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LOW-GRADE GASTRIC MALT LYMPHOMA: A RETROSPECTIVE STUDY
Abstracts / Digestive and Liver Disease 41S (2009), S1–S167 to an annual incidence of 5/1000 and 2/1000 ABG patient/year for all NL and for GC, respectively. The logistic regression identified as risk factor for the development of NL the concomitant presence of atrophy in antrum and body mucosa (OR=6.7, 95%CI 2.1-21.2), which was observed in 62.5% of ABG patients with NL vs 23.4% of ABG without NL (p=0.0014). Conclusions: This study shows that ABG patients are at risk for developing NL, in particular those with atrophic damage in both, the gastric antrum and body. Thus, in this subset of ABG patients a regular endoscopic-histological follow-up may be advisable. # J. GI Oncology 5. Gastric cancer
P.114 LOW-GRADE GASTRIC MALT LYMPHOMA: A RETROSPECTIVE STUDY S. Segato 4 , M. Parravicini 4 , C. Cortelezzi 4 , J. Testa 4 , C. Chini 5 1 Gastroenterologia
Azienda Ospedaliera Macchi, Varese; 2 Oncologia Azienda Ospedaliera Macchi, Varese Background and aim: Little is still known about clinical features and prognosis of gastric low-grade B-cell lymphoma of mucosa associated lymphoid tissue (MALT lymphoma) in” real world”. The aim of the study was to carry out a retrospective analysis of the clinical characteristics and treatment results of gastric low- grade MALT lymphoma in a large series of patients. Material and methods: Between 1991 and 2007 128 patients with low-grade MALT lymphoma were reviewed; 11 patients had incomplete data and were not examined. 117 patients (56 women, 61 men, mean age 57.6 yrs, range 15-83 yrs) were included in the study. 112 (95.7%) patients had H.Pylori (H.P.) infection and received anti H.P therapy, also following consecutive therapeutic attempts. Patients with lymphoma persistence or progression received further treatments (surgery/chemotherapy). Results: Between 1991 and 2007, 128 patients with low-grade MALT lymphoma were reviewed; 11 patients had incomplete data and were not examined. 117 patients (56 women, 61 men, mean age 57.6 yrs, range 15-83 yrs) were included in the study. 112 (95.7%) patients had H.Pylori (H.P.) infection and received anti H.P therapy, also following consecutive therapeutic attempts. Patients with lymphoma persistence or progression received further treatments (surgery/chemotherapy). Conclusions: Gastric MALT lymphomas have an indolent clinical course. Eradication therapy for H.P. is an appropriate treatment for early-stage. Surgery and chemotherapy are reserved to non responder or relapser to H.P. therapy patients. Surgery is effective for treatment of gastric MALT lymphoma. # J. GI Oncology 5. Gastric cancer
P.115 ROLE OF DESMOPLASIA IN RECURRENCE OF STAGE II COLORECTAL CANCER WITHIN FIVE YEARS AFTER SURGERY AND THERAPEUTIC IMPLICATIONS P. Crispino 1 , G. De Toma 1 , A. Ciardi 1 , A. Bella 2 , M. Rivera 1 , G. Cavallaro 1 , A. Polistena 1 , H. Unim 1 , R. Pica 1 , P.L. Mingazzini 1 , E. Corazziari 1 , P. Paoluzi 1 1 University Sapienza of Rome, Department of Clinical Sciences, Roma; 2 Statistical Unit, Istituto Superiore di Sanità, Roma
Background and aim: Colorectal cancer (CRC) metastasis is enhanced in patients with venous embolization increasing the risk of recurrence and therefore mortality rate. A subgroup of CRC patients develop extranodal and blood metastases within 5 years after surgery. For this reason one or more factors that permit the early identification of this patient subgroup would allow post-surgical therapeutic measures,
S117
possibly resulting in a lower rate of cancer recurrence. The desmoplastic response is a poorly understood process, which involves the excessive production of stroma around group of tumour cells. It has been suggested desmoplasia might constitute a protective mechanism to contain invasive neoplasms. Others have suggested that desmoplasia can represent an obstacle to host-immune response to the neoplasia and facilitate de-differentiated cancer cells in the process of blood vessels invasion which later can give metastasis in different organs. The aim of the study was demonstrate if quantitative and qualitative desmoplastic response and lymphocytic infiltration are prognostic factor involved in the recurrence of CRC within five years from surgery, considering possible clinical and therapeutical implications. Material and methods: Thirty-four patients with CRC underwent colectomy and the UICC-TNM classification was applied for disease staging. Histological variables were semi-quantitatively evaluated. Qualitative evaluation of desmoplasia was obtained with the haematoxillin-eosin method using Ueno’s stromal CRC classifications. Results: Survival rate arose 88% at stage II, at five years of followup and the 12% not treated with adiuvant chemotherapy developed metastasis. Immature desmoplasia is strongly associated with venous neoplastic invasiveness (OR: 21.93; 95%CI: 1.012-475.26, p=0.02), and therefore, with mortality rate (OR: 14.33; 95%CI: 0.67-304, p=0.04). Moreover, mortality rate was significantly higher in patients with immature desmoplasia compare to mature stromal tissue (OR: 15.61, 95%CI: 0.69-343.38, p=0.04). Conclusions: These observations should prompt a future evaluation of desmoplasia to extent more suitably the use of adjuvant chemotherapy in II stage patients. Further clinical trials are needed to determine if these findings will be able to reduce mortality rate, in stage II CRC patients. # J. GI Oncology 7. Colon cancer
P.116 DIETARY MANIPULATIONS REDUCE ADENOMATOUS POLYP DEVELOPMENT IN INTACT MALE APCMin/+ MICE BY MODULATING INTESTINAL ESTROGEN RECEPTOR BETA (ERβ) EXPRESSION M. Barone 1 , S. Tanzi 1 , K. Lofano 1 , M.P. Scavo 1 , M. Pricci 1 , L. Demarinis 1 , S. Papagni 1 , N. De Tullio 1 , R. Guido 1 , M.C. Comelli 2 , E. Maiorano 3 , A. Francavilla 1 , A. Di Leo ∗,1 1 Section
of Gastroenterology, Dept. of Emergency and Organ Transplantation (D.E.T.O.), Univ. of Bari, Bari; 2 CM&D Pharma Limited, UK; 3 Department of Pathologic Anatomy, Univ. of Bari, Bari Background and aim: ERβ is recognized to be decreasingly expressed in adenomatous and carcinomatous tissues, and regarded as a relevant inhibitory mediator in CRC tumorigenesis. Thus, ERβ up-modulation could represent a chemopreventive approach against CRC development. In intact male APCMin/+mice, this study evaluated intestinal polyp development following the addition of a combination of the ERβ selective agonist silymarin and lignin to a western style, high fat/low fiber diet. Material and methods: Forty-six APCMin/+ mice were divided in 4 groups: animals fed on the control high fat/low fiber (tumorigenic) diet or the control diet added with silymarin (0.02%), purified lignin (6.24%), and silymarin (0.005%) + lignin. We assessed: polyps (number and volume), degree of dysplasia, epithelial cell proliferation and migration along the crypt-villus axis by the incorporation of BrdU into DNA. Cell apoptosis was assessed by TUNEL assay and cleaved caspase-3 immunodetection. ERβ and ERa mRNA and protein levels were measured by RT-PCR and Western blotting. Results: In the APCMin/+ mice, silymarin or the combination of silymarin + lignin significantly reduced total polyp number and volume as compared to controls. Moreover, the number of mice with high grade dysplastic lesions significantly decreased as compared to controls. Cell proliferation and apoptosis were rebalanced, and cell migration accel-
P.114 LOW-GRADE GASTRIC MALT LYMPHOMA: A RETROSPECTIVE STUDY S. Segato 4 , M. Parravicini 4 , C. Cortelezzi 4 , J. Testa 4 , C. Chini 5 1 Gastroenterologia
Azienda Ospedaliera Macchi, Varese; 2 Oncologia Azienda Ospedaliera Macchi, Varese Background and aim: Little is still known about clinical features and prognosis of gastric low-grade B-cell lymphoma of mucosa associated lymphoid tissue (MALT lymphoma) in” real world”. The aim of the study was to carry out a retrospective analysis of the clinical characteristics and treatment results of gastric low- grade MALT lymphoma in a large series of patients. Material and methods: Between 1991 and 2007 128 patients with low-grade MALT lymphoma were reviewed; 11 patients had incomplete data and were not examined. 117 patients (56 women, 61 men, mean age 57.6 yrs, range 15-83 yrs) were included in the study. 112 (95.7%) patients had H.Pylori (H.P.) infection and received anti H.P therapy, also following consecutive therapeutic attempts. Patients with lymphoma persistence or progression received further treatments (surgery/chemotherapy). Results: Between 1991 and 2007, 128 patients with low-grade MALT lymphoma were reviewed; 11 patients had incomplete data and were not examined. 117 patients (56 women, 61 men, mean age 57.6 yrs, range 15-83 yrs) were included in the study. 112 (95.7%) patients had H.Pylori (H.P.) infection and received anti H.P therapy, also following consecutive therapeutic attempts. Patients with lymphoma persistence or progression received further treatments (surgery/chemotherapy). Conclusions: Gastric MALT lymphomas have an indolent clinical course. Eradication therapy for H.P. is an appropriate treatment for early-stage. Surgery and chemotherapy are reserved to non responder or relapser to H.P. therapy patients. Surgery is effective for treatment of gastric MALT lymphoma. # J. GI Oncology 5. Gastric cancer
P.115 ROLE OF DESMOPLASIA IN RECURRENCE OF STAGE II COLORECTAL CANCER WITHIN FIVE YEARS AFTER SURGERY AND THERAPEUTIC IMPLICATIONS P. Crispino 1 , G. De Toma 1 , A. Ciardi 1 , A. Bella 2 , M. Rivera 1 , G. Cavallaro 1 , A. Polistena 1 , H. Unim 1 , R. Pica 1 , P.L. Mingazzini 1 , E. Corazziari 1 , P. Paoluzi 1 1 University Sapienza of Rome, Department of Clinical Sciences, Roma; 2 Statistical Unit, Istituto Superiore di Sanità, Roma
Background and aim: Colorectal cancer (CRC) metastasis is enhanced in patients with venous embolization increasing the risk of recurrence and therefore mortality rate. A subgroup of CRC patients develop extranodal and blood metastases within 5 years after surgery. For this reason one or more factors that permit the early identification of this patient subgroup would allow post-surgical therapeutic measures,
S117
possibly resulting in a lower rate of cancer recurrence. The desmoplastic response is a poorly understood process, which involves the excessive production of stroma around group of tumour cells. It has been suggested desmoplasia might constitute a protective mechanism to contain invasive neoplasms. Others have suggested that desmoplasia can represent an obstacle to host-immune response to the neoplasia and facilitate de-differentiated cancer cells in the process of blood vessels invasion which later can give metastasis in different organs. The aim of the study was demonstrate if quantitative and qualitative desmoplastic response and lymphocytic infiltration are prognostic factor involved in the recurrence of CRC within five years from surgery, considering possible clinical and therapeutical implications. Material and methods: Thirty-four patients with CRC underwent colectomy and the UICC-TNM classification was applied for disease staging. Histological variables were semi-quantitatively evaluated. Qualitative evaluation of desmoplasia was obtained with the haematoxillin-eosin method using Ueno’s stromal CRC classifications. Results: Survival rate arose 88% at stage II, at five years of followup and the 12% not treated with adiuvant chemotherapy developed metastasis. Immature desmoplasia is strongly associated with venous neoplastic invasiveness (OR: 21.93; 95%CI: 1.012-475.26, p=0.02), and therefore, with mortality rate (OR: 14.33; 95%CI: 0.67-304, p=0.04). Moreover, mortality rate was significantly higher in patients with immature desmoplasia compare to mature stromal tissue (OR: 15.61, 95%CI: 0.69-343.38, p=0.04). Conclusions: These observations should prompt a future evaluation of desmoplasia to extent more suitably the use of adjuvant chemotherapy in II stage patients. Further clinical trials are needed to determine if these findings will be able to reduce mortality rate, in stage II CRC patients. # J. GI Oncology 7. Colon cancer
P.116 DIETARY MANIPULATIONS REDUCE ADENOMATOUS POLYP DEVELOPMENT IN INTACT MALE APCMin/+ MICE BY MODULATING INTESTINAL ESTROGEN RECEPTOR BETA (ERβ) EXPRESSION M. Barone 1 , S. Tanzi 1 , K. Lofano 1 , M.P. Scavo 1 , M. Pricci 1 , L. Demarinis 1 , S. Papagni 1 , N. De Tullio 1 , R. Guido 1 , M.C. Comelli 2 , E. Maiorano 3 , A. Francavilla 1 , A. Di Leo ∗,1 1 Section
of Gastroenterology, Dept. of Emergency and Organ Transplantation (D.E.T.O.), Univ. of Bari, Bari; 2 CM&D Pharma Limited, UK; 3 Department of Pathologic Anatomy, Univ. of Bari, Bari Background and aim: ERβ is recognized to be decreasingly expressed in adenomatous and carcinomatous tissues, and regarded as a relevant inhibitory mediator in CRC tumorigenesis. Thus, ERβ up-modulation could represent a chemopreventive approach against CRC development. In intact male APCMin/+mice, this study evaluated intestinal polyp development following the addition of a combination of the ERβ selective agonist silymarin and lignin to a western style, high fat/low fiber diet. Material and methods: Forty-six APCMin/+ mice were divided in 4 groups: animals fed on the control high fat/low fiber (tumorigenic) diet or the control diet added with silymarin (0.02%), purified lignin (6.24%), and silymarin (0.005%) + lignin. We assessed: polyps (number and volume), degree of dysplasia, epithelial cell proliferation and migration along the crypt-villus axis by the incorporation of BrdU into DNA. Cell apoptosis was assessed by TUNEL assay and cleaved caspase-3 immunodetection. ERβ and ERa mRNA and protein levels were measured by RT-PCR and Western blotting. Results: In the APCMin/+ mice, silymarin or the combination of silymarin + lignin significantly reduced total polyp number and volume as compared to controls. Moreover, the number of mice with high grade dysplastic lesions significantly decreased as compared to controls. Cell proliferation and apoptosis were rebalanced, and cell migration accel-