WCIM 2014 SEOUL KOREA 403
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
(Low, 574 [71.8%]; Intermediate, 170 [21.3%]; High, 55 [6.9%]). In univariate analy- sis, LNR was signifi cantly associated with worse relapse-free survival (3-yr RFS rate 84.8% in low vs. 66.2% in intermediate vs. 54.3% in high; P <0.0001, log-rank test).
In multivariate analysis, LNR was not signifi cantly associated with recurrence after adjustment of other clinical factors (Age, histologic grade, intrinsic subtype, ypT-stage, ypN-stage, lymphatic or vascular invasion, and pCR).
Conclusions: LNR is not superior to ypN-stage in predicting clinical outcome of breast cancer after neoadjuvant chemotherapy.
P-10 Colorectal Cancer
Activation of YAP1 Is Signifi cantly Associated with Poor Prognosis and Cetuximab Resistance in Colorectal Cancer Patients
Keun-Wook Lee1, Sung Sook Lee2, Sang-Bae Kim2, Yun-Yong Park2, Bo Hwa Sohn2, Hyun-Sung Lee2, Ju-Seog Lee2
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea1, Department of Systems Biology, The University of Texas MD Anderson Cancer Center, USA2
Background: To investigate the clinical signifi cance of activation of YAP1, a newly identifi ed oncogene in colorectal cancer (CRC).
Methods: A gene expression signature refl ecting YAP1 activation was identifi ed in CRC cells, and CRC patients were stratifi ed into two groups according to this signa- ture: activated YAP1 CRC (AYCC) or inactivated YAP1 CRC (IYCC). Stratifi ed patients in six test cohorts were evaluated to determine the effect of the signature on CRC prognosis and response to treatment with cetuximab.
Results: The activated YAP1 signature was associated with poor prognosis for CRC in four independent patient cohorts with stage I-III disease (total n = 1,028). In a mul- tivariate analysis, the impact of the YAP1 signature on the disease-free survival rate was independent of other clinical variables [hazard ratio (HR), 1.63; 95% confi dence interval (CI), 1.25-2.13; P < .001]. In patients with stage IV CRC, AYCC patients had a poorer disease control rate and progression-free survival duration after cetuxi- mab-based monotherapy than did IYCC patients (HR, 1.82; 95% CI, 1.05-3.16; P = .03). In multivariate analysis, the effect of YAP1 activation on PFS was independent of KRAS mutation status and cetuximab-based therapy was effective only in IYCC patients without KRAS mutations.
Conclusions: Activation of YAP1 is highly associated with poor prognosis for CRC and may be useful in identifying patients with CRC resistant to treatment with cetuximab.
P-12 Colorectal Cancer
Analysis of Young-Age Onset Colorectal Cancer in Korea
Jieun Lee1, Myung Ah Lee1, Jun Ki Kim2, Seung Tack Oh2, Won Kyung Kang2 Division of Medical Oncology, Department of Internal Medicine, Colorectal Cancer Center, Seoul St.
Mary’s Hospital; The Catholic University of Korea, Korea1, Department of Surgery; Colorectal Cancer Center, Seoul St. Mary’s Hospital; The Catholic University of Korea, Korea2
Background: The incidence of CRC is increasing in young age patients, but the natural history of young age CRC is not established. In this study, we analyzed the clinical outcomes of CRC arising in young age patient.
Methods: Between Jan.2006 to Jan.2014, 100 CRC patients diagnosed at the age of 10 to 39 were retrospectively analyzed. We reviewed the clinicopathologic character- istics and clinical outcomes (overall survival [OS], disease free survival [DFS]) based on the medical records.
Results: Eighty-six patients were diagnosed as CRC at their thirties. 79% of patients had no family history of cancer at fi rst or second-degree relatives. At initial diagnosis, 62.1%
of patients showed normal CEA level (=3ng/mL). 61% of patients were diagnosed as ad- vanced CRC (stage III 40% and stage IV 21%, respectively). 64% of cancer was located at the sigmoid colon, rectosigmoid junction, or rectum. Among 64 patients, 22 patients (34.4%) had K-ras mutation. Recurrence rate was 7.9% in stage I~III CRC. In patient population, OS was not reached but patients with normal CEA level showed better sur- vival outcome (P = 0.013). Patients with perineural invasion at surgical specimen showed poorer survival (median OS not reached, P=0.011). Mucinous or signet ring cell histology showed inferior outcome (P=0.019, OS not reached). The median OS of stage IV patients were 19 months (range 7.9-60.63), which is shorter than historical data.
Conclusions: Young age CRC was most commonly diagnosed at the thirties, with no familial history, normal range of CEA and located below sigmoid colon. The incidence rate of mucinous and signet ring cell carcinoma was similar to historical data. Stage IV CRC showed inferior OS compared to historical data. Considering the increasing inci- dence of CRC in young age group, active surveillance other than serum CEA level (e.g.
sigmoidoscopy) is warranted.
P-13 Colorectal Cancer
Carbohydrate Antigen 19-9 Levels Associated with Pathological Responses to Preoperative Chemoradiotherapy in Rectal Cancer
Seung-Gu Yeo1, Dae Yong Kim2, Tae Hyun Kim2, Sun Young Kim2, Ji Yeon Baek2, Hee Jin Chang2, Ji Won Park2, Jae Hwan Oh2
Soonchunhyang University Hospital, Korea1, National Cancer Center, Korea2
Background: To investigate whether pretreatment serum carbohydrate antigen 19-9 (CA 19-9) levels are associated with pathological responses to preoperative chemora- diotherapy (CRT) in patients with rectal cancer.
Methods: In total, 260 patients with locally advanced rectal cancer (cT3-4NanyM0) who underwent preoperative CRT and radical surgery were analyzed retrospectively.
CRT consisted of 50.4 Gy pelvic radiotherapy and concurrent chemotherapy. Radical surgery was performed at median 7 weeks after CRT completion. Pathological CRT response criteria included downstaging (ypStage 0-I) and ypT0-1. A discrimination threshold of CA 19-9 level was determined using a receiver operating characteristics analysis.
Results: The median CA 19-9 level was 8.0 (1.0-648.0) U/mL. Downstaging occurred in 94 (36.2%) patients and ypT0-1 in 50 (19.2%). The calculated optimal threshold of CA 19-9 level was 10.2 U/mL for downstaging and 9.0 U/mL for ypT0-1. On multivariate analysis, CA 19-9 (= 9.0 U/mL) was signifi cantly associated with downstaging (odds ratio, 2.089; 95% confi dence interval, 1.189-3.669; P = 0.010) or ypT0-1 (OR, 2.207;
95% CI, 1.079-4.512; P = 0.030), independent of clinical stage or carcinoembryonic antigen.
Conclusions: This study fi rstly showed a signifi cant association of pretreatment serum CA 19-9 levels with pathological CRT responses of rectal cancer. The CA 19-9 levels are suggested to be valuable in predicting CRT responses of rectal cancer before treat- ment.
