Predictors of cancer mortality in elderly subjects

Cancer mortality was analysed in 3282 elderly subjects aged greater than or equal to 65 years from 2 cohorts of general population having different li fe-style patterns. They took part in the CASTEL (CArdiovascular STudy in th e ELderly), a 12-year lasting prospective Italian study. The aim of the pre sent analysis was to identify the items able to influence cancer mortality. A biochemical profile and a questionnaire on lifestyle were collected. Con tinuous items were averaged and compared with analysis of variance, frequen cies with the Pearson's chi(2) test. Mortality was recorded yearly for 12 y ears from the Registrar's Office and causes of death double-checked by cons ulting medical case sheets and family doctors' files. The influence of item s on mortality was evaluated with the Cox multivariate analysis. Relative r isk (RR) of each item was adjusted for confounders. Age, gender, tobacco sm oking, the presence of respiratory symptoms, low body mass index in males, serum alanine transaminase (ALT) and alkaline phosphatase (ALP), as well as the town of residence, were powerful predictors of cancer mortality. In th e entire population, 12-year overall mortality was 49.4%, cardiovascular 22 .8%, and neoplastic 11%; the latter was higher in males than in females (15 .7% vs. 7.9%, p < 0.00001). In subjects with respiratory symptoms neoplasti c mortality was 11.6% (RR: 1.47) vs. 9.7% in those without symptoms (p < 0. 01). Subjects with very low cholesterol (less than or equal to 178 mg/dl), those with high uric acid (greater than or equal to 8.7 mg/dl) and males wi th low body mass index (less than or equal to 22.7 kg/m(2)) has an increase d risk of cancer mortality. RR of cancer mortality increased with increasin g ALT or ALP. It was similar to 1 in those having ALT and ALP between 9 and 41.2U/I, 1.41 in those exceeding this latter level and < 1 in those below 9U/I. RR of ALP had a similar trend, the best protective cut-off value bein g < 106 and the worst one > 177U/I. When both serum enzymes were simultaneo usly raised, RR of cancer mortality increased to 2.84.