Abstract P2-19-07: Current trends of breast reconstruction after mastectomy for breast cancer patients in China

Background: To ascertain the current trends of breast reconstruction (BR) for breast cancer patients in China, we conducted a retrospective study in Committee of Breast Cancer Society, Chinese Anti-Cancer Association.

Methods: We designed a questionnaire for this study, and it included questions on surgeon demographics, number of mastectomy and BR, type and timing of BR, reconstructive choices in the setting of preoperative or postoperative radiotherapy (RT) or chemotherapy, complication, oncoplastic surgery, fat grafting, physician and patient satisfaction, etc. All data were collected until 2012. Questionnaires were sent to 52 members of Committee of Breast Cancer Society by e-mail. By Jun-2013, 30 questionnaires (response rate 57.7%) had been returned. Among all, 3 were excluded for not performing BR. Finally, 27 respondents were included.

Results: All but one of these 27 hospitals were Class Three Grade A hospitals in China. A total of 402 surgeons worked in the general surgery or oncological surgery department, among them, only 84 (20.9%) were able to perform BR. Surgeons from 10 hospitals would also choose to cooperate with the plastic department to finish the complicated reconstructive procedure. In 2012, 21026 mastectomies were performed; among them, 679 (3.2%) received immediate BR, 102 (0.5%) received delayed BR while 192 (0.9%) received delayed-immediate one. At the same time, 414 (2.0%) had their breast reconstructed by implant while 393 (1.9%) chose the autologous ones, the choices of reconstructive type were not recorded for other 166 (0.8%) cases. According to these 27 respondents, 88.9% predominantly performed prosthetic (1265 cases in all) or latissimus dorsi myocutaneous flap (LDMF) with or without an implant (1571 cases in all) BR from the time of their first BR operation to the end of 2012. During the same period, 327 pedicled transverse rectus abdominis myocutaneous (TRAM) BR were performed in 20 hospitals, while 169 free TRAM BR, which requiring technique of microsurgery, were carried out in 9 hospitals (68.6% were performed by a single surgeon from Nov-2006). The overall complication rate of BR was 12.4%. As RT had low to medium effect on increasing the operational difficulties and influencing the esthetic outcomes of BR, about 75% surgeons would choose delayed autologous BR in patients who had previous RT. Autologous flaps were also recommended for patients who need postoperative RT, but the timing still remained controversial. The overall cosmetic outcomes of the reconstructed breasts satisfied the majority of physicians and patients.

Conclusion: With the growing number of breast cancer patients who need to undergo mastectomy, more and more BR are needed to improve the quality of life for them, but the ratio is still low in China, partially because of the lack of qualified plastic surgeons. As free flap BR requiring microsurgical techniques seems still complicated for most surgeons, implant and LDMF BR are the most common choices for patients nowadays in China. In addition, the effect of radiotherapy will be an important consideration when deciding the type and timing of BR.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-19-07.

Alcohol and sexual risk: an event-level analysis in commercial sex setting

OBJECTIVE

To assess the episodic relationship between alcohol and sexual risk in multiple-client occasions among female sex workers (FSWs).

METHODS

Data on alcohol use and sexual episodes with clients from the past two days were collected among FSWs in Guangxi, China (N=336 for yesterday, and N=299 for the day before yesterday). Logistic regression using generalized estimating equations with robust variance estimation was used to assess the alcohol-sexual risk relationship, controlling for contextual variables salient in the setting of commercial sex.

RESULTS

Alcohol use among FSWs was associated with a higher likelihood of unprotected sex with clients during both days. This relationship was modified by the number of clients received within a day. Additionally, having a larger number of drinks was associated with higher odds of unprotected sex, but the association was not consistent across the two days.

CONCLUSION

Findings from the study support an association between alcohol use and sexual risk among FSWs. The design of alcohol and sexual risk reduction intervention among FSWs in China may take advantage of the interaction between contextual factors and alcohol use on sexual risk.

Cognitive trio: relationship with major depression and clinical predictors in Han Chinese women

BACKGROUND

Previous studies support Beck's cognitive model of vulnerability to depression. However, the relationship between his cognitive triad and other clinical features and risk factors among those with major depression (MD) has rarely been systematically studied.

METHOD

The three key cognitive symptoms of worthlessness, hopelessness and helplessness were assessed during their lifetime worst episode in 1970 Han Chinese women with recurrent MD. Diagnostic and other risk factor information was assessed at personal interview. Odds ratios (ORs) were calculated by logistic regression.

RESULTS

Compared to patients who did not endorse the cognitive trio, those who did had a greater number of DSM-IV A criteria, more individual depressive symptoms, an earlier age at onset, a greater number of episodes, and were more likely to meet diagnostic criteria for melancholia, postnatal depression, dysthymia and anxiety disorders. Hopelessness was highly related to all the suicidal symptomatology, with ORs ranging from 5.92 to 6.51. Neuroticism, stressful life events (SLEs) and a protective parental rearing style were associated with these cognitive symptoms.

CONCLUSIONS

During the worst episode of MD in Han Chinese women, the endorsement of the cognitive trio was associated with a worse course of depression and an increased risk of suicide. Individuals with high levels of neuroticism, many SLEs and high parental protectiveness were at increased risk for these cognitive depressive symptoms. As in Western populations, symptoms of the cognitive trio appear to play a central role in the psychopathology of MD in Chinese women.

Substrate induced emergence of different active bacterial and archaeal assemblages during biomethane production

This study analyzed the composition of a methane-generating microbial community and the corresponding active members during the transformation of three target substrates (food waste, cellulose or xylan) by barcoded 454 pyrosequencing of the bacterial and archaeal 16S rRNA genes in the DNA and RNA. The number of operational taxonomic units at 97% similarity for bacteria and archaea ranged from 162-261 and 31-166, respectively. Principal coordinates analysis and Venn diagram revealed that there were significant differences in the microbial community structure between the active members transforming each substrate and the inoculum. The active bacterial populations detected were those required for the hydrolysis of the amended substrate. The active archaeal populations were methanogens but the ratio of Methanosarcinales and Methanomicrobiales varied between the cultures. Overall, results of this study showed that a subset of the populations became active and altered in relative abundance during methane production according to the amended substrate.

Expression of STAT3 and IGF2 in adrenocortical carcinoma and its relationship with angiogenesis

OBJECTIVE

The aim of this study was to determine the correlation between human adrenocortical carcinoma and the proteins involved in tumor angiogenesis, and to evaluate the angiogenic status of adrenocortical carcinoma.

METHODS

The expression of signal transducer and activator of transcription 3 and insulin-like growth factor 2 as well as microvessel density was measured in a series of tissue samples from 44 human sporadic adrenocortical tumors by immunohistochemistry. These specimens were classified as adenomas (n = 20) and carcinomas (n = 24) according to the histological criteria defined by Weiss.

RESULTS

A total of 19 of 24 (79.17 %) malignant cases showed positive staining for signal transducer and activator of transcription 3 and 4 of 20 (20.00 %) benign cases showed positive, the difference of signal transducer and activator of transcription 3 expression between adrenocortical adenomas and adrenocortical carcinomas was statistically significant (P < 0.001). Similarly, insulin-like growth factor 2 staining was seen in 70.83 % (17/24) of the malignant cases versus 25.00 % (5/20) of the benign, the difference of insulin-like growth factor 2 expression among two groups was statistically significant (P = 0.002). Malignant cases showed higher microvessel density compared to benign tumors (84.70 ± 12.44 vs 21.05 ± 8.07, P < 0.001). Signal transducer and activator of transcription 3 and insulin-like growth factor 2 expression were positively correlated with microvessel density in all specimens (r_s = 0.832, P < 0.001; r_s = 0.703, P = 0.001).

CONCLUSIONS

This study has confirmed that adrenocortical carcinoma overexpress signal transducer and activator of transcription 3 and insulin-like growth factor 2; these results suggest that angiogenesis of human adrenocortical carcinoma may be mediated by these proteins and they could represent selective targets for the molecularly targeted treatments of adrenocortical carcinoma.

Increased levels of SLP-2 correlate with poor prognosis in gastric cancer

BACKGROUND

Stomatin-like protein 2 (SLP-2) is a member of the highly conserved stomatin protein family whose homologues span from Archaea to humans and include stomatin, SLP-1, and SLP-3. Several studies have indicated that overexpression of SLP-2 is strongly associated with adhesion and migration in several human cancers. The aim of the present study was to evaluate SLP-2 expression at the mRNA and protein level in patients with gastric cancer (GC) and to examine the relationships between SLP-2 expression, clinicopathological features, and prognosis.

METHODS

We investigated SLP-2 expression in primary GC and paired normal gastric tissue by real-time PCR (RT-PCR; n = 16) and Western blot analysis (n = 32). Additionally, we performed immunohistochemistry (IHC) on 113 paraffin-embedded GC specimens, 30 matched normal specimens, and 30 paired metastatic lymph node samples.

RESULTS

SLP-2 is overexpressed in GC compared with the adjacent normal gastric epithelium (p < 0.001), and high-level SLP-2 expression is significantly correlated with the depth of invasion, lymph node metastasis, distant metastasis, and American Joint Committee on Cancer (AJCC) stage. Furthermore, elevated SLP-2 expression is an independent prognostic factor in multivariate analysis using the Cox regression model (p = 0.005).

CONCLUSIONS

Overexpression of SLP-2 may contribute to the progression and poor prognosis of GC.

Evaluation of the expression and role of IGF pathway biomarkers in human sarcomas

Recent studies have shown that insulin-like growth factor (IGF) signaling components have been involved in the pathogenesis and progression of different types of sarcomas. There has been some evidence to indicate the differential expression of IGF2 and insulin-like growth factor 1 receptor (IGF1R) in human sarcomas. The present study utilized immunohistochemistry (IHC) and in situ hybridization (ISH) to determine the expression of IGF2 and IGF1R in eighty-two cases of human sarcoma specimens and eight cases of non-tumor tissue (NTT). IGF2/IGF1R signaling was blocked by recombinant adenovirus-mediated IGF1R small hairpin RNA (shIGF1R), which was used to transfect into human osteosarcoma (OS) MG-63 cells. The expression of IGF2, IGF1R, matrix metallopeptidase-2 (MMP-2) and MMP-9 was detected by Real-time PCR. Cell migration was evaluated by wound healing assay. As a consequence, the expression of IGF1R and IGF2 was found in human OS with higher strong reactivity rate compared with the NTT (85.0 percent vs 50.0 percent, P=0.022; 95.0 percent vs 100.0 percent, P=0.042), elevating with the ascending order of tumor malignancy. Also, IGF1R had differential expression in different types of sarcomas (P=0.002), while IGF2 had no significant difference (P=0.105). Targeted blockade of IGF2/IGF1R signaling decreased the expression of IGF2, IGF1R, and MMP-2/-9, and diminished the migration capabilities of MG-63 cells. In conclusion, IGF1R is differentially-expressed in different types of human sarcomas, and targeted blockade of IGF1R pathway may inhibit human OS migration through down-regulation of MMP-2/-9 expression. IGF1R pathway may represent a significant therapeutic modality for the treatment of sarcomas.

[[Screening of differentially expressed miRNAs related to muscle strain and their target genes]

Muscle strain is one of the most common muscle injuries seen in the office of a practicing physician. To get a better understanding of this injury, we identified the differentially expressed miRNAs in muscle stem cells collected from injured muscle tissues of mouse. In this study, we downloaded the gene expression microarray (GSE26780) from Gene Expression Omnibus database. The dataset contained a total of 12 samples (murine muscle stem cells), including normal controls and samples collected from tissues at different time points after the injury. Differentially expreesed miRNAs were identified by LIMMA package and target genes of mmu-miR-143 were found by TargetScan. Then, a protein-protein in- teraction (PPI) network was constructed for the products of these target genes by using KUPS. Finally, Cytoscape and its plugins were used to identify and analyze the modules in this network. According to the results, 121, 136 and 148 differentially expressed miRNAs were identified in injured samples at each time point, and among them, 60 miRNAs were overlapping between all three groups. The expression values of mmu-miR-143 were most significantly altered over time at 36-72 h after the injury. Therefore, 510 target genes of mmu-miR-143 were found and a PPI network for the products of these target genes was constructed. Moreover, two modules were identified in the PPI network. Together with the previous studies, we suppose that proteins in module B, most of which are collagens or integrins, most likely participate in healing of strain injuries through cell adhesion processes.

Incidence and risk of hemorrhagic events with vascular endothelial growth factor receptor tyrosine-kinase inhibitors: an up-to-date meta-analysis of 27 randomized controlled trials

BACKGROUND

We aimed at determining the overall incidence and risk of hemorrhagic events associated with vascular endothelial growth factor receptor-tyrosine-kinase inhibitors (VEGFR-TKIs).

METHODS

We searched PubMed, EMBASE and Cochrane library databases for relevant prospective, randomized controlled trials (RCTs). Statistical analyses were conducted to calculate the summary incidence, relative risks (RRs) and 95% confidence intervals (CIs) by using either random-effects or fixed-effects models according to the heterogeneity of included studies.

RESULTS

The overall incidence of all-grade and high-grade hemorrhagic events was 9.1% (95% CI: 6.8-12.1%) and 1.3% (95% CI 0.8% to 2.1%), respectively. And the use of VEGFR-TKIs was associated with an increased risk of hemorrhagic events, with a relative risk (RR) of 1.67 (95% CI 1.19-2.33, P = 0.003), but not for high-grade hemorrhagic events (RR 1.23, 95% CI 0.86-1.77, P = 0.25). The risk of developing all-grade hemorrhagic events varied significantly with tumor types (P < 0.001) and different VEGFR-TKIs (P < 0.001). Additionally, the most common causes of all-grade hemorrhagic events were hemoptysis (48.6%) and epistaxis (20.7%), while hemoptysis (41.8%) and CNS hemorrhage (13.4%) was the most common cause of high-grade hemorrhagic events.

CONCLUSIONS

While the use of VEGFR-TKIs is associated with a significantly increased risk of developing hemorrhagic events in cancer patients, this is primarily for lower grade events.

First Report of Puccinia emaculata Infection on Switchgrass in Virginia

During the spring of 2007, approximately 2,000 switchgrass plants, representing 168 core switchgrass germplasm, were established in a field nursery at the Virginia Tech Kentland Farm Research Center in Montgomery County, VA. These germplasms were originally obtained from the USDA Plant Genetic Resources Conservation Unit (Griffin, GA) and included both lowland and upland ecotypes. After planting, the switchgrass plants were allowed to establish for 3 years. In the summers of 2009, 2010, and 2011, a substantial infection of a foliar rust pathogen was observed on more than 90% of switchgrass lines in the field. The infected leaves had dark brown pustules that were arranged in a linear fashion between the veins and mainly located on the adaxial surface of the leaf. We observed the infected leaf samples under a microscope and isolated the urediniospores. The urediniospores were brown, round, and averaged 26.08 ± 1.67 μm long and 24.65 ± 1.66 μm wide. Teliospores were observed late in the summers of 2009 and 2010. The teliospores were two-celled, oblong to ellipsoid in shape, and averaged 32.23 ± 3.07 μm in length. The apical cell width averaged 17.6 ± 1.83 μm and the basal cell width averaged 15.08 ± 1.75 μm. The morphology of both the urediniospores and teliospores were similar to Puccinia emaculata Schw. (P. emaculata) (2,3). Using previously established rust disease scoring methods (1), the infected switchgrass lines were evaluated and scored for infection severity on a 0 to 9 scale based on the percentage of leaf area infected, with 0 being either highly resistant or escaping infection and 9 being highly susceptible. The majority of upland switchgrass cultivars, including Caddo, Cave-in-rock, Blackwell, Sunburst, Pathfinder, and Dacotah, were moderately to highly susceptible to this rust pathogen and on average, scored between 7 and 8. However, the majority of lowland switchgrass cultivars, including Alamo, Kanlow, TEM-SEC, TEM-SLC, and TEM-LoDorm, were moderately to highly resistant and scored on average between 3 and 4. This result is consistent with previous reports that show that lowland ecotypes are more resistant to rust diseases (1). To further validate the identity of the rust pathogen, we designed two primers (5'-CCAGTAACGGCGAGTGAAGAG-3' and 5'-CGACTTCCATGGCCACCGTGCGGCTGTCT-3') based on the 18S rDNA sequence of P. emaculata (3). DNA was extracted from bulk infected leaf material for PCR amplification. The 1.2 kb PCR product was isolated and sent for DNA sequencing. The DNA sequence was 98% identical to the 18S rDNA sequence of P. emaculata (EU915294.1). To our knowledge, this study represents the first report of rust on a wide range of various switchgrass cultivars in Virginia. References: (1) D. M. Gustafson et al. Crop Sci. 43:755, 2003. (2) R. L. Hirsch et al. Plant Dis. 94:381, 2010. (3) J. Zale et al. Plant Dis. 92:1710, 2008.

Abstract P6-07-35: Dragonfly Effect or Ironic Paradox: Prognostic Implication of Postsurgical Drain in Breast Cancer Patients

Background: Surgical removal of primary breast cancer may result in subsequent alterations of host milieu. Massive clinical data have indicated that surgical extirpation favorably modifies the natural history for some patients, but it may also precipitate the metastatic outgrowth for others. Drainage fluid, harvested from a post-surgical wound, appears to be a physiological response to surgical trauma. However, few clinicians have recognized that the volume of wound drain might mirror the postoperative recurrence kinetics.

Methods: A total of 1439 patients were selected retrospectively from a large database of patients who underwent surgery between Jan 1, 2000 and Dec 31, 2002 in Fudan University Shanghai Cancer Center, Shanghai, China. The Spearman rank correlation analysis was conducted to evaluate the association between drainage volume of postoperative day 1 (POD1) and clinicopathological parameters, which included age at diagnosis, body weight at diagnosis, total number of excised axillary lymph nodes (ALNs), time to drainage volume less than 30ml (TTV30), total protein and albumin concentrations in serum. Survival curves were performed with Kaplan–Meier method and annual recurrence hazard was estimated by hazard function.

Results: Drainage volume of POD1 was positively correlated with age at diagnosis (Spearman's P &lt; 0.001), weight at diagnosis (P &lt;0 .001) and number of excised ALNs (P &lt;0 .001) and TTV30 (P &lt;0 .001), whereas it was inversely correlated with total protein concentration in serum (p = 0.028). We also observed that drainage volume of POD1 was significantly higher in patients with larger tumors (P &lt; 0.001) and ALNs involvement (P = 0.030).

In the univariate survival analysis, there was less recurrence and death in patients with lower drainage volume of POD1 (both p = 0.006). Cox proportional hazards regression analysis revealed that drainage volume of POD1 was an independent predictor of recurrence-free survival (RFS; p = 0.035) and overall survival (OS; p = 0.047). Additionally, triple negative patients with larger volume of POD1 seemed to have poorer RFS (log-rank p = 0.022; Cox model P &lt; 0.05) and OS (log-rank p = 0.015; Cox model P &lt; 0.05).

Conclusions: Our study suggests that postsurgical drainage volume was strongly correlated with prognosis in breast cancer patients. The aim of this study was not only to enlighten novel prognostic factors, but also to infer that some host related characteristics such as extent of reaction to surgery play very important roles in the growth of micro-metastases. Therefore, integration of both host and tumor related factors be more precise to predict relapse risk than current modalities such as the St Gallen criteria, Oncotype-21 and Mammaprint etc. Further research on the underlying mechanism of this phenomena may lead the way to new adjuvant treatment targets and strategies.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-35.

Clinicopathological significance of NMIIA overexpression in human gastric cancer

Altered expressions of nonmuscle myosin IIA (NMIIA) have been observed in certain types of cancers, but the impact of the alterations in gastric cancer (GC) remains unclear. The purpose of this study was to evaluate the expression of NMIIA at the mRNA and protein level in patients with GC and to assess its clinical significance. We investigated the expression of NMIIA in fresh, paired GC tissues by reverse transcriptase polymerase chain reaction (RT-PCR; n = 14) and Western blot analysis (n = 36). Simultaneously, we performed immunohistochemistry (IHC) on paraffin embedded specimens, including 96 GC specimens, 30 matched normal specimens and 30 paired metastatic lymph node samples. NMIIA is overexpressed in GC compared with the adjacent normal gastric epithelium (p < 0.001) and high-level NMIIA expression is significantly correlated with the depth of wall invasion, lymph node metastasis, distant metastasis and Tumor Node Metastasis (TNM) stage. Furthermore, elevated NMIIA expression is an independent prognostic factor in multivariate analysis using the Cox regression model (p = 0.021). These findings indicate that overexpression of NMIIA may contribute to the progression and poor prognosis of GC.

Visualizing orbital angular momentum of plasmonic vortices

Plasmonic vortices (PVs) are generated by focusing a radially polarized optical vortex (OV) beam onto a metal surface. The intensity distribution of the PV is registered with a near-field scanning optical microscopy and agrees well with a theoretical prediction as well as numerical calculation. Beside the dark central spot, the numerical calculation also shows an azimuthal Poynting vector belonging to the PV, implying that the orbital angular momentum (OAM) was transferred from the radially polarized OV. To directly verify the OAM, plasmonic trapping experiments with gold micrometer particles are performed and the particle rotation is visualized. Further experiments by varying the topological charge of radially polarized OVs show the corresponding changes in rotation in terms of speed and radius.

HGFK1 inhibits bone metastasis in breast cancer through the TAK1/p38 MAPK signaling pathway

Breast cancer metastasis to bone represents a devastating complication of advanced breast cancer, frequently resulting in significant increases in morbidity and mortality. An understanding of the mechanisms that govern breast cancer metastasis at the molecular level should lead to more effective therapies. Recently, the kringle 1 domain of human hepatocyte growth factor (HGFK1) was identified as a candidate metastasis suppressor gene. Here, we investigated whether HGFK1 is a key regulator of breast cancer bone metastasis. Of the 193 human breast carcinoma tissue samples examined, HGFK1 expression was relative higher in 82 (42.4%) by western blot and in 84 (43.5%) by quantitative real-time PCR. The higher expression of HGFK1 was significantly associated with a better prognostic value (P<0.001) and inversely correlated with bone metastasis (P=0.003). The efficacy of adeno-associated virus carrying HGFK1 (AAV-HGFK1) in osteolytic bone metastasis was then evaluated using an in vivo bone metastasis model. AAV-HGFK1 significantly inhibited osteolytic bone metastasis and prolonged the survival of mice in this model (P<0.01). In vitro, HGFK1 expression resulted in significant anti-invasion effects, enhanced the phosphorylation of TAK1 (transforming growth factor-β-activated kinase 1), p38 MAPK (mitogen-activated protein kinase) and MAPKAPK2 (MAPK-activated protein kinase 2) and decreased the expression of receptor activator of nuclear factor-κB (RANK), which was abrogated by the p38 MAPK inhibitor SB203580. This study shows for the first time that HGFK1 significantly inhibits the metastasis of breast cancer to bone by activating the TAK1/p38 MAPK signaling pathway and inhibiting RANK expression. Thus, AAV-HGFK1 treatment represents a potential therapy for bone metastasis in breast cancer.