- Email: [email protected]
P62
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ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
siHuR demonstrated an 85-90% knockdown of HuR expression based on Western blot analysis. Additionally, after transient transfection with siHuR, the MiaPaCa-2 cells demonstrated a statistically significant decrease in VEGF expression compared to untransfected (UT) cells and cells transfected with a scrambled siRNA sequence. Average decrease in VEGF was 49% (p ⫽ 0.005) and 21% (p ⬍ 0.001) at 48hrs and 72hrs following transfection, respectively. Conclusions: We conclude that HuR is an important post-transcriptional regulator of VEGF in pancreatic adenocarcinoma cells. Therapies targeting HuR and other post-transcriptional regulators of VEGF may have important clinical applications.
ONCOLOGY VIII: CLINICAL OUTCOMES P61. CORRELATION OF RADIOLOGIC AND PATHOLOGIC FINDINGS IN INVASIVE LOBULAR BREAST CANCER. T. L. Bowles, P. D. Schneider, V. P. Khatri, J. E. Goodnight, Jr., R. J. Bold; University of California, Davis, Sacramento, CA Introduction: Standard imaging may underestimate the extent of disease in invasive lobular breast cancer (ILC), which represents approximately 10% of breast cancers. Mammographic and ultrasonographic findings in ILC can be subtle and tumor size may be underestimated. Accurate preoperative evaluation of tumor size is important in counseling patients on surgical options and ensuring adequate resection. We hypothesize that mammography and ultrasonography underestimate the size and extent of tumor in ILC. Methods: A retrospective chart review of 62 women treated for ILC over a 5 year period (2000-2004) at a tertiary care center was conducted. Sensitivity of mammography and ultrasonography in ILC, Pearson’s correlation coefficient of mammographic and ultrasonographic tumor size to final pathologic size, and frequency of reoperation for residual disease were determined. Results: 64 tumors in 62 women with invasive lobular breast cancer were evaluated. Mammography was performed for all patients; a subset of patients was also evaluated with ultrasonography (Table 1). The correlation of final pathologic tumor size to radiographic tumor size was similar for mammography (r⫽.426) and ultrasonography (r⫽.312). Both mammography and ultrasonography consistently underestimated pathologic tumor size by an average of 1.5 cm and 1.3 cm, respectively. For those patients who were treated with breast conserving therapy (N⫽41), 41.5% required a repeat operation for positive margins. When comparing the findings on mammogram, premenopausal status, but not histologic grade or tumor size predicted a false negative finding (p⫽.0006). Conclusions: ILC is often misdiagnosed or underdiagnosed by both mammography and ultrasonography. Additional evaluation with other modalities, such as magnetic resonance imaging, may improve preoperative planning for patients with ILC.
Table 1. Comparison of mammography and ultrasonography for invasive lobular breast cancer
False negative rate Size undetermined
Mammography
Ultrasonography
14/64(22%) 18/50(36%)
4/42(10%) 4/38(11%)
P62. A POPULATION BASED ANALYSIS OF PRESENTATION AND LONGTERM SURVIVAL IN PATIENTS WITH PERIAMPULLARY ADENOCARCINOMA. T. S. Riall, M. L. Torres-Torres, W. H. Nealon, C. M. Townsend, Jr., Y. Kuo, J. L. Freeman; University of Texas Medical Branch, Galveston, TX Background: The 5-year survival of patients with periampullary adenocarcinoma (pancreas, bile duct, ampulla of Vater, and duode-
num) following surgical resection at major centers has been well documented. Little has been reported about the presentation, resectability, and long-term survival of all patients (resected and unresected) with periampullary cancer. Objective: To use a large population-based dataset to compare the presentation and the longterm survival of patients with different types of periampullary cancers. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database all patients aged 18-95 with periampullary adenocarcinoma diagnosed between 1988 and 2002 were identified and grouped based on the site of tumor origin (pancreas, bile duct, ampulla, duodenum). The tumor stage at presentation, patient demographics, and percent resected were compared for each tumor (all p-values represent overall differences between all four groups). For the overall cohort and the subset of patients undergoing surgical resection, Kaplan-Meier long-term survival was evaluated and compared for each tumor type (logrank tests). A multivariate Cox Proportional Hazards model was used to determine the factors that independently influenced survival. Results: 58,735 patients with periampullary adenocarcinoma were identified. The univariate comparison of the four different tumor types is shown in Table 1. By multivariate analysis, being younger, married, or Caucasian, having localized/regional disease, tumor arising in the bile duct, ampulla, or duodenum, or negative lymph nodes, and undergoing surgical resection improved survival. SEER region also influenced survival with some regions having significantly better survival than others. When evaluating resected patients only, race was no longer and independent predictor of survival. Conclusions: This study is the first population-based report of the presentation and long-term outcomes of patients with periampullary adenocarcinoma. When compared to patients with pancreatic and bile duct cancers, patients with ampullary and duodenal cancer present at an earlier stage, are more likely to be resected, and have significantly improved 5-year survival for both the overall group and the subset of resected patients. While periampullary cancers are often discussed as a group, their presentation and prognosis are markedly different. The actuarial survival in the general population is similar to the survival seen at major centers for patients undergoing surgical resection. Variable Age ⫾ SD (years) Percent Male Percent Caucasian Localized Disease Regional Disease Distant Disease Unstaged Disease Surgical Resection Negative Lymph Nodes Overall 5-year Survival Resected 5-year Survival
Pancreas
Bile Duct
Ampulla
Duodenum p-value
69.6⫾12.3 70.9⫾13.0 69.3⫾13.2 66.7⫾14.2 ⬍0.0001 48% 50% 53% 52% ⬍0.0001 81% 7% 25% 51% 17%
80% 15% 35% 22% 27%
80% 20% 55% 10% 15%
71% 30% 30% 24% 16%
⬍0.0001 ⬍0.0001 ⬍0.0001 ⬍0.0001 ⬍0.0001
11%
19%
39%
36%
⬍0.0001
54%
84%
63%
67%
⬍0.0001
3%
8%
24%
30%
⬍0.0001
16%
22%
35%
54%
⬍0.0001
P63. THE RELATIONSHIP OF LYMPH NODE DISSECTION AND EXTRAHEPATIC CHOLANGIOCARCINOMA IN THE VA CENTRAL CANCER REGISTRY. J. M. Mammen, L. E. James, J. J. Sussman; University of Cincinnati, Cincinnati, OH Introduction: For most patients with extrahepatic cholangiocarcinoma, surgery is the initial (and often only) therapy. While several studies have suggested a change in survival based on number of lymph nodes harvested and positive lymph nodes in intrahepatic cholangiocarcinoma, few large studies in this country have examined extrahepatic cholangiocarcinoma. Methods: A VA Central Cancer
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
siHuR demonstrated an 85-90% knockdown of HuR expression based on Western blot analysis. Additionally, after transient transfection with siHuR, the MiaPaCa-2 cells demonstrated a statistically significant decrease in VEGF expression compared to untransfected (UT) cells and cells transfected with a scrambled siRNA sequence. Average decrease in VEGF was 49% (p ⫽ 0.005) and 21% (p ⬍ 0.001) at 48hrs and 72hrs following transfection, respectively. Conclusions: We conclude that HuR is an important post-transcriptional regulator of VEGF in pancreatic adenocarcinoma cells. Therapies targeting HuR and other post-transcriptional regulators of VEGF may have important clinical applications.
ONCOLOGY VIII: CLINICAL OUTCOMES P61. CORRELATION OF RADIOLOGIC AND PATHOLOGIC FINDINGS IN INVASIVE LOBULAR BREAST CANCER. T. L. Bowles, P. D. Schneider, V. P. Khatri, J. E. Goodnight, Jr., R. J. Bold; University of California, Davis, Sacramento, CA Introduction: Standard imaging may underestimate the extent of disease in invasive lobular breast cancer (ILC), which represents approximately 10% of breast cancers. Mammographic and ultrasonographic findings in ILC can be subtle and tumor size may be underestimated. Accurate preoperative evaluation of tumor size is important in counseling patients on surgical options and ensuring adequate resection. We hypothesize that mammography and ultrasonography underestimate the size and extent of tumor in ILC. Methods: A retrospective chart review of 62 women treated for ILC over a 5 year period (2000-2004) at a tertiary care center was conducted. Sensitivity of mammography and ultrasonography in ILC, Pearson’s correlation coefficient of mammographic and ultrasonographic tumor size to final pathologic size, and frequency of reoperation for residual disease were determined. Results: 64 tumors in 62 women with invasive lobular breast cancer were evaluated. Mammography was performed for all patients; a subset of patients was also evaluated with ultrasonography (Table 1). The correlation of final pathologic tumor size to radiographic tumor size was similar for mammography (r⫽.426) and ultrasonography (r⫽.312). Both mammography and ultrasonography consistently underestimated pathologic tumor size by an average of 1.5 cm and 1.3 cm, respectively. For those patients who were treated with breast conserving therapy (N⫽41), 41.5% required a repeat operation for positive margins. When comparing the findings on mammogram, premenopausal status, but not histologic grade or tumor size predicted a false negative finding (p⫽.0006). Conclusions: ILC is often misdiagnosed or underdiagnosed by both mammography and ultrasonography. Additional evaluation with other modalities, such as magnetic resonance imaging, may improve preoperative planning for patients with ILC.
Table 1. Comparison of mammography and ultrasonography for invasive lobular breast cancer
False negative rate Size undetermined
Mammography
Ultrasonography
14/64(22%) 18/50(36%)
4/42(10%) 4/38(11%)
P62. A POPULATION BASED ANALYSIS OF PRESENTATION AND LONGTERM SURVIVAL IN PATIENTS WITH PERIAMPULLARY ADENOCARCINOMA. T. S. Riall, M. L. Torres-Torres, W. H. Nealon, C. M. Townsend, Jr., Y. Kuo, J. L. Freeman; University of Texas Medical Branch, Galveston, TX Background: The 5-year survival of patients with periampullary adenocarcinoma (pancreas, bile duct, ampulla of Vater, and duode-
num) following surgical resection at major centers has been well documented. Little has been reported about the presentation, resectability, and long-term survival of all patients (resected and unresected) with periampullary cancer. Objective: To use a large population-based dataset to compare the presentation and the longterm survival of patients with different types of periampullary cancers. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database all patients aged 18-95 with periampullary adenocarcinoma diagnosed between 1988 and 2002 were identified and grouped based on the site of tumor origin (pancreas, bile duct, ampulla, duodenum). The tumor stage at presentation, patient demographics, and percent resected were compared for each tumor (all p-values represent overall differences between all four groups). For the overall cohort and the subset of patients undergoing surgical resection, Kaplan-Meier long-term survival was evaluated and compared for each tumor type (logrank tests). A multivariate Cox Proportional Hazards model was used to determine the factors that independently influenced survival. Results: 58,735 patients with periampullary adenocarcinoma were identified. The univariate comparison of the four different tumor types is shown in Table 1. By multivariate analysis, being younger, married, or Caucasian, having localized/regional disease, tumor arising in the bile duct, ampulla, or duodenum, or negative lymph nodes, and undergoing surgical resection improved survival. SEER region also influenced survival with some regions having significantly better survival than others. When evaluating resected patients only, race was no longer and independent predictor of survival. Conclusions: This study is the first population-based report of the presentation and long-term outcomes of patients with periampullary adenocarcinoma. When compared to patients with pancreatic and bile duct cancers, patients with ampullary and duodenal cancer present at an earlier stage, are more likely to be resected, and have significantly improved 5-year survival for both the overall group and the subset of resected patients. While periampullary cancers are often discussed as a group, their presentation and prognosis are markedly different. The actuarial survival in the general population is similar to the survival seen at major centers for patients undergoing surgical resection. Variable Age ⫾ SD (years) Percent Male Percent Caucasian Localized Disease Regional Disease Distant Disease Unstaged Disease Surgical Resection Negative Lymph Nodes Overall 5-year Survival Resected 5-year Survival
Pancreas
Bile Duct
Ampulla
Duodenum p-value
69.6⫾12.3 70.9⫾13.0 69.3⫾13.2 66.7⫾14.2 ⬍0.0001 48% 50% 53% 52% ⬍0.0001 81% 7% 25% 51% 17%
80% 15% 35% 22% 27%
80% 20% 55% 10% 15%
71% 30% 30% 24% 16%
⬍0.0001 ⬍0.0001 ⬍0.0001 ⬍0.0001 ⬍0.0001
11%
19%
39%
36%
⬍0.0001
54%
84%
63%
67%
⬍0.0001
3%
8%
24%
30%
⬍0.0001
16%
22%
35%
54%
⬍0.0001
P63. THE RELATIONSHIP OF LYMPH NODE DISSECTION AND EXTRAHEPATIC CHOLANGIOCARCINOMA IN THE VA CENTRAL CANCER REGISTRY. J. M. Mammen, L. E. James, J. J. Sussman; University of Cincinnati, Cincinnati, OH Introduction: For most patients with extrahepatic cholangiocarcinoma, surgery is the initial (and often only) therapy. While several studies have suggested a change in survival based on number of lymph nodes harvested and positive lymph nodes in intrahepatic cholangiocarcinoma, few large studies in this country have examined extrahepatic cholangiocarcinoma. Methods: A VA Central Cancer