The Korean Society of Gastroenterology & SIDDS 2014
502 32nd World Congress of Internal Medicine (October 24-28, 2014)
K-BP-27 Pancreatobiliary
Early Check Up CA 19-9 for Pancreatic Cancer Screening in New Onset Diabetic Patient
Jung Wan Choe1, Jae Seon Kim1, Soon Young Hwang2, Hyo Jung Kim1, Moon Kyung Joo1, Beom Jae Lee1, Ji Hoon Kim1, Jong Eun Yeon1, Jong-Jae Park1, Kwan Soo Byun1, Young-Tae Bak1
Korea University Guro Hospital, Korea1, Korea University Medical College Biostatistics, Korea2 Background: Patients with diabetes have higher risk for pancreatic cancer and the risk is reported to be high in early period after diagnosis. We had reported the usefulness of CA 19-9 with the new onset (< 2yrs) diabetes as a screening test for pancreatic cancer. (KJS, abstract 251) This study was to evaluate the validity of CA 19-9 check soon after diagnosis of diabetes as a pancreatic cancer screening tool.
Methods: We reviewed medical records of diabetes patients who were diagnosed fi rst time at our hospital from Jan.2004 to Jan.2013. Among them, 2385 patients who checked CA 19-9 were enrolled. We classifi ed groups according to the timing of CA 19-9 measurement; First group, checked CA 19-9 within 1 year after diagnosis of dia- betes and second group checked within 1~2 year after diabetes diagnosis.
Results: Of 2385 diabetes patients, 91 (3.8%) were diagnosed with pancreatic cancer.
In fi rst group, 72 (4.1%) of 1739 diabetes patients developed pancreatic cancer and odd ratio of pancreatic cancer according to abnormal CA 19-9 was 13.7 (p<0.001).
10 of pancreatic cancer (4.4%) were detected in second group of 226 patients and odd ratio was 8.02 (p=0.002). But after 2 years, the odd ratio for pancreatic cancer had no statistically signifi cance. The incidences of pancreatic cancer in 1965 patients with new onset diabetes followed by checking CA 19-9 within 2 years and in 420 patients with diabetes established for more than 2 years were 82 (4.1%) and 9 (2.1%), respectively. The odd ratio of pancreatic cancer for abnormal CA 19-9 within 2 year following diabetes diagnosis was 12.5 (P<0.001)
Conclusion: Early check up of CA 19-9 following new onset diabetes diagnosis is meaningful as a screening test for pancreatic cancer.
K-BP-28 Pancreatobiliary
Prognostic Value of CA 19-9 Kinetics during Gemcitabine-Based Chemotherapy in Patients with Advanced Cholangiocarcinoma
Ban Seok Lee1, Sang Hyub Lee1, Dong Kee Jang1, Kwang Hyun Chung1, Ji Kon Ryu1, Yong-Tae Kim1
Seoul National University Hospital, Korea1
Background: CA 19-9 and CEA were reported to be prognostic factors in various ma- lignant diseases, but no studies have investigated the prognostic role of their kinetics during chemotherapy in patients with advanced cholangiocarcinoma.
Methods: A total of 223 patients with inoperable cholangiocarcinoma received gem- citabine-based chemotherapy as a fi rst line regimen. Of the patients, 179 had pre- and post-treatment CEA and CA19-9 values. Baseline, pre-, and post-treatment (after 2 cycles of chemotherapy) values of those markers were checked, and survival was compared according to various cutting points of those measurements.
Results: Patients with a decrease of = 50% in CA 19-9 level had better survival than the others (16.0 vs. 9.0 mon). However, CEA decline did not predict survival gain.
Signifi cant prognostic factors in multivariable analysis included CA 19-9 > 1000U/
ml (HR 1.7), = 50% decline in CA 19-9 level during chemotherapy (HR 0.49), and tu- mor location (intra;perihilar;distal, HR=1;1.3;1.9, respectively). Subgroup analysis was conducted in 102 patients with baseline CA 19-9 > 37U/ml and bilirubin = 2mg/dL.
CA 19-9 decline = 50% was also the only predictor for survival. For the validation of the cut-off point (50%) of CA19-9 decline, receiver operating characteristic analysis was conducted to predict survival = 11 month (median value in this cohort). A value of 51.6% was the optimal cut-off decline point in CA 19-9 level, and decline of 50% had positive and negative predictive value of 80.7% and 62.0%, respectively.
Conclusions: CA19-9 but not CEA kinetics serves as a predictor of better survival in patients with advaced cholangiocarcinoma on gemcitabine-based chemotherapy, and a = 50% decline in CA 19-9 level after 2 cycles of chemitherapy may have clinical utility as a early indicator of better response to gemcitabine-based chemotherapy.
K-BP-29 Pancreatobiliary
Visceral Obesity is Associated with Poor Prognosis in Pancreatic Adenocarcinoma
Bun Kim1, Moon Jae Chung1, Se Woo Park2, Jeong Youp Park1, Seungmin Bang1, Seung Woo Park1, Si Young Song1, Jae Bock Chung1
Institute of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Korea1, Division of Gastroenterology, Department of Internal Medicine, Hallym University College of Medicine, Dongtan Sacred Heart Hospital, Korea2
Background: An association between obesity and unfavorable outcomes for various types of malignancy has been established. Nevertheless, the impact of visceral obesity on outcomes in pancreatic cancer is still unknown and controversial. The aim of this study was to uncover an association between visceral obesity (VO) and pancreatic cancer outcomes.
Methods: We retrospectively reviewed 499 patients in pancreatic cancer who were diagnosed and treated in the Severance Hospital from January 2006 to December 2011, and collected the data of the clinical features, pathologic fi nding, staging, tu- mor marker and history of surgery, radiation therapy or chemotherapy. In this study, progression free survival (PFS) and overall survival (OS) were used as factors of cancer prognosis to evaluate association with visceral fat (defi ned as an abdominal fat vol- ume distribution using CT scan obtained from a slice with a disc reference (L3-L4); the percentage of visceral fat to total fat area (VF%) at initial diagnosis.
Results: Compared to the low visceral obesity group (low-VO group, n=260), the high visceral obesity group (high-VO group, n=239) was mostly male (68.2% vs. 31.8%, p<0.001), and was more likely to have current smoking status (29.7% vs. 17.7%, p<0.001), current alcohol intake status (52.3% vs. 26.4%, p<0.001) and diabetes mellitus (54.4% vs. 31.9%, p=0.028). The PFS and OS were found to be signifi cantly shorter by the Kaplan-Meier method in the high-VO group than in the low-VO group (PFS: p=0.044, OS: p=0.013). In addition, the higher percentage of visceral fat was correlated with more lymph node metastasis and shorter OS (correlation coeffi cient:
0.165, p=0.011 and -0.107, p=0.017, respectively).
Conclusions: In patients with pancreatic cancer, VO at the time of diagnosis is associ- ated with negative outcomes, such as shorter PFS and OS.
K-BP-30 Pancreatobiliary
Signifi cance of Prognostic Nutritional Index for all Stage of Pancreatic Cancer
Sang Hoon Lee1, Moon Jae Chung1, Jeong Youp Park1, Seungmin Bang1, Seung Woo Park1, Si Young Song1
Severance Hospital, Korea1
Background: Nutritional status is an important factor which can affect the prognosis of various tumors. The prognostic nutritional index (PNI) which is calculated based on the serum albumin concentration and peripheral blood lymphocyte count, was already reported a useful predictor for postoperative outcome in resectable pancreatic cancer patients. The aim of this study was to validate the prognostic value of PNI in all stage of pancreatic cancer patients.
Methods: We retrospectively reviewed 499 patients with pancreatic cancer who were diagnosed and treated in Severance Hospital from January 2006 to December 2011, including all stage of pancreatic cancer. The value of PNI was calculated as 10
× serum albumin (g/dL) + 0•005 × total lymphocyte count (per mm3) at initial diag- nosis. Demographic, clinical and laboratory data including performance status (ECOG), tumor marker (CEA and CA19-9), white blood cells, hemoglobin, platelet counts, total protein, albumin and PNI at initial diagnosis were analyzed.
Results: The median age of the patients was 63 years (range 34- 88 years) and 289 (57.9%) were male. The study group comprised of localized disease (24.2 %), locally advanced disease (23.4 %) and metastatic disease (52.1 %). The median survival of all patients was 10 months. Univariate analysis indicated that initial lower PNI was signifi cantly associated with shorter survival in localized (p = 0.047), metastatic, stage (p< 0.001) and in the whole group (p<0.001), but not in locally advanced disease (p = 0.355). Multivariate analyses also showed the same fi ndings except in locally advanced disease (p = 0.047 for local disease, p = 0.003 for metastatic stage, and p=0.038 for all stages).
Conclusions:The PNI could be a prognostic factor and useful predictor for assessing the nutritional condition of pancreatic cancer patients.
