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Survival predictors after endoscopic retrograde cholangiopancreatography biliary drainage in pancreatic adenocarcinoma
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Abstracts / Pancreatology 15 (2015) S1eS141
in the locally advanced group than the resected group (92.7% v.s. 64.8%; P¼.000). Of these mentioned cytokines, only IL-8 was significantly elevated in the locally advanced group compared with the normal and resected groups and positively correlated with CC status. IL-8 levels in both serum and tissue samples were also positively associated with weight loss. Additionally, high IL-8 expression combined with the presence of CC is an independent predictor of OS and DFS. Conclusion: High IL-8 expression shows significantly higher relevance with CC in PC patients than other cytokines and thus is useful in prediction and definition of CC development.
889. Surgical outcome of superior mesenteric artery-first approach with radical antegrade modular pancreatosplenectomy for borderline resectable pancreatic cancer
Results: Our knowledge-based and model-informed biomarker discovery strategy led to the discovery of a highly accurate (up to 95%) and robust 6-gene prognostic signature, which we designated as “PanGUIDE”. The expression pattern of the PanGUIDE genes can faithfully reflect the degree of differentiation and stemness in the tumors, thereby enabling a rationalized classification and prognostic prediction of pancreatic cancer patients (Gastroenterology 2013;145:1110). Several of the PanGUIDE genes are novel regulators of cancer stemness including most notably ASPM (abnormal spindle-like and microcephaly associated), which promotes tumor aggressiveness through augmenting Wnt signaling and may serve as a druggable target in pancreatic cancer. Conclusion: The PanGUIDE gene signature is hitherto the most accurate and robust prognosis-classification system in pancreatic cancer. The PanGUIDE assay may help clarify the role of cancer stemness in pancreatic tumor progression and may serve as a companion diagnosis in clinical trials related to cancer-stem-cell-targeted therapeutics and may eventually assist patient-tailored cancer treatment decision.
Yasunari Kawabata, Kazunori Mizutani, Yoshitsugu Tajima Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Japan Introduction: Radical antegrade modular pancreatosplenectomy (RAMPS) is a rational surgical procedure for pancreatic body and tail cancers. Aims: Here we report a modified technique of RAMPS utilizing the superior mesenteric artery (SMA)-first approach for borderline resectable cancers (BRPC) of the pancreas to obtain complete negative tangential margins. Patients & methods: A total of 13 consecutive patients underwent a SMA-first approach with RAMPS for BRPC between July 2013 and December 2014 at Shimane University Hospital. We defined patients as having BRPC based on the National Comprehensive Cancer Network guidelines on 2014. A margin was designated “R1” if tumor cells are 1mm from the margins. Results: There were 6 males and 7 females, with a median age of 70 (range: 52 to 82) years.The median operative time was 422 (range: 300 to 624) minutes and the median intraoperative blood loss was 480 (range: 50 to 1030) ml. No patients required blood transfusion. One patient had a T1 tumor, one patient had a T2 tumor, 10 patients had a T3 tumor, and one patient had a T4 tumor. Lymph node metastasis was positive in 11 patients (85%). R0 resection was achieved in 11 patients (85%). There were no postoperative or in-hospital deaths, and morbidity was 31%. The median postoperative hospital stay was 15 (range: 8 to 58) days. At the median follow-up time of 13.5 months (range: 3.5 to 18.4), the 1-year disease-free survival rate was 85%. Conclusion: SMA-first approach with RAMPS achieved satisfactory surgical outcome along with a high rate of negative tangential margins even in patients with BRPC.
891. PanGUIDE: A prognostically accurate gene signature related to pancreatic cancer stemness and differentiation Tze-Sian Chan 1, 2, Kelvin K. Tsai 1, Li-Tzong Chen 1 1 2
National Institute of Cancer Research, Taiwan Taipei Medical University Wan Fang Hospital, Taipei, Taiwan
Introduction: Molecular portraits of stem cell differentiation may identify key regulatory factors and pathways and help improve outcome prediction in human cancers. It remains to be established if the stemness and tissue differentiation program is linked to the malignant behaviors of human pancreatic cancer. Aims: To translate the above concept to clinics and to facilitate patienttailored treatment decision in pancreatic cancer. Materials & methods: We combined comparative genomic analysis of tissue microarchitectures generated by CD133þCD44þ stem-like pancreatic ductal epithelial cells in a three-dimensional organotypic culture system with clinical correlative analysis across 3 independent cohorts of patients with pancreatic cancer (total n ¼ 128).
895. Comparison of morbidity and mortality rates after two different methods of portal vein reconstruction in patients with borderline resectable pancreatic cancer (BRPC) and TYPE 4 vein resection according to the ISGPS classification scheme Magdalena Derejska, Marek Durlik The Central Clinical Hospital of the Ministry of Interior, The Department of Gastroenterological Surgery & Transplantation, Poland Introduction: BRPC is a tumor with very a high risk of margin-positive resection, and early treatment failure. Developments in surgical technique has led to more radical approaches in these patients. Portal vein resection has now become a standard surgical procedure for this kind of tumors. Type 4 vein resection is segmental vessel resection and reconstruction using a vessel conduit with at least two anasthomoses. Aims: The evaluation of morbidity and mortality rates in patients with borderline resectable pancreatic adenocarcinoma after pancreatoduodenectomy with segmental portal vein resection. Materials & methods: Two different methods of reconstruction were analyzed: left renal grafting and use of a PTFE graft. Data from 1 January 2013 to 30 January 2015 were retrospectively analyzed. Results: In 41 patients with BRPC, pancreatoduodenectomy with portal vein reconstruction was performed; in 11 patients, left renal grafting; and in 30, reconstruction using PTFE. In the cases of 8 patients, reoperation was performed within one month of the initial operation. The overall mortality rate was 7.3% (3 patients from the PTFE group). The overall morbidity rate was 39%; in the left renal grafting group 36% and in the PTFE grafting group 40%. Thrombosis of the graft was diagnosed in five patients from the PTFE group after one month. All patients with left renal grafting reconstruction have well functioning grafts. Conclusion: Reconstruction using the left renal vein seems to be a safer procedure then PTFE grafting. PTFE grafting is more suitable in cases where a longer segment needs to be reconstructed, or more than two anasthomoses need to be performed.
1152. Survival predictors after endoscopic retrograde cholangiopancreatography biliary drainage in pancreatic adenocarcinoma Eduardo Rodrigues-Pinto, Pedro Pereira, Armando Ribeiro, Pedro Moutinho-Ribeiro, Jos e Alexandre Sarmento, Filipe Vilas-Boas, o Santos-Antunes, Guilherme Macedo Joa o Jo Centro Hospitalar Sa ao, Gastroenterology Department, Portugal Introduction: Biliary drainage by endoscopic retrograde cholangiopancreatography (ERCP) allows symptomatic palliation in advanced
Abstracts / Pancreatology 15 (2015) S1eS141
pancreatic adenocarcinoma. There is scarce information on predictors of survival after ERCP. Aims: Evaluate survival predictors after ERCP biliary drainage in pancreatic adenocarcinoma. Patients & methods: Cross-sectional study of patients referred for ERCP biliary drainage of obstruction conditioned by advanced pancreatic adenocarcinoma, over a period of 3 years. Results: Seventy-nine patients underwent biliary drainage. Mortality rate at 3 months was 39% and at 6 months was 62%. Mortality was higher in patients with higher AST (178U/L vs 73U/L, p¼0.031), higher ALT (221U/L vs 85U/L, p<0.001), higher GGT (970U/L vs 423U/L, p¼0.014) and higher AF (816U/L vs 469U/L, p¼0.033). Survival was lower in patients who began adjuvant therapy prior to ERCP (80 days vs 302 days, p¼0.006), in patients with metastasis (63 days vs 160 days, p¼0.013) and tend shorter in patients who placed longer stents (80 days vs 157 days, p¼0.073). In multivariate analysis, survival was lower in patients who began adjuvant therapy prior to ERCP (HR 3.8, p¼0.012), with higher AST (HR 1.1, p¼0.003), with higher bilirubin (HR 1.2, p¼0.004) and with lower decrease of bilirubin after drainage (HR 1.4, p<0.001). Conclusion: Biliary stents by ERCP allows lasting palliation of symptoms in pancreatic adenocarcinoma, even in situations where it is not possible to perform chemotherapy. Best results are obtained in patients who started adjunctive therapy after ERCP, in those with lower AST and bilirubin and in those with higher decrease of bilirubin after ERCP.
1155. Postoperative pancreatitis after pancreaticoduodenectomy predicts clinically relevant postoperative pancreatic fistulas Christian Kuhlbrey, Olivia Sick, Nikki Samiei, Frank Makowiec, Ulrich T. Hopt, Uwe A. Wittel
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902. Socio-economic status influences chance of undergoing surgical treatment for pancreatic cancer in The Netherlands Maikel Bakens 1, Yvette van Gestel 2, Marlies Bongers 1, Valery Lemmens 2, Ignace de Hingh 1 1
Catharina hospital Eindhoven, Department of Surgery, Netherlands Netherlands Comprehensive Cancer Organisation (IKNL), Netherlands Cancer Registry (NCR), Netherlands 2
Introduction: In the USA, a high socio-economic status (SES) has been shown to be associated with a higher chance for surgical treatment and improved survival. In The Netherlands the health care system is not comparable to that in the USA and the effects of SES might be different. Aims: The aim of this study is to analyze the influence of socioeconomic status on surgical treatment and survival in non-metastasized (M0) pancreatic cancer patients in The Netherlands. Patients & methods: All patients diagnosed with M0-pancreatic cancer between 2005 and 2012 in the Eindhoven Cancer Registry (ECR), The Netherlands were included. Data on patient characteristics, tumor characteristics and treatment were extracted. Patients were grouped as surgical treated or not surgical treated. Groups were compared using chisquare tests. The influence of SES on the chance for surgical treatment was assessed by multivariable logistic regression. Influence of SES on overall survival was analyzed by multivariable Cox regression analysis. Results: In total, 748 M0-patients were included. Of these patients 67% underwent surgical treatment. Patients with LSES less often underwent surgical treatment (27%) than patients with HSES (42%). Conclusion: Socio-economic status in pancreatic cancer patients determined the chance for surgical treatment. However, SES had no influence on survival. As surgical treatment is the only option for long-term survival in pancreatic cancer patients, it is important to provide more insights in the causes of these inequalities to ultimately minimalize the effects of SES in pancreatic cancer care.
Department of General- and Visceral Surgery Universityclinic Freiburg, Germany Introduction: Clinically relevant postoperative pancreatic fistulas are the most frequent complications after pancreas resections. Risk factors for POPF development appear to be soft pancreatic tissue and a small pancreatic duct. Aims: The aim of our study was to examine the predictive value of the systemic amylase concentration on the occurrence of POPFs after pancreaticoduodenectomy. Patients & methods: Perioperative data from 864 consecutive pancreas resections were assessed in a prospectively maintained SPSS database. Whipple resections, pylorus preserving, and laparoscopically assisted pancreaticoduodenectomies were evaluated. Serum and drain amylase concentrations were determined by routine clinical chemistry. POPFs were graded into A-C according to ISGPF definitions. In addition to descriptive statistics, chi-square and nonparametric Kruskal-Wallis-test was performed. Results: Between all groups gender, blood loss, surgical technique was equally distributed. In patients with reduced serum amylase (n¼82) on day 1 after duodenopancreatectomy, clinically relevant POPFs were not observed. In patients with normal serum amylase concentrations, POPS grade B and C occurred only in 7% while in 39% of the patients with more than 3x elevated amylase concentrations a clinically relevant postoperative fistula developed postoperatively (p<0.001). The predictive value of increased serum amylase on day 1 after pancreaticoduodenectomy in receiver operated characteristic analysis showed an area under the curve of 0.888 (95%CI 0.863-0.915, p<0.001) indicating that the systemic hyperamylasia detected on day one after pancreas resections is a good predictor of clinically relevant POPFs. Conclusion: Patients with serum amylase concentrations as definied in acute pancreatitis have a a high risk for developing clinically relevant POPFs.
904. Blood expression of matrix metalloproteinases 8 AND 9 and of their inducers S100A8 and S100A9 Supports diagnosis and prognosis of PDAC-associated diabetes mellitus Stefania Moz 1, Daniela Basso 2, Andrea Padoan 1, Dania Bozzato 1, Paola Fogar 2, Carlo-Federico Zambon 1, Michela Pelloso 1, Cosimo Sperti 3, Saula Vigili de Kreutzenberg 1, Claudio Pasquali 3, Sergio Pedrazzoli 4, Angelo Avogaro 1, Mario Plebani 1 1
Department of Medicine DIMED, University of Padova, Padova, Italy Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy 3 Department of Surgical, Oncological and Gastroenterological Sciences DISCOG, University of Padova, Padova, Italy 4 Associazione Wirsung-Onlus, Padua, Italy 2
Introduction: New onset type 2 diabetes mellitus (T2DM) is suggested as first filter for screening patients at high risk for PDAC, the second filter being sensitive and specific incoming biomarkers. Matrix metalloproteinases (MMPs) and S100A8/A9 work in causing PDAC-associated T2DM, tissue and blood MMP8, MMP9, S100A8 and S100A9 expression might help in distinguishing PDAC among diabetics. Aims: We verified whether the tissue and blood mRNA expression of S100A8, S100A9, MMP8 and MMP9 and the serum levels of ApoA1 are useful markers of PDAC-T2DM. Patients & methods: Relative quantification of MMP8, MMP9, S100A8 and S100A9 was performed in tissues from 8 PDAC, 4 chronic-pancreatitis (ChrPa), 4 non-PDAC tumors and in PBMCs from 30 controls, 43 T2DM, 41 ChrPa, 91 PDAC and 33 pancreatic-biliary tract tumors.
Abstracts / Pancreatology 15 (2015) S1eS141
in the locally advanced group than the resected group (92.7% v.s. 64.8%; P¼.000). Of these mentioned cytokines, only IL-8 was significantly elevated in the locally advanced group compared with the normal and resected groups and positively correlated with CC status. IL-8 levels in both serum and tissue samples were also positively associated with weight loss. Additionally, high IL-8 expression combined with the presence of CC is an independent predictor of OS and DFS. Conclusion: High IL-8 expression shows significantly higher relevance with CC in PC patients than other cytokines and thus is useful in prediction and definition of CC development.
889. Surgical outcome of superior mesenteric artery-first approach with radical antegrade modular pancreatosplenectomy for borderline resectable pancreatic cancer
Results: Our knowledge-based and model-informed biomarker discovery strategy led to the discovery of a highly accurate (up to 95%) and robust 6-gene prognostic signature, which we designated as “PanGUIDE”. The expression pattern of the PanGUIDE genes can faithfully reflect the degree of differentiation and stemness in the tumors, thereby enabling a rationalized classification and prognostic prediction of pancreatic cancer patients (Gastroenterology 2013;145:1110). Several of the PanGUIDE genes are novel regulators of cancer stemness including most notably ASPM (abnormal spindle-like and microcephaly associated), which promotes tumor aggressiveness through augmenting Wnt signaling and may serve as a druggable target in pancreatic cancer. Conclusion: The PanGUIDE gene signature is hitherto the most accurate and robust prognosis-classification system in pancreatic cancer. The PanGUIDE assay may help clarify the role of cancer stemness in pancreatic tumor progression and may serve as a companion diagnosis in clinical trials related to cancer-stem-cell-targeted therapeutics and may eventually assist patient-tailored cancer treatment decision.
Yasunari Kawabata, Kazunori Mizutani, Yoshitsugu Tajima Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Japan Introduction: Radical antegrade modular pancreatosplenectomy (RAMPS) is a rational surgical procedure for pancreatic body and tail cancers. Aims: Here we report a modified technique of RAMPS utilizing the superior mesenteric artery (SMA)-first approach for borderline resectable cancers (BRPC) of the pancreas to obtain complete negative tangential margins. Patients & methods: A total of 13 consecutive patients underwent a SMA-first approach with RAMPS for BRPC between July 2013 and December 2014 at Shimane University Hospital. We defined patients as having BRPC based on the National Comprehensive Cancer Network guidelines on 2014. A margin was designated “R1” if tumor cells are 1mm from the margins. Results: There were 6 males and 7 females, with a median age of 70 (range: 52 to 82) years.The median operative time was 422 (range: 300 to 624) minutes and the median intraoperative blood loss was 480 (range: 50 to 1030) ml. No patients required blood transfusion. One patient had a T1 tumor, one patient had a T2 tumor, 10 patients had a T3 tumor, and one patient had a T4 tumor. Lymph node metastasis was positive in 11 patients (85%). R0 resection was achieved in 11 patients (85%). There were no postoperative or in-hospital deaths, and morbidity was 31%. The median postoperative hospital stay was 15 (range: 8 to 58) days. At the median follow-up time of 13.5 months (range: 3.5 to 18.4), the 1-year disease-free survival rate was 85%. Conclusion: SMA-first approach with RAMPS achieved satisfactory surgical outcome along with a high rate of negative tangential margins even in patients with BRPC.
891. PanGUIDE: A prognostically accurate gene signature related to pancreatic cancer stemness and differentiation Tze-Sian Chan 1, 2, Kelvin K. Tsai 1, Li-Tzong Chen 1 1 2
National Institute of Cancer Research, Taiwan Taipei Medical University Wan Fang Hospital, Taipei, Taiwan
Introduction: Molecular portraits of stem cell differentiation may identify key regulatory factors and pathways and help improve outcome prediction in human cancers. It remains to be established if the stemness and tissue differentiation program is linked to the malignant behaviors of human pancreatic cancer. Aims: To translate the above concept to clinics and to facilitate patienttailored treatment decision in pancreatic cancer. Materials & methods: We combined comparative genomic analysis of tissue microarchitectures generated by CD133þCD44þ stem-like pancreatic ductal epithelial cells in a three-dimensional organotypic culture system with clinical correlative analysis across 3 independent cohorts of patients with pancreatic cancer (total n ¼ 128).
895. Comparison of morbidity and mortality rates after two different methods of portal vein reconstruction in patients with borderline resectable pancreatic cancer (BRPC) and TYPE 4 vein resection according to the ISGPS classification scheme Magdalena Derejska, Marek Durlik The Central Clinical Hospital of the Ministry of Interior, The Department of Gastroenterological Surgery & Transplantation, Poland Introduction: BRPC is a tumor with very a high risk of margin-positive resection, and early treatment failure. Developments in surgical technique has led to more radical approaches in these patients. Portal vein resection has now become a standard surgical procedure for this kind of tumors. Type 4 vein resection is segmental vessel resection and reconstruction using a vessel conduit with at least two anasthomoses. Aims: The evaluation of morbidity and mortality rates in patients with borderline resectable pancreatic adenocarcinoma after pancreatoduodenectomy with segmental portal vein resection. Materials & methods: Two different methods of reconstruction were analyzed: left renal grafting and use of a PTFE graft. Data from 1 January 2013 to 30 January 2015 were retrospectively analyzed. Results: In 41 patients with BRPC, pancreatoduodenectomy with portal vein reconstruction was performed; in 11 patients, left renal grafting; and in 30, reconstruction using PTFE. In the cases of 8 patients, reoperation was performed within one month of the initial operation. The overall mortality rate was 7.3% (3 patients from the PTFE group). The overall morbidity rate was 39%; in the left renal grafting group 36% and in the PTFE grafting group 40%. Thrombosis of the graft was diagnosed in five patients from the PTFE group after one month. All patients with left renal grafting reconstruction have well functioning grafts. Conclusion: Reconstruction using the left renal vein seems to be a safer procedure then PTFE grafting. PTFE grafting is more suitable in cases where a longer segment needs to be reconstructed, or more than two anasthomoses need to be performed.
1152. Survival predictors after endoscopic retrograde cholangiopancreatography biliary drainage in pancreatic adenocarcinoma Eduardo Rodrigues-Pinto, Pedro Pereira, Armando Ribeiro, Pedro Moutinho-Ribeiro, Jos e Alexandre Sarmento, Filipe Vilas-Boas, o Santos-Antunes, Guilherme Macedo Joa o Jo Centro Hospitalar Sa ao, Gastroenterology Department, Portugal Introduction: Biliary drainage by endoscopic retrograde cholangiopancreatography (ERCP) allows symptomatic palliation in advanced
Abstracts / Pancreatology 15 (2015) S1eS141
pancreatic adenocarcinoma. There is scarce information on predictors of survival after ERCP. Aims: Evaluate survival predictors after ERCP biliary drainage in pancreatic adenocarcinoma. Patients & methods: Cross-sectional study of patients referred for ERCP biliary drainage of obstruction conditioned by advanced pancreatic adenocarcinoma, over a period of 3 years. Results: Seventy-nine patients underwent biliary drainage. Mortality rate at 3 months was 39% and at 6 months was 62%. Mortality was higher in patients with higher AST (178U/L vs 73U/L, p¼0.031), higher ALT (221U/L vs 85U/L, p<0.001), higher GGT (970U/L vs 423U/L, p¼0.014) and higher AF (816U/L vs 469U/L, p¼0.033). Survival was lower in patients who began adjuvant therapy prior to ERCP (80 days vs 302 days, p¼0.006), in patients with metastasis (63 days vs 160 days, p¼0.013) and tend shorter in patients who placed longer stents (80 days vs 157 days, p¼0.073). In multivariate analysis, survival was lower in patients who began adjuvant therapy prior to ERCP (HR 3.8, p¼0.012), with higher AST (HR 1.1, p¼0.003), with higher bilirubin (HR 1.2, p¼0.004) and with lower decrease of bilirubin after drainage (HR 1.4, p<0.001). Conclusion: Biliary stents by ERCP allows lasting palliation of symptoms in pancreatic adenocarcinoma, even in situations where it is not possible to perform chemotherapy. Best results are obtained in patients who started adjunctive therapy after ERCP, in those with lower AST and bilirubin and in those with higher decrease of bilirubin after ERCP.
1155. Postoperative pancreatitis after pancreaticoduodenectomy predicts clinically relevant postoperative pancreatic fistulas Christian Kuhlbrey, Olivia Sick, Nikki Samiei, Frank Makowiec, Ulrich T. Hopt, Uwe A. Wittel
S101
902. Socio-economic status influences chance of undergoing surgical treatment for pancreatic cancer in The Netherlands Maikel Bakens 1, Yvette van Gestel 2, Marlies Bongers 1, Valery Lemmens 2, Ignace de Hingh 1 1
Catharina hospital Eindhoven, Department of Surgery, Netherlands Netherlands Comprehensive Cancer Organisation (IKNL), Netherlands Cancer Registry (NCR), Netherlands 2
Introduction: In the USA, a high socio-economic status (SES) has been shown to be associated with a higher chance for surgical treatment and improved survival. In The Netherlands the health care system is not comparable to that in the USA and the effects of SES might be different. Aims: The aim of this study is to analyze the influence of socioeconomic status on surgical treatment and survival in non-metastasized (M0) pancreatic cancer patients in The Netherlands. Patients & methods: All patients diagnosed with M0-pancreatic cancer between 2005 and 2012 in the Eindhoven Cancer Registry (ECR), The Netherlands were included. Data on patient characteristics, tumor characteristics and treatment were extracted. Patients were grouped as surgical treated or not surgical treated. Groups were compared using chisquare tests. The influence of SES on the chance for surgical treatment was assessed by multivariable logistic regression. Influence of SES on overall survival was analyzed by multivariable Cox regression analysis. Results: In total, 748 M0-patients were included. Of these patients 67% underwent surgical treatment. Patients with LSES less often underwent surgical treatment (27%) than patients with HSES (42%). Conclusion: Socio-economic status in pancreatic cancer patients determined the chance for surgical treatment. However, SES had no influence on survival. As surgical treatment is the only option for long-term survival in pancreatic cancer patients, it is important to provide more insights in the causes of these inequalities to ultimately minimalize the effects of SES in pancreatic cancer care.
Department of General- and Visceral Surgery Universityclinic Freiburg, Germany Introduction: Clinically relevant postoperative pancreatic fistulas are the most frequent complications after pancreas resections. Risk factors for POPF development appear to be soft pancreatic tissue and a small pancreatic duct. Aims: The aim of our study was to examine the predictive value of the systemic amylase concentration on the occurrence of POPFs after pancreaticoduodenectomy. Patients & methods: Perioperative data from 864 consecutive pancreas resections were assessed in a prospectively maintained SPSS database. Whipple resections, pylorus preserving, and laparoscopically assisted pancreaticoduodenectomies were evaluated. Serum and drain amylase concentrations were determined by routine clinical chemistry. POPFs were graded into A-C according to ISGPF definitions. In addition to descriptive statistics, chi-square and nonparametric Kruskal-Wallis-test was performed. Results: Between all groups gender, blood loss, surgical technique was equally distributed. In patients with reduced serum amylase (n¼82) on day 1 after duodenopancreatectomy, clinically relevant POPFs were not observed. In patients with normal serum amylase concentrations, POPS grade B and C occurred only in 7% while in 39% of the patients with more than 3x elevated amylase concentrations a clinically relevant postoperative fistula developed postoperatively (p<0.001). The predictive value of increased serum amylase on day 1 after pancreaticoduodenectomy in receiver operated characteristic analysis showed an area under the curve of 0.888 (95%CI 0.863-0.915, p<0.001) indicating that the systemic hyperamylasia detected on day one after pancreas resections is a good predictor of clinically relevant POPFs. Conclusion: Patients with serum amylase concentrations as definied in acute pancreatitis have a a high risk for developing clinically relevant POPFs.
904. Blood expression of matrix metalloproteinases 8 AND 9 and of their inducers S100A8 and S100A9 Supports diagnosis and prognosis of PDAC-associated diabetes mellitus Stefania Moz 1, Daniela Basso 2, Andrea Padoan 1, Dania Bozzato 1, Paola Fogar 2, Carlo-Federico Zambon 1, Michela Pelloso 1, Cosimo Sperti 3, Saula Vigili de Kreutzenberg 1, Claudio Pasquali 3, Sergio Pedrazzoli 4, Angelo Avogaro 1, Mario Plebani 1 1
Department of Medicine DIMED, University of Padova, Padova, Italy Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy 3 Department of Surgical, Oncological and Gastroenterological Sciences DISCOG, University of Padova, Padova, Italy 4 Associazione Wirsung-Onlus, Padua, Italy 2
Introduction: New onset type 2 diabetes mellitus (T2DM) is suggested as first filter for screening patients at high risk for PDAC, the second filter being sensitive and specific incoming biomarkers. Matrix metalloproteinases (MMPs) and S100A8/A9 work in causing PDAC-associated T2DM, tissue and blood MMP8, MMP9, S100A8 and S100A9 expression might help in distinguishing PDAC among diabetics. Aims: We verified whether the tissue and blood mRNA expression of S100A8, S100A9, MMP8 and MMP9 and the serum levels of ApoA1 are useful markers of PDAC-T2DM. Patients & methods: Relative quantification of MMP8, MMP9, S100A8 and S100A9 was performed in tissues from 8 PDAC, 4 chronic-pancreatitis (ChrPa), 4 non-PDAC tumors and in PBMCs from 30 controls, 43 T2DM, 41 ChrPa, 91 PDAC and 33 pancreatic-biliary tract tumors.