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P.121 THE FIRST TWO YEARS OF COLORECTAL CANCER SCREENING IN THE FERRARA DISTRICT, ITALY
S146
Abstracts / Digestive and Liver Disease 42S (2010) S61–S192
P.121 THE FIRST TWO YEARS OF COLORECTAL CANCER SCREENING IN THE FERRARA DISTRICT, ITALY V.G. Matarese ∗ , N. Fusetti, V. Cifalà, L. Trevisani, A. Pezzoli, L. Simone, A. Zelante, R. Stockbrugger, S. Gullini Azienda Ospedaliero-Universitaria S. Anna, Ferrara Background and aim: In Italy, nation-wide screening for colorectal cancer (CRC) was approved in 2004. The organization was delegated to the 12 regions. We report on the first screening round in the District of Ferrara in the region of Emilia-Romagna (March 2005 to March 2007), illustrating the entire effort of such screening from administration and information to therapy and follow-up. Material and methods: After multi-media information and invitation to 38.344 persons aged 50 to 69 years (28.5% of the district population), 19.480 (50.8%) accepted the i-FOBT, 1.149 (6%) being positive. After gastroenterological consultation, 1001 i-FOBT positive (88.2%) accepted examination by either colonoscopy (99.5%) or barium enema (0.5%). Results: During colonoscopy, 231 patients with low-risk and 239 with high-risk adenomas were treated (endoscopically 96%, surgically 4%) and submitted to follow-up. Ninety-one cancers were diagnosed (Dukes stadia: A 58.2%; B 19.8%; C 18.7%; D 3.3%), 37 localised in polyps and 54 not. Fourteen cancers (in polyps) were treated endoscopically, the other 77 by surgery. The majority of the cancer patients was subjected to endoscopic follow-up; one Dukes B patient and 13/17 Dukes C patients received adjuvant chemotherapy. During the 2-year study period, 87 screenees had a follow-up colonoscopy: no neoplasia was found in 35 patients with initial cancer; low risk-adenomas were found in 31 of 52 patients with initial high-risk adenomas. Conclusions: The first CRC screening round in this district was easy to organize, had a high acceptance and resulted in the discovery of 91 cancers (78% Dukes A+ B, compared to 40% in spontaneous cancers diagnosed in the same period), necessitating chemotherapy in only 14 cases. This report may motivate others to initiate similar CRC screening campaigns. # H. GI oncology - 9. Screening
P.122 TWO CONSECUTIVE COLORECTAL CANCER (CRC) SCREENING ROUNDS IN AN ITALIAN NORTH-EASTERN DISTRICT (ULSS-1) WITH HIGH ADHERENCE L. Cavallaro ∗ ,1 , P. Lesis 1 , E. Galliani 1 , E. Dal Pont 1 , F. Soppelsa 2 , R. Mel 2 , S. Di Camillo 2 , M. Battistel 3 , G. Bertiato 3 , P. Iuzzolino 4 , B. Germanà 1 1 U.O.C.
Gastrenterologia Ospedale San Martino, Belluno; 2 Servizio Igiene Pubblica, Ospedale San Martino, ULSS-1, Belluno; 3 Medicina di Laboratorio, San Martino Hospital, ULSS-1, Belluno; 4 U.O. Anatomia Patologica, Ospedale San Martino, ULSS-1, Belluno Background and aim: Colorectal cancer (CRC) screening is widely recommended because of its efficacy in reducing the CRC mortality. Generally, in the second round, both adhesion and cancer detection rate are lower than in the first round. Aim: To compare first with second round results in a district with high adherence. Material and methods: The ULSS-1 Veneto sanitary district consists of a part of Belluno Province with about 120,000 inhabitants whose 30,000 into the CRC screening target age (range 50-69). First round of CRC screening was performed from February 2005 to February 2007; the second one from March 2007 to March 2009. All the inhabitants included into the target age were invited, by mail, to collect, every two years, a 1-day faecal specimen without any dietary restriction. The specimens, collected by both Chemists and General Practitioners, were processed according to an immunochemical procedure based on latex agglutination (faecal immunochemical test, FIT). The positive subjects were invited to undergo colonoscopy. Results: In the first CRC screening round, 21,775 out of 30,269 (71%) subjects were invited to perform FIT. 1134 subjects (5.2%) were FIT+ve. 994 (89%) performed colonscopy (13 were excluded or lost and 127 refused). CRC cancer was detected in 56 (detection rate: 2.6‰). In the second round, 20,360 out of 31,584 subjects (64%) were invited to perform FIT, p<0.05. 814 (4.0%)
were FIT+ve, p<0.05. 721 (89%) performed colonoscopy (2 were excluded or lost and 88 refused). CRC cancer was detected in 37 (detection rate: 1.8‰), p<0.05. 33 out of 51 (65%) and 27 out of 35 (77%) CRC detected were in stage I or II in first and second round respectively, p=NS (5 and 2 malignant polyps, in first and second round respectively, were removed endoscopically). Conclusions: A slight but significant decrease of compliance population to FIT, FIT+ve rate and CRC detection rate were observed comparing the first with second round, maintaining a similar adhesion to colonoscopy. The majority of the CRC detected were in stage I-II (not needing post-operative chemotherapy), showing the efficacy of the screening program. # H. GI oncology - 9. Screening
P.123 MICRORNAS ARE DEREGULATED IN BARRETT’S CARCINOGENESIS M. Fassan 1 , C. Mescoli ∗ ,1 , S. Volinia 2 , M. Pizzi 1 , J. Palatini 2 , R. Baffa 3 , R. Clemente 4 , C. Rizzetto 4 , C. Croce 2 , G. Zaninotto 5 , E. Ancona 5 , M. Rugge 1 1 Department of Medical Diagnostic Sciences & Special Therapies, Pathology Unit, University of Padova, Padova; 2 Comprehensive Cancer Center, Ohio State University, Columbus, OH, USA; 3 Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA; 4 Istituto Oncologico Veneto IOV-IRCCS, Padova; 5 Department of Gastroenterological & Surgical Sciences, University of Padova, Padova
Background and aim: Barrett’s Mucosa (BM) is a metaplastic replacement of the native esophageal (squamous) epithelium (ESq) by columnar-intestinalized mucosa. BM is the main risk factor for Barrett’s adenocarcinoma (BAc). MicroRNAs (miRNAs) are a class of small non-coding RNAs that control gene expression by targeting mRNAs; miRNAs deregulation has been associated with Barrett’s oncogenesis. Material and methods: To explore the hypothesis that a specific miRNAs signature is associated with BM (and its associated cancer risk) a miRNA microarray analysis (OSU-CCC version 4.0; Ohio State University) compared ESq versus all the spectrum of the phenotypic lesions of the Barrett’s carcinogenesis. Specimens were collected at Department of Pathology of Padova University from 14 patients undergone esophagectomy for BAc or High-grade non-invasive neoplasia (HG-NiN). Tissues samples for the microarray study included: ESq= 14 samples; BM= 14; Low-grade non-invasive neoplasia (LG-NiN) = 7; HG-NiN= 5; BAc= 11. Results: The miRNA-profiling study consistently disclosed increased expression of 6 miRNAs (hsa-miR-215, hsa-miR-560, hsa-miR-615-3p, hsamiR-192, hsa-miR-326, hsa-miR-147), and decreased expression of 7 others (hsa-miR-100, hsa-miR-23a, hsa-miR-605, hsa-miR-99a, hsa-miR-205, hsalet-7c, hsa-miR-203). Microarray results were further validated by qRT-PCR, using a different series of 10 consecutive BAc cases (Esq= 10 samples; BM= 6 samples; BAc= 10 samples). Interestingly, some of the miRNAs found deregulated in this series are already known as suitable markers of cancer progression in other models of epithelial oncogenesis (i.e.: hsa-let-7c, hsa-miR-192, hsamiR-203, hsa-miR-205, hsa-miR-215). The results achieved by the miRNA profiling study were further validated by the immunohistochemical (IHC) analysis on a well-defined miRNA gene target (HMGA2 [hsa-let-7c]). The IHC expression of the protein product was consistent with the corresponding miRNA’s deregulation. In fact, HMGA2 IHC expression was up-regulated in HG-NiN and Bac. Conclusions: The achieved results confirm that specific miRNAs are involved in BM carcinogenesis and that they may represent a novel diagnostic/prognostic tool in the characterization of BAc gene targets. # H. GI oncology -10. Preneoplastic lesions
Abstracts / Digestive and Liver Disease 42S (2010) S61–S192
P.121 THE FIRST TWO YEARS OF COLORECTAL CANCER SCREENING IN THE FERRARA DISTRICT, ITALY V.G. Matarese ∗ , N. Fusetti, V. Cifalà, L. Trevisani, A. Pezzoli, L. Simone, A. Zelante, R. Stockbrugger, S. Gullini Azienda Ospedaliero-Universitaria S. Anna, Ferrara Background and aim: In Italy, nation-wide screening for colorectal cancer (CRC) was approved in 2004. The organization was delegated to the 12 regions. We report on the first screening round in the District of Ferrara in the region of Emilia-Romagna (March 2005 to March 2007), illustrating the entire effort of such screening from administration and information to therapy and follow-up. Material and methods: After multi-media information and invitation to 38.344 persons aged 50 to 69 years (28.5% of the district population), 19.480 (50.8%) accepted the i-FOBT, 1.149 (6%) being positive. After gastroenterological consultation, 1001 i-FOBT positive (88.2%) accepted examination by either colonoscopy (99.5%) or barium enema (0.5%). Results: During colonoscopy, 231 patients with low-risk and 239 with high-risk adenomas were treated (endoscopically 96%, surgically 4%) and submitted to follow-up. Ninety-one cancers were diagnosed (Dukes stadia: A 58.2%; B 19.8%; C 18.7%; D 3.3%), 37 localised in polyps and 54 not. Fourteen cancers (in polyps) were treated endoscopically, the other 77 by surgery. The majority of the cancer patients was subjected to endoscopic follow-up; one Dukes B patient and 13/17 Dukes C patients received adjuvant chemotherapy. During the 2-year study period, 87 screenees had a follow-up colonoscopy: no neoplasia was found in 35 patients with initial cancer; low risk-adenomas were found in 31 of 52 patients with initial high-risk adenomas. Conclusions: The first CRC screening round in this district was easy to organize, had a high acceptance and resulted in the discovery of 91 cancers (78% Dukes A+ B, compared to 40% in spontaneous cancers diagnosed in the same period), necessitating chemotherapy in only 14 cases. This report may motivate others to initiate similar CRC screening campaigns. # H. GI oncology - 9. Screening
P.122 TWO CONSECUTIVE COLORECTAL CANCER (CRC) SCREENING ROUNDS IN AN ITALIAN NORTH-EASTERN DISTRICT (ULSS-1) WITH HIGH ADHERENCE L. Cavallaro ∗ ,1 , P. Lesis 1 , E. Galliani 1 , E. Dal Pont 1 , F. Soppelsa 2 , R. Mel 2 , S. Di Camillo 2 , M. Battistel 3 , G. Bertiato 3 , P. Iuzzolino 4 , B. Germanà 1 1 U.O.C.
Gastrenterologia Ospedale San Martino, Belluno; 2 Servizio Igiene Pubblica, Ospedale San Martino, ULSS-1, Belluno; 3 Medicina di Laboratorio, San Martino Hospital, ULSS-1, Belluno; 4 U.O. Anatomia Patologica, Ospedale San Martino, ULSS-1, Belluno Background and aim: Colorectal cancer (CRC) screening is widely recommended because of its efficacy in reducing the CRC mortality. Generally, in the second round, both adhesion and cancer detection rate are lower than in the first round. Aim: To compare first with second round results in a district with high adherence. Material and methods: The ULSS-1 Veneto sanitary district consists of a part of Belluno Province with about 120,000 inhabitants whose 30,000 into the CRC screening target age (range 50-69). First round of CRC screening was performed from February 2005 to February 2007; the second one from March 2007 to March 2009. All the inhabitants included into the target age were invited, by mail, to collect, every two years, a 1-day faecal specimen without any dietary restriction. The specimens, collected by both Chemists and General Practitioners, were processed according to an immunochemical procedure based on latex agglutination (faecal immunochemical test, FIT). The positive subjects were invited to undergo colonoscopy. Results: In the first CRC screening round, 21,775 out of 30,269 (71%) subjects were invited to perform FIT. 1134 subjects (5.2%) were FIT+ve. 994 (89%) performed colonscopy (13 were excluded or lost and 127 refused). CRC cancer was detected in 56 (detection rate: 2.6‰). In the second round, 20,360 out of 31,584 subjects (64%) were invited to perform FIT, p<0.05. 814 (4.0%)
were FIT+ve, p<0.05. 721 (89%) performed colonoscopy (2 were excluded or lost and 88 refused). CRC cancer was detected in 37 (detection rate: 1.8‰), p<0.05. 33 out of 51 (65%) and 27 out of 35 (77%) CRC detected were in stage I or II in first and second round respectively, p=NS (5 and 2 malignant polyps, in first and second round respectively, were removed endoscopically). Conclusions: A slight but significant decrease of compliance population to FIT, FIT+ve rate and CRC detection rate were observed comparing the first with second round, maintaining a similar adhesion to colonoscopy. The majority of the CRC detected were in stage I-II (not needing post-operative chemotherapy), showing the efficacy of the screening program. # H. GI oncology - 9. Screening
P.123 MICRORNAS ARE DEREGULATED IN BARRETT’S CARCINOGENESIS M. Fassan 1 , C. Mescoli ∗ ,1 , S. Volinia 2 , M. Pizzi 1 , J. Palatini 2 , R. Baffa 3 , R. Clemente 4 , C. Rizzetto 4 , C. Croce 2 , G. Zaninotto 5 , E. Ancona 5 , M. Rugge 1 1 Department of Medical Diagnostic Sciences & Special Therapies, Pathology Unit, University of Padova, Padova; 2 Comprehensive Cancer Center, Ohio State University, Columbus, OH, USA; 3 Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA; 4 Istituto Oncologico Veneto IOV-IRCCS, Padova; 5 Department of Gastroenterological & Surgical Sciences, University of Padova, Padova
Background and aim: Barrett’s Mucosa (BM) is a metaplastic replacement of the native esophageal (squamous) epithelium (ESq) by columnar-intestinalized mucosa. BM is the main risk factor for Barrett’s adenocarcinoma (BAc). MicroRNAs (miRNAs) are a class of small non-coding RNAs that control gene expression by targeting mRNAs; miRNAs deregulation has been associated with Barrett’s oncogenesis. Material and methods: To explore the hypothesis that a specific miRNAs signature is associated with BM (and its associated cancer risk) a miRNA microarray analysis (OSU-CCC version 4.0; Ohio State University) compared ESq versus all the spectrum of the phenotypic lesions of the Barrett’s carcinogenesis. Specimens were collected at Department of Pathology of Padova University from 14 patients undergone esophagectomy for BAc or High-grade non-invasive neoplasia (HG-NiN). Tissues samples for the microarray study included: ESq= 14 samples; BM= 14; Low-grade non-invasive neoplasia (LG-NiN) = 7; HG-NiN= 5; BAc= 11. Results: The miRNA-profiling study consistently disclosed increased expression of 6 miRNAs (hsa-miR-215, hsa-miR-560, hsa-miR-615-3p, hsamiR-192, hsa-miR-326, hsa-miR-147), and decreased expression of 7 others (hsa-miR-100, hsa-miR-23a, hsa-miR-605, hsa-miR-99a, hsa-miR-205, hsalet-7c, hsa-miR-203). Microarray results were further validated by qRT-PCR, using a different series of 10 consecutive BAc cases (Esq= 10 samples; BM= 6 samples; BAc= 10 samples). Interestingly, some of the miRNAs found deregulated in this series are already known as suitable markers of cancer progression in other models of epithelial oncogenesis (i.e.: hsa-let-7c, hsa-miR-192, hsamiR-203, hsa-miR-205, hsa-miR-215). The results achieved by the miRNA profiling study were further validated by the immunohistochemical (IHC) analysis on a well-defined miRNA gene target (HMGA2 [hsa-let-7c]). The IHC expression of the protein product was consistent with the corresponding miRNA’s deregulation. In fact, HMGA2 IHC expression was up-regulated in HG-NiN and Bac. Conclusions: The achieved results confirm that specific miRNAs are involved in BM carcinogenesis and that they may represent a novel diagnostic/prognostic tool in the characterization of BAc gene targets. # H. GI oncology -10. Preneoplastic lesions