Mo1142 The Impact of Age on the Clinicopathological Features and Survival in Patients With Gastric Adenocarcinoma

Mo1141

AGA Abstracts

Biliary Tract Malignancies in Iceland: Epidemiology and Prognosis - A Nationwide Population Based Study Gunnar S. Juliusson, Jon G. Jonasson, Pall H. Möller, Sara B. Jonsdottir, Jon O. Kristinsson, Einar Bjornsson Background: Malignancies originating in the biliary tract are uncommon and few population based studies exist on the incidence and prognosis of these tumors. Recent studies based on large registries from the US and Europe have reported changes in the incidence during the last decades but whether the prognosis has changed is unclear. We aimed to determine the incidence, clinical characteristics and prognosis of these malignancies during two different time periods. Methods: The study population included all patients diagnosed with intraand extrahepatic cholangiocarcinoma, gallbladder and ampullary cancer in Iceland from 1986-2009. Patients were identified through the Icelandic Cancer Registry and relevant clinical information were obtained from medical records. The study period was divided into two twelve year periods, P1 (1986-1997) and P2 (1998-2009). Results: A total of 203 patients were identified (Table). Histologically confirmed diagnoses were 70% of intra- and extrahepatic cholangiocarcinomas, 94% of gallbladder cancers and 91% of ampullary cancers. Two year survival for nonhistologically confirmed cancers was nil. Women were 55% of all patients and 79% of gallbladder cancer patients. Incidence of intrahepatic cholangiocarcinoma rose significantly from P1 to P2 whereas the incidence of gallbladder cancer decreased during the study period (Table). Incidence of extrahepatic cholangiocarcinoma and ampullary cancer did not change significantly. Five year absolute survival for patients with intrahepatic cholangiocarcinoma who had reached a 5 year follow-up was 0% in P1 vs 8% in P2 (NS), 0% vs 7% (NS) for extrahepatic cholangiocarcinoma, 19% vs 13% (NS) for gallbladder cancer and 24% vs 30% (NS) for ampullary cancer. The total number of cholecystectomies performed in the country increased from 30 per 100.000 inhabitants in P1 to 70 patients per 100.000 in P2 (p,0.001). Conclusion: In this population based study the incidence of intrahepatic biliary tract cancers increased during the study period whereas the incidence of gallbladder cancer decreased. The latter might be partly explained by an increase in cholecystectomies. The prognosis of bile duct cancers has unfortunately not improved in recent years despite diagnostic and therapeutic advances. All models were conditioned on the matching factors sex, age at recruitment, study center and menopausal status, and were adjusted for mody mass index (continuous), diabetes mellitus (yes, no), hormone replacement therapy (yes, no), physical activity (inactive, moderately inactive, moderately active, active), educational level (none, primary school, technical/ professional school, secondary school, university), smoking status (never, former, current) and intake of alcohol, energy from fat, energy from non-fat, fibers, fruit, vegetables, dairy products, red meat and processed meat (all continuous). Mo1140 Characteristics of Second Primary Cancer in Patients With Early Gastric Cancer After Endoscopic Resection Jung-Wook Kim, Jae-Young Jang, Hoehoon Chung, Chang Kyun Lee Background and aim Second primary cancer influences the prognosis of gastric cancer patients. Increment in diagnosis of EGC and improvement of the prognosis for gastric cancer has led to increased incidence of second primary cancer. Endoscopic resection(ER) of early gastric cancer(EGC) is widely performed in Korea. The aim of this study is to analyze the incidence rate, clinicopathologic features and risk factors of second primary cancer in patients with EGC with history of ER and those with AGC, and compare the results between the two groups. Subjects and Methods We retrospectively reviewed medical information of 716 adult patients with gastric cacner, between January 2006 and December 2010 at a single center, Kyung Hee Medical Center, Seoul, South Korea. The patients who underwent operation for EGC, those with history of previous malignancy and those lost to follow up within 12 months were excluded, and 461 patients were enrolled for the study. We defined synchronous cancers as those occurring within 6 months after diagnosis of the first primary cancer, and metachronous cancers as those occurring more than 6 months later. We collected the demographic data of patients, the incidence rates of synchronous and metachronous cancers and the clinico-pathologic features in EGC with ER and AGC, respectively. Results Out of 461 patients, 232 patients (232/461, 50.3%) underwent ER for EGC, and 229 patients(229/461, 49.7%) were diagnosed with AGC. There were no significant differences between the two groups with regard to mean follow-up period(32.9±14.9 months vs. 33.4±16.7 months, P=0.679) and mean age( ,60 vs. .60, P= 0.850). Synchronous cancers were diagnosed in 9(3.9%) patients of EGC with ER group and in 10(4.4%) patients of AGC group. Metachronous cancers were diagnosed in 10(4.3%) patients of EGC with ER group and in 11(4.8%) patients of AGC group. There was no difference in overall incidence of synchronous and metachronous cancers between the two groups (3.9% and 4.3% vs 4.4% and 4.8%, P=0.819 and P=0.828). The most common site of second primary cancer occurrence in EGC with ESD group was the lung(21%), followed by colorectum(16%) and esophagus(16%). The most frequent site of second primary cancer occurence in AGC group was the colorectum (14%), lung (14%) and esophagus(14%). Logistic regression analyses showed no meaningful risk factors in either group. Conclusion There was no significant differences in the incidence rate of synchronous and metachronous cancers between EGC with ER and AGC group. Therefore, careful evaluation and close surveillance for detecting synchronous and metachronous cancer is strongly recommended in patients who underwent ESD for ER. Key words: Gastric cancer, Synchronous, Metachronous, EGC with ER, AGC

AGA Abstracts

* p ,0.001 Mo1142 The Impact of Age on the Clinicopathological Features and Survival in Patients With Gastric Adenocarcinoma Marita C. Bautista, Sheng-Fang Jiang, Debbie A. Postlethwaite, Dan Li Introduction: Gastric cancer often occurs in the elderly and is uncommon in younger individuals. Whether young patients with gastric cancer have different clinical behaviors and outcomes compared with older patients remains unclear. The goal of this study is to compare the clinicopathological features and survival of gastric adenocarcinoma in different age groups. Methods: Between 2000 and 2010, a total of 1,378 cases of newly diagnosed noncardia gastric adenocarcinoma were identified from Kaiser Permanente, Northern California (KPNC)'s Cancer Registry. Clinical and pathological information including demographics, history of Helicobacter pylori infection, and tumor information (location, histology, grade, and stage) were collected from additional KPNC databases. Clinicopathological features and survival rates were compared between different age groups ( ≤40 years, 41-49 years, 50-59 years, 60-69 years, and ≥70 years). Results: The age distribution in gastric cancer patients was as follows: 58 patients (4.2%) in age ≤ 40 years; 103 (7%) in 41-49 years; 194 (14%) in 50-59 years; 315 (23%) in 60-69 years; and 708 (51%) in ≥ 70 years. The mean and median ages of diagnosis were 68 and 70 years, respectively. Male:female ratio differed significantly between younger and older patients (0.81 in age ,50 years vs. 1.53 in ≥60 years, P,0.01). There were significantly more Hispanics in younger patients (45% in age ,50 years vs. 19% in ≥70 years) and more Whites in older groups (49% in age ≥70 years vs. 20% in ,50 years; overall P,0.001). Diffuse/mixed histological type (Lauren Classification) was more prevalent in younger patients (71% in ≤40 years, 65% in 41-49 years vs. 28% in ≥70 years), whereas intestinal type was more frequent in older groups (71% in ≥70 years vs. 29% in ≤40 years and 32% in 41-49 years; P ,0.001). Poorly differentiated adenocarcinoma was more common in younger patients (81% in ≤40 years vs. 60% in ≥70 years) who also had a higher proportion of metastatic disease (52% in ≤40 years vs. 37% in ≥70 years). The percentages of Helicobacter pylori infection were not statistically different across the age groups. Survival rates at 1-year, 2-year and 5-year gradually declined with increasing age (overall P ,0.001) with the exception of the age group 41-49 years which had a trend toward lower survival rates at 2-year and 5-year. Conclusions: We identified significant age-related variations in clinicopathological features and survival rates in patients with gastric cancer. Young patients were more likely to have aggressive disease although their overall survival rates were non-inferior compared with older patients. More Hispanics were diagnosed with gastric cancer in younger age groups

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Mo1143 Is Lymph Node Ratio (LNR) a Prognostic Marker in Patients With Colon Cancer? A Study in National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Database Siddesh V. Besur, Jyothsna Talluri, Gandhi Lanke, Siva K. Talluri Introduction: Colon cancer is the second leading cause of cancer death in the United States. Surgery is the most common form of treatment for all stages of colon cancer. Surgery involves resection of the affected part of bowel and associated lymph nodes. Lymph Node Ratio (LNR) is defined as ratio of metastatic to examined lymph node. It is a useful prognostic indicator in breast, esophageal, pancreatic and gastric cancer. The primary objective of our study is to evaluate lymph node ratio as a prognostic marker in patients with stage III and stage IV colon cancer. Methods: We studied a retrospective cohort of stage III and stage IV colon cancer patients included in National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry from 1988 to 2009. The LNR's were grouped into 4 categories (LNR 1 ,0.05, LNR 2 0.05-0.19, LNR 3 0.2-0.39 and LNR 4 0.4-1) based on accepted lymph node ratios for colon cancer. We compared demographic and tumor characteristics of colon cancer patients using Chi-square tests. Multivariate analysis was performed using Cox proportional hazard regression to compare survival between different LNR groups after adjusting for age, colon cancer stage and grade. Results: We included 26,562 patients with stage III and IV colon cancer. The mean age was 67.2 years and median number of examined lymph nodes was 14. A median of 3 lymph nodes were positive for the disease. The majority (39%) of patients were in LNR 2 category (0.05-0.19). We included 18,167 patients with stage III and 7331patients with stage IV disease. The univariate analysis showed a 5-year colon cancer-specific survival of 70%, 57%, 41% and 23% with increasing LNRs (P,0.001). The Cox proportional hazard regression analysis after adjusting for stage, age and grade of the tumor shows the effect of LNR on survival as shown in Table 1and Figure 1. Conclusion: Lymph node ratio in colon cancer is an important independent predictor of prognosis in patients with stage III and IV colon cancer. Table 1

Mo1146 Pancreatic Cancer Hospitalizations in the United States: Trends, Characteristics, Resource Utilization and Outcomes in the Past Decade Sravanthi Parasa, Neil Gupta, Gokulakrishnan Balasubramanian, Vijay Kanakadandi, Prateek Sharma Background and Aims: Little is known about the rates of hospitalization for pancreatic cancer and health care utilization. The objective was to examine trends in pancreatic cancer related hospitalization in the United States over the past decade. Methods: Trends in patient characteristics, resource utilization and outcomes were calculated and assessed using data from the Nationwide Inpatient Sample for years 2000-2009. All hospital discharges with a primary diagnosis of pancreatic cancer were selected. Total number of hospitalizations, annual discharge rates, and 95% confidence intervals were calculated and trends assessed using linear regression as well as Cochran-Armitage test for trend. Results: Between 2000 and 2010 the total number of hospitalizations for pancreatic cancer increased by 13% from 31,563 to 36,188 but this was not statistically significant. No significant differences were seen in the proportion of hospitalizations based on gender and age groups. (See figure1). The mean costs of hospitalization increased from $27,589 to $60, 107 (p trend , 0.01). The direct age-standardized mortality fell by 24% in males and by 37% in females. The in-hospital mortality improved from 16.6% to 9.9 %( p trend , 0.05) during this time period. Conclusion: The rates of hospitalization for pancreatic cancer have been stable have remained stable over the last decade. Although inpatient mortality has improved, approximately 10% of patients still die in-house. Despite these trends, the costs of hospitalization have significantly increased and need further evaluation.

Multi-variate Analysis with effect of Lymph Node Ratio on survival in patients with stage III and stage IV colon cancer after adjusting for age, grade and stage of colon cancer.

Mo1147 Colorectal Cancer Incidence in U.S.-Born and Foreign-Born Asians in California, and Influence of Neighborhood Socioeconomic Status and Ethnic Neighborhood Enclave Uri Ladabaum, Christina A. Clarke, Parvathi A. Myer, David Press, Scarlett L. Gomez Background: Colorectal cancer (CRC) incidence in Asian-Americans is lower than in whites. However, Asians include multiple subgroups and rates have been shown to vary widely across subgroups. We hypothesized that rates among Asians vary by nativity (U.S.-born vs. foreign-born), as well as neighborhood socioeconomic status (SES), and the degree to which a neighborhood is an "ethnic enclave" (EE). Aims: To estimate CRC incidence rates in Asian subgroups in California, and to explore the influence of nativity, SES, and EE. Methods: We used California Cancer Registry data from 1990 to 2004, the period for which relevant data were available. Age-adjusted CRC incidence rates were calculated. Rates were compared using incidence rate ratios (IRRs). Trends in rates were explored with joinpoint analysis. Neighborhood-level SES and EE were determined based on census tracts by principal component analysis. Results (Overall yearly CRC incidence): CRC incidence in U.S.-born Japanese was similar to that in whites, while in foreign-born Japanese it was significantly higher (Table 1). In all other Asian subgroups, CRC incidence was significantly lower than in whites (Table 1). For Chinese and Filipino, CRC incidence was lower in foreign-born persons compared with U.S.-born persons (Table 1). Results (Trends in CRC incidence): In whites aged 50-75y, CRC incidence rates decreased by 0.8% (95% CI, 0.3-1.3%) per year from 1990 to 2000, and by 2.4% (95% CI, 0.7-4.8%) per year from 2000 to 2004 (Table 1). This pattern was not observed in Asian subgroups (Table 1). Results (SES and EE): Among whites, CRC incidence decreased with increasing SES. In Asians, no such clear pattern was observed. CRC incidence decreased among Asians with increasing EE. SES and EE showed a complex interaction. The greatest contrast was seen within the high SES Asians, in whom those residing in the least EE had the highest CRC incidence, and those residing in the most EE had the lowest CRC incidence (Table 2). Conclusions: CRC incidence in foreign-born Asians was lower than in whites and U.S.-born Asians, except for in Japanese, in whom incidence was 1.43-fold higher among foreign-born compared to U.S.-born. The

Mo1144 Relationship Between Colorectal Polyps and Angiotensin Receptor Blockers and Angiotensin-Converting Enzime Inhibitor Guillermo N. Panigadi, Lisandro Pereyra, Raquel González, Estanislao J. Gómez, José M. Mella, Carolina Fischer, Leandro Correa, Alfredo G. Torres, Gastón Babot, Adriana Mohaidle, Pablo Luna, Silvia C. Pedreira, Daniel G. Cimmino, Luis A. Boerr Introduction: Angiotensin-receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEI) are widely used drugs. The renin-angiotensin system has been related with angiogenesis and tumor progression. The association of these drugs with colorectal neoplasia has not been described. Aim: To determine the risk of colonic polyps in patients under ARBs or ACE inhibitors treatment. Materials and methods: A prospective transversal cohort study was conducted in a private community hospital from August 2010 to October 2012. Patients scheduled for an outpatient colonoscopy during this period were included, and were asked to complete a survey with information about their behavioral factors (diet, exercise and smoking), disease history (diabetes, obesity, dyslipidemia and hypertension), medications (hypolipemiant, antihypertensive and non-steroidal anti-inflammatory drugs) and personal and family history of colorectal neoplasia. In those patients under ARBs or ACEI treatment, type and treatment duration was also consigned. We calculated the risk of adenomas, adenomas with high grade dysplasia, advanced neoplastic lesions (ANL) (size . 1 cm, high grade dysplasia and/or . 75% of villous component) and cancer (CRC) in patients under ARBs or ACE inhibitors treatment. Risk was expressed in OR and its 95%

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AGA Abstracts

confidence intervals (CI). A p value , 0,05 was considered statistically significant. Results: 1278 patients were analyzed, 280 (22%) under ARBs or ACE inhibitors treatment and 998 (78%) without treatment. There were significant differences between both groups respect to average age (63 vs. 56 (p 0,001)), gender male 65% vs.46% (p 0,001), diabetes 17% vs. 4% (p 0,0001), BMI 28 vs. 25 (p 0.001), dyslipidemia 46% vs.31% (p 0,0001), and chronic non steroidal anti-inflammatory drugs 37% vs. 29% (p 0,05), former smoker 26% vs.16% (p 0,001), CRC history family 10% vs 17% p 0,004). The risk of adenomas, adenoma with high grade dysplasia, ANL and CRC was similar in both groups: OR 1,3 (CI 0.9 - 1,8), OR 0,8 (CI 0,3 - 2,2), OR 1,3 (CI 0.8 - 2,1), OR 1,6 (CI 0,6 - 3,9) respectively. We did not find statistically significant differences when analyzing separately those patients taking ACEI and those taking ARBs nor in those under different treatment durations ( ,5 years, between 5 and 10 years, .10 years). Conclusion: we did not find an increased risk of colorectal neoplasia among those patients under ARB or ACEI treatment.

compared with Whites. Whether this finding reflects differences in biological predisposition and/or environmental exposures remains to be investigated.