- Email: [email protected]
TGF-B and P53 expression in EUS-FNA specimens of pancreatic adenocarcinoma
AJG – September, Suppl., 2001
therapy: (3 pts-1 died). Combined endoscopic and surgical therapy: (2 pts-both died). Conclusions: Endoscopic therapy is a minimally invasive procedure, effective and safe in the treatment of biliary complications following Hepatic Transplantation.
304 Psychological assessment of the chronic pancreatic pain syndrome Judith Scheman, PhD1, Darwin L. Conwell, MD2*, Teresa Dews, MD3, Gregory Zuccaro, MD2 and R Matthew Walsh, MD. 1The Pancreatic Disease Study Group, Departments of Psychology, Gastroenterology, Anesthesiology, and General Surgery, Cleveland Clinic Foundation, Cleveland, Cleveland, United States. Purpose: Patients with chronic disease such as chronic pancreatitis (CP) are at risk for psychological adjustment disorders, major depression and addictive disorders. Studies assessing the functional limitations and emotional profiles of chronic pancreatitis patients are lacking. Our interdisciplinary team approach for chronic pancreatic pain includes a formal psychological evaluation. This abstract reports our findings in a cohort of patients referred for the evaluation and management of chronic pancreatic pain. Our study aims were to describe the impact of chronic pancreatitis on functional limitations and emotional symptomatology. Methods: Outpatients with a confirmed diagnosis of chronic pancreatitis (abnormal pancreatogram, calcifications on pancreatic imaging) seen in the Pancreas Clinic underwent a formal interview by a clinical psychologists. Results: A total of 22 patients with CP were interviewed. The mean age was 44 years old (range 18 –78 years old). Ten of the patients were female. Alcohol (n ⫽ 11) was the most common cause of CP. All patients had chronic abdominal pain rated as an average low intensity of 4 and average high intensity of 9.5/10 on a verbal response scale (0 –10). 18 (81%) were receiving opiod analgesics for pain control. 15 (68%) were on chronic narcotic maintenance. 14 (63%) patients were considered vocationally disabled due to abdominal pain. The mean disability payment was $503 (range $400-$740). 15/22 (68%) patients scored within the depressed range on the Beck Depression Inventory. Three patients had suicidal ideation and another three had attempted suicide in the past. 13 (59%) of the patients smoke cigarettes. Conclusions: Pain associated with chronic pancreatitis is vocationally disabling and often leads to psychological co-morbidity including addictive disorders (alcohol, nicotine, opiods). Untreated psychological impairment and addiction from this chronic pain syndrome leads to increased functional impairment, depression and places patients at risk for suicide. Smoking cessation and alcohol abstinence should be encouraged. Given the preponderance of these problems, all patients seen for the treatment of chronic pancreatic pain should have formal psychological evaluation and treatment.
305 TGF-B and P53 expression in EUS-FNA specimens of pancreatic adenocarcinoma Dawn Sears, MD1, Richard A. Erickson, MD, FACG1*, Lubna SayageRabie, MD2 and Martha Escobar, MD2. 1Medicine, Scott & White, Texas A&M HSC, Temple, TX, United States; and 2Pathology, Scott & White, Texas A&M HSC, Temple, TX, United States. Purpose: Pancreatic carcinoma is the 5th leading cause of cancer death in the United States with a one year survival of less than 12%. To help select the most appropriate therapies, investigators have looked at a variety of prognostic markers including the cytokine TGF-b and oncogene p53. However, these studies have generally been done on the select group of patients having surgical specimens and not from cytologic specimens at initial diagnosis. Additionally, two previously published studies have shown opposite relationships between survival and TGF-b status. To de-
Abstracts
S97
termine whether stored specimens from EUS and CT-guided biopsy of pancreatic carcinoma can be stained for TGF-b and p53 and to determine whether TGF-b or p53 status correlates with tumor grade, stage or patient survival. Methods: Pancreatic carcinoma specimens from 1993 to March 1999 were studied. EUS-FNA cytology slides and paraffin-imbedded blocks from CT-guided biopsy were de-stained and then re-stained with mouse antihuman p53 antibody and mouse anti-human TGF-b 1,2,3 antibody. Slides were rated on a 0 to 4⫹ scale of staining intensity by a cytopathologist blinded to the patient’s identity. Statistical comparison of these results were made using univariate and multivariate analysis to: age, gender, stage at diagnosis, survival, tumor diameter and cytologic differentiation. Results: 124 patients were analyzed (56% male), average age 68 ⫾ 11 years, average tumor diameter 3.8 ⫾ 1.3 cm, and mean survival was 7 months. TGF-b was 1 to 4⫹ in 26% of cases and had no correlation to patient’s age, sex, survival, tumor stage, grade or size. p53 was 1 to 4⫹ in 22% of cases and had no correlation to patient’s age, sex, survival, tumor stage, or size. However, p53 was more frequently positive (60%) in patients with well-differentiated (grade 1) tumors (p ⬍ 0.05). Conclusions: This is the largest study to date of the correlation between TGF-b and p53 expression in pancreatic carcinoma and patient demographics, prognosis and tumor attributes. This is also the first study which did not select for surgical candidates. The expression of TGF-b and p53 can be tested on preserved cytology specimens from patients with pancreatic carcinoma. Although TGF-b expression was detectable in one fourth of tumors, this carried no prognostic significance nor did it correlate with tumor biology. On the other hand p53 was expressed in one fifth of patients and was more common in welldifferentiated tumors. This finding might suggest that p53 is an early mutation in pancreatic adenocarcinoma and is lost in more poorly differentiated tumors.
306 Does sphincter of Oddi manometry predispose to post-ERCP pancreatitis? Pankaj Singh, Anant Indaram*, Bernard Stark and Simmy Bank. 1 Gastroenterology, Albert Einstein College of Medicine, New Hyde Park, NY, United States. Purpose: To evaluate sphincter of oddi manometry (SOM) as an independent risk factor for post-ERCP pancreatitis. Methods: Non-concurrent prospective study was carried out with 80 patients of sphincter of oddi dysfunction (SOD) referred for an elective ERCP. Study group included twenty patients with ERCP and manometry. Control group comprised of 60 patients with ERCP alone. Patients with active pancreatitis and common bile duct stone or microcalculi were excluded from the study. SOD was defined and classified by Milwaukee criteria. Primary endpoint of the study included development of post-ERCP acute pancreatitis. Capillary perfusion method was used for manometry. The following data were recorded: age, gender, clinical type of SOD, duct cannulated and whether ERCP with or without sphincterotomy was performed. Sample size calculation suggested that more than 60 patients will be required to achieve power(1-error) of 80% at a level of 0.05. Chisquare test was used to compare incidence of acute pancreatitis in two groups. Univariate and multivariate analysis were used to identify risk factors and to control for confounding factors. Results: In total one hundred ERCP’s were performed in 80 patients. Twenty of these ERCP’s included manometric studies. Patients in manometric group were significantly younger than without manometric (p ⫽ 0.03). Univariate analysis revealed sphincter of oddi manometry as a risk factor for post-ERCP pancreatitis with incidence of acute pancreatitis of 32% as compared to ERCP alone of 13.6% (p ⫽ 0.03). Multivariate analysis revealed endoscopic sphincterotomy (p ⫽ 0.01) and pancreatic duct evaluation (p ⫽ 0.04) as an independent risk factors.
therapy: (3 pts-1 died). Combined endoscopic and surgical therapy: (2 pts-both died). Conclusions: Endoscopic therapy is a minimally invasive procedure, effective and safe in the treatment of biliary complications following Hepatic Transplantation.
304 Psychological assessment of the chronic pancreatic pain syndrome Judith Scheman, PhD1, Darwin L. Conwell, MD2*, Teresa Dews, MD3, Gregory Zuccaro, MD2 and R Matthew Walsh, MD. 1The Pancreatic Disease Study Group, Departments of Psychology, Gastroenterology, Anesthesiology, and General Surgery, Cleveland Clinic Foundation, Cleveland, Cleveland, United States. Purpose: Patients with chronic disease such as chronic pancreatitis (CP) are at risk for psychological adjustment disorders, major depression and addictive disorders. Studies assessing the functional limitations and emotional profiles of chronic pancreatitis patients are lacking. Our interdisciplinary team approach for chronic pancreatic pain includes a formal psychological evaluation. This abstract reports our findings in a cohort of patients referred for the evaluation and management of chronic pancreatic pain. Our study aims were to describe the impact of chronic pancreatitis on functional limitations and emotional symptomatology. Methods: Outpatients with a confirmed diagnosis of chronic pancreatitis (abnormal pancreatogram, calcifications on pancreatic imaging) seen in the Pancreas Clinic underwent a formal interview by a clinical psychologists. Results: A total of 22 patients with CP were interviewed. The mean age was 44 years old (range 18 –78 years old). Ten of the patients were female. Alcohol (n ⫽ 11) was the most common cause of CP. All patients had chronic abdominal pain rated as an average low intensity of 4 and average high intensity of 9.5/10 on a verbal response scale (0 –10). 18 (81%) were receiving opiod analgesics for pain control. 15 (68%) were on chronic narcotic maintenance. 14 (63%) patients were considered vocationally disabled due to abdominal pain. The mean disability payment was $503 (range $400-$740). 15/22 (68%) patients scored within the depressed range on the Beck Depression Inventory. Three patients had suicidal ideation and another three had attempted suicide in the past. 13 (59%) of the patients smoke cigarettes. Conclusions: Pain associated with chronic pancreatitis is vocationally disabling and often leads to psychological co-morbidity including addictive disorders (alcohol, nicotine, opiods). Untreated psychological impairment and addiction from this chronic pain syndrome leads to increased functional impairment, depression and places patients at risk for suicide. Smoking cessation and alcohol abstinence should be encouraged. Given the preponderance of these problems, all patients seen for the treatment of chronic pancreatic pain should have formal psychological evaluation and treatment.
305 TGF-B and P53 expression in EUS-FNA specimens of pancreatic adenocarcinoma Dawn Sears, MD1, Richard A. Erickson, MD, FACG1*, Lubna SayageRabie, MD2 and Martha Escobar, MD2. 1Medicine, Scott & White, Texas A&M HSC, Temple, TX, United States; and 2Pathology, Scott & White, Texas A&M HSC, Temple, TX, United States. Purpose: Pancreatic carcinoma is the 5th leading cause of cancer death in the United States with a one year survival of less than 12%. To help select the most appropriate therapies, investigators have looked at a variety of prognostic markers including the cytokine TGF-b and oncogene p53. However, these studies have generally been done on the select group of patients having surgical specimens and not from cytologic specimens at initial diagnosis. Additionally, two previously published studies have shown opposite relationships between survival and TGF-b status. To de-
Abstracts
S97
termine whether stored specimens from EUS and CT-guided biopsy of pancreatic carcinoma can be stained for TGF-b and p53 and to determine whether TGF-b or p53 status correlates with tumor grade, stage or patient survival. Methods: Pancreatic carcinoma specimens from 1993 to March 1999 were studied. EUS-FNA cytology slides and paraffin-imbedded blocks from CT-guided biopsy were de-stained and then re-stained with mouse antihuman p53 antibody and mouse anti-human TGF-b 1,2,3 antibody. Slides were rated on a 0 to 4⫹ scale of staining intensity by a cytopathologist blinded to the patient’s identity. Statistical comparison of these results were made using univariate and multivariate analysis to: age, gender, stage at diagnosis, survival, tumor diameter and cytologic differentiation. Results: 124 patients were analyzed (56% male), average age 68 ⫾ 11 years, average tumor diameter 3.8 ⫾ 1.3 cm, and mean survival was 7 months. TGF-b was 1 to 4⫹ in 26% of cases and had no correlation to patient’s age, sex, survival, tumor stage, grade or size. p53 was 1 to 4⫹ in 22% of cases and had no correlation to patient’s age, sex, survival, tumor stage, or size. However, p53 was more frequently positive (60%) in patients with well-differentiated (grade 1) tumors (p ⬍ 0.05). Conclusions: This is the largest study to date of the correlation between TGF-b and p53 expression in pancreatic carcinoma and patient demographics, prognosis and tumor attributes. This is also the first study which did not select for surgical candidates. The expression of TGF-b and p53 can be tested on preserved cytology specimens from patients with pancreatic carcinoma. Although TGF-b expression was detectable in one fourth of tumors, this carried no prognostic significance nor did it correlate with tumor biology. On the other hand p53 was expressed in one fifth of patients and was more common in welldifferentiated tumors. This finding might suggest that p53 is an early mutation in pancreatic adenocarcinoma and is lost in more poorly differentiated tumors.
306 Does sphincter of Oddi manometry predispose to post-ERCP pancreatitis? Pankaj Singh, Anant Indaram*, Bernard Stark and Simmy Bank. 1 Gastroenterology, Albert Einstein College of Medicine, New Hyde Park, NY, United States. Purpose: To evaluate sphincter of oddi manometry (SOM) as an independent risk factor for post-ERCP pancreatitis. Methods: Non-concurrent prospective study was carried out with 80 patients of sphincter of oddi dysfunction (SOD) referred for an elective ERCP. Study group included twenty patients with ERCP and manometry. Control group comprised of 60 patients with ERCP alone. Patients with active pancreatitis and common bile duct stone or microcalculi were excluded from the study. SOD was defined and classified by Milwaukee criteria. Primary endpoint of the study included development of post-ERCP acute pancreatitis. Capillary perfusion method was used for manometry. The following data were recorded: age, gender, clinical type of SOD, duct cannulated and whether ERCP with or without sphincterotomy was performed. Sample size calculation suggested that more than 60 patients will be required to achieve power(1-error) of 80% at a level of 0.05. Chisquare test was used to compare incidence of acute pancreatitis in two groups. Univariate and multivariate analysis were used to identify risk factors and to control for confounding factors. Results: In total one hundred ERCP’s were performed in 80 patients. Twenty of these ERCP’s included manometric studies. Patients in manometric group were significantly younger than without manometric (p ⫽ 0.03). Univariate analysis revealed sphincter of oddi manometry as a risk factor for post-ERCP pancreatitis with incidence of acute pancreatitis of 32% as compared to ERCP alone of 13.6% (p ⫽ 0.03). Multivariate analysis revealed endoscopic sphincterotomy (p ⫽ 0.01) and pancreatic duct evaluation (p ⫽ 0.04) as an independent risk factors.