The clinical, laboratory, and pathologic data of 310 patients who had curative resections were prospectively collected and analyzed in a multiple stepwise regression model. Although several factors (i.e., venous invasion) were of importance in univariate analysis, the following conclusions reflect the outcome and relative importance of the regression analysis only. Blood loss as an initial symptom and duration of symptoms were associated with a better prognosis. Location of the primary tumor, age, and sex did not appear to have prognostic value. Observations during operation such as palpable lymph nodes, fixity to adjacent organs, and tumor spill were related to a diminished tumor-free survival. Laboratory data (hemoglobin, leukocytes, ESR, GGTP, SGOT, SGPT, LDH, total protein, CEA) were tested for their potential prognostic values. Only a preoperative low protein level or an elevated CEA level were associated with an increased risk of death due to recurrent tumor. The histopathologic features (stage and grade), with the exception of venous invasion, were of relative importance in the determination of prognosis. The aforementioned variables can be included in a prognostic index on the base of which high-risk groups suitable for adjuvant studies can be identified.

Although several epidemiologic studies have been conducted on alcohol consumption and bladder cancer risk, the risk according to quantity and type of alcohol consumed is not clear. The authors investigated these associations in a large prospective cohort study on diet and cancer among 120,852 subjects in the Netherlands aged 55-69 years at baseline (1986). Subjects completed a questionnaire on risk factors for cancer, including alcohol consumption. Follow-up for incident cancer was established by record linkage to cancer registries. The case-cohort analysis was restricted to a follow-up period of 6.3 years and was based on 594 cases with bladder cancer and 3,170 subcohort members. The authors corrected for age and smoking in multivariable analyses. The incidence rate ratios for men who consumed <5, 5-<15, 15-<30, and ≥30 grams of alcohol per day were 1.49, 1.52, 1.16, and 1.63 compared with nondrinkers, respectively (p for trend = 0.13). Alcohol consumed from beer, wine, and liquor was associated with moderately elevated risks, although most were not statistically significant. The incidence rate ratios for women varied around unity. The results of this study do not suggest an important association between alcohol consumption and bladder cancer risk. Although several epidemiologic studies have been conducted to investigate the association between alcohol consumption and bladder cancer risk, the risk according to quantity and type of alcohol consumed is still not clear. In a recent meta-analysis of these studies, a slightly elevated risk of bladder cancer was demonstrated for men currently drinking alcohol compared with abstainers (1). In this metaanalysis, however, no data were available to explore the influence of quantity and types of alcoholic beverages consumed. These results prompted us to investigate these associations in more detail in the ongoing Netherlands Cohort Study. MATERIALS AND METHODS CohortThe study design has been described in detail previously (2). The study population originated from 204 municipal population registries throughout the Netherlands, and the cohort includes 58,279 men and 62,573 women who were aged 55-69 years at baseline (1986). We used the case-cohort approach for data processing and analysis (3). A subcohort of 3,500 subjects was randomly sampled from the cohort after baseline exposure measurement and was followed up to obtain vital status information. No subcohort members were lost to follow-up during the follow-up period. Follow-upFollow-up for incident cancer was established by record linkage to cancer registries and the Dutch database of pathology reports (4), and follow-up was more than 95 percent complete (5). The present analysis was restricted to 6.3 years of follow-up. After we excluded prevalent cases, 3,346 subcohort members and 619 incident cases with microscopically confirmed carcinomas of the bladder, ureters, renal pelvis, or urethra were identified. Because the overwhelming majority of tumors occurred in the bladder, and because the renal pelvis and ureter are ...

During the production ofcoke, large quantities of coke oven gas are emitted. People who work on the top or on the sides of coke ovens are exposed to this oven gas, which contains a range of carcinogenic chemicals. To investigate the cancer risks under these work conditions, a retrospective study was undertaken. In total 11 399 former workers were enrolled in the study. Ofthese, 5639 had worked in the coke plant for at least six months between 1945 and 1969. The other 5740 had worked in another plant during the same period and formed a non-exposed group for comparison. The study group was followed up until 1984 for mortality. The causes of death were obtained from the Central Bureau of Statistics. Among the coke oven workers significantly higher death rates were found for lung cancer and non-malignant respiratory disease. Mortality in the byproduct section was similar to that expected. Among workers in the tar distillery the rate for lung cancer was higher than expected. The risk for gastric cancer and non-malignant respiratory disease among the workers of the coke shipping department was increased but the SMRs did not reach statistical significance. No data were collected about individual smoking habits or socioeconomic state of the study subjects and the possibility that the risk found could be attributed to these factors cannot be ruled out. It has been stated by other investigators, however, that the effect of not controlling for smoking tends to be modest.

A cross-sectional analysis of the relation between the estimated healthy worker effect (HWE), as measured by a total Standardized Mortality Ratio (SMR) less than 100, and relevant design characteristics in 270 published retrospective occupational cohort studies is presented. The majority of the reviewed studies showed a HWE, varying in SMR from 50 to 99 (mean: 84). The estimated HWE seemed to influence the final outcomes of the studies to a great extent. A tendency for a positive relation between the study size in terms of the number of exposed workers, total number of person-years of follow-up, and the HWE emerged. Studies with a comparatively short follow-up period had an increased chance of resulting in a HWE. Cross-sectional cohorts did not show a stronger HWE than open cohorts. Studies of chemical exposures revealed a fivefold excess of having a HWE compared with other studies.

In order to investigate which characteristics, besides physical limitations, of elderly people living at home contribute to the utilization of professional home care, a study was conducted in which 450 elderly people aged 55 and over, 123 with and 327 without professional home care, were interviewed. To obtain a selection for the interviews, a postal questionnaire, containing questions on functional status and care utilization, sent out to a random sample of the elderly people (55+) living at home (n = 2451), preceded the actual interviews. The oral interviews yielded the same information, plus an inventory of aspects of the mental status, the social network, the socio-economic status and the housing condition. Analysis was performed in three ways: bivariate analysis, logistic regression analysis and discriminant analysis. The bivariate analysis revealed that users of professional care were older, more often female and more often not married. Their social network was less extensive, as they received less informal care and lived alone more often. Besides they had more mental and financial problems. From the regression analysis it appeared that, in addition to the functional status, the amount of informal care and the household composition contributed to the utilization of professional home care. For the other characteristics inventoried, no independent association with the utilization of professional care could be established. With hindsight, it appeared that in this study long interviews hardly had additional value over postal questionnaires, in which the contribution of functional status and informal care to professional care was already discovered.