Hina Y. Bhutta

Neutrophil-lymphocyte ratio predicts medium-term survival following elective major vascular surgery: a cross-sectional study.

Background: The systemic nature of atherosclerosis compromises medium-term survival following major vascular surgery. Neutrophil—lymphocyte ratio (NLR) is a simple index of systemic inflammatory burden which correlates with survival following percutaneous coronary intervention. Methods: Patients undergoing elective major vascular surgery in 2 tertiary vascular units were identified from prospectively maintained databases. Factors associated with 2-year mortality were assessed by univariate and multivariate analyses. Results: Over a 4-year period, 1021 patients underwent elective major vascular surgery (carotid endarterectomy, abdominal aortic aneurysm repair, lower limb revascularization). Two-year mortality was 11.2%. In multivariate analysis, preoperative NLR > 5 was independently associated with 2-year mortality (multivariate odds ratio [OR] 2.21; 95% confidence interval [CI] 1.22-4.01). Conclusion: Preoperative NLR identifies patients at increased risk of death within 2 years of major vascular surgery. This simple index may facilitate targeted preventive measures for high-risk patients.

Statin Use Is Associated With Reduced Risk of Histologic Subtypes of Esophageal Cancer: A Nested Case-Control Analysis

BACKGROUND & AIMS Most patients with esophageal adenocarcinoma (EAC) or squamous cell cancer (ESCC) present with advanced, incurable disease. Statins have reported anti-carcinogenic effects and may be chemoprotective. We investigated the association between regular use of statins and the main histologic subtypes of esophageal malignancy (EAC, esophagogastric junctional adenocarcinoma, and ESCC) in the UK general population. METHODS We identified all individuals in the UK General Practice Research Database diagnosed with esophageal cancer from 2000 through 2009. Patients were linked to the National Cancer Registry to confirm histologic subtypes. Each patient was matched with up to 4 controls for age, sex, and practice. We performed a nested case-control analysis using conditional logistic regression to estimate the risk of each subtype with regular statin use, adjusted for body mass index, smoking, alcohol intake, and concomitant use of medications. RESULTS In total, 581 participants with EAC, 213 with esophagogastric junctional adenocarcinoma, and 332 with ESCC were matched to 2167, 783, and 1242 controls, respectively. Regular statin use was inversely associated with development of EAC (odds ratio = 0.58; 95% confidence interval: 0.39-0.87) (with significant dose and duration responses) and esophagogastric junctional adenocarcinoma (odds ratio = 0.29; 95% confidence interval: 0.09-0.92) (with high-dose use only). Statin use for 1-4 years was inversely associated with ESCC (odds ratio = 0.51; 95% confidence interval: 0.27-0.98). CONCLUSIONS In a nested case-control analysis of a UK population-based cohort, statin use was inversely associated with histologic subtypes of esophageal cancer. Randomized controlled trials are warranted to determine whether statins have chemopreventive effects in high-risk groups.

Anaesthetic specialisation leads to improved early- and medium-term survival following major vascular surgery.

OBJECTIVE Vascular surgical specialisation is associated with improved outcomes. We aimed to assess the effect of anaesthetic specialisation on outcome following major vascular surgery. DESIGN Retrospective cohort study. METHODS Patients undergoing major vascular surgery (lower limb revascularisation, elective and ruptured abdominal aortic aneurysm repair, endovascular aneurysm repair and carotid endarterectomy) over a five-year period were identified from a prospective database. The primary outcomes were death within 30 days and death within two years of surgery. Potential risk factors for mortality were assessed using multivariate logistic regression modelling. RESULTS The analysis cohort comprised 1155 patients followed up for a median of 583 days. Mortality within two years of surgery was 16%. For the overall cohort, care from vascular anaesthetists was independently associated with reduced 30-day (odds ratio 0.22; 95% CI 0.12-0.62) and medium-term mortality (0.31; 95% CI 0.18-0.55). For elective patients (n=851), vascular anaesthesia reduced two-year mortality (odds ratio 0.29; 95% CI 0.15-0.58; P=0.0004) though not 30-day mortality (odds ratio 0.55; 95% CI 0.15-1.95; P=0.35). For emergency patients, care by a vascular anaesthetist influenced neither 30-day mortality (odds ratio 0.33; 95% CI 0.08-1.41; P=0.13) nor medium-term mortality (odds ratio 0.45; 95% CI 0.17-1.21; P=0.11). CONCLUSIONS Anaesthetic specialisation reduced early- and medium-term mortality rates following major vascular surgery. If replicated by prospective studies, these results suggest that vascular surgery services would benefit from specialised anaesthetic support.

Ovarian vein syndrome: a review.

The Ovarian Vein Syndrome was first reported in 1964, yet its existence as a true pathophysiological entity remains controversial. It may present as an acute or chronic disease, typically affecting young, multiparous women. This review discusses the literature to date on this poorly recognised cause of ureteric obstruction and pelvic pain, including developments in the diagnosis and management of this eminently treatable condition.

Association Between Statin Use After Diagnosis of Esophageal Cancer and Survival: A Population-Based Cohort Study

BACKGROUND & AIMS Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors), commonly prescribed in the primary and secondary prevention of cardiovascular disease, promote apoptosis and limit proliferation of esophageal cancer cell lines. We investigated whether statin use after a diagnosis of esophageal cancer is associated with reduced esophageal cancer-specific and all-cause mortality. METHODS We identified a cohort of 4445 men and women in the United Kingdom diagnosed with esophageal cancer from January 2000 through November 2009 using the General Practice Research Database. The National Cancer Registry and Office of National Statistics datasets established the histologic subtype and cancer-specific mortality, respectively. Cox proportional hazard regression analysis with time-dependent exposures estimated the association between statin use after diagnosis and esophageal cancer-specific and all-cause mortality. RESULTS The median survival time of the entire cohort was 9.2 months (interquartile range [IQR], 3.7-23.2 mo). Among subjects who used statins after a diagnosis of esophageal cancer, the median survival time was 14.9 months (IQR, 7.1-52.3 mo) compared with 8.1 months for nonusers (IQR, 3.3-20 mo). In the entire cohort, statin use after diagnosis was associated with a decreased risk of esophageal cancer-specific mortality (adjusted hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.44-0.86) and all-cause mortality (HR, 0.67; 95% CI, 0.58-0.77). In patients with esophageal adenocarcinoma, statin use after diagnosis was associated with a decreased risk of esophageal cancer-specific mortality (HR, 0.61; 95% CI 0.38-0.96) and all-cause mortality (HR, 0.63; 95% 0.43-0.92). This effect was not observed in patients with esophageal squamous cell carcinoma. There was no evidence for effect modification of these associations with statin use before the cancer diagnosis. CONCLUSIONS In a large population-based cohort, statin use after a diagnosis of esophageal adenocarcinoma, but not esophageal squamous cell carcinoma, was associated with reduced esophageal cancer-specific and all-cause mortality.

Mo1542 Do Statins Prevent the Histological Subtypes of Esophageal Cancer? Prospective Data From the UK General Practice Research Database (GPRD)

Introduction The incidence of oesophageal adenocarcinoma (OAC) has risen dramatically in the Western world and is associated with a poor prognosis. Statins show anti-cancer properties in experimental work with OAC cell lines for example reduced cell proliferation, increased apoptosis. This study aimed to investigate if statins are negatively associated with the development of two different histological subtypes of oesophageal cancer, OAC and oesophageal squamous cell cancer (OSCC), in a prospective cohort study. Methods The cohort was over 4 million people in the General Practice Research Database (GPRD), a UK database of 488 nationwide general practices. Information is recorded on medication use prior to development of other illnesses, including cancers. Statin use was defined as a prescription for a minimum of 10 months preceding diagnosis of oesophageal cancer. Approximately half the GP practices in the GPRD are linked to the NHS cancer registry, allowing identification and sub-classification of histologically confirmed cases of OAC and OSCC. Each case was matched with four controls and conditional logistic regression estimated the OR plus 95% CIs for the development of each type of cancer, adjusted for diabetes, BMI, smoking, aspirin, PPIs and drugs that relax the lower oesophageal sphincter. Results 581 histologically confirmed cases of OAC (77.8% men, mean age 70.7 years, SD=11.4) and 332 cases of OSCC (38.6% men, 71.9 years, SD=12.3) were identified between 2000 and 2008. The median length of statin use in cases and controls prior to diagnosis or index date was 3.9 years (IQR 2.3–6.1 years). Analysis by histological subtype showed an inverse association for OAC (OR 0.61, 95% CI 0.39 to 0.94) and for OSCC (OR 0.41, 95% CI 0.21 to 0.80). Categorisation into lipophilic and hydrophilic statins demonstrated significant inverse associations for only lipophilic statins for both OAC (OR 0.60, 95% CI 0.38 to 0.95) and OSCC (OR 0.46, 95% CI 0.23 to 0.91). There was a dose-response effect for statins and both OAC and OSCC (p Conclusion The data supports lipophilic statins having a protective effect against the development of both OAC and OSCC, with evidence of a dose-response trend. Confirmation in other populations is required. Detailed statin use, according to class and dose, should be measured in future aetiological studies of both OAC and OSCC. The information supports assessment of these drugs in chemoprevention of OAC in the general population and those with Barrett9s oesophagus in clinical trials. Competing interests None declared.

Su1938 Statin Use Is Associated With Improved Survival in Patients With Oesophageal Cancer: A Survival Analysis Using the UK General Practice Research Database and National Cancer Registry

Introduction Patients with oesophageal cancer (OC) commonly present with an advanced stage of disease, and are often only amenable to palliative therapies. Of the minority suitable for potentially curative surgery, up to 50% develop recurrence at one year. Statins demonstrate several anticarcinogenic properties in oesophageal adenocarcinoma (OAC) cell lines including reducing cell proliferation, stimulating apoptosis and potentially limiting metastatic potential. We investigated for the first time the hypothesis that statin use after diagnosis or post-oesophagectomy was associated with improved survival in patients with OC. Methods Cases of OC diagnosed between 1st January 2000 and 31st December 2009 were identified from the UK General Practice Research Database (GPRD). The GPRD data was linked to the UK National Cancer Registry (NCR) to determine histological subtype. Cox proportional hazard regression analysis with time-dependent exposures, estimated the associations between statin use (versus non-users) from diagnosis and post-surgery on overall survival and disease-specific survival. Multivariate analyses were adjusted for age, gender, body mass index, diabetes mellitus, cardiovascular disease, oesophagectomy, chemotherapy, radiotherapy and ACE inhibitor use. Results In total 4445 cases of OC were identified, of which 606 were OAC and 344 were OSCC (histology data was available for 21.4% of patients). Overall 585 (13.2%) patients underwent oesophagectomy. In total 609 (13.7%) of patients were statin users following diagnosis and 109 (19.2%) following surgery. There were improved survival times following diagnosis for patients prescribed a statin with OC overall (HR = 0.71, 95% CI = 0.64–0.79, p Conclusion Statin use in patients with OC either after diagnosis or post-oesophagectomy is associated with improved survival. This data suggests a need for randomised controlled trials of statins in patients with OC. Disclosure of Interest None Declared