compared with Whites. Whether this finding reflects differences in biological predispositionand/or environmental exposures remains to be investigated.

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Is Lymph Node Ratio (LNR) a Prognostic Marker in Patients With ColonCancer? A Study in National Cancer Institute's Surveillance, Epidemiology,and End Results (SEER) DatabaseSiddesh V. Besur, Jyothsna Talluri, Gandhi Lanke, Siva K. Talluri

Introduction: Colon cancer is the second leading cause of cancer death in the United States.Surgery is the most common form of treatment for all stages of colon cancer. Surgery involvesresection of the affected part of bowel and associated lymph nodes. Lymph Node Ratio(LNR) is defined as ratio of metastatic to examined lymph node. It is a useful prognosticindicator in breast, esophageal, pancreatic and gastric cancer. The primary objective of ourstudy is to evaluate lymph node ratio as a prognostic marker in patients with stage III andstage IV colon cancer. Methods: We studied a retrospective cohort of stage III and stage IVcolon cancer patients included in National Cancer Institute's Surveillance, Epidemiology,and End Results (SEER) registry from 1988 to 2009. The LNR's were grouped into 4categories (LNR 1 ,0.05, LNR 2 0.05-0.19, LNR 3 0.2-0.39 and LNR 4 0.4-1) basedon accepted lymph node ratios for colon cancer. We compared demographic and tumorcharacteristics of colon cancer patients using Chi-square tests. Multivariate analysis wasperformed using Cox proportional hazard regression to compare survival between differentLNR groups after adjusting for age, colon cancer stage and grade. Results: We included26,562 patients with stage III and IV colon cancer. The mean age was 67.2 years and mediannumber of examined lymph nodes was 14. A median of 3 lymph nodes were positive forthe disease. The majority (39%) of patients were in LNR 2 category (0.05-0.19). We included18,167 patients with stage III and 7331patients with stage IV disease. The univariate analysisshowed a 5-year colon cancer-specific survival of 70%, 57%, 41% and 23% with increasingLNRs (P,0.001). The Cox proportional hazard regression analysis after adjusting for stage,age and grade of the tumor shows the effect of LNR on survival as shown in Table 1andFigure 1. Conclusion: Lymph node ratio in colon cancer is an important independentpredictor of prognosis in patients with stage III and IV colon cancer.Table 1

Multi-variate Analysis with effect of Lymph Node Ratio on survival in patients with stageIII and stage IV colon cancer after adjusting for age, grade and stage of colon cancer.

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Relationship Between Colorectal Polyps and Angiotensin Receptor Blockersand Angiotensin-Converting Enzime InhibitorGuillermo N. Panigadi, Lisandro Pereyra, Raquel González, Estanislao J. Gómez, José M.Mella, Carolina Fischer, Leandro Correa, Alfredo G. Torres, Gastón Babot, AdrianaMohaidle, Pablo Luna, Silvia C. Pedreira, Daniel G. Cimmino, Luis A. Boerr

Introduction: Angiotensin-receptor blockers (ARBs) and angiotensin-converting enzymeinhibitors (ACEI) are widely used drugs. The renin-angiotensin system has been relatedwith angiogenesis and tumor progression. The association of these drugs with colorectalneoplasia has not been described. Aim: To determine the risk of colonic polyps in patientsunder ARBs or ACE inhibitors treatment. Materials and methods: A prospective transversalcohort study was conducted in a private community hospital from August 2010 to October2012. Patients scheduled for an outpatient colonoscopy during this period were included,and were asked to complete a survey with information about their behavioral factors (diet,exercise and smoking), disease history (diabetes, obesity, dyslipidemia and hypertension),medications (hypolipemiant, antihypertensive and non-steroidal anti-inflammatory drugs)and personal and family history of colorectal neoplasia. In those patients under ARBs orACEI treatment, type and treatment duration was also consigned. We calculated the risk ofadenomas, adenomas with high grade dysplasia, advanced neoplastic lesions (ANL) (size .1 cm, high grade dysplasia and/or . 75% of villous component) and cancer (CRC) inpatients under ARBs or ACE inhibitors treatment. Risk was expressed in OR and its 95%

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confidence intervals (CI). A p value , 0,05 was considered statistically significant. Results:1278 patients were analyzed, 280 (22%) under ARBs or ACE inhibitors treatment and 998(78%) without treatment. There were significant differences between both groups respectto average age (63 vs. 56 (p 0,001)), gender male 65% vs.46% (p 0,001), diabetes 17% vs.4% (p 0,0001), BMI 28 vs. 25 (p 0.001), dyslipidemia 46% vs.31% (p 0,0001), and chronicnon steroidal anti-inflammatory drugs 37% vs. 29% (p 0,05), former smoker 26% vs.16%(p 0,001), CRC history family 10% vs 17% p 0,004). The risk of adenomas, adenoma withhigh grade dysplasia, ANL and CRC was similar in both groups: OR 1,3 (CI 0.9 - 1,8), OR0,8 (CI 0,3 - 2,2), OR 1,3 (CI 0.8 - 2,1), OR 1,6 (CI 0,6 - 3,9) respectively. We did notfind statistically significant differences when analyzing separately those patients taking ACEIand those taking ARBs nor in those under different treatment durations ( ,5 years, between5 and 10 years, .10 years). Conclusion: we did not find an increased risk of colorectalneoplasia among those patients under ARB or ACEI treatment.

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Pancreatic Cancer Hospitalizations in the United States: Trends,Characteristics, Resource Utilization and Outcomes in the Past DecadeSravanthi Parasa, Neil Gupta, Gokulakrishnan Balasubramanian, Vijay Kanakadandi,Prateek Sharma

Background and Aims: Little is known about the rates of hospitalization for pancreatic cancerand health care utilization. The objective was to examine trends in pancreatic cancer relatedhospitalization in the United States over the past decade. Methods: Trends in patient charac-teristics, resource utilization and outcomes were calculated and assessed using data fromthe Nationwide Inpatient Sample for years 2000-2009. All hospital discharges with a primarydiagnosis of pancreatic cancer were selected. Total number of hospitalizations, annual dis-charge rates, and 95% confidence intervals were calculated and trends assessed using linearregression as well as Cochran-Armitage test for trend. Results: Between 2000 and 2010 thetotal number of hospitalizations for pancreatic cancer increased by 13% from 31,563 to36,188 but this was not statistically significant. No significant differences were seen in theproportion of hospitalizations based on gender and age groups. (See figure1). The meancosts of hospitalization increased from $27,589 to $60, 107 (p trend , 0.01). The directage-standardized mortality fell by 24% in males and by 37% in females. The in-hospitalmortality improved from 16.6% to 9.9 %( p trend , 0.05) during this time period. Conclu-sion: The rates of hospitalization for pancreatic cancer have been stable have remained stableover the last decade. Although inpatient mortality has improved, approximately 10% ofpatients still die in-house. Despite these trends, the costs of hospitalization have significantlyincreased and need further evaluation.

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Colorectal Cancer Incidence in U.S.-Born and Foreign-Born Asians inCalifornia, and Influence of Neighborhood Socioeconomic Status and EthnicNeighborhood EnclaveUri Ladabaum, Christina A. Clarke, Parvathi A. Myer, David Press, Scarlett L. Gomez

Background: Colorectal cancer (CRC) incidence in Asian-Americans is lower than in whites.However, Asians include multiple subgroups and rates have been shown to vary widelyacross subgroups. We hypothesized that rates among Asians vary by nativity (U.S.-born vs.foreign-born), as well as neighborhood socioeconomic status (SES), and the degree to whicha neighborhood is an "ethnic enclave" (EE). Aims: To estimate CRC incidence rates in Asiansubgroups in California, and to explore the influence of nativity, SES, and EE. Methods:We used California Cancer Registry data from 1990 to 2004, the period for which relevantdata were available. Age-adjusted CRC incidence rates were calculated. Rates were comparedusing incidence rate ratios (IRRs). Trends in rates were explored with joinpoint analysis.Neighborhood-level SES and EE were determined based on census tracts by principalcomponent analysis. Results (Overall yearly CRC incidence): CRC incidence in U.S.-bornJapanese was similar to that in whites, while in foreign-born Japanese it was significantlyhigher (Table 1). In all other Asian subgroups, CRC incidence was significantly lower thanin whites (Table 1). For Chinese and Filipino, CRC incidence was lower in foreign-bornpersons compared with U.S.-born persons (Table 1). Results (Trends in CRC incidence):In whites aged 50-75y, CRC incidence rates decreased by 0.8% (95% CI, 0.3-1.3%) peryear from 1990 to 2000, and by 2.4% (95% CI, 0.7-4.8%) per year from 2000 to 2004(Table 1). This pattern was not observed in Asian subgroups (Table 1). Results (SES andEE): Among whites, CRC incidence decreased with increasing SES. In Asians, no such clearpattern was observed. CRC incidence decreased among Asians with increasing EE. SES andEE showed a complex interaction. The greatest contrast was seen within the high SES Asians,in whom those residing in the least EE had the highest CRC incidence, and those residingin the most EE had the lowest CRC incidence (Table 2). Conclusions: CRC incidence inforeign-born Asians was lower than in whites and U.S.-born Asians, except for in Japanese,in whom incidence was 1.43-fold higher among foreign-born compared to U.S.-born. The

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