Ratio of Circulating Estrogen Receptors Beta and Alpha (ERß/ERα) Indicates Endoscopic Activity in Patients with Crohn's Disease.

BACKGROUND: Data supporting a role of female hormones and/or their receptors in inflammatory bowel disease (IBD) are increasing, but most of them are derived from animal models. Estrogen receptors alpha (ERα) and beta (ERß) participate in immune and inflammatory response, among a variety of biological processes. Their effects are antagonistic, and the net action of estrogens may depend on their relative proportions. AIM: To determine the possible association between the balance of circulating ERß and ERα (ERß/ERα) and IBD risk and activity. METHODS: Serum samples from 145 patients with IBD (79 Crohn's disease [CD] and 66 ulcerative colitis [UC]) and 39 controls were retrospectively studied. Circulating ERα and ERß were measured by ELISA. Disease activities were assessed by clinical and endoscopic indices specific for CD and UC. RESULTS: Low values of ERß/ERα ratio were directly associated with clinical (p = 0.019) and endoscopic (p = 0.002) disease activity. Further analyses by type of IBD confirmed a strong association between low ERß/ERα ratio and CD clinical (p = 0.011) and endoscopic activity (p = 0.002). The receiver operating curve (ROC) analysis showed that an ERß/ERα ratio under 0.85 was a good marker of CD endoscopic activity (area under the curve [AUC]: 0.84; p = 0.002; sensitivity: 70%; specificity: 91%). ERß/ERα ratio was not useful to predict UC activity. CONCLUSIONS: An ERß/ERα ratio under 0.85 indicated CD endoscopic activity. The determination of serum ERß/ERα might be a useful noninvasive screening tool for CD endoscopic activity.

Positive Resection Margins Detected by Standardized Study of a Pancreaticoduodenectomy Sample: Is There Any Real Impact on Long-term Survival? / Margen de resección positivo tras la aplicación de un examen estandarizado de la muestra de duodenopancreatectomía cefálica: ¿tiene un impacto real en la supervivencia a largo plazo?

INTRODUCTION: The pathological evaluation of pancreaticoduodenectomy (PD) samples and the impact of R1 resections on survival has recently been questioned. This study evaluates the introduction of a standardized pathology study protocol (PSP) and the prognosis of R1 resections after long-term follow-up. METHODS: We reviewed data from a prospectively maintained database regarding 109 periampullary tumors treated by PD from 2005 to 2013. The results of the introduction of a PSP were analysed, and the recurrence rate (RR), disease-free survival (DFS) and overall survival (OS) of the R1 resections were evaluated for each positive margin. RESULTS: The PD specimens of periampullary tumors analyzed by PSP showed a higher rate of isolated lymph nodes (17 vs. 8; P=.003), N+ (60% vs. 31%; P<.001), microvascular invasion (67% vs. 34%; P=.001) and R1 resections (42% vs. 18%; P=.010). Pancreatic adenocarcinomas with R1 resection in the PSP group were compared with R0, presenting higher percentages of vascular resections (P=.033), N+ (P=.029), lymphatic and perineural invasion (P=.047; P=.029), higher RR (P=.026), lower DFS (P=.016) and lower OS (P=.025). Invasion of the medial margin correlated with a worse prognosis. CONCLUSIONS: Our series shows an increase in R1 resection after the introduction of a PSP. Infiltration of the medial margin seems to be associated with a higher RR and a decrease in DFS and OS.

Margen de resección positivo tras la aplicación de un examen estandarizado de la muestra de duodenopancreatectomía cefálica: ¿tiene un impacto real en la supervivencia a largo plazo? / Positive Resection Margins Detected by Standardized Study of a Pancreaticoduodenectomy Sample: Is There Any Real Impact on Long-term Survival?

INTRODUCCIÓN: La evaluación patológica de las muestras de duodenopancreatectomía cefálica (DPC) y el impacto de las resecciones R1 sobre la supervivencia ha sido recientemente cuestionado. Este estudio evalúa la introducción de un protocolo de estudio anatomopatológico estandarizado (PE) y el pronóstico de las resecciones R1 después de un seguimiento a largo plazo. MÉTODOS: Se revisaron 109 tumores periampulares sometidos a DPC desde 2005 hasta 2013 a partir de una base de datos mantenida prospectivamente. Se analizaron los resultados de la introducción de un PE y se evaluaron la tasa de recurrencia (TR), la supervivencia libre de enfermedad (SLE) y la supervivencia global (SG) de la resección R1 para cada margen positivo. RESULTADOS: Las piezas de DPC de tumores periampulares analizadas mediante un PE mostraron una mayor tasa de ganglios linfáticos aislados (17 vs. 8; p = 0,003), N+ (60% vs. 31%; p < 0,001), invasión microvascular (67% vs. 34%; p = 0,001) y resecciones R1 (42% vs. 18%; p = 0,010). Se compararon los adenocarcinomas pancreáticos con resección R1 en el grupo PE con los R0, presentando mayores porcentajes de resecciones vasculares (p = 0,033), N+ (p = 0,029), invasión linfática y perineural (p = 0,047; p = 0,029), una mayor TR (p = 0,026), menor SLE (p = 0,016) y menor SG (p = 0,025). La infiltración del margen medial se relacionó con un peor pronóstico. CONCLUSIONES: Nuestra serie muestra un aumento en la resección R1 después de la introducción de un PE. La infiltración del margen medial parece asociarse con una mayor TR y una disminución de la SLE y SG

INTRODUCTION: The pathological evaluation of pancreaticoduodenectomy (PD) samples and the impact of R1 resections on survival has recently been questioned. This study evaluates the introduction of a standardized pathology study protocol (PSP) and the prognosis of R1 resections after long-term follow-up. METHODS: We reviewed data from a prospectively maintained database regarding 109 periampullary tumors treated by PD from 2005 to 2013. The results of the introduction of a PSP were analysed, and the recurrence rate (RR), disease-free survival (DFS) and overall survival (OS) of the R1 resections were evaluated for each positive margin. RESULTS: The PD specimens of periampullary tumors analyzed by PSP showed a higher rate of isolated lymph nodes (17 vs. 8; P = .003), N+ (60% vs. 31%; P < .001), microvascular invasion (67% vs. 34%; P = .001) and R1 resections (42% vs. 18%; P = .010). Pancreatic adenocarcinomas with R1 resection in the PSP group were compared with R0, presenting higher percentages of vascular resections (P = .033), N+ (P = .029), lymphatic and perineural invasion (P = .047; P = .029), higher RR (P = .026), lower DFS (P = .016) and lower OS (P = .025). Invasion of the medial margin correlated with a worse prognosis. CONCLUSIONS: Our series shows an increase in R1 resection after the introduction of a PSP. Infiltration of the medial margin seems to be associated with a higher RR and a decrease in DFS and OS