Early-stage Adenocarcinoma Research Articles

The frequency of lymph node metastasis in early-stage adenocarcinoma of the esophagus with incipient submucosal invasion (pT1b sm1) depending on histological risk patterns.

A prerequisite for endoscopic treatment (ET) of not only mucosal, but also submucosal early adenocarcinoma of the esophagus (EAC) would be a rate of lymph node (LN) metastasis below the mortality rate of esophagectomy (2-5%). The aim of the present study was to evaluate the rate of LN metastasis in patients with pT1b sm1 EAC. 1996-2010, 1,718 patients with suspicion of EAC were referred to the Department of Internal Medicine II at HSK Wiesbaden. In 123/1718 patients, the suspicion (endoscopic ultrasound, EUS) or definitive diagnosis of sm1 EAC (ER/surgery) was made. Rate of LN metastasis was analyzed separately for low-risk (LR; G1-2, L0, V0) and high-risk lesions (HR; G3, L1, V1; ≥ 1 risk factor). LN metastasis was only evaluated in patients who had a proven maximum invasion depth of sm1 (ER and/or surgery), and who in case of ET had a follow-up (FU) by EUS of at least 24 months. Of the 72/123 patients included into the study, 49 patients had LR (68%) and 23 HR lesions (32%). In endoscopically treated LR patients (37/49), mean EUS-FU was 60 ± 30 mo (range 25-146); in HR patients undergoing ET (6/23), it was 63 ± 17 mo (46-86; p = 0.4). Mean number of resected LN was 27 ± 16 (12-62) in operated LR patients and 27 ± 10 (12-47) in HR-patients. The rate of LN metastasis was 2% in the LR (1 patient) and 9% in the HR group (2 patients; p = 0.24). Mortality of esophagectomy was 3%. The rate of LN metastasis in pT1b sm1 early adenocarcinoma with histological LR pattern was lower than the mortality rate of esophagectomy. ER may therefore be used alternatively to surgery in this group of patients.

Usefulness and safety of endoscopic treatment for nonampullary duodenal adenoma and adenocarcinoma

Safety and efficacy data on endoscopic treatment of duodenal neoplasm are limited. We suggest the technical feasibility of endoscopic procedures by evaluating the results of endoscopic treatment for nonampullary duodenal adenoma and adenocarcinoma. Forty-five patients who underwent endoscopic treatment for nonampullary duodenal adenoma with or without malignant transformation between September 2003 and March 2012 were included. Endoscopic polypectomy of duodenal polyp (DPP), duodenal endoscopic mucosal resection (DEMR), and duodenal endoscopic submucosal dissection (DESD) were selected as endoscopic treatments for each lesion. Mean lesion size was 9.1 mm, and most lesions were located in the second portion of the duodenum. There were 40 adenomas and five early-stage adenocarcinomas arising from adenomas. Of the 45 duodenal neoplasms, five patients were treated with DPP, 33 with DEMR, and seven patients with a large duodenal lesion underwent DESD. Minimum of 1-year follow-up endoscopies were performed in 42 patients, excepting three patients treated after October 2011. Median follow-up was 24.8 months. Of the 45 patients, en bloc resection was performed in 43 (95.6%). A complete resection was performed in 41 patients (91.1%). No significant bleeding events occurred. Perforations occurred in three patients who underwent DESD. All perforations were noticed during the procedures and completely closed by endoscopic clipping. There was one recurrence at 6 months after DPP. Endoscopic treatment is minimally invasive management for duodenal adenomas and superficial adenocarcinomas. It would be helpful for medical doctors in the management of duodenal neoplasms.

Reclassification of early stage pulmonary adenocarcinoma and its consequences.

The classification of pulmonary adenocarcinoma has recently undergone several proposed changes. Among these, the most striking pertains to the discontinuation of the term "bronchioloalveolar carcinoma (BAC)" and its replacement by the terms "adenocarcinoma in situ (AIS)" or "minimally invasive adenocarcinoma (MIA)" for small solitary adenocarcinomas with either pure bronchiolalveolar growth or predominant bronchioloalveolar growth and ≤5 mm invasion, respectively, in resection specimens. The recommendation for these new concepts was based on discussion and review of the literature by a panel of experts from multiple disciplines. However, the results of a recent study investigating the topic of early stage adenocarcinoma (pT1N0M0) which was based on an actual series of cases, have raised questions as to the concept, validity and justification of such new terminology and have reinforced the need to evaluate actual cases that meet the newly proposed definitions and compare them in terms of patient outcome. This is even more important when proposing terminology that implies benign behavior and that could result in a false sense of security putting patients at risk for suboptimal treatment approaches. The controversies surrounding these issues are the subject of this work.

The potential role of extracellular regulatory kinase in the survival of patients with early stage adenocarcinoma.

Lung cancer is among the most common types of neoplasias, and adenocarcinoma is the most frequent histological type. There is currently an extensive search for prognostic biomarkers of nonsmall cell lung cancer (NSCLC). We analyzed the correlation of clinical data and patient survival with the levels of activated extracellular regulatory kinase (ERK) in histological samples of surgically resected early stage lung adenocarcinoma. We randomly selected 36 patients with stage I or II lung adenocarcinoma who underwent pulmonary lobectomy between 1998 and 2004. Patients were divided into the following two groups according to immunohistochemical profile: a group with <15% ERK-positive tumor cells and a group with ≥15% ERK-positive tumor cells. For data comparison, an enrichment analysis of a microarray database was performed (GSE29016, n=72). Activated ERK levels were ≥15% and <15% in 21 (58%) and 15 (42%) patients, respectively. There were no statistically significant differences in age, sex, smoking history, and body mass index (BMI) among the groups stratified by ERK levels. The survival rate was lower in the ERK ≥15% group than in the ERK <15% group (P=0.045). Enrichment analyses showed no correlation between variations in gene expression of ERK in patients with adenocarcinoma and survival rates in patients with stage I and combined stage II + III disease. Our findings suggest that high ERK positivity in cells from biological samples of lung adenocarcinoma is related with tumor aggressiveness and a poorer prognosis.

Pulmonary adenocarcinoma T1N0M0 and its classification.

Over the last decade, use of the term bronchioloalveolar carcinoma (BAC) has come under constant scrutiny as some consider it an anachronism or a term that provides incorrect information about this neoplasm. To that extent, it has recently been suggested to replace the term BAC with that of in situ adenocarcinoma (AIS) or minimally invasive adenocarcinoma (MIA) for small solitary adenocarcinomas with either pure bronchioloalveolar growth (AIS) or predominant bronchioloalveolar growth and ≤5-mm invasion (MIA). However, as of today, there is no comprehensive study of these tumors, and most of what has been published in this context is based on a review of the literature that focused on scattered short series of cases describing either small adenocarcinomas or BAC. More recently, a large series of cases of a more comprehensive nature that included all early-stage adenocarcinomas (T1N0M0) has cast some doubt regarding the need for the proposed change in nomenclature. At the same time, it was suggested that if indeed that notion is maintained, a more serious and comprehensive study of actual cases must be undertaken. The details of the issues surrounding this subject are presented in this review.

Association of a DNA damage response deficiency (DDRD) assay and prognosis in early-stage esophageal adenocarcinoma.

4015 Background: The incidence of esophageal adenocarcinoma (EAC) has increased 6-fold in the last 30 years and in early stage EAC 5-year survival remains poor at 25-35%. Neoadjuvant therapy confer...

Randomized phase III trial of FOLFOX versus XELOX as adjuvant chemotherapy in patients with early-stage colorectal adenocarcinoma.

3617 Background: The aim of the trial was to compare two active adjuvant chemotherapy regimens in patients with early stage colorectal cancer (CRC). Methods: Patients were assigned to oxaliplatin 8...

Endoscopic resection for synchronous esophageal squamous cell carcinoma and gastric adenocarcinoma in early stage is a possible alternative to surgery.

Background/AimsWe investigated the clinical outcomes according to the method of treatment in synchronous esophageal and gastric cancer.MethodsSynchronous esophageal squamous cell carcinoma and gastric adenocarcinoma were diagnosed in 79 patients between 1996 and 2010. We divided the patients into four groups according to treatment; Group 1 received surgical resection for both cancers or surgery for gastric cancer with chemoradiotherapy for esophageal cancer (n=27); Group 2 was treated by endoscopic resection with or without additional treatment (n=14); Group 3 received chemoradiotherapy only (n=18); and Group 4 received supportive care only (n=20).ResultsThe median survival times in groups 1 and 2 were 86 and 60 months, respectively. The recurrence rate and mortality were 23% and 48%, respectively, in group 1 and 21% and 4%, respectively, in group 2. The median survival time was 12 months in group 3 and 9 months in group 4. Multivariate analysis showed that age (p<0.001) and treatment group (p=0.019) were significantly associated with death. Compared with group 1, treatment in the intensive care unit (p=0.003), loss of body weight (p=0.042), and decrease in hemoglobin (p=0.033) were worse in group 1.ConclusionsEndoscopic resection for synchronous esophageal and gastric cancer could be considered as a possible alternative to surgery for early-stage cancer.

Lack of any impact of histopathology type on prognosis in patients with early-stage adenocarcinoma and squamous cell carcinoma of the uterine cervix.

The aim of this study was to evaluate the prognosis of patients with stage IA-IIB cervical carcinoma and to investigate a possible correlation of histology with prognosis. Two hundred fifty one patients with adenocarcinoma and squamous cell carcinoma (SCC) histology for FIGO (International Federation of Gynecology and Obstetrics) stage IA-IIB uterine cervical carcinomas at the Radiation Oncology Clinic of GH Okmeydani Training and Research Hospital between January 1996 and December 2006 were selected, analyzed retrospectively and evaluated in terms of general characteristics and survival. Disease-free survival (DFS) and overall survival (OS) was calculated using the Kaplan-Meier method and differences were compared with the log-rank test. Multivariate analysis using a Cox-proportional hazards model was used to adjust for prognostic factors and to estimate hazard ratio (HR) with 95% confidence interval (CI). There was no differences between the two tumour types in age, stage, pelvic nodal metastasis, parametrial invasion, surgical margin status, DSI, LVSI, maximal tumor diameter, grade, and treatment modalities. 5-year OS and DFS were 73% and 77%, versus 64% and 69%, for SCC and adenocarcinoma, respectively (p> 0.05). Multivariate analysis revealed independent prognostic factors including pelvic nodal metastasis and resection margin status for OS (p=0.008, p=0.002, respectively). Prognosis of FIGO stage IA-IIB cervical cancer patients was found to be the same for those with adenocarcinoma and SCC.

ECT2 amplification and overexpression as a new prognostic biomarker for early‐stage lung adenocarcinoma

Genetic abnormality in early-stage lung adenocarcinoma was examined to search for new prognostic biomarkers. Six in situ lung adenocarcinomas and nine small but invasive adenocarcinomas were examined by array-comparative genomic hybridization, and candidate genes of interest were screened. To examine gene abnormalities, 83 cases of various types of lung carcinoma were examined by quantitative real-time genomic PCR and immunohistochemistry. The results were then verified using another set of early-stage adenocarcinomas. Array-comparative genomic hybridization indicated frequent amplification at chromosome 3q26. Of the seven genes located in this region, we focused on the epithelial cell transforming sequence 2 (ECT2) oncogene, as ECT2 amplification was detected only in invasive adenocarcinoma, and not in in situ carcinoma. Quantitative PCR and immunohistochemistry analyses also detected overexpression of ECT2 in invasive adenocarcinoma, and this was correlated with both the Ki-67 labeling index and mitotic index. In addition, it was associated with disease-free survival and overall survival of patients with lung adenocarcinoma. These results were verified using another set of early-stage adenocarcinomas resected at another hospital. Abnormality of the ECT2 gene occurs at a relatively early stage of lung adenocarcinogenesis and would be applicable as a new biomarker for prognostication of patients with lung adenocarcinoma.

A preoperative clinical staging and metabolic imaging model to predict prognosis in early-stage esophageal adenocarcinoma.

63 Background: Accurate prediction of outcome for neo-adjuvant therapy in early stage esophageal adenocarcinoma (EAC) is essential for clinical trial design, patient counseling and treatment decisions. The use of 18F-fluorodeoxyglucose positron emission tomography (PET) has improved the staging of EAC and can predict pathological response and survival. Our aim was to develop a pre-operative prognostic model based on metabolic imaging and clinical parameters. Methods: Between April 2004 and December 2010, 118 patients with early stage adenocarcinoma of the distal esophagus or gastro-esophageal junction were treated with platinum and fluorouracil-based combination chemotherapy prior to surgical resection. Patients were staged by endoscopic ultrasound and PET/CT was performed prior to, and upon completion of, chemotherapy. A metabolic response was defined as a &gt;35% reduction in the maximum standard uptake variable (SUVmax). The final prognostic model was selected by multivariate Cox regression analyses and the concordance-index (c-index) was used to assess the fit of the final multivariate model. Results: In both the univariate and multivariate analysis of patient prognosis post-surgery, five pre-surgery factors were included: clinical T and N staging, PET response, neutrophil-lymphocyte ratio and albumin levels. The majority of the patients were T3 (82.1%) and N1 (73.7%) and 69.8% of patients demonstrated a PET response. In the univariate analysis PET response was the only significant prognostic factor with a median overall survival (OS) of 60.4 months for responders compared to 23.3 months for non-responders (p=0.0241). The final multivariate model of T staging and PET response had a c-index of 0.624 with T3/PET non-response resulting in a poorer prognosis compared to T3/PET response and T2/PET responder or non-responder (median OS 11.5 vs 44.5 vs undefined months; p=0.0284). We seek to validate our model in an independent patient dataset to assess its predictive capability. Conclusions: Metabolic imaging and clinical staging can be combined in a prognostic model in early stage EAC. Our model can inform patient counseling and the development of clinical trial strategies.

Second primary pancreatic adenocarcinoma three years after successfully treated index esophageal cancer.

Development of a second primary malignancy after an index esophageal cancer is a rare event, primarily due to short survival of patients with esophageal cancer. However, the number of long-term esophageal cancer survivors has been increasing due to advances in early detection and therapy.We report herein a case of pancreatic adenocarcinoma that developed three years after a successfully treated early-stage adenocarcinoma of the esophagus. A 70-year-old Caucasian male presented with vague complaints of nausea, vomiting and abdominal distention, with subsequent development of jaundice. A computed tomography scan of abdomen revealed a 2.9 cm soft tissue mass in the head of the pancreas and the patient underwent a Whipple's procedure, with pathology confirming the diagnosis of pancreatic adenocarcinoma. Three years previously, the patient was successfully treated for adenocarcinoma of the esophagus via minimally invasive esophagogastrectomy. Despite chemoradiotherapy for localized disease and subsequent systemic chemotherapy for metastatic pancreatic cancer, the patient eventually succumbed to his illness.We discuss the association between esophageal cancer and subsequent second malignancies, along with implications for surveillance and therapy.

Prognostic value of tumor-stroma ratio in early stage cervical adenocarcinoma

Background Tumor-stroma ratio (TSR) represents a percentage of neoplastic component to the combined neoplastic and tumor-associated stromal area. TSR has been demonstrated to be a new prognostic factor in cancers of several organs including the uterine cervix. In cervical cancer, TSR was evaluated in only one previous series of carcinoma with mixed histologic types. This study was aimed to assess the prognostic value of TSR in early-stage cervical cancer patients with adenocarcinoma histology only. Methods Histologic slides of patients with early stage (IB-IIA) cervical adenocarcinoma who underwent surgical treatment between January 2003 and December 2011 were reviewed. TSR was categorized as low ( 50%: stroma-poor). The clinical and pathological variables were correlated with the follow-up outcomes. Results Of 131 patients, 38 (29.0%) had low TSR and 93 (71.0%) had high TSR. Cases with low TSR had significantly higher rates of infiltrative border ( p p = 0.011), and parametrial involvement ( p = 0.026). Low TSR was associated with decreased overall survival in the univariate analysis ( p = 0.041), but not in the multivariate analysis. TSR was not associated with tumor recurrence or decreased disease-free survival. Conclusions TSR is not an independent prognostic predictor in surgically-treated early-stage cervical adenocarcinoma patients.

11. ROS1 gene rearrangements in non-small cell lung carcinoma - A new genetic target

<h3>Background</h3> Targeted therapies aimed at specific molecular genetic alterations are revolutionising cancer treatment, particularly in non-small cell lung cancer (NSCLC). Driver mutations involving translocation of the <i>ROS1</i> gene have recently been identified in NSCLC and show promise as a target for tyrosine kinase inhibitors. <h3>Aim</h3> To investigate the incidence and clinicopathological features of NSCLC harbouring <i>ROS1</i> rearrangements and the accuracy of IHC compared to FISH at identifying these tumours. Methods: We tested for <i>ROS1</i> translocations using a FISH break-apart probe and immunohistochemistry (IHC) in (1) tissue micro-arrays from a retrospective cohort of 308 early stage adenocarcinomas, (2) a prospective cohort of 23 NSCLC, selected on clinical grounds for mutation testing. <h3>Results</h3> Only 1 of 308 cases was positive by FISH in the retrospective cohort giving a 0.3% incidence of <i>ROS1</i> gene rearrangements. ROS1 IHC was positive in 7 (2.3%) of these cases, including the FISH+ case (sensitivity 100%, specificity 98%). In the prospective cohort, three cases with <i>ROS1</i> rearrangement were identified by FISH (all IHC positive). All 4 cases of ROS1 gene rearrangement identified by FISH occurred in adenocarcinomas that were <i>EGFR</i>-wild-type, ALST-negative, from non-smoking females (age range 33-81 years, mean 59). Two were of Asian ethnicity. <h3>Conclusions</h3> <i>ROS1</i> gene rearrangements occur in a very small percentage of lung adenocarcinomas and are mutually exclusive with EGFR and <i>ALK</i> alterations. Screening with IHC may be a suitable method of reducing the number of cases requiring FISH.

SNP rs10248565 in HDAC9 as a novel genomic aberration biomarker of lung adenocarcinoma in non-smoking women

BackgroundNumerous efforts have been made to elucidate the etiology and improve the treatment of lung cancer, but the overall five-year survival rate is still only 15%. Although cigarette smoking is the primary risk factor for lung cancer, only 7% of female lung cancer patients in Taiwan have a history of smoking. Since cancer results from progressive accumulation of genetic aberrations, genomic rearrangements may be early events in carcinogenesis.ResultsIn order to identify biomarkers of early-stage adenocarcinoma, the genome-wide DNA aberrations of 60 pairs of lung adenocarcinoma and adjacent normal lung tissue in non-smoking women were examined using Affymetrix Genome-Wide Human SNP 6.0 arrays. Common copy number variation (CNV) regions were identified by ≥30% of patients with copy number beyond 2 ± 0.5 of copy numbers for each single nucleotide polymorphism (SNP) and at least 100 continuous SNP variant loci. SNPs associated with lung adenocarcinoma were identified by McNemar’s test. Loss of heterozygosity (LOH) SNPs were identified in ≥18% of patients with LOH in the locus. Aberration of SNP rs10248565 at HDAC9 in chromosome 7p21.1 was identified from concurrent analyses of CNVs, SNPs, and LOH.ConclusionThe results elucidate the genetic etiology of lung adenocarcinoma by demonstrating that SNP rs10248565 may be a potential biomarker of cancer susceptibility.

Minimally invasive surgery for esophageal cancer: a review on sentinel node concept

Lymphoadenectomy is a cornerstone of esophageal cancer treatment, and sentinel node (SN) biopsy (SNB) might provide surgeons with an extra tool to limit unnecessarily extended lymphadenectomy and to implement a minimally invasive approach. The aim of our study was to review all the available literature on the use of SNB in esophageal surgery for malignancy. The review was conducted according to the PRISMA guidelines. A systematic search was performed in PubMed, EMBASE, and the Cochrane database to identify all original articles on the role of SNB in esophageal cancer. Data on methodologies, tumor stage and localization, and results were summarized and used to address relevant clinical questions related to the application of the SNB technique in esophageal cancer. Twelve studies were included, with a total of 492 patients. Different methods for SN identification were used (radionuclide, blue dye, computed tomography [CT] lymphography). The pooled values estimated using the random-effects model were, respectively: technetium-99 m overall detection rate (DR) 0.970 (95 % CI 0.814-0.996), accuracy (ACC) 0.902 (95 % CI 0.736-0.968); blue-dye DR 0.971 (95 % CI 0.890-0.993), ACC 0.790 (95 % CI 0.681-0.870); and CT lymphoscintigraphy DR 0.970 (95 % CI 0.814-0.996), ACC 0.902 (95 % CI 0.736-0.968). Based on these results, the concept of SN in esophageal cancer is technically feasible with an acceptable DR and ACC, and it might be applicable in the event of early-stage adenocarcinoma of the gastroesophageal junction in patients with a high surgical risk or in a patient where an endoscopic resection is taken into consideration. Further studies focused on a single tumor type and localizations are needed in order to predict the correct utilization of this concept in minimally invasive treatment of esophageal cancer.

Pattern in lung cancer pathology may predict disease recurrence

A specific pattern found in the tumor pathology of some patients with lung cancer is a strong predictor of recurrence after surgery, a factor that could be important in guiding treatment, say researchers at Memorial Sloan-Kettering Cancer Center in New York City.1 To the best of their knowledge, the study offers the first scientific evidence indicating which patients are more likely to benefit from less radical lung-sparing surgery and which will benefit from more extensive surgery. Making this distinction could potentially reduce the risk of lung cancer recurrence by 75%, the authors say. Researchers retrospectively evaluated the clinical characteristics and pathology information of 734 patients who underwent surgery for early-stage adenocarcinoma, the most common subtype of non-small cell lung cancer. They found that tumors in 40% of those patients exhibited an abnormal cell pattern that was strongly associated with disease recurrence after surgery. Currently, there are no evidence-based criteria for choosing the most effective surgical approach for patients with small early-stage lung adenocarcinomas. The study suggests that limited surgical resection may not be best for patients with this classification, called micropapillary (MIP) morphology. This group was found to have a 34% risk of the cancer returning 5 years after lungsparing surgery, in which the tumor is removed by minimally invasive means and lung function is preserved. The same group of patients who underwent lobectomy only had a 12% recurrence rate over a 5-year period. If the surgeon performs lung-sparing surgery in the presence of the MIP pattern, the chance of recurrence is high in the spared lobe. A lobectomy can reduce the risk of disease recurrence by 75%. If the MIP pattern is not found, the surgeon can perform the lung-sparing surgery without as great a risk of recurrence. The researchers at Memorial Sloan-Kettering Cancer Center are working to develop new technology that can identify the MIP pattern before or during surgery. That knowledge would not only help physicians to determine treatment but also would reduce the need for additional surgeries, they say.

MET Gene Copy Number Gain is an Independent Poor Prognostic Marker in Korean Stage I Lung Adenocarcinomas

MET gene copy number gain (CNG) and protein overexpression have been reported in lung cancer, but the clinical implications in early stage adenocarcinoma remain unclear. We investigated MET gene copy number and protein expression in 141 cases of surgically resected stage I pulmonary adenocarcinoma. MET gene CNG was determined by silver in situ hybridization, and MET protein expression was assessed by immunohistochemistry. The correlation between MET gene CNG/protein expression and clinicopathologic parameters and prognostic significance was analyzed. MET gene CNG was found in 24.1% (34 of 141) of the cases and was associated with larger tumor size, pleural invasion, and lymphatic vessel invasion. MET gene CNG was inversely correlated with the presence of lepidic subtype (r = -0.17, p = 0.045) and was not associated with EGFR, KRAS mutation, or ALK gene rearrangement. In addition, MET gene CNG was significantly associated with shorter disease-free survival (DFS) (49 vs. 75 months; p < 0.001) and shorter overall survival (OS) (65 vs. 78 months; p = 0.01). Multivariate analysis confirmed that MET gene CNG was significantly associated with poorer DFS [p < 0.001; hazard ratio (HR) 5.5; 95% confidence interval (CI) 2.2-13.9] but was not significantly associated with OS. MET overexpression was observed in 71.3% of cases (97 of 136), but it was not correlated with gene CNG. MET gene CNG is an independent poor prognostic factor in patients with stage I lung adenocarcinoma. It is associated with aggressive pathologic features and is inversely correlated with the presence of lepidic subtype.

An assessment of the impact of geographic variation on resection rates and survival for early-stage pancreatic adenocarcinoma.

e15052 Background: Pancreatic resection is the only known curative option for pancreatic adenocarcinoma. Resection has been previously reported to be underutilized in patients with early stage disease. To develop a better understanding of this issue and control for treatment selection factors, we examined the relationship between geographic area resection rates and survival in patients with stage I/II pancreatic cancer. Methods: We queried Surveillance, Epidemiology, and End Results (SEER) data for patients with stage I/II cancer of the pancreatic head diagnosed from 2004-2009. We excluded patients with less than 3mo survival. Resection rates were calculated within Health Service Areas (HSAs) across all 18 SEER regions. Resection rate was defined as the number of patients who had an operation divided by the total number diagnosed with early stage pancreatic cancer. Multivariate Cox regression was used to estimate the overall survival effect of HSA rates while controlling for age, gender, marital status, poverty level, education, and AJCC stage. Results: 8,323 patients with stage I (n=1,454) and stage II (n=6,869) disease were analyzed. Pancreatectomy was performed in 476 patients (32.7%) with stage I disease and 3,846 (56.0%) with stage II disease. HSA resection rates were arranged into five groups (quintiles) which ranged from 42.7 to 65.7% (Table). Across the quintiles, median overall survival increased from 11 to 14 months, suggesting a positive association with resection rate. Multivariate analysis revealed that for every 10.00% increase in resection rate, the risk of overall death decreased by 5.26% (p&lt;0.001). Conclusions: Patients with early stage pancreatic cancer who live in areas with higher resection rates have longer average survival times. Because geography should not influence treatment response, we conclude that efforts to raise resection rates should increase survival times in patients for whom there is uncertainty about the risk/benefits of resection. [Table: see text]

Prognostic significance of presence of any mucinous component in curatively resected stage II and III colorectal cancer patients who received adjuvant treatments: Data from a single tertiary center.

e14660 Background: Mucinous adenocarcinoma colorectal cancer (CRC) is defined as presence of more than 50% mucinous component and its prognostic significance is debatable. We analyzed the prognostic importance of positivity of any mucinous component in early stage adenocarcinoma patients who were operated and received adjuvant treatments in a single tertiary cancer center. Methods: Data from charts of early stage CRC patients curatively treated between January 1998-December 2009 in our clinic was retrospectively analyzed. Cases with any degree of mucine presence in final pathology reports were noted (including mucinous adenocarcinomas). Adjuvant treatments were either 5-FU or oxaliplatin based regimens. All rectal carcinoma patients received postoperative radiotherapy. Survival analyses were made by Kaplan-Meier estimator, and independent factors of survival were tested with Cox regression test. Survival data of subgroups were compared with log-rank test. Results: 532 patients (45% female) were analyzed. Median follow-up was 36 months. Median age at diagnosis was 62 years (24-84). Fifty-four percent of patients had rectal primary (n=292). Presence of any mucinous component was found in 94 patients (17.7%). There was a close relation between mucine presence and T stage (p=0.0001) or tumor grade (p=0.0001). There was no statistical relation between presence of mucine and lymphatic invasion, vascular invasion, or perineural invasion. Five-year disease-free survival for mucine (+) and mucine (-) tumors were, 45.7% and 61.4%, respectively (p=0.031). Five -year overall survival of mucine (+) tumors was worse than mucine (-) tumors (65% vs. 74%, p=0.004). Conclusions: Presence of any mucinous component in early stage CRC appears to be an important bad prognostic feature in our patient group, which was not previously reported in the literature to our knowledge. This “context specific prognostic property” of presence of any mucinous component might serve as a stratification factor for further adjuvant CRC studies.