Digestive and Liver Disease - Volume 48 - Supplement 2 - February 2016

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Abstracts of the 22nd National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231 e135
Conclusions: This is the first meta-analysis evaluating the rate of
occasionally detected PCLs in asymptomatic individuals. The rate
is as high as 11%, and is higher in older subjects, and in studies
employing MRCP. IPMNs seem the most common occasionally
detected PCL. These findings underline the importance of better
defined follow-up policies for asymptomatic IPMNs.
P.02.3
ASPIRIN, STATINS AND PANCREATIC CANCER: IS THERE ROOM
FOR CHEMOPREVENTION?
Archibugi L.*1, Piciucchi M.2, Valente R.1, Maisonneuve P.3,
Delle Fave G.1, Capurso G.1
1A.O. Sant’Andrea, Roma, Italy, 2Ospedale Città di Castello, Città di
Castello, Italy, 3Istituto Europeo di Oncologia (IEO), Milano, Italy
Background and aim: Pancreatic ductal adenocarcinoma (PDAC)
has increasing incidence and poor prognosis, mostly due to delayed
diagnosis. Prevention can be a cornerstone in the fight against this
deathly cancer. In this context, chemopreventive action of aspirin
and statins might prove interesting. However, published data are
conflicting, with effect sometimes limited to subgroups; the possible
combined effect of the two drugs has never been explored.
The aim of the study is to investigate the possible protective role of
aspirin and statin use and their combination on PDAC.
Material and methods: This is a case-control study, with risk factors
screened through questionnaires about environmental factors,
family and medical history. PDAC cases were matched to controls for
age and gender with a 1:2 ratio.
We performed a power calculation analysis, considering an exposure
of 22% and 23% respectively for aspirin and statins recorded in the
first 200 controls; to have a 80% power of identifying a <0,61 OR for
aspirin and <0,62 OR for statins 345 cases and 690 controls were
needed. With a 10% rate for the combined use of aspirin and statins
among controls, the same number of subjects allows to detect an OR
of 0,47 with 80% of power.
Results: 346 patients with PDAC and 692 matched controls (54%
males, mean age 69 in both groups) were enrolled. Aspirin (19.1%
vs 23.8%) use was similar in both case and control group. Neither>5-
year use of aspirin (7.2% vs 10.8%) nor its combination with statin
(10.1% vs 11.3%) showed different prevalence among cases and
controls. Statin use was significantly higher in the control group
(19.1% vs 24.9%); a protective effect was also demonstrated in
multivariate logistic regression (OR 0.66, 95%CI: 0.46-0.96).
In multivariate logistic regression analysis smoking (OR:1.61, CI95%:
1.56-2.26), heavy drinking (OR:2.08, CI95%:1.31-3.29), history of
previous diabetes (OR:1.6, CI95%: 1.01-2.54), chronic pancreatitis
(OR:16.96, CI95%:2.01-143.03) and family history of PDAC (OR:3.92,
CI95%: 1.9-8.07) were all significant risk factors.
Conclusions: This study suggested a chemopreventive effect for
statins, but not for aspirin (OR similar to that recently reported
in another large C-C study in the US). The possible combined
chemopreventive effect of aspirin and statins was hereby analyzed
for the first time with null results. All known factors associated with
increased risk for PDAC were confirmed, supporting the genuineness
of our population.
P.02.4
REASSESSMENT OF HISTOLOGICAL FEATURES AT DISEASE
PROGRESSION DURING THE FOLLOW-UP OF NEUROENDOCRINE
TUMOURS
Cicchese N.*, Pilozzi E., Rinzivillo M., Iannicelli E., Panzuto F.,
Merola E., Pucci E., Capurso G., Delle Fave G.
Ospedale Sant’Andrea, Roma, Italy
Background and aim: Neuroendocrine Neoplasms (NENs) are
relatively rare diseases with an heterogeneous clinical behaviour.
The proliferative index ki-67 is the most important prognostic
factor. However, whether repeating histological assessment at time
of disease progression (DP) is still debated, since there are few data
regarding potential Ki-67 modification during the course of disease.
Our aim is to investigate modification of ki-67 index at time of DP
in NENs.
Material and methods: Retrospective analysis of sporadic NENs
patients in which histological sampling (bioptic or surgical) was
repeated at time of DP. Histological evaluation was assessed
according with WHO 2010 classification by a pathologist blinded
about the disease clinical course.
Results: 29 pts, median age 59 (range 37-74 yr), repeated histological
evaluation at time of DP, and were included. Of these, 17 (58.6%)
showed increase in lesions number/size, whereas 12 (41.4%) had
recurrent disease after previous radical surgery. Primary tumour
sites were: distal jejunum/ileum (14, 48.2%), pancreas (9, 31%),
bronchial (3, 10.3%), unknown (2, 6.8%), colonic (1, 3.4%). At time of
initial evaluation, a total of 15 pts (51.7%) had G1 tumor, whereas 14
(48.3%) had G2 tumor. Median ki-67 was 2% (range 1%-20%).
The median interval between initial assessment and repeated
histology was 51 months. At DP, 22 pts (75.8%) experienced ki-67%
changes (9 pancreatic NENs, 8 intestinal NENs, 5 other primary
NENs). Of these, 10 (34.4%) underwent G modifications. In detail, 3
patients changed grading from G2 to G3 (3 pancreatic NENs), 5 from
G1 to G2, and the remaining 2 pts from G2 to G1. Overall, median
ki67 at time of DP was 5% (range 1%-70%; p=0.006 vs Ki67 at time
of initial assessment). No difference was observed neither in ki-67
nor in grading changes between patients who underwent increase
in lesions number/size and those who had recurrent disease after
previous radical surgery.
Conclusions: Significant increase in Ki-67 index occur in a relevant
group of NEN patients at time of DP, thus suggest the usefulness
of repeating histology before planning medical treatments in these
patients.
P.02.5
PREVALENCE OF CHRONIC PANCREATITIS IN THE PRIMARY CARE
SETTING
Capurso G.*1, Archibugi L.1, Bianco M. 2, Cavallini F.2, Cremaschi R.2,
Colantonio P.2, Filabozzi A.2, Giovannetti P.2, Lanna G.2,
Mastrantoni A.2, Medori C.2, Balducci P.2, Merletti E.2, Nunnari E.2,
Paris F.2, Pasquali P.2, Pavone M. 2, Centofanti S.2, Piacenti A.2,
Rossi A.2, Taborchi M.2, Chiriatti A.2, Delle Fave G.1
1S. Andrea Hospital, Rome, Italy, 2Primary Care, Roma, Italy
Background and aim: Data on the prevalence of chronic pancreatitis
are scanty, as a formal diagnosis is often difficult to be made.
Moreover, most epidemiological studies are hospital-based and
therefore might not represent the general population.
We aimed at investigating the prevalence of chronic pancreatitis in
the general population.
Material and methods: About 160 primary care physicians (PCPs)
were invited to take part in clinical meetings on chronic pancreatitis
(CP) and pancreatic exocrine insufficiency (PEI). Afterwards, a
survey was conducted among the participants. Each PCP was asked
to report his total number of assisted individuals, and the number
affected by definite or suspected CP, filling in a form with details
about environmental factors and disease characteristics of each CP
patient. The forms were reviewed and patients with “uncertain”
diagnosis of CP were invited to our pancreatic disease unit for a
specialist appointment.
Results: 23 PCPs accepted to take part to our study. Their pooled
assisted population was of 34.000 individuals. According with