Eun Hye Park

Attributable fraction of tobacco smoking on cancer using population-based nationwide cancer incidence and mortality data in Korea

BackgroundSmoking is by far the most important cause of cancer that can be modified at the individual level. Cancer incidence and mortality rates in Korea are the highest among all Asian countries, and smoking prevalence in Korean men is one of the highest in developed countries. The purpose of the current study was to perform a systematic review and provide an evidence-based assessment of the burden of tobacco smoking-related cancers in the Korean population.MethodsSex- and cancer-specific population-attributable fractions (PAF) were estimated using the prevalence of ever-smoking and second-hand smoking in 1989 among Korean adults, respectively, and the relative risks were estimated from the meta-analysis of studies performed in the Korean population for ever-smoking and in the Asian population for passive smoking. National cancer incidence data from the Korea Central Cancer Registry and national cancer mortality data from Statistics Korea for the year 2009 were used to estimate the cancer cases and deaths attributable to tobacco smoking.ResultsTobacco smoking was responsible for 20,239 (20.9%) cancer incident cases and 14,377 (32.9%) cancer deaths among adult men and 1,930 (2.1%) cancer incident cases and 1,351 (5.2%) cancer deaths among adult women in 2009 in Korea. In men, 71% of lung cancer deaths, 55%–72% of upper aerodigestive tract (oral cavity, pharynx, esophagus and larynx) cancer deaths, 23% of liver, 32% of stomach, 27% of pancreas, 7% of kidney and 45% of bladder cancer deaths were attributable to tobacco smoking. In women the proportion of ever-smoking-attributable lung cancer was 8.1%, while that attributable to second-hand smoking among non-smoking women was 20.5%.ConclusionsApproximately one in three cancer deaths would be potentially preventable through appropriate control of tobacco smoking in Korean men at the population level and individual level. For Korean women, more lung cancer cases and deaths were attributable to second-hand than ever-smoking. Effective control programs against tobacco smoking should be further developed and implemented in Korea to reduce the smoking-related cancer burden.

Statistics of hematologic malignancies in Korea: incidence, prevalence and survival rates from 1999 to 2008

Background The nationwide statistical analysis of hematologic malignancies in Korea has not been reported yet. Methods The Korea Central Cancer Registry and the Korean Society of Hematology jointly investigated domestic incidence rates and prevalence of hematologic malignancies occurred between 1999 and 2008, and analyzed survival rates of patients who were diagnosed between 1993 and 2008. Data of hematologic malignancies from 1993 to 2008 were obtained from the Korean National Cancer Incidence Data base. The crude incidence rates, age-specific incidence rates, age-standardized incidence rates, annual percentage change of incidence, and prevalence from 1999-2008 were calculated. Survival rates for patients diagnosed in 1993-2008 were estimated. Results In 2008, a total of 8,006 cases of hematologic malignancies were occurred, which comprised 4.5% of all malignancies. In all genders, non-Hodgkin lymphoma, myeloid leukemia, and multiple myeloma were most frequent diseases. In terms of age, ages between 60 and 69 were most prevalent. From 1999 to 2008, the age-standardized incidence rates increased from 10.2 to 13.7, and the annual percentage change was 3.9%. The 5-year survival rate increased from 38.2% during 1993-1995 to 55.2% during 2004-2008. As of January 2009, number of patients with 10-year prevalence was 33,130, and with 5- to 10-year prevalence was 10,515. Conclusion This is the first nationwide statistical report of hematologic malignancies in Korea. It could be used as the basic information to help investigate epidemiologic characteristics, evaluate progress during the past years, and establish future strategies for hematologic malignancies. Periodic statistical analysis of hematologic malignancies in Korea should be continued.

Seven-Day Continuous Abstinence Rate from Smoking at 1, 2, or 3 Years after the Use of Varenicline

Background Varenicline, a selective partial agonist/antagonist of the α4β2 nicotinic receptor, has proven effectiveness for smoking cessation by several randomized, controlled trials. Because few studies have evaluated the long-term efficacy of varenicline, we tried to evaluate the smoking status of varenicline users up to 3 years after the initial prescription of the drug. Methods We interviewed varenicline users who were prescribed the drug from June 2007 to May 2010 by telephone, from June 2010 to May 2011. Results One-hundred and thirty-three of 250 varenicline users (53.2%) were available for the survey. Seven-day continuous abstinence from smoking was adhered to by 17 of 39 respondents (43.6%) at 1 year, and 11 of 36 (30.6%) and 19 of 58 (32.8%) at 2 and 3 years since the first use of varenicline, respectively. Compared to current smokers, successful quitters were older (55.0 years vs. 49.9 years, p=0.01), had better compliance to the 12-week course (27.7 vs. 9.3%, p=0.01), and had taken varenicline longer (10.1 vs. 5.9 weeks, p=0.01). Fifty-four of 71 current smokers (76.1%) were willing to stop smoking in the near future. The preferred ways to cease smoking were will-power (48.1%), varenicline (25.9%), nicotine replacement therapy (11.1%), and others (14.9%). Conclusion Smokers should be encouraged to stick to the proven way for recommended period of time for successful cessation of smoking.

SAT0323 Two-Year Follow-Up Study of the Relationship Between Serum Homocysteine, Uric Acid and Renal Function in Gouty Patients

Background Gout is known to be associated with metabolic syndrome and cardiovascular disease (CVD), which are major cause of increasing mortality in gouty patients. Homocysteine (Hcy) is related with endothelial cell damage and is regarded as an important risk factor for CVD. Although both hyperhomocysteinemia and gout are closely related to CVD, the only few cases about serum Hcy in gouty patients have been reported. Objectives We investigated the associations between serum Hcy level and the other parameters such as serum uric acid level, renal function, and cholesterol profiles in gouty patients with 2 year follow-up data. Methods Ninety-one male patients with gout and 97 age-matched healthy male controls were included in this study. The average age of each was 51.19±15.08 and 51.57±17.01 years old, respectively. Among them, 33 patients with gout and 39 healthy controls underwent follow-up tests for Hcy levels with 24.00±9.12 months on average. Serum Hcy levels were measured by a competitive immunoassay using direct chemiluminescent. The estimated glomurular filtration rate (eGFR) was calculated using modification of diet in renal disease equation, and then chronic kidney disease (CKD) was defined as an eGFR below 60 ml/min/1.73m2. Results Patients with gout showed significantly higher levels in serum Hcy than those in controls (13.96±4.05 μmol/L vs 12.67±3.51 μmol/L, p=0.022). However there was no significant difference between gouty patients and controls in the serum uric acid level (6.15±2.23 mg/dL vs 5.82±1.22 mg/dL, p=0.214). In patients with gout, serum Hcy level was negatively correlated with eGFR (γ=-0.413, p<0.001), while it was uncorrelated with serum uric acid levels or cholesterol profiles. Serum Hcy levels were not different between the groups treated with allopurinol and with benzbromarone. When we observed the follow-up results in gouty group, the change of serum Hcy level was positively correlated with the change of serum creatinine level (γ=0.560, p<0.001), and negatively correlated with the change of eGFR (γ=-0.556, p<0.001). However the change of serum Hcy level was uncorrelated with the changes of uric acid level or the lipid profiles. The gouty patients with CKD showed significantly higher serum Hcy level than those without CKD (17.45±4.68 μmol/L vs 13.15±3.46 μmol/L, p<0.001), and the follow-up result also showed similar tendency (19.12±4.29 μmol/L vs 15.69±5.73 μmol/L, p=0.059). In multiple linear analyses, serum Hcy level was affected by eGFR (β=-0.385, p<0.001), however, was not affected by the serum uric acid level. Conclusions Serum Hcy level was elevated in gouty patients than in controls. The change of serum Hcy level was negatively correlated with the change of eGFR. High level of serum Hcy in gouty patients was related with decreased renal function, and was not with serum uric acid or lipid profiles. Disclosure of Interest None declared

SAT0309 The Utility of Spot Urine Uric Acid to Creatinine Ratio for Predictor of 24-Hour Urine Uric Acid Excretion in Gouty Patients

Background Gout is an inflammatory disease resulted from hyperuricemia. The measurement of 24-hour urine uric acid excretion is important not only to evaluate the disease status but also to choose the kind of uric acid lowering agents. 24-hour urine collection, however, is cumbersome, inconvenient, and often unreliable because of errors in collection. The average person excretes approximately 1 g of creatinine per day, and a lot of studies showed that the spot urine protein to creatinine ratio was correlated with 24-hour urine protein excretion. Objectives In this study, we investigated the utility of the spot urine uric acid to creatinine ratio for predicting 24-hour urine uric acid excretion in gouty patients. Methods Fifty-one gouty patients without any use of uric acid lowering agents were enrolled in this study. The average age was 48.1±17.1 years old and 90.2% (46/51) were male patients. 24-hour urine collections of the patients were conducted to the evaluate uric acid excretion and renal function. Spot urine uric acid and creatinine specimens were obtained from all participants at the same day when 24-hour urine was collected. The creatinine clearance (CCr) was measured from the 24-hour urine collected sample, and chronic kidney disease was defined when their CCr level was below 60 ml/min/1.73m2. Results The mean of 24-hour uric acid excretion was 643.5±259.2 mg, and those of serum uric acid levels and CCr values were 7.45±1.35 mg/dl and 103.5±41.8 ml/min/1.73m2, respectively. Spot urine uric acid to creatinine ratio was significantly correlated with the absolute and log transformed 24-hour urinary uric acid values (γ =0.410, p =0.003; γ =0.610, p <0.001, respectively). In the linear regression analysis, the amount of absolute 24-hour urine uric acid excretion was estimated by 0.799 x (spot urine uric acid to creatinine ratio) + 336.239 (R2 =0.410, p =0.003). The correlation between spot urine uric acid to creatinine ratio and 24-hour urine uric acid excretion was also found in the patients with chronic kidney disease (γ =0.964, p <0.001). Conclusions Spot urine uric acid to creatinine ratio showed well correlation with the absolute and log transformed 24-hour urine uric acid excretions. The spot urine uric acid to creatinine ratio could be a good predictor of 24-hour urine uric acid excretion in gouty patients. Disclosure of Interest None declared

AB0519 Relationship between Various Psychological Problems with the Disease Activity or Damage Indices in Patients with Sle

Background Systemic lupus erythematosus (SLE) is a chronic inflammatory disease in which almost every organ may be affected. Various psychological problems are associated with systemic conditions, but the influence of SLE is still a matter of discussion. Objectives We evaluated depression, anxiety, anger, fatigue and quality of life in patients with SLE, compared to healthy controls. We also investigated the relationship between these psychological problems, disease activity and damage in patients with SLE. Methods 108 patients with SLE and 52 healthy controls completed a psychological questionnaire. Psychological parameters were assessed as follows: depression, Center for Epidemiologic Studies Depression Scale (CES-D); anxiety, Hospital Anxiety and Depression Scale (HADS); anger, State Trait Anger Expression Inventory (STAXI); fatigue, the Profile of Mood States fatigue-inertia scale (POM); quality of life (QOL), Functional Assessment Chronic Illness Therapy (FACIT). Disease activity and damage indices were measured by the SLE Disease Activity Index (SLEDAI) and the SLE Collaborating Clinics/American College of Rheumatology (SLICC/ACR), respectively. Results Patients with SLE showed higher symptoms of depression, anxiety, anger and fatigue (p=0.005; p=0.057; p=0.044; p=0.020, respectively), and lower level of QOL (p=0.003) than healthy controls. In the patients with SLE, mood symptoms such as depression, anxiety, and anger were correlated with each other (depression and anxiety: r=0.710, p<0.001; depression and anger: r=0.602, p<0.001; anxiety and anger: r=0.546, p<0.001). Fatigue and QOL were closely correlated with mood symptoms, respectively. The patients with higher prednisolone use (>7.5 mg/day) showed higher levels of depression, anxiety, anger and fatigue (p=0.002; p=0.022; p=0.027; p=0.010, respectively), and lower level of QOL (p=0.001) than the patients with lower prednisolone use (≤7.5mg/day). However, there were no significant differences in evaluating these parameters according to disease activity or damage indices. Conclusions The patients with SLE had higher levels of depression, anger and fatigue and lower level of QOL compared to healthy controls. Psychological parameters were affected by daily glucocorticoid dose rather than disease activity or damage indices. These findings suggested that the comprehensive evaluation of the various psychological problems could be helpful to SLE patients, especially those with higher doses of glucocorticoid, even if disease activity and damage are not severe. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4112

SAT0523 The Usefulness of Procalcitonin for Differentiating Acute Gout Arthritis from Infectious Disease

Background Acute gout arthritis is usually accompanied by tenderness, swelling, redness and fever. These features and laboratory findings including leukocytosis, elevation of serum ESR or CRP levels, are similar to those of infectious diseases. Moreover, normal to low serum uric acid levels have been noted in many cases of acute gout arthritis. For these reasons, the differential diagnosis of acute gout arthritis with infectious disease can be difficult. Objectives Procalcitonin, the precursor peptide of calcitonin, is known to be elevated in the patients with bacterial infection. We investigate whether or not serum procalcitonin levels are higher in patients with acute gout arthritis than in the others. We also evaluate the usefulness of procalcitonin for differentiating diagnosis between acute gout arthritis and bacterial infection. Methods The serum samples were obtained from 67 patients with acute gout arthritis and 90 age-matched patients with bacterial infection. Serum procalcitonin levels were measured by an enzyme-linked fluorescent assay. Results The serum procalcitonin levels in patients with acute gouty arthritis were significantly lower than those in patients with bacterial infection (0.096±0.105 ng/mL vs 4.941±13.763 ng/mL, p =0.001). However, other inflammatory parameters, such as ESR, CRP and WBC, showed no significant differences between these two groups. Patients with acute gout arthritis had statistically higher serum uric acid levels than the patients with bacterial infection (7.62±2.03 mg/dL vs 5.19±2.36 mg/dL, p<0.001); however, 19.4% (13/67) among the acute gout arthritis group had lower uric acid level (below 6.0 mg/dL). To determine the discriminative ability of procalcitonin between acute gout arthritis and bacterial infection, we conducted ROC analysis about procalcitonin, uric acid, ESR, CRP and WBC. The area under the curve (AUC) of procalcitonin and uric acid were 0.852 (95% CI 0.793-0.911, p<0.001) and 0.808 (95% CI 0.738-878, p<0.001), respectively. There was no significance at ESR, CRP and WBC. With a cut off value of 0.095 ng/dL, the sum of sensitivity and specificity of procalcitonin were the highest (80.0% and 80.6%, respectively). Conclusions Serum procalcitonin levels were significantly lower in patient with acute gout arthritis than in patients with bacterial infection. The serum procalcitonin level is expected to be a useful serologic marker for the differentiating acute gout arthritis from bacterial infection. References Simon L et al. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 2004:39:206-17. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4127