The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 501
Slide Session
K-BP-23 Pancreatobiliary
Detection of Malignancy and Natural Course of Incidental Pancreatic Cystic Neoplasms
Ji Won Kim1, Jae Seon Kim1, Ho Kim1, Yong Jeoung1, Jin Sung Koh1, Jung Wan Choe1, Hyo Jung Kim1, Beom Jae Lee1, Jong Jae Park1, Hong Sik Lee2, Chang Duck Kim2, Young-Tae Bak1
Korea University Guro Hospital, Korea1, Korea University Anam Hospital, Korea2
Background: Although some pancreatic cystic neoplasms(PCNs) is a surgical indica- tion, slow-growing and favorable prognosis have been suggested in contrast to ductal adenocarcinomas. The aim of this study was to evaluate natural course of PCNs and the detection of malignant transformation according to risk factor during follow up.
Methods: We retrospectively reviewed a record of patients diagnosed with incidental PCNs from March 2000 to June 2013 in Guro and Anam hospital, Korea University College of Medicine, Seoul.
Results: Of enrolled 301 patients, 19 patients were excluded (15 patients with less than 1 year of follow up, 4 patients with operation due to malignancy at initial cyst diagnosis). Data from total 282 patients was analyzed (Mean age: 59.4 years, median follow up: 28.5 months) and 97 patients had the risk factors such as more than 3cm in diameter or presence of mural nodule/solid portion. 41 patients (41/282, 14.5%) had changes in followed imaging CT (median duration of event in follow up imaging was 24 months), 32 cases showed increase of size and 9 cases changed in characteristics of cyst. Cyst-related malignancy was occurred in 5 patients (1.8%, 5/282). All these patients had risk factor and increase of size. Post-operative morbidity was observed in 31 of 93 cases (33.3%). 2 patients were died (1; intra-abdominal infection, 1; mechan- ical obstruction due to post operative adhesion). Motality during study period was in 9 patients but disease specifi c mortality was only one patient.
Conclusions: Although the risk of malignant transformation of incidental PCNs was higher than the general population, detection of malignancy or disease specifi c mor- tality during surveillance was low, even if high risk group. Under surveillance the regu- lar imaging follow up is seemed to be important especially in 2 years after initial cyst diagnosis.
K-BP-24 Pancreatobiliary
Prognosis of Non-Surgery Patients with High-Risk Intraductal Papillary Mucinous Neoplasm
Dong Kee Jang1, Ji Kon Ryu1, Kwang Hyun Chung1, Ban Seok Lee1, Joo Kyung Park1, Sang Hyub Lee1, Yong-Tae Kim1
Seoul National University Hospital, Korea1
Background: According to the 2012 international guidelines, surgery should be con- sidered in all main-duct (MD)/mixed type and branch-duct (BD) type intraductal pap- illary mucinous neoplasm (IPMN) with high-risk stigmata. The aim of this study was to evaluate the prognosis of non-surgery patients with high-risk IPMN.
Methods: Forty-three patients with high-risk IPMN who did not undergo surgery for some reason at Seoul National University Hospital between 2004 and 2014 were retrospectively enrolled. High-risk features included all MD/mixed type and BD type IPMNs with mural nodules, main pancreatic duct dilation of =10 mm, or obstructive jaundice. The patients were divided into progression and non-progression group, and compared regarding clinical features.
Results: The most common risk factor was MD/mixed type (28/43, 65.1%), followed by BD type with defi nite mural nodules (14/43, 32.6%). Twenty-eight (65.1%) patients showed no progression during the median follow-up period of 22.7 months (3.1-71.6 months), while fi fteen (34.9%) patients showed progression, two of whom underwent malignant transformation radiologically during the mean period of 39.8 months. Only one (2.3%) patient died of IPMN. In terms of several clinical features including age, sex, types of risk factors, cyst size, multifocality, and site, the two groups were not signifi cantly different except cyst size (3.67 vs 2.28 cm, P=0.041). The portion of pa- tients with cyst size of <2 cm was also different between two groups (2/15,13.3% vs 12/28, 42.9%; P=0.049). In addition, both diameter of main pancreatic duct in MD/
mixed type and size of mural nodules in BD type were not related to progression.
Conclusions: This study suggests that careful follow-up could be possible in some IPMN patients with high-risk stigmata, particularly in cyst size of smaller than 2 cm.
K-BP-25 Pancreatobiliary
Is Diabetes a Useful Diagnostic Clue to Detect Early Stage of Pancreatic Cancer?
Kyungsoo Lee1, Jae Hyuck Chang1, Chang Whan Kim1, Sok Won Han1 The Catholic University of Korea, Bucheon St. Mary`s Hospital, Korea1
Background: Diabetes mellitus (DM) is recognized as a risk factor for pancreatic can- cer and expected to be a clue for early diagnosis. However, it is still obscure whether a diagnostic strategy using DM as a clue can detect early pancreatic cancer or not Methods: We retrospectively reviewed the records of consecutive 150 patients with pancreatic cancer, and investigated the stage with regard to the reasons for diagnosis.
We compared patients diagnosed by imaging studies performed in groups that DM were newly diagnosed, longstanding, and not accompanied.
Results: The prevalence of DM in patients with pancreatic cancer was 41% (62/150).
The disease stages consisted of IA (5%), IB (14%), IIA (2%), IIB (4%), III (24%), and IV (51%). Forty percents (25/62) of DM in pancreatic cancer patients was new-onset (<
2 years in duration). Sixteen patients (11%) were asymptomatic at diagnosis of pan- creatic cancer. The disease stage did not differ among patients with new-onset DM (< 2 years in duration), those with longstanding DM (> 2 years in duration), and those without DM. In asymptomatic patients, the prevalence of stage I patients was high as 32%, but it was not statistically signifi cant. The majority (88%) of pancreatic cancer patients with new-onset DM had symptoms.
Conclusions: Diabetes is very common (41%) in pancreatic cancer. Our analysis did not reveal that pancreatic cancer patients diagnosed in association with new-onset DM had lower disease stage than longstanding DM or non-DM patients.
K-BP-26 Pancreatobiliary
Can Metformin Change the Prognosis of Pancreatic Cancer?
Sang Hyun Yoon1, Hee Seung Lee1, Moon Jae Chung1, Jeong Youp Park1, Seung Woo Park1, Si Young Song1, Jae Bock Chung1, Seungmin Bang1
Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yon- sei University College of Medicine, Korea1
Background: In recent studies, metformin has shown potential anti-cancer effects by lowering serum insulin and insulin-like growth factor 1 levels, and direct inhibition of cancer cell growth by activating 5’ adenosine monophosphate-activated protein kinase protein, which inactivates proteins in the mammalian target of rapamycin pathway.
The aim of this study was to evaluate potential anti-tumor effect of metformin on the treatment outcomes of patients with pancreatic adenocarcinoma (PAC).
Methods: From May 2005 to December 2013, patients who were confi rmed as PAC and diabetes mellitus (DM) were analyzed retrospectively. For this study, medical records including DM history, medication, clinical outcomes of PAC and radiologic images were reviewed. Exclusion criteria were insuffi cient medical records, no history of DM before diagnosis of PAC, no treatment of PAC or other than adenocarcinoma in histology.
Results: During the study period, 270 patients were included for the analysis. There were 175 patients (64.8%) with metformin exposure for DM management. The median overall survival time was 12.4 months for metformin-exposed group, and 8.8 months for metformin-unexposed group (P = 0.004, Log-rank test). In univariate analysis, metformin exposure, low serum CA19-9 level (<1000 U/mL), small primary cancer size (=20mm), no tail involvement, good performance status and resectable cancer stage were associated with favorable outcome of survival. In multivariate analysis, met- formin exposure, low serum CA19-9 level (<1000 U/mL) and resectable cancer stage were associated with favorable outcome. The treatment modality of DM other than metformin (insulin, sulfonylurea, thiazolidinedione, dipeptidyl peptidase IV inhibitor) did not show the signifi cant effect on survival.
Conclusions: Metformin exposure showed favorable treatment outcomes in PAC pa- tients. Future prospective studies are required.
