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Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
e111
OC.11 IBD 2
OC.11.1
INFLAMMATORY BOWEL DISEASE PHENOTYPE AS RISK FACTOR
FOR CANCER IN A PROSPECTIVE MULTICENTER NESTED CASE-
CONTROL IG-IBD STUDY
Biancone L.*
1
, Armuzzi A.
2
, Scribano M.L.
3
, D’Incà R.
4
, Castiglione F.
5
,
Papi C.
6
, Angelucci E.
1
, Daperno M.
7
, Riegler G.
9
, Fries W.
10
,
Meucci G.
11
, Alvisi P.
12
, Spina L.
13
, Ardizzone S.
14
, Petruzziello C.
1
,
Mocciaro F.
17
, Ruffa A.
1
, Kohn A.
3
, Vecchi M.
13
, Guidi L.
2
, Di Mitri R.
8
,
Renna S.
15
, Calabrese E.
1
, Rogai F.
16
, Rossi A.
1
, Orlando A.
15
, Pallone F.
1
1
University of “Tor Vergata”, Rome, Rome, Italy,
2
Columbus, Catholic
University and IBD Unit, Rome, Rome, Italy,
3
A.O. San Camillo-
Forlanini, IBD Unit, Rome, Rome, Italy,
4
U.O. Gastroenterology,
University of Padua;, Padova, Italy,
5
University of Padua; 5GI Unit,
University “Federico II di Napoli”, Naples, Napoli, Italy,
6
S. Filippo
Neri Hospital, Rome;, Roma, Italy,
7
A.O. Ordine Mauriziano di Torino,
Turin, Torino, Italy,
8
8GI Unit, ARNAS Civico-DI Cristina Benfratelli,
Palermo, Palermo, Italy,
9
9GI Unit, SUN, II University of Naples,
Naples;, Napoli, Italy,
10
10Dpt. of Clinical and Experimental Medicine,
University of Messina, Messina, Messina, Italy,
11
S. Giuseppe”
Hospital, Milan, Milano, Italy,
12
Maggiore Hospital, Bologna, Bologna,
Italy,
13
13Department of Biomedical Sciences for Health, University
of Milan, and GI Unit, IRCCS Policlinico San Donato, San Donato
Milanese, Milan, Milano, Italy,
14
Hospital Fatebenefratelli, Milan,
Milano, Italy,
15
Division of Internal Medicine “Villa Sofia-Cervello”
Hospital, University of Palermo, Palermo, Palermo, Italy,
16
Department
of Medical and Surgical Specialties, Gastroenterology SOD2, A.O.
Universitaria Careggi, Florence, Firenze, Italy,
17
GI Unit, ARNAS Civico-
DI Cristina Benfratelli, Palermo, Palermo, Italy
Background and aim:
The risk of cancer using immunomodulators
for Inflammatory Bowel Disease (IBD) is debated. In a 3-year
prospective, multicenter, nested case-control study, we aimed to
characterize incident cases of cancer in IBD. The role of clinical
characteristics of IBD vs immunomodulators use in determining the
cancer risk was also investigated.
Material and methods:
From January 2012 to December 2014,
all incident cancers in IBD patients referring to 16 IBD Units were
recorded. Each patient with cancer (IBD-K) was matched with 2 IBD
patients without cancer (IBD-C) for: IBD type, gender, age (±5 years).
Data were expressed as median (range), Wilcoxon test, multivariate
logistic regression analysis (OR [95%CI]), Chi-Square test.
Results:
Overall, 44,619 IBD patients were considered: 21,953 CD,
22,666 UC. Cancer occurred in 174 IBD patients: 99 CD (CD-K), 75
UC (UC-K). Cancer incidence in IBD was 3.9/1000, being higher
in CD (4.5/1000 [99/ 21,953]) than in UC (3.3/1000 [75/22,666];
p=0.042). Cancers involved: digestive system (36.8%: CRC 67.2%;
ileum 12.5%; others 20.3%), skin (13.2%), urinary tract (12.1%), lung
(8.6%), breast (8%), genital (6.9%), thyroid (4.6%), lymphoma (6CD;
3.5%), others (6.3%). The percentage of patients with penetrating CD
was higher in CD-K vs CD-C (26%; 26/99 vs 15%; 30/198; p=0.02)
and with extensive UC in UC-K vs UC-C (55%; 41/75 vs 34%; 51/159;
p=0.003). In CD, penetrating behavior and combined thiopurines (IS)
and TNF
a
antagonists were risk factors for cancer overall (OR 2.33
[1.01-5.47]; 1.97 [1.1-3.5]), for extracolonic cancers (OR 3.9 [1.56-
10.1]; 2.15 [1.17-4.1]), but not for CRC. Risk factors in UC included
pancolitis and surgery for cancer overall (OR 2.52 [1.26-5.1]; 5.09
[1.73-17.1]); surgery for CRC (OR 3.6 [1.0-12]); extensive vs distal,
subtotal vs distal UC for extracolonic cancers (OR 2.55 [1.15-5.9]; 2.6
[1.04-6.6]).
Conclusions:
In a multicenter study, CD phenotype, penetrating CD,
extensive UC represented risk factors for cancer overall.
OC.11.2
CROHN’S DISEASE-ASSOCIATED SMALL BOWEL CARCINOMAS
SHOW DISTINCTIVE HISTOLOGY AND PHENOTYPE IN
COMPARISON TO SPORADIC CASES: AN ITALIAN MULTICENTRE
STUDY
Vanoli A.
1
, Grillo F.
2
, Mescoli C.
3
, Nesi G.
4
, Giuffrida P.
1
, Papi C.
5
,
Luinetti O.
1
, Sampietro G.
6
, Latella G.
7
, Fociani P.
6
, Tonelli F.
4
,
Cannizzaro R.
8
, Coppola L.
5
, D’Incà R.
3
, Monteleone G.
9
, Biancone L.
9
,
Solina G.
10
, Villanacci V.
11
, Martino M.
1
, Orlandi A.
9
, Rizzo A.
10
,
Salemme M.
11
, Astegiano M.
12
, Migliora P.
12
, Rugge M.
3
, Fiocca R.
2
,
Corazza G.R.
1
, Solcia E.
1
, Di Sabatino A.*
1
1
Policlinico San Matteo, Pavia, Italy,
2
Azienda Ospedaliera Universitaria
San Martino, Genova, Italy,
3
Azienda Ospedaliera di Padova, Padova,
Italy,
4
Azienda Ospedaliera Universitaria Careggi, Firenze, Italy,
5
Azienda Ospedaliera San Filippo Neri, Roma, Italy,
6
Ospedale Luigi
Sacco, Milano, Italy,
7
Ospedale San Salvatore dell’Aquila, L’Aquila,
Italy,
8
Centro di Riferimento Oncologico, Aviano, Italy,
9
Policlinico
Tor Vergata, Roma, Italy,
10
Ospedale Vincenzo Cervello, Palermo,
Italy,
11
Spedali Civili di Brescia, Brescia, Italy,
12
Azienda Ospedaliera
Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
Background and aim:
Although the small intestine accounts for
75% of the length of the gastrointestinal tract, non-ampullary small
bowel carcinoma (SBC) is a remarkably rare tumor in the general
population. Crohn’s disease (CD) is associated with an increased
risk of development of SBC. Histomorphology and phenotype of
CD-associated SBC (CD-SBC) have, however, not been thoroughly
examined.
Material and methods:
We evaluated histologically 25 cases of
CD-SBCs (median age 59 years, range 33-84) in comparison to 24
sporadic SBCs (median age 65 years, range 27-88). Immunoreactions
for intestinal markers (CDX2, CD10, CK20), gastric markers (MUC5AC,
MUC6), pancreatobiliary marker cytokeratin (CK)7, mismatch repair
(MMR) proteins (MLH1, PMS2, MSH2, MSH6), p53 and HER2 were
performed. HER2 gene amplification was also investigated by FISH
testing in cases with HER2 membranous reactivity.
Results:
CD-SBCs were frequently characterized by high grade and/
or diffuse histology (poorly cohesive cells with or without overt
signet ring cells). CK7 was expressed with significantly (p<0.005)
higher frequency in CD-SBCs (64%) in comparison to sporadic
SBCs (17%). Additionally, MUC5AC was also detected with higher
frequency, even not significantly, in CD-SBCs (48%) in comparison
to sporadic SBCs (21%). On the contrary, CDX2 and CK20 expression
was significantly (p<0.05) less frequent in CD-SBCs (both 36%) in
comparison to sporadic SBCs (71% and 79%). Moreover, CD10 was
also detected with lower frequency, even not significantly, in CD-
SBCs (16%) in comparison to sporadic SBCs (42%). There was no
difference between sporadic and CD-SBCs regarding MUC6 and p53.
Three CD-SBC and 4 sporadic SBC lacked both MLH1 and PMS2. HER2
amplification was observed in two out of 25 CD-SBCs. No significant
difference was observed in terms of survival between CD-SBCs and
sporadic SBCs.
Conclusions:
Compared with sporadic SBCs, SBCs arising in CD
had several distinguishing histological and immunophenotypical
features, in particular the gastric and, possibly, pancreatobiliary
differentiation. HER2 amplification made the two patients with CD-
SBCs eligible for treatment with trastuzumab.