327 Background: Advanced gastric cancer (GC) is a disease with high morbidity and poor prognosis. We hypothesize that different sites of metastasis have different impact in terms of symptoms and complications. We sought to evaluate if site specific morbidity in our patients impacted treatment and survival. Methods: Medical records from patients with advanced GC treated from Jan 2005 to Dec 2015 were retrospectively reviewed. Morbidity was defined as having any symptom by metastases in a specific site. OS was estimated by Kaplan Meier method and compared by Log-rank test. P value < 0.05 was considered significant. Results: We included 180 consecutive patients, median age at diagnosis was 56 years (21-90), 55% were women. Most common sites of metastases were: peritoneum 76.1%, non-regional lymph nodes 38.9%, liver 22.8%, lung 26.7%, bone 9.4% and ovary 12.8%. Regarding morbidity, at diagnosis 68% of patients presented morbidity by the primary tumor: obstruction 56%, bleeding 27%, obstruction and bleeding 3%, other 14%. Disease by peritoneum caused morbidity in 30%, by lung in 8%, by ovarian in 4.4%, by lymph nodes in 3.3%, and by other sites in 5.6% of patients. OS in the global cohort was: 3.53 months (2.2 to 4.8), nevertheless by univariate analysis we found that OS was affected by morbidity at some sites as it is show in table. More patients with peritoneal morbidity could not receive treatment vs those without peritoneal morbidity (p = 0.042). Conclusions: We found that morbidity in peritoneum, lung and ovary adversely affected prognosis of patients with advanced GC. Moreover, peritoneal morbidity preclude patients from receiving oncological treatment. [Table: see text]
590 Background: universal screening has been proposed as an alternative to clinical criteria for detection of Lynch syndrome (LS). Results of such policy have not been evaluated in mexican population with low incidence of colo-rectal cancer (CCR). Objective: to determine the proportion of patients tested by immunohistochemistry (IHC) for mismatch repair-deficient (dMMR) and characterize subsequent molecular and clinical work up for abnormal results. Methods: we identified all consecutive cases of CCR during 2016 at Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico. We recorded clinical variables, IHC for mismatch repair (MMR) proteins and/or clinical genetics evaluation and molecular confirmation of LS if available. Results: universal screening policy was adopted by our institution in 2016. 209 CRC patients had an outpatient consultation. The median age at diagnosis was 59.8 years. 103 IHC for MMR proteins were done (49%) regardless of age at diagnosis and a family history of CRC. 36/103 (35%) IHC showed abnormal result meaning lack of expression of at least one of four MMR proteins: 26 MLH1, 7 MSH2, 10 MSH6 and 23 PMS2. 11/36 patients (30%) had a family history of CRC. 26/36 (72%) were evaluated by clinical genetics service. Of 26 MLH1 deficient patients, only one case was tested for BRAF mutation. 14/36 patients (39%) were tested by sequencing analysis: 7 MLH1, 5 MSH2, 1 MSH6, 1 PMS2. 2/14 patients were tested by MLPA assay given negative sequencing analysis. Germ-line mutations were identified in 7/36 patients (19%). All mutations were identified in patients with a clinical suspicion given strong family history of CRC. No identified mutations could be attributed to universal screening policy. Conclusions: during the first year of implementing universal screening for LS in CRC patients only half of the patients were screened by IHC. Despite MLH1/PMS2 deficiency was the most frequent abnormality, BRAF mutation analysis was not performed as recommended, given the lack of access to the test. A clinical suspicion of LS was a determinant driver for confirmatory molecular testing therefore limiting the usefulness of universal screening.
644 Background: liver metastases (LM) from well-differentiated gastroenteropancreatic neuroendocrine tumors (wd-GEP-NET) can develop in 28-77% of patients (pts) in their lifetime. Multiple treatments can provide radiological and symptomatic response. Our aim was to evaluate responses to locoregional (LRT) and systemic (SYST) treatments in wd-GEP-NET with LM. Methods: we included consecutive records of pts with confirmed histological diagnosis of wd-GEP-NET and radiological LM, treated at our institution between 2008-2019. Relevant variables were retrospectively extracted from electronic records. Radiological response was assessed with RECIST 1.1 by radiological independent review. Results: 55 pts, 45.5% male. Median age at LM diagnosis 49 years (IQR 41-63). Primary tumor sites: 49% pancreatic, 27.3% small intestine, 11% unknown, 12.7% others. WHO 2019 grade 1, 2 and 3 in 52.7, 41.8 and 1.8%, respectively. Twentynine tumors (52.7%) were functional, with carcinoid syndrome in n20. At LM diagnosis, 91% of pts had symptomatic disease: hormonal n8, local n4, systemic n4, hormonal + local n4, local + systemic n22, hormonal + systemic n5, hormonal + local + systemic n5. LM tumoral burden was <10% in 22%, 11-50% in 43.6, > 50% in 30.9% of pts. 49.1% of pts had extra hepatic metastatic disease. LRT to LM was administered to 32 pts: TAE/TACE n26, ablation n8. SYST to 22 pts: somatostatin analog n15, Lutetium-177 n4, chemotherapy n2, everolimus n1. 1 pt did not receive treatment. Response to treatments is shown. In the LRT group, -- pts developed complications: n16 postembolization syndrome, n2 infections, n3 liver failure, n7 others. There was 1-procedure-related death. Conclusions: Patients treated with LRT at our institution achieved similar efficacy and safety results compared to those reported by previous studies.[Table: see text]
e18056 Background: Cancer awareness months (CAM) are a health promotion tool that pursues to increase the public knowledge of a specific type of cancer. Awareness campaigns have benefited from the ease of access to the internet and social media. Analysis of internet search data has been used as an indirect tool to determine the information-seeking patterns of people and may reflect the impact of a campaign. We aim to determine national cancer awareness months’ impact on people’s internet search habits focusing on malignancies that have a specific awareness month in Mexico: breast, colorectal and prostate. Methods: We used Google Trends (GT) to obtain search volume indexes (SVIs), a term designed by GT scaled from 0 to 100 based on total searches during a specified period, of malignancies with an awareness month in Mexico from January 2008 to December 2018. Terms were consulted in Spanish: "cáncer de mama" (breast cancer), "cáncer de colon + cáncer colorrectal" (colon + colorectal cancer), "cáncer de próstata" (prostate cancer). We compared mean SVIs from each cancer awareness month to mean SVIs from the rest of the year using two-tailed two-independent sample T-tests. For prostate and colorectal, SVI’s were compared from the year its CAM was nationally instituted. Results: For breast cancer, mean SVI from October, its awareness month was 54.18 vs 12.09 for the rest of the year (p < 0.001). For colorectal cancer, mean SVI from its awareness month March, was 65.0 vs 55.5 for the rest of the year (p = 0.34). For prostate cancer, mean SVI from November, Mexican prostate awareness month, was 72.0 vs 35.52 for the rest of the year (p = 0.44). Conclusions: Google’s search volume for breast cancer was significantly higher in its awareness month compared to the rest of the year, which proves the impact of its CAM on modifying online activity. For more recently instituted CAMs on prostate and colorectal cancer, search volume didn’t change significantly between their CAM and the rest of the year. There are perhaps lessons to be learned from the breast cancer awareness month campaign which might usefully be adapted for the highest incident malignancies in Mexico.
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