH family had two members with hearing loss, who underwent molecular genetic analysis of the LQTS founder mutation, connexin 26 and thereafter exome sequencing. Another family with hearing loss in repeat generations was also analyzed for connexin 26 and underwent exome sequencing. RESULTS: Of nine LQTS patients studied, four carried a HFE mutation (two p.C282Y, two p.H63D), none was homozygous. Three LQTS patients confirmed origin in a female founder ( b 1694, identical to AJ b 1694, a HFE pedigree member from the Fax river. Her descent of 44 HH families, included also 29 families with hearing loss (HL) suggesting JLNS. Eleven LQTS probands confirmed origin in a second founder couple (b 1614/1605) in which the woman b 1605 was identical to a HFE pedigree member from the Fjällsjö river. In her descent there were not only 64 HH, six WND families, one JLNS, but also 48 hearing loss families. Most hearing loss was non syndromic and caused by founder effects of the late 16th century. One was of Swedish origin carrying the WHRN, c.1977delC, (p.S660Afs*30) mutation, the other was a TMC1(NM_138691),c.1814T>C,(p.L605P) mutation, possibly of Finnish origin. CONCLUSIONS: Deep human HFE genealogies show HFE to be associated with other genetic disorders like Wilson´s disease, LQTS, JLNS, and autosomal recessive hearing loss. Two new homozygous HL mutations in WHRN/p.S660Afs*30 and TMC1/p.L605P were identified,none of them previously reported from Scandinavia. The rarity of JLNS was possibly caused by miscarriage or intrauterine death. Most hearing loss (81.7%) was seen after 1844 when first cousin marriages were permitted. However, only 10 (10.3%) came from 1st cousin unions and only 2 (2.0 %) was born out of wedlock

Functional polymorphisms within the inflammatory pathway regulate expression of extracellular matrix components in a genetic risk dependent model for anterior cruciate ligament injuries

Objectives: To investigate the functional effect of genetic polymorphisms of the inflammatory pathway on structural extracellular matrix components (ECM) and the susceptibility to an anterior cruciate ligament (ACL) injury. Design: Laboratory study, case–control study. Methods: Eight healthy participants were genotyped for interleukin (IL)1B rs16944 C > T and IL6 rs1800795 G > C and

Comment on the consensus report on the management of hyperglycaemia in Type 2 diabetes by the American Diabetes Association and the European Association for the Study of Diabetes

Letter to the edito

Insulin-like growth factors and cancer: no role in screening. Evidence from the BUPA study and meta-analysis of prospective epidemiological studies

Insulin-like growth factor-1 (IGF-1), insulin-like growth factor-2 (IGF-2), and insulin-like growth factor binding protein-3 (IGFBP-3) were measured in frozen serum samples from 1051 men with cancer and 3142 controls in a nested case–control study from the British United Provident Association (BUPA) study cohort and associations with 14 cancers were examined, including prostate, colorectal, and lung. A meta-analysis of studies on these three cancer sites was also conducted. In the meta-analysis the odds ratio between the highest quartile IGF-1 group and the lowest quartile group was 1.31 (95% confidence interval (CI): 1.03–1.67) for prostate, 1.37 (1.05–1.78) for colorectal and 1.02 (0.80–1.31) for lung cancer, and for IGF-2 it was 0.72 (0.36–1.44) for prostate and 1.95 (1.26–3.00) for colorectal cancer. Results from the BUPA study were consistent with the estimates from the other studies. There were no statistically significant associations with IGFBP-3 and any of the cancer sites considered. Our results suggest that IGF-1, IGF-2, and IGFBP-3 measurements have no value in cancer screening, although IGF-1 and IGF-2 may be of aetiological significance in relation to colorectal and prostate cancer

Plasma phyto-oestrogens and prostate cancer in the European Prospective Investigation into Cancer and Nutrition

We examined plasma concentrations of phyto-oestrogens in relation to risk for subsequent prostate cancer in a case–control study nested in the European Prospective Investigation into Cancer and Nutrition. Concentrations of isoflavones genistein, daidzein and equol, and that of lignans enterolactone and enterodiol, were measured in plasma samples for 950 prostate cancer cases and 1042 matched control participants. Relative risks (RRs) for prostate cancer in relation to plasma concentrations of these phyto-oestrogens were estimated by conditional logistic regression. Higher plasma concentrations of genistein were associated with lower risk of prostate cancer: RR among men in the highest vs the lowest fifth, 0.71 (95% confidence interval (CI) 0.53–0.96, P trend=0.03). After adjustment for potential confounders this RR was 0.74 (95% CI 0.54–1.00, P trend=0.05). No statistically significant associations were observed for circulating concentrations of daidzein, equol, enterolactone or enterodiol in relation to overall risk for prostate cancer. There was no evidence of heterogeneity in these results by age at blood collection or country of recruitment, nor by cancer stage or grade. These results suggest that higher concentrations of circulating genistein may reduce the risk of prostate cancer but do not support an association with plasma lignans

Data on diabetes-specific distress are needed to improve the quality of diabetes care [Correspondence]

no abstract availabl

Blood Glucose and Risk of Incident and Fatal Cancer in the Metabolic Syndrome and Cancer Project (Me-Can): Analysis of Six Prospective Cohorts

Tanja Stocks and colleagues carry out an analysis of six European cohorts and confirm that abnormal glucose metabolism is linked with increased risk of cancer overall and at specific sites

Associations among the parent–adolescent relationship, aggression and delinquency in different ethnic groups: a replication across two Dutch samples

Background: The aim of the present study is to examine whether the patterns of association between the quality of the parent-adolescent relationship on the one hand, and aggression and delinquency on the other hand, are the same for boys and girls of Dutch and Moroccan origin living in the Netherlands. Since inconsistent results have been found previously, the present study tests the replicability of the model of associations in two different Dutch samples of adolescents. Method: Study 1 included 288 adolescents (M age = 14.9, range 12-17 years) all attending lower secondary education. Study 2 included 306 adolescents (M age = 13.2, range = 12-15 years) who were part of a larger community sample with oversampling of at risk adolescents. Results: Multigroup structural analyses showed that neither in Study 1 nor in Study 2 ethnic or gender differences were found in the patterns of associations between support, autonomy, disclosure, and negativity in the parent-adolescent relationship and aggression and delinquency. The patterns were largely similar for both studies. Mainly negative quality of the relationship in both studies was found to be strongly related to both aggression and delinquency. Discussion: Results show that family processes that affect adolescent development, show a large degree of universality across gender and ethnicity