P.02.3 ASPIRIN, STATINS AND PANCREATIC CANCER: IS THERE ROOM FOR CHEMOPREVENTION?

Abstracts of the 22nd National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231

Conclusions: This is the first meta-analysis evaluating the rate of occasionally detected PCLs in asymptomatic individuals. The rate is as high as 11%, and is higher in older subjects, and in studies employing MRCP. IPMNs seem the most common occasionally detected PCL. These findings underline the importance of better defined follow-up policies for asymptomatic IPMNs.

P.02.3 ASPIRIN, STATINS AND PANCREATIC CANCER: IS THERE ROOM FOR CHEMOPREVENTION? Archibugi L.*1, Piciucchi M.2, Valente R.1, Maisonneuve P.3, Delle Fave G.1, Capurso G.1 A.O. Sant’Andrea, Roma, Italy, 2Ospedale Città di Castello, Città di Castello, Italy, 3Istituto Europeo di Oncologia (IEO), Milano, Italy

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Background and aim: Pancreatic ductal adenocarcinoma (PDAC) has increasing incidence and poor prognosis, mostly due to delayed diagnosis. Prevention can be a cornerstone in the fight against this deathly cancer. In this context, chemopreventive action of aspirin and statins might prove interesting. However, published data are conflicting, with effect sometimes limited to subgroups; the possible combined effect of the two drugs has never been explored. The aim of the study is to investigate the possible protective role of aspirin and statin use and their combination on PDAC. Material and methods: This is a case-control study, with risk factors screened through questionnaires about environmental factors, family and medical history. PDAC cases were matched to controls for age and gender with a 1:2 ratio. We performed a power calculation analysis, considering an exposure of 22% and 23% respectively for aspirin and statins recorded in the first 200 controls; to have a 80% power of identifying a <0,61 OR for aspirin and <0,62 OR for statins 345 cases and 690 controls were needed. With a 10% rate for the combined use of aspirin and statins among controls, the same number of subjects allows to detect an OR of 0,47 with 80% of power. Results: 346 patients with PDAC and 692 matched controls (54% males, mean age 69 in both groups) were enrolled. Aspirin (19.1% vs 23.8%) use was similar in both case and control group. Neither>5year use of aspirin (7.2% vs 10.8%) nor its combination with statin (10.1% vs 11.3%) showed different prevalence among cases and controls. Statin use was significantly higher in the control group (19.1% vs 24.9%); a protective effect was also demonstrated in multivariate logistic regression (OR 0.66, 95%CI: 0.46-0.96). In multivariate logistic regression analysis smoking (OR:1.61, CI95%: 1.56-2.26), heavy drinking (OR:2.08, CI95%:1.31-3.29), history of previous diabetes (OR:1.6, CI95%: 1.01-2.54), chronic pancreatitis (OR:16.96, CI95%:2.01-143.03) and family history of PDAC (OR:3.92, CI95%: 1.9-8.07) were all significant risk factors. Conclusions: This study suggested a chemopreventive effect for statins, but not for aspirin (OR similar to that recently reported in another large C-C study in the US). The possible combined chemopreventive effect of aspirin and statins was hereby analyzed for the first time with null results. All known factors associated with increased risk for PDAC were confirmed, supporting the genuineness of our population.

P.02.4 REASSESSMENT OF HISTOLOGICAL FEATURES AT DISEASE PROGRESSION DURING THE FOLLOW-UP OF NEUROENDOCRINE TUMOURS Cicchese N.*, Pilozzi E., Rinzivillo M., Iannicelli E., Panzuto F., Merola E., Pucci E., Capurso G., Delle Fave G. Ospedale Sant’Andrea, Roma, Italy

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Background and aim: Neuroendocrine Neoplasms (NENs) are relatively rare diseases with an heterogeneous clinical behaviour. The proliferative index ki-67 is the most important prognostic factor. However, whether repeating histological assessment at time of disease progression (DP) is still debated, since there are few data regarding potential Ki-67 modification during the course of disease. Our aim is to investigate modification of ki-67 index at time of DP in NENs. Material and methods: Retrospective analysis of sporadic NENs patients in which histological sampling (bioptic or surgical) was repeated at time of DP. Histological evaluation was assessed according with WHO 2010 classification by a pathologist blinded about the disease clinical course. Results: 29 pts, median age 59 (range 37-74 yr), repeated histological evaluation at time of DP, and were included. Of these, 17 (58.6%) showed increase in lesions number/size, whereas 12 (41.4%) had recurrent disease after previous radical surgery. Primary tumour sites were: distal jejunum/ileum (14, 48.2%), pancreas (9, 31%), bronchial (3, 10.3%), unknown (2, 6.8%), colonic (1, 3.4%). At time of initial evaluation, a total of 15 pts (51.7%) had G1 tumor, whereas 14 (48.3%) had G2 tumor. Median ki-67 was 2% (range 1%-20%). The median interval between initial assessment and repeated histology was 51 months. At DP, 22 pts (75.8%) experienced ki-67% changes (9 pancreatic NENs, 8 intestinal NENs, 5 other primary NENs). Of these, 10 (34.4%) underwent G modifications. In detail, 3 patients changed grading from G2 to G3 (3 pancreatic NENs), 5 from G1 to G2, and the remaining 2 pts from G2 to G1. Overall, median ki67 at time of DP was 5% (range 1%-70%; p=0.006 vs Ki67 at time of initial assessment). No difference was observed neither in ki-67 nor in grading changes between patients who underwent increase in lesions number/size and those who had recurrent disease after previous radical surgery. Conclusions: Significant increase in Ki-67 index occur in a relevant group of NEN patients at time of DP, thus suggest the usefulness of repeating histology before planning medical treatments in these patients.

P.02.5 PREVALENCE OF CHRONIC PANCREATITIS IN THE PRIMARY CARE SETTING Capurso G.*1, Archibugi L.1, Bianco M.2, Cavallini F.2, Cremaschi R.2, Colantonio P.2, Filabozzi A.2, Giovannetti P.2, Lanna G.2, Mastrantoni A.2, Medori C.2, Balducci P.2, Merletti E.2, Nunnari E.2, Paris F.2, Pasquali P.2, Pavone M.2, Centofanti S.2, Piacenti A.2, Rossi A.2, Taborchi M.2, Chiriatti A.2, Delle Fave G.1 1

S. Andrea Hospital, Rome, Italy, 2Primary Care, Roma, Italy

Background and aim: Data on the prevalence of chronic pancreatitis are scanty, as a formal diagnosis is often difficult to be made. Moreover, most epidemiological studies are hospital-based and therefore might not represent the general population. We aimed at investigating the prevalence of chronic pancreatitis in the general population. Material and methods: About 160 primary care physicians (PCPs) were invited to take part in clinical meetings on chronic pancreatitis (CP) and pancreatic exocrine insufficiency (PEI). Afterwards, a survey was conducted among the participants. Each PCP was asked to report his total number of assisted individuals, and the number affected by definite or suspected CP, filling in a form with details about environmental factors and disease characteristics of each CP patient. The forms were reviewed and patients with “uncertain” diagnosis of CP were invited to our pancreatic disease unit for a specialist appointment. Results: 23 PCPs accepted to take part to our study. Their pooled assisted population was of 34.000 individuals. According with