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Systemic inflammatory response and elevated tumour markers predict worse survival in pancreatic ductal adenocarcinoma
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Abstracts / Pancreatology 16 (2016) S1eS130 1 2
Hospital of Emergency Medical Care, Minsk, Belarus Belarusian State Medical University, Minsk, Belarus
Introduction: Drainage and resection constitude the main principles of surgery for chronic pancreatitis (CP). Aims: The estimation of efficiency of Frey procedure (FP) at the patients operated concerning various complications CP in terms of pain relief, control of complications arasing from adjacent organs and quality of the life. Patients & methods: It was performed prospective research by several criteria without randomization. We have analyzed treatment's results at 92 patients whom were performed FP in surgical hepatology department in Minsk from January, 2008 till December 2014. The age of patients were Me [25%; 75%] ¼42.5[36.5; 49.1]. Male/female ¼ 7.4/1. The etiology was alcohol and smoking in 94.6% of them. The estimation of efficiency FP performance we've been analyzed results in the early postoperative period, and their indicators of questionnaire SF-36 v.2tm (Russian version) before and after surgery (follow-up 12 and 36 months). Results: Surgery-related perioperative morbidity was 13.5% and mortality e 2.17%. At comparison of indicators of questionnaire SF-36 v.2tm at 90 survived patients positive effect on removing the painful syndrome and improvement of the quality of life (Wilcoxon's rank test low 0.01) were observed. A strong decrease in quality of life were detected, when the impact of continuing consumption of alcohol on long-term outcomes were analyzed. Conclusion: The obtained data (follow-up more 3 years) confirm expediency and efficiency of the FP, at patient suffering from the complicated CP, which selection on the basis of the criteria offered by our prospective research. Patients' selection should be strictly individualized, proceeding from features of pathological anatomy hepatopancreatoduodenal area, accompanying pathology
Abstract ID: 1287.
Conclusion: For patients with resectable PDAC, preoperative CRP, albumin, CEA, and CA19-9 are useful for predicting prognosis.
Abstract ID: 1288. Low lipase levels as an independent marker of pancreatic cancer: A frequently neglected condition in clinical setting Metin Basaranoglu Bezmialem Vakif University, Turkey Introduction: Low lipase levels which may be an indication of low production due to organ failure are frequently encountered at clinical setting but usually overlooked. Aims: We aimed to examine the value of low serum lipase levels and other clinical parameters in the diagnosis of several clinical conditions, particularly pancreatic cancer. Patients & methods: Patients with low lipase levels (8 U/L) were included in this retrospective study. Clinical data including diagnostic category, demographic properties, biochemical and hematological measurements including serum lipase levels were extracted. Multivariate analysis was done to identify independent predictors of certain diagnostic categories. Results: A total of 198 patients with low lipase levels were included. Among these patients with low lipase levels 45 (22.7%) were diagnosed with pancreas cancer. Multivariate analysis identified low lipase levels as significant predictor of pancreas cancer (OR 0.70 [%95 CI, 0.52-0.93], p¼0.02). For predicting pancreatic cancer, an optimal cut-off value of 5.5 U/L for lipase has sensitivity and specificity levels of 76% and 37%, respectively. Conclusion: Low lipase levels close to zero may be an indication of pancreatic cancer and should not be underestimated in the clinical setting. However, large studies are warranted to delineate the exact diagnostic significance of such low lipase levels.
Systemic inflammatory response and elevated tumour markers predict worse survival in pancreatic ductal adenocarcinoma Aino Salmiheimo 1, Harri Mustonen 1, Ulf-Hlkan Stenman 2, €nen 1, Pauli Puolakkainen 1, Esko Kemppainen 1, Hanna Seppa Caj Haglund 1 1
Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland 2 Department of Clinical Chemistry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland Introduction: Estimation of the prognosis of resectable pancreatic ductal adenocarcinoma (PDAC) currently relies on tumour-related factors such as resection margins and lymph-node ratio (LNR) both inconveniently available only postoperatively. Aims: Our aim was to assess the accuracy of preoperative laboratory data in predicting PDAC prognosis. Patients & methods: Collection of laboratory and clinical data was retrospective from 265 consecutive patients undergoing surgery for PDAC at Helsinki University Hospital. Cancer-specific survival assessment utilized Kaplan-Meier analysis, and independent associations between factors were by the Cox regression model. Minimum follow-up time was two years. Results: During follow-up 76% of the patients died of PDAC, with a median survival time of 19.6 months. In univariate analysis, CRP, albumin, CEA, and CA19-9 were significantly associated with postoperative cancerspecific survival. In multivariate analysis, taking into account age, gender, LNR, resection margins, tumour status, and adjuvant chemotherapy, the preoperative biomarkers independently associated with adverse prognosis were hypoalbuminemia (< 36 g/L, hazard ratio (HR) 1.56, 95% confidence interval (CI) 1.10e2.19, p ¼ 0.011), elevated CRP (>5 mg/L, HR 1.44, 95% CI 1.03e2.02, p ¼ 0.036), CEA (>5 mg/L, HR 1.60, 95% CI 1.07e2.53, p ¼ 0.047), and CA19-9 (555 kU/L, HR 1.91, 95% CI 1.18e3.08, p ¼ 0.008).
Abstract ID: 1289. Increased prevalence of chronic type pancreas abnormalities characterized by echoendoscopy in patients with celiac disease Metin Basaranoglu Bezmialem Vakif University, Turkey Introduction: It was reported that involvement of the pancreas is rare in patients with celiac disease (CD). Aims: Our aim was to find pancreas parancyhmal changes by using transabdominal ultrasound (US). Additionally, we further characterized these changes by echoendoscopy (EUS). Patients & methods: We evaluated patients with CD. We first used US to show pancreas abnormalities. Then, patients with pancreas abnormalities were further examined by EUS. Patients with recent onset dyspepsia were used as a control group. Results: Of the 198 patients with CD, 102 had documented US results. There were 102 patients without CD as a control group. All of the patients, 25% in IBD and 33% in control were male (p> 0.05). The prevalence of abnormalities as follows: gallbladder polip, 3.9% in CD vs 6.9% in controls (p> 0.05); gallbladder sludge&stone, 4.9% in CD vs 11.8% in controls (p > 0.05); gallbladder operation, 5.9% in CD vs 8.8% in controls (p < 0.001); pancreas parancyhmal changes, 5.9% in CD vs 0% in controls (p ¼ 0.029). EUS investigation was performed in all of the patients with pancreas paranchymal changes. EUS showed major B or minor criteria according to the Rosemont classification. Echoendoscopy findings as follows: main duct and side branch dilation, small cysts, pancreas atrophy, hyperechogen stria and foci. None was autoimmune pancreatitis (AIP). Conclusion: Our results showed that chronic pancreas parancyhmal changes is significantly frequent in patients with CD. Thus, we consider
Abstracts / Pancreatology 16 (2016) S1eS130 1 2
Hospital of Emergency Medical Care, Minsk, Belarus Belarusian State Medical University, Minsk, Belarus
Introduction: Drainage and resection constitude the main principles of surgery for chronic pancreatitis (CP). Aims: The estimation of efficiency of Frey procedure (FP) at the patients operated concerning various complications CP in terms of pain relief, control of complications arasing from adjacent organs and quality of the life. Patients & methods: It was performed prospective research by several criteria without randomization. We have analyzed treatment's results at 92 patients whom were performed FP in surgical hepatology department in Minsk from January, 2008 till December 2014. The age of patients were Me [25%; 75%] ¼42.5[36.5; 49.1]. Male/female ¼ 7.4/1. The etiology was alcohol and smoking in 94.6% of them. The estimation of efficiency FP performance we've been analyzed results in the early postoperative period, and their indicators of questionnaire SF-36 v.2tm (Russian version) before and after surgery (follow-up 12 and 36 months). Results: Surgery-related perioperative morbidity was 13.5% and mortality e 2.17%. At comparison of indicators of questionnaire SF-36 v.2tm at 90 survived patients positive effect on removing the painful syndrome and improvement of the quality of life (Wilcoxon's rank test low 0.01) were observed. A strong decrease in quality of life were detected, when the impact of continuing consumption of alcohol on long-term outcomes were analyzed. Conclusion: The obtained data (follow-up more 3 years) confirm expediency and efficiency of the FP, at patient suffering from the complicated CP, which selection on the basis of the criteria offered by our prospective research. Patients' selection should be strictly individualized, proceeding from features of pathological anatomy hepatopancreatoduodenal area, accompanying pathology
Abstract ID: 1287.
Conclusion: For patients with resectable PDAC, preoperative CRP, albumin, CEA, and CA19-9 are useful for predicting prognosis.
Abstract ID: 1288. Low lipase levels as an independent marker of pancreatic cancer: A frequently neglected condition in clinical setting Metin Basaranoglu Bezmialem Vakif University, Turkey Introduction: Low lipase levels which may be an indication of low production due to organ failure are frequently encountered at clinical setting but usually overlooked. Aims: We aimed to examine the value of low serum lipase levels and other clinical parameters in the diagnosis of several clinical conditions, particularly pancreatic cancer. Patients & methods: Patients with low lipase levels (8 U/L) were included in this retrospective study. Clinical data including diagnostic category, demographic properties, biochemical and hematological measurements including serum lipase levels were extracted. Multivariate analysis was done to identify independent predictors of certain diagnostic categories. Results: A total of 198 patients with low lipase levels were included. Among these patients with low lipase levels 45 (22.7%) were diagnosed with pancreas cancer. Multivariate analysis identified low lipase levels as significant predictor of pancreas cancer (OR 0.70 [%95 CI, 0.52-0.93], p¼0.02). For predicting pancreatic cancer, an optimal cut-off value of 5.5 U/L for lipase has sensitivity and specificity levels of 76% and 37%, respectively. Conclusion: Low lipase levels close to zero may be an indication of pancreatic cancer and should not be underestimated in the clinical setting. However, large studies are warranted to delineate the exact diagnostic significance of such low lipase levels.
Systemic inflammatory response and elevated tumour markers predict worse survival in pancreatic ductal adenocarcinoma Aino Salmiheimo 1, Harri Mustonen 1, Ulf-Hlkan Stenman 2, €nen 1, Pauli Puolakkainen 1, Esko Kemppainen 1, Hanna Seppa Caj Haglund 1 1
Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland 2 Department of Clinical Chemistry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland Introduction: Estimation of the prognosis of resectable pancreatic ductal adenocarcinoma (PDAC) currently relies on tumour-related factors such as resection margins and lymph-node ratio (LNR) both inconveniently available only postoperatively. Aims: Our aim was to assess the accuracy of preoperative laboratory data in predicting PDAC prognosis. Patients & methods: Collection of laboratory and clinical data was retrospective from 265 consecutive patients undergoing surgery for PDAC at Helsinki University Hospital. Cancer-specific survival assessment utilized Kaplan-Meier analysis, and independent associations between factors were by the Cox regression model. Minimum follow-up time was two years. Results: During follow-up 76% of the patients died of PDAC, with a median survival time of 19.6 months. In univariate analysis, CRP, albumin, CEA, and CA19-9 were significantly associated with postoperative cancerspecific survival. In multivariate analysis, taking into account age, gender, LNR, resection margins, tumour status, and adjuvant chemotherapy, the preoperative biomarkers independently associated with adverse prognosis were hypoalbuminemia (< 36 g/L, hazard ratio (HR) 1.56, 95% confidence interval (CI) 1.10e2.19, p ¼ 0.011), elevated CRP (>5 mg/L, HR 1.44, 95% CI 1.03e2.02, p ¼ 0.036), CEA (>5 mg/L, HR 1.60, 95% CI 1.07e2.53, p ¼ 0.047), and CA19-9 (555 kU/L, HR 1.91, 95% CI 1.18e3.08, p ¼ 0.008).
Abstract ID: 1289. Increased prevalence of chronic type pancreas abnormalities characterized by echoendoscopy in patients with celiac disease Metin Basaranoglu Bezmialem Vakif University, Turkey Introduction: It was reported that involvement of the pancreas is rare in patients with celiac disease (CD). Aims: Our aim was to find pancreas parancyhmal changes by using transabdominal ultrasound (US). Additionally, we further characterized these changes by echoendoscopy (EUS). Patients & methods: We evaluated patients with CD. We first used US to show pancreas abnormalities. Then, patients with pancreas abnormalities were further examined by EUS. Patients with recent onset dyspepsia were used as a control group. Results: Of the 198 patients with CD, 102 had documented US results. There were 102 patients without CD as a control group. All of the patients, 25% in IBD and 33% in control were male (p> 0.05). The prevalence of abnormalities as follows: gallbladder polip, 3.9% in CD vs 6.9% in controls (p> 0.05); gallbladder sludge&stone, 4.9% in CD vs 11.8% in controls (p > 0.05); gallbladder operation, 5.9% in CD vs 8.8% in controls (p < 0.001); pancreas parancyhmal changes, 5.9% in CD vs 0% in controls (p ¼ 0.029). EUS investigation was performed in all of the patients with pancreas paranchymal changes. EUS showed major B or minor criteria according to the Rosemont classification. Echoendoscopy findings as follows: main duct and side branch dilation, small cysts, pancreas atrophy, hyperechogen stria and foci. None was autoimmune pancreatitis (AIP). Conclusion: Our results showed that chronic pancreas parancyhmal changes is significantly frequent in patients with CD. Thus, we consider