AG

AA

bst

ract

spancreatic adenocarcinoma diagnosis code claim was specifically identified. Results: A totalof 16103 cases were identified. Cancer directed surgery (CDS) was performed in 9.2%,chemotherapy (CT) in 27.2%, and radiation therapy (RT) in 15.1%. In the bivariate analysis,African Americans were less likely to undergo CDS (p= 0.013), CT (p=<.001), and RT (p=0.023) compared to whites and others. A multivariate model for each therapy type wascreated to include race, SES, gender, marital status, comorbidity, SEER registry, tumor site,tumor type (solid or cystic), cancer stage, diagnosis year, and physician specialty. Race(African American vs. white) was not an independent predictor of CDS (OR=0.89, 95%CI =0.63-1.25), CT (OR=1.04, 95% CI =0.85-1.28), or RT (OR=1.04, 95% CI=0.85-1.28).An early claim for a visit with a surgeon carried an odds for undergoing CDS of 2.09 (95%CI =1.74-2.52) compared to a primary care provider or non-GI internist. A visit witha surgeon (OR=1.67, 95% CI=1.47-1.89), oncologist (OR=2.46, 95% CI=2.22-2.74), orgastroenterologist (OR=1.31, 95% CI=1.16-1.48) also increased the odds of CT. For RT,odds were also increased with an encounter with a surgeon (OR=1.77, 95% CI=1.52-2.06),oncologist (OR=2.14, 95% CI=1.86-2.46), or gastroenterologist (OR=1.32, 95% CI=1.13-1.53). Conclusions: Although therapies for pancreatic adenocarcinoma were performed atlower rates in African Americans, when controlling other patient, tumor, and providervariables, disparities were no longer present. A clinical visit with a surgeon, oncologist, orgastroenterologist at the time of diagnosis was independently associated with higher ratesof CT and RT. An early encounter with a surgeon was associated with increased odds ofundergoing CDS. The role of additional provider factors in the distribution of cancer therapiesdeserves further study.

M1286

Role of CA 19-9 As a Prognosis Factor Before and After Pancreatic CancerTreatmentYoun Joo Kim, Joo Kyung Park, Ki Young Yang, Jeong Kyun Seo, Yong-Tae Kim, YongBum Yoon

Purpose: CA 19-9 is used extensively when diagnosing pancreatic cancer. However, its roleto predict treatment response and prognosis has not been established. CA 19-9 level maybe increased by biliary tract obstruction, as well as pancreatic cancer, but the previousstudies have limitation as they have not considered the latter. This study is designed to seewhether CA19-9 level can be used as a prognosis factor for pancreatic cancer and a biochem-ical marker to evaluate treatment response by focusing on pancreatic cancer patients withoutbiliary tract obstruction Methods: 460 patients, who were diagnosed with pancreatic cancerbetween May, 1996 and May 2008, had total bilirubin level under 1.2mg/ml and had CA19-9 level checked before and after the cancer treatment. We analyzed the difference inprognosis between those with CA 19-9 level over and under 575 U/ml, which the medianlevel. We also analyzed whether there was any difference in treatment response or prognosisbetween those whose CA 19-9 level decreased by 50% or not. Results and Conclusion:Median survival period of those whose CA 19-9 level on diagnosis was under 575 U/mlwas 9.9 months, longer than 6.4 months of those over 575 U/ml. (p<0.001) When weanalyzed the patients with the upper limit of normal CA 19-9 level, which is 39 U/ml, therewas a difference in survival period between those over and under the level. Median survivalperiod of those whose CA 19-9 level decreased by more than 50% after the first treatment(n=93) was 14.4 months (CI; 13.0-15.8) and longer than 8.3 months (95% CI; 6.9-9.8) ofthose whose CA 19-9 level did not. (p<0.001) When we analyzed the patients accordingto treatment type, among those who received only palliative chemotherapy, those with higherinitial CA 19-9 level showed survival period longer than those with lower level. (9.3 vs 7.0months) In addition, those with CA 19-9 level decreased by more than 50% after thechemotherapy showed survival period longer than those with less than 50%. (13.5 vs 7.8months, p=0.0065) However, among the 68 patients who received surgical resection, therewas no survival period difference between those with higher and lower initial CA 19-9 level(17 vs 14.8 months) and postoperational decrease of CA 19-9 level did not affect the survivalperiod. (decrease group 16.2 vs not decrease group 17.3 months) In conclusion, pre-treatment CA 19-9 level is a predictor factor for survival period of pancreatic cancer patientsand the decrease of the level after the palliative chemotherapy helps predict the treatmentresponse and the prognosis.

M1287

New-Onset Diabetes Mellitus Is Not Associated with the Prognosis ofPancreatic CancerSuguru Mizuno, Yousuke Nakai, Keisuke Yamamoto, Hiroshi Yagioka, Yoko Yashima,Kazumichi Kawakubo, Hirofumi Kogure, Takashi Sasaki, Naoki Sasahira, Kenji Hirano,Takeshi Tsujino, Hiroyuki Isayama, Minoru Tada, Takao Kawabe, Masao Omata

Background: High prevalence of new-onset diabetes mellitus (DM) is reported in patientswith pancreatic cancer (PaC). However, it is uncertain whether new-onset DM can be a clueof early diagnosis of PaC. Methods: We reviewed the medical records of 395 cases withPaC diagnosed at our department between November 1993 and September 2008. DM wasdefined as casual plasma glucose of 200 mg/dl or greater, HbA1c of 6.5% or greater, ortreatment for diabetes. We classified 395 cases into 3 groups: ”Non DM”, cases withoutDM; “New-onset DM”, cases with DM diagnosed within 2 years of PaC diagnosis; and “Long-standing DM”, cases with DM diagnosed 2 years or more before. Cases with DM incidentallydiagnosed at the time of PaC diagnosis were classified into New-onset DM. We comparedclinical characteristics, UICC stage, and prognosis among the 3 groups. Results: Of 395cases (238 men and 157 women), median age was 67 years (range, 31-93 years), and mediantumor diameter was 30 mm (range, 8-200 mm). UICC stage was I in 7%, II in 19%, III in31%, and IV in 43%. Twenty five percent received surgery, 54% received chemotherapy,and 22% received BSC only. The prevalence of DM was 47%, and new-onset DM was 44%in all DM. There were no significant differences in clinical characteristics among the threegroups. Median tumor diameter of each group was 30 mm in Non DM, 34 mm in New-onset DM, and 30 mm in Long-standing DM. The proportions of earlier stage (stage I/II)were 24%, 28%, and 28%. The resection rates were 25%, 25%, and 24%. Median survivaltime (MST) were 10.1 months, 11.5 months, and 12.6 months respectively. In nine cases,New-onset DM was the initial sign of PaC diagnosis, and MST of these nine cases was not

A-390AGA Abstracts

significantly different from that of others. The prevalence of DM was 51% at Stage I/II and46% at Stage III/IV. The prevalence of New-onset DM was 23% and 21% respectively.Median HbA1c of New-onset DM was 7.4% at stage I, 7.2% at stage II, 8.7% at stage III,and 7.3% at stage IV. There was no correlation between disease extention of PaC and theseverity of DM. Conclusions: In our retrospective analysis, New-onset DM did not lead toearly diagnosis and better prognosis in PaC.

M1288

Prevalence of Pancreatic Cancer in Diabetics and Clinical Characteristics ofDiabetes Associated with Pancreatic Cancer in KoreaSeung Goun Hong, Jae Seon Kim, Sung Joo Jung, Moon Kyung Joo, Beom Jae Lee, JongEun Yeon, Jong-Jae Park, Kwan Soo Byun, Young-Tae Bak

Background & Aims: Diabetes mellitus (DM) has been postulated to be both a risk factorand a consequence of pancreatic cancer (PC). In Korea, the prevalence of PC in generalpopulation has been reported as 14.8 in 100,000. However, that in DM has not beenelucidated yet. This study was designed to estimate the prevalence of PC among DM patients,to characterize the patients with PC with and without DM, and to compare the clinicalcharacteristics of DM patients with and without PC at a single center of Korea. Methods:5,082 patients (4,890 DM patients without PC, 78 PC patients with DM, and 114 PC patientswithout DM) were enrolled from Korea University Guro Hospital during a period of 4 yearsbetween January 2004 and January 2008. Multivariate logistic regression and discriminantanalysis were used to compare the clinical characteristics. Results: The prevalence of PC inDM patients was 1.6% and that of DM in PC patients was 40.6%. No significant differencesin the clinical characteristics were observed between PC patients with DM and without DM.Among 78 PC patients with DM, DM was diagnosed in 19 (29.4%) and 29 (37.1%) patientsconcomitantly or within 2 years prior to the diagnosis of PC, respectively. Among the caseswith recent onset DM (less than 2 years' duration), the disease duration of DM before thediagnosis of PC was less than 1 year before the diagnosis of PC was 14 patients (17.9%),and 1 to 2 years in 15 patients (19.2%). DM patients with PC were found to have significantlyhigher total bilirubin, ALP, and ALT levels than in DM patients without PC (4.7±7.8 vs.0.9±1.6 mg/dL, 235.6±250.2 vs. 86.1±68.2 IU/L, and 89.5±144.6 vs. 39.8±158.0 IU/L,p<0.01). Conclusions: The prevalence of PC in DM patients was higher than in the generalpopulation. DM in PC patients was frequently of recent onset (less than 2 years' duration).Clinicians should keep a possibility of PC in their minds when DM patients show abnormallevel of bilirubin, ALP, or ALT.

M1289

Family History of Certain Cancers Is Not Associated with Younger Age AtDiagnosis of Pancreatic AdenocarcinomaEmmy Ludwig, Anne S. Reiner, Nancy Chung, Jennifer Simon, Sharon Bayuga, Eileen M.O'Reilly, Peter J. Allen, Robert C. Kurtz, Sara H. Olson

Background and Aims: Pancreatic cancer (PC) has been associated with several inheritedcancer syndromes, including Hereditary Non-Polyposis Colon Cancer (HNPCC), breastcancer susceptibility genes (BRCA1 and 2), Familial Atypical Multiple Mole Melanoma(FAMMM), and Peutz-Jaeger syndrome. A recent study suggested a younger age of onset ofPC in patients (pts) with a family history (FH) of cancers associated with these syndromes.In this study we examined FH of cancer and other factors (smoking, gender, religion) inrelation to age at diagnosis of PC. Methods: Our Familial Pancreatic Cancer Registry includesboth familial and sporadic PC pts. Using data from our registry we conducted a case-controlstudy between April 2004 and April 2008. 470 pts were personally interviewed about PCrisk factors and completed a questionnaire on FH. Wilcoxon sum rank or Kruskal-Wallistests were used to evaluate for difference in age of onset in pts with and without a familyhistory of certain cancers including breast, colon, pancreatic, ovarian and melanoma. FHwas defined as having at least one first or second degree relative with the specific cancer.Linear regression models were used to adjust for possible confounding variables. Results:After adjusting for religion, smoking intensity, and gender, we did not find a difference inage of onset of PC between those with and without a FH of pancreatic (P = .58), breast(P = .95), ovarian (P = .69), colon (P = .33) cancer or melanoma (P = .93). Independentof FH and other variables, Jewish pts were diagnosed at a later age (mean age 66.7) thanCatholics (62.6) or Protestant/other pts (63.4), p= <0.001. After adjustment for other vari-ables, age at diagnosis decreased in a linear fashion with increasing intensity of tobaccoexposure; never smokers had a mean age at diagnosis of 63.2 as compared with pts with>1 pack per day at maximum smoking usage (58.3) p= 0.01. Women were somewhat, butnot significantly, younger than men in our population p= 0.06. Conclusion: While inheritedcancer syndromes are associated with an increased risk of PC, there does not appear to bean association between younger age of onset of PC and a FH of cancers associated withthese syndromes. Tobacco exposure remains a significant factor in the development ofPC regardless of FH. Differences from the earlier report may be attributable to differentstudy populations.

M1290

Calcification Is a Factor of Cancer Incidence in Chronic PancreatitisNaoki Sasahira, Minoru Tada, Suguru Mizuno, Keisuke Yamamoto, Hiroshi Yagioka, YokoYashima, Kazumichi Kawakubo, Hirofumi Kogure, Takashi Sasaki, Yousuke Nakai, KenjiHirano, Takeshi Tsujino, Hiroyuki Isayama, Haruhiko Yoshida, Takao Kawabe, MasaoOmata

Background: Patients with chronic pancreatitis (CP) has an increased risk of pancreaticcancer compared with the general population. If the chronic continuous inflammation causescancer in the pancreas, the carcinogenesis may be increased in advanced CP accompaniedwith calcification. Methods: Consecutive patients of CP and referred to the Department ofGastroenterology of Tokyo University Hospital from January 1995 to December 2007 wereprospectively studied. Imaging modalities were performed in all patients at their first visit