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Articles by P Parfrey
Total Records ( 2 ) for P Parfrey
  P Ravani , P Parfrey , J MacRae , M James , R Quinn , F Malberti , G Brunori , S Mandolfo , M Tonelli , B Hemmelgarn , B Manns and B. Barrett
 

Background and objectives: Comparing outcomes of arteriovenous grafts and fistulas is challenging because the pathophysiology of access dysfunction and failure rate profiles differ by access type. Studying how risks vary over time may be important.

Design, setting, participants, & measurements: Longitudinal data from 535 incident hemodialysis patients were used to study the relationship between access type and access survival, without (semiparametric Cox modeling) and with specification of the underlying hazard function (parametric Weibull modeling).

Results: The hazard for failure of fistulas and grafts declined over time, becoming proportional only after 3 months from surgery, with a graft versus fistula hazard ratio of 3.2 (95% confidence interval 1.9 to 5.3; Cox and Weibull estimation) and time ratio of 0.11 (i.e., the estimated access survival time was approximately one tenth shorter in grafts; 95% confidence interval 0.04 to 0.28; Weibull estimation only). Considering the entire observation period, grafts had slower hazard decline (P < 0.001) with shorter median survival times than fistulas (8.4 versus 38.3 months; Weibull regression only).

Conclusions: Parametric models of arteriovenous access survival may provide relevant information about temporal risk profiles and predicted survival times.

  P. T Campbell , E. T Jacobs , C. M Ulrich , J. C Figueiredo , J. N Poynter , J. R McLaughlin , R. W Haile , E. J Jacobs , P. A Newcomb , J. D Potter , L Le Marchand , R. C Green , P Parfrey , H. B Younghusband , M Cotterchio , S Gallinger , M. A Jenkins , J. L Hopper , J. A Baron , S. N Thibodeau , N. M Lindor , P. J Limburg , M. E Martinez and for the Colon Cancer Family Registry
  Background

Being overweight or obese is an established risk factor for colorectal cancer, more so for men than for women. Approximately 10%–20% of colorectal tumors display microsatellite instability (MSI), defined as the expansion or contraction of small repeated sequences in the DNA of tumor tissue relative to nearby normal tissue. We evaluated associations between overweight or obesity and colorectal cancer risk, overall and by tumor MSI status.

Methods

The study included 1794 case subjects with incident colorectal cancer who were identified through population-based cancer registries and 2684 of their unaffected sex-matched siblings as control subjects. Recent body mass index (BMI), BMI at age 20 years, and adult weight change were derived from self-reports of height and weight. Tumor MSI status, assessed at as many as 10 markers, was obtained for 69.7% of the case subjects and classified as microsatellite (MS)-stable (0% of markers unstable; n = 913), MSI-low (>0% but <30% of markers unstable; n = 149), or MSI-high (≥30% of markers unstable; n = 188). Multivariable conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). All statistical tests were two-sided.

Results

Recent BMI, modeled in 5 kg/m2 increments, was positively associated with risk of colorectal cancer for men and women combined (OR = 1.24; 95% CI = 1.15 to 1.34), for women only (OR = 1.20; 95% CI = 1.10 to 1.32), and for men only (OR = 1.30; 95% CI = 1.15 to 1.47). There was no interaction with sex (P = .22). Recent BMI, per 5 kg/m2, was positively associated with the risk of MS-stable (OR = 1.38; 95% CI = 1.24 to 1.54) and MSI-low (OR = 1.33; 95% CI = 1.04 to 1.72) colorectal tumors, but not with the risk of MSI-high tumors (OR = 1.05; 95% CI = 0.84 to 1.31).

Conclusion

The increased risk of colorectal cancer associated with a high BMI might be largely restricted to tumors that display the more common MS-stable phenotype, suggesting further that colorectal cancer etiology differs by tumor MSI status.

 
 
 
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