The authors studied the familial occurrence of tumors in 154 individuals with gastric cancer by reviewing the clinical data and the genealogical tree of all patients registered in 1986 through 1987 in the Local Health Care District of Modena, Italy, for cancer of the stomach. Crude and age-adjusted (world population) incidence rates of gastric cancer were 34.0 and 21.4 new cases/100,000/year, respectively, in men, and 24.5 and 10.9 in women, respectively. Among first-degree relatives of the registered patients there were 30 cases of gastric carcinoma versus 15 cases in a control group matched for age and sex (Mantel-Haenszel odds ratio [M-H OR] 3.14, P less than 0.01). This excess of gastric neoplasms was observed in siblings (17 versus 7, M-H OR 4.33, P less than 0.02) but not in parents (13 versus 8, not significant). Besides gastric cancer, there was no significant excess of other type of tumors in case families. The familial occurrence of gastric cancer tended to be more frequent in patients with "diffuse" carcinoma (52%) than in subjects with "intestinal" cancer (33%), although the difference was not statistically significant. In conclusion, the current investigation suggests that a "family history" for gastric neoplasms is usually observed in approximately 10% to 15% of the registered cases. As already described for other common malignancies, therefore, the familial occurrence of gastric carcinoma suggests the existence of a genetic susceptibility to cancer of the stomach, at least in a fraction of these patients.

The institution of a colorectal Cancer Register in a health care district of Northern Italy gave the authors the opportunity to evaluate the prognostic relevance of several morphologic and clinical variables by univariate and multivariate analyses. Of the 134 patients registered in 1984,132 were followed up until the end of 1989. Overall 5‐year survival was 37%, but the figure increased to 43% when only colorectal cancer‐related deaths were considered. Univariate analysis for clinical variables showed that TNM staging and age at diagnosis were significantly related to prognosis, whereas none of the other parameters were indicative of the clinical outcome. With a similar analysis, among the various morphologic variables, pattern of growth (infiltrating versus expanding) and extent of fibrosis (extensive versus little or absent) appeared to be indicators of prognosis. When the variables that were significant (stage, age, pattern of growth, and fibrosis) in the univariate analysis were entered into the Cox model of multivariate analysis, TNM staging was the only parameter that maintained an independent prognostic importance. The authors state that their results confirm the importance of stage in predicting survival for cancer of the large bowel and suggest that the possible prognostic value of clinical and morphologic variables should be investigated within each of the major TNM or Dukes' classes.

The first year of registration of colorectal tumors in a predominantly urban population (263,546 inhabitants) of northern Italy gave us the opportunity to investigate: (a) the incidence (crude, age-specific, age-standardized) of both colorectal cancer and polyps and their localization; (b) the familial occurrence of these neoplasms; and (c) if the data could fit into the "Adenoma-Carcinoma Sequence." Crude incidence of cancer was 52.8 new cases/100,000 in 1984, with 53.4 cases in men and 52.2 cases in women. The corresponding figures for polyps were 59.6 new cases, with 83.4 in men and 37.3 cases in women. The incidence increased with age for both cancer and polyps, although the latter were more frequent until patients were in their sixties and the peak of incidence of polyps anticipated that of cancer by a 5 year period. Both cancer and polyps had a similar distribution in the large bowel, more than 60% being located in the left distal portion. There were 72 cases of colorectal cancer among the first-degree relatives of the registered patients compared with 16 in the controls (RR = 4.26, chi 2 = 27.2 p less than 0.001). An increased frequency of cases of colorectal cancer in the families was found in both the cancer group and the polyp group. In conclusion, the observed incidence of large bowel tumors was similar to that of other well-developed countries. The earlier rise and peak of age-specific incidence of polyps as compared to cancer, the similar distribution of benign and malignant neoplasms in the various intestinal tracts, and the similar familial aggregation observed both in the cancer and in the polyp groups further support the "polyp-cancer sequence" and provide us with a promising strategy for the prevention of colorectal malignancies.

The frequency of gastroduodenal lesions has been investigated in 142 patients with liver cirrhosis of various degrees of severity and in 63 patients with mild liver disease (controls) in whom liver biopsy excluded nodular regeneration. Cirrhotic patients were subdivided in three groups according to the Pugh modification of the Child-Turcotte criteria. Although the frequency of peptic ulcer was not different, gastroduodenal erosions were observed more frequently in cirrhotics than in controls (29.6% vs 11.1%, P less than 0.01). The occurrence of erosions was related to the severity of the disease: in Child A and B patients their frequency was 21 and 26% respectively, but rose to 48.4 (15 of 31 vs 7 of 63 in controls, P less than 0.001) in the Child C group. Both mild and severe gastroduodenitis occurred more frequently, although not significantly, in patients with liver cirrhosis. All together one or more endoscopic lesions were observed in almost 60% of cirrhotics but only in 25.4% of controls (P less than 0.001). In conclusion, our data do not show an increased prevalence of peptic ulcer in cirrhotic patients; in contrast, liver cirrhosis is significantly associated with the endoscopic finding of gastroduodenal erosions, especially in the more advanced stages of the disease. These findings would suggest a cautious use, in cirrhotic patients, of drugs which may damage the gastroduodenal mucosa; moreover, long-term administration of antacids or of other drugs with a protective effect on gastroduodenal mucosa might be taken into consideration for Child C patients.

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