national cancer statistics registries. Records corresponding to patients over the age of 16years diagnosed with colorectal cancer between 1985 and 2004 were included in the study.After preprocessing and joining the raw data across both registries, the population consistedof 135,000 data records, containing 60 usable variables for potential inclusion in the model.After dividing the test set into training and testing sets, we used the information gain rationmethodology, as well as a novel oversampling balancing technique that generates syntheticdata points to account for the loss of information resulting from death of patients betweenyears 1 and 5 post-diagnosis. We selected 11 predictive attributes, including tumor size andextension, lymph node involvement, regional nodes and primary site involvement, stage,histologic type, and demographic factors including age, gender, and place of residence.Then, experiments were run on 25 data classification schemes consisting of basic classifiers(trees, functions, and logistic regression) and boosting meta-classifiers. Using 10-fold cross-validation, the validity of each of these classification schemes was tested. Results: Combiningbasic and meta classifiers chosen from the 25 candidate schemes resulted in highly accurateprediction of survival rates using only 11 of the most predictive patient data features from60 potential features. Namely, the model achieved 89.5% accurate prediction of the 1-yearpost-diagnosis survival rates of CRC patients, and 86.2% accurate prediction of the 5-yearpost-diagnosis CRC survival rates. Conclusion: By combining basic and meta-classifiers andusing a novel combined database larger than others in preceding studies, a model wasdeveloped using just 11 of 60 potential variables to predict mortality rates of CRC patients1 and 5 years post-diagnosis, with accuracy of approximately 90% and 86%, respectively.The insights generated by this model could aid diagnosed patients and clinicians greatly indeveloping cancer treatment and surveillance plans.

Mo1909

Prognostic Significance of Bioelectrical Impedance Analysis Defined BodyComposition in Upper Gastrointestinal CancerLlion Davies, Paul A. Blake, Andrew Beamish, Alex Karran, Charlotte E. Thomas, JoleneWitherspoon, Gary Howell, Rachael C. Barlow, Wyn G. Lewis

Introduction Upper gastrointestinal (UGI) surgery is by definition high risk and contemporaryvalidated risk assessment tools include the American Society of Anaesthesiologists (ASA)physical status classification system, Cardio-pulmonary exercise (CPEX) testing, and thePhysiological and Operative Severity Score for the enUmeration of Mortality and Morbidity(POSSUM). More recently Bioelectrical Impedance Analysis (BIA) has been championed asa prognostic factor in colo-rectal, pancreatic and lung cancer, but has not been tested inthe arena of UGI cancer. The aim of this work was to investigate the relation of BIA definedbody composition parameters in UGI cancer. Methods Consecutive 85 patients [median age66 (range 24-86), 65 m, 52 oesophageal and 33 gastric cancer] undergoing surgery werestudied prospectively. All patients underwent BIA (Maltron Bioscan 920) assessment pre-operatively to measure patient specific Free Fat Mass (FFM, Kg), Body Fat (BF, Kg), TotalBody Water (TBW, percent), Lean Muscle Mass (LMM, Kg) and the Phase Angle (PhA).The primary outcome measure was survival. Results Operative mortality (n=4, 4.7%) wasassociated with lower BF (11.0 vs. 21.5Kg, p=0.019), and higher TBW (67.4 vs. 55.9%, p=0.011). Survival on univariate analysis was related to BF (p<0.001), TBW (p<0.001) andradiological (r)TNM stage (p=0.040), but not age (p=0.578), gender (p=0.665), body massindex (p=0.238), ASA (p=0.073), FFM (p=0.639), LMM (p=0.328), or PhA (p=0.576). LowerBF was associated with poorer survival [2yr survival LQ (<12.6Kg) 53.0% vs. UQ (>26.5Kg)76.2% respectively, p<0.001]. Conversely, higher TBW was associated with poorer survival[2yr survival LQ (<52%) 72.2% vs. UQ 56.5% (>61%) respectively, p<0.001]. On multivariateanalysis only TBW was independently associated with duration of survival; HR 1.079,95% CI 1.035-1.124, p<0.001. Conclusion BIA defined body composition parameters areimportant prognostic indicators in UGI cancer and enhanced recovery programs containingbespoke nutritional strategies require research and development.

Mo1910

Visceral Adiposity Is a Risk Factor for Poor Prognosis in Colorectal CancerPatients Receiving Adjuvant ChemotherapyChun Seng Lee, David J. Murphy, Colm McMahon, Blathnaid Nolan, Garret Cullen, HughMulcahy, Kieran Sheahan, David Fennelly, Elizabeth J. Ryan, Glen Doherty

Background Obesity is an important risk factor for the development of malignancy includingcolorectal cancer (CRC). However, it is not clear how obesity impacts on oncological out-comes. Studies using B.M.I. as a marker of obesity show no impact on outcome in CRCpatients. Radiological assessment of body composition by computerized tomography (CT)is a reliable method for assessing for obesity and offers an alternative approach to examinethe interaction between body composition and CRC survival. We hypothesize that increasedvisceral obesity may negatively impact on survival in our cohort of CRC patients. Aims andMethods We conducted a retrospective review of CRC patients who received adjuvantchemotherapy at our center during the period 2006-2009 identified from a prospectivelymaintain database. Patient demographics, surgery details, tumor pathology and chemotherapydetails were recorded. Visceral adiposity was determined by measuring visceral fat area(VFA) on pre-operative staging CT. Patients with VFA >130 cm2 were defined as havingvisceral obesity. All patients were followed up to study completion or death. Results 62CRC patients (33 males) received adjuvant chemotherapy and had pre-surgery CT imagesavailable for analysis. Mean age at diagnosis was 63.2 years (Range= 30.5 to 78.8) and 35patients (56.4%) had positive nodes on pathological staging. Median VFA was 129.5 cm2(SD: 89.0) and 31 patients (50%) were thus classified as having visceral obesity. 85.4% ofthe patients completed their course of chemotherapy. Visceral obesity was not associatedwith increased risk of chemotherapy toxicity or failure to complete treatment. After a medianfollow up of 5 years, cumulative overall survival (OS) and disease-free survival (DFS) were72.6% and 62.9% respectively. Patients with visceral obesity had a significantly lowercumulative OS (54.8% v 90.3%, p=0.02)(fig. 1) and DFS (48.4% v 77.4%, p=0.01)(fig. 2)compared with non-viscerally obese patients. Multivariate analysis using cox proportionalhazards model showed that visceral obesity is independently associated with reduced OS(Hazard ratio= 3.73; 95 CI 1.04-13.3; p=0.04) Conclusion This study shows that visceralobesity increases the likelihood of a poor prognosis in CRC patients undergoing adjuvant

S-689 AGA Abstracts

chemotherapy. These findings suggest a possible negative impact on the efficacy of adjuvantchemotherapy in obese patients and warrant further investigation in a prospective study.

Mo1911

Association of Type 2 Diabetes and Colorectal Polyps and AdenomasShahla Majdi-Yazdi, Anteneh Zenebe, Gail Nunlee-bland, Mansour Paydar, Adeyinka O.Laiyemo, Andrew K. Sanderson, Rehana Begum, Hassan Brim, Mehdi Nouraie,Mohammad Semati, Hassan Ashktorab

Background:There is increasing evidence that type 2 diabetes mellitus (DM2) is associatedwith an increased risk for colorectal adenoma because of the hyperinsulinemic state of thepatients and the fact that high Insulin Growth Factor 1(IGF1) is linked to the developmentof colorectal adenoma. African Americans (AA) have higher risks for DM2 and colon adenoma.We evaluated whether DM2 is associated with an increased risk of colorectal adenomaamong Africa Americans. Material and methods We conducted a retrospective chart reviewof 806 patients who underwent colonoscopy at Howard University Hospital (HUH) fromJan-2010 to Dec-2011 and identified 131 patients with DM. We compared the demographicand lifestyle characteristics of patients with and without DM. We used logistic regressionmodels to evaluate the association between DM and the prevalence of polyps and adenoma.Results We reviewed 806 patients. There was a higher proportion of females (448 vs. 358respectively). Median (interquartile) age was 57 (52-64) years. There were more screeningpatients than diagnostic one (59% vs. 16%, respectively) and in 21% of patient the indicationof colonoscopy was follow up of previous colonoscopies. Normal colonoscopy were seenin 304 (38%) of the subjects. Patients with adenoma was 294(36%) in which 258 (88%)were tubular adenoma. There were 12(1%) colorectal cancers. Of all adenomas, 163 (55%)were right sided and 64 (22%) had more than 1 cm size. With regards to polyps, previouspolyp history and alcohol use had a significant relation for developing polyps (p=0.02 andp=0.05 respectively). Diabetes diagnosis was significantly associated with higher risk ofpolyp (OR= 1.66,95%CI=1.09-2.58) or adenoma (OR=1.74, 95%CI=1.17-2.59). There wasno relation between any history of colon disease, colon polyp, smoking or alcohol use withadenoma. Discussion Our data showed that DM2 is a risk factor for colon polyp andadenoma. Since African Americans are more at risk for both diseases, this finding will havean impact on screening the patients for either disease. The fact that patients with DM2 areprone to have polyps, and polyps are seen during colonoscopy, this should lead us toconsider new guidelines for colorectal and diabetic screening programs that reduce the riskof either diseases.

Mo1912

The Prevalence of Colorectal Adenomas and Advanced Neoplasms DetectedThrough PAN-Chromocolonoscopy in Patients With Non-Alcoholic Fatty LiverDisease (NAFLD). A Prospective StudyAlina Tantau, Marcel Tantau

Background and aim: To compare prevalence rate of colonic adenomas and advancedneoplasms detected by panchromoendoscopy in patients with or without NAFLD. Design:Prospective study; case-control study Setting: Tertiary referral center Patients and methods:Patients aged 35-75 with or without NAFLD who underwent consecutive panchromoendos-copy. NASH was diagnosed by liver biopsy or by abdominal ultrasounds followed bylaboratory tests to eliminate the other causes of steatosis (viral, toxic, immunologic, genetic).Personal and family medical history, age, gender, environmental status, blood pressure,anthropometric measures, BMI, cholesterol and triglycerides blood levels, as well as diabeticmellitus status were noted. Results: Out of 100 patients, who underwent panchromoednos-copy, 50 were with NAFLD and 50 were non- NAFDL. Out of 50 patients with NAFLD,16 (32%) were with NASH and 34 (68%) were without NASH. At panchromoendoscopy12 advanced colonic neoplasms (10 in the group with NAFLD and 2 in the group withoutNAFDL with statistical difference) and 52 adenomas (33 adenomas in16 patients from theNAFLD group and 19 adenomas in 11 patients from the control group), were detected.There was no difference in the detection rate of adenomas between patients with NAFLDor without NAFLD (32% vs. 22%; p=0,260), but there was difference in the prevalence ofadvanced colonic neoplasms between patients with or without NAFLD (20% vs. 4%;p<0,014). In the NAFDL group, the presence of adenomas have a statistically significantcorrelation with the presence of NASH (p=0,044, OR 3, 48; 95%IC: 1,007-12,057), higherwaist circumference (p=0,027) and BMI greater than 30 kg/m2 (p=0,041). Multivariateregression analysis demonstrated an independent risk of colorectal adenomas with NASHafter adjustment, according to demographic and metabolic factors (OR 9, 52 (955CI 1,71/52,85; p=0,010). Younger age ( 62 years vs. 69,27 years) (p=0,005), higher waist circumfer-ence (p<0,001), obesity (p=0,001) and the presence of the metabolic syndrome (p<0,001)are statistically significant more frequent in the NAFDL group with adenomas, than in thecontrol group with adenomas. Higher waist circumference (p<0,001), obesity (p<0,001) andhypertriglyceridemia (p=0,029) present a statistically significant association with advancedneoplasms in patients with NAFDL, than in the control group with advanced neoplasms.Conclusions: The prevalence of adenomas and carcinomas is higher in patients with NAFLDthan non-NAFDL patients. NASH is an independent factor that is associated with the presenceof colorectal adenomas. Younger age, high waist circumference, obesity, metabolic syndromeand hypertriglyceridemia are more associated with adenomas and advanced neoplasms inpatients with NAFDL, than in control patients.

AG

AA

bst

ract

s