WCIM 2014 SEOUL KOREA 581
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 1016 GI Oncology
Characteristics and Outcomes of Colorectal Cancers Arose from Sessile Serrated Adenoma and Traditional Serrated Adenoma
Ji Yeon Seo1, Changhyun Lee2, Ji Min Choi1, Eun Hyo Jin1, Sung Wook Hwang1, Jaeyoung Chun1, Jong Pil Im1, Sang Gyun Kim1, Joo Sung Kim1
Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Korea1, Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Cen- ter, Seoul National University Hospital, Korea2
Background: Sessile serrated adenoma (SSA) and traditional serrated adenoma (TSA) are known as precancerous lesion with distinct pathogenesis from adenoma. The effi cacy and safety of endoscopic resection of colorectal cancer (CRC) from SSA or TSA are unknown. The aims of this study were to verify clinical characteristics and outcomes of endoscopically resected CRCs developed from SSA or TSA.
Methods: Patients who had endoscopic resection of CRCs from 2008 to 2011 were reviewed retrospectively. CRCs with documented preexisting lesions were included and CRCs were classifi ed as CRC-adenoma, CRC-SSA or CRC-TSA according to the base- line lesions. Clinical characteristics such as patient demographics, polyp sizes, polyp locations, and pathologic diagnosis were collected.
Results: Among 208 CRCs from 198 patients, 5 CRCs were in both CRC-SSA and CRC-TSA groups, respectively and 198 CRCs were in CRC-adenoma group. The CRC- SSA group had signifi cantly more synchronous SSA/TSAs and had higher prevalence of high grade dysplasia. The CRC-TSA group showed some trends of distal location and protruding type dominant, but there were no statistical signifi cance. There was no local recurrence in the CRC-SSA or CRC-TSA groups during studied periods. However, the metachronous recurrences were detected in 2 cases for both CRC-SSA and CRC- TSA groups, respectively.
Conclusions: SSA with high grade dysplasia in the base of CRC is a direct evidence of serrated neoplasia pathway. CRCs with baseline SSA have higher risk of synchronous SSAs and missed or metachronous lesions were more frequent. Cautious observation and early endoscopic resection of SSA/TSA are necessary for decreasing interval cancers.
PS 1017 GI Oncology
Mucinous Colorectal Cancers: Correlation of Microsatellite Instability with Clinicopathological Features and Survival
Yong Sik Yoon1, Chan Wook Kim1, In Ja Park1, Seok-Byung Lim1, Chang Sik Yu1, Jin Cheon Kim1
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea1 Background: Colorectal adenocarcinoma with microsatellite instability (MSI) has a characteristic clinicopathological profi le, typically forming right-sided, younger onset, better prognosis, and frequent histology of poor or mucinous differentiation. Mucinous adenocarcinomas (MAC) of the colorectum in general have been linked to slightly ad- verse prognosis in many studies. The purpose of this study was to evaluate association of MSI with clinicopathological features and oncologic outcomes in patients with MAC.
Methods: Tumor tissue samples obtained during curative surgery were analyzed using MSI assay. As histological differentiation, patients were divided into MAC and ade- nocarcinomas (AC). Clinicopathological parameters and survival outcomes were com- pared according to histological differentiation and MSI status. The median follow-up period was 43 months.
Results: Among 2025 patients, 84 patients (4%) were MAC and 202 patients (10%) were MSI. Patients with MAC were frequent in MSI tumors (12%) than in microsatel- lite stable (MSS) tumors (3%, P < 0.001). Patients with MAC had tumors characterized by younger age onset, right-colon predilection, large-size, and high frequency of MSI compared with those with AC (P < 0.001). Patients with MSI-MAC had characteristics of right-colon predilection, large-size, and remarkably infrequent lymph node metas- tasis compared with those with MSS-MAC (P < 0.001-0.005). Patients with MSI-MAC showed lower 4-year recurrence rates and better overall survival rates than those with MSS-MAC (P = 0.018 and P = 0.046).
Conclusions: Clinicopathological characteristics of MAC were closely related with MSI. The outcome for MSI-MAC tumor is better than that of MSS-MAC, although this fi nding did not reach statistical signifi cance in multivariate analysis.
PS 1018 GI Oncology
The Gastric Cancer Development in Peptic Ulcer Patients with Helicobacter pylori Infection
Jae Jin Hwang1, Dong Ho Lee1, Ae-Ra LEE1, Yong Hwan Kwon1, Yeon Sang Jeong1, Hyun Joo Lee1, KiChul Yoon1, Hyuk Yoon1, Cheol Min Shin1, Young Soo Park1, Nayoung Kim1
Department of Internal Medicine, Seoul National University Bundang Hospital, Korea1
Background: The aim of this study was to investigate the incidence of gastric cancer development and compare the clinical characteristics of gastric cancer between gas- tric ulcer and duodenal ulcer with H. pylori infection.
Methods: In this retrospective study patients, with newly diagnosed with gastric can- cer were classifi ed into two groups. The patients diagnosed as new gastric cancer with previous presence of gastric ulcer with H. pylori infection were assigned to the GU group (n = 86), and those diagnosed as new gastric cancer with previous presence of duodenal ulcer with H. pylori infection were assigned to the DU group (n = 15).
Results: The incidence rates of gastric cancer in gastric ulcer with H. pylori infection were 3.60% (86/2387) and in duodenal ulcer with H. pylori infection were 0.84%
(15/1775). The rates of moderate to severe atrophic mucosal change were 86% in GU and 33.3% in DU group (p = 0.041). The rates of moderate to severe intestinal meta- plasia were 61.6% in GU and 13.3% in DU group (p = 0.037). The prognosis of gastric cancer was signifi cantly lower in the DU than that in the GU group by Kaplan-Meier analysis with log-rank test (p = 0.01). The relative risk of the GU group for gastric can- cer development against the DU group corrected by age and gender was calculated to be 1.71 (95% CI: 1.09-2.70; p = 0.02).
Conclusions: The incidence rate and relative risk of gastric cancer development in pa- tients of gastric ulcer with H. pylori infection were signifi cantly higher than in those of duodenal ulcer with H. pylori infection, but the prognosis of gastric cancer in patients of duodenal ulcer with H. pylori infection was more poor than in those of gastric ulcer with H. pylori infection in Korea.
PS 1019 GI Oncology
Esophageal Squamous Cell Carcinoma Patients Have Increased Risk of Coexisting Colorectal Neoplasms
Myong Ki Baeg1, Myung-Gyu Choi1, Chul-Hyun Lim1, Hyung Hun Kim1, Jin Su Kim1, Yu Kyung Cho1, Jae Myung Park1, In-Seok Lee1, Sang Woo Kim1
The Catholic University of Korea, Seoul St. Mary’s Hospital, Korea1
Background: Esophageal squamous cell carcinoma (ESCC) and colorectal neoplasms (CRNs) share demographic, environmental and genetic risk factors. Our aim was to investigate whether CRN risk is increased in ESCC patients.
Methods: We reviewed ESCC patients who had colonoscopy within 1 year of di- agnosis. Patients were matched 1:3 by age, gender, and body mass index (BMI) to asymptomatic controls. CRN was defi ned as histological confi rmation of adenoma or adenocarcinoma. Advanced CRN was defi ned as any of the following: =3 adenomas, high-grade dysplasia, villous features, adenocarcinoma, or tumor =1 cm. Risk factors for both CRN and advanced CRN were evaluated by univariate and multivariate analy- sis.
Results: 626 patients were diagnosed with ESCC; 540 were excluded because they did not have colonoscopy. Fourteen did not have colonoscopy within 1 year of ESCC diagnosis and 12 had incomplete examinations. The 60 patients in the ESCC group had signifi cantly higher numbers of CRNs (OR 2.311, 95% CI 1.265–4.220, P = 0.006) and advanced CRNs (OR 2.317, 95% CI 1.185–4.530, P = 0.013). ESCC, males, older age, higher BMI, and higher triglyceride level were signifi cant risk factors of CRN by univar- iate analysis. Multivariate analysis revealed signifi cant risk factors of CRN as ESCC (OR 2.157; 95% CI 1.106–4.070; P = 0.024) and older age (OR 1.068; 95% CI 1.032–1.106;
P < 0.001). In advanced CRN patients, ESCC, older age, diabetes, and total cholesterol level were signifi cant risk factors by univariate analysis. Multivariate analysis showed that ESCC (OR 2.157; 95% CI 1.045–4.454; P = 0.038) and older age (OR 1.065; 95%
CI 1.024–1.109; P = 0.002) were signifi cant advanced CRN risk factors.
Conclusions: The risks of CRN and advanced CRN are increased signifi cantly in ESCC.
Colonoscopy should be considered at ESCC diagnosis.
