Proteotranscriptomic classification and characterization of pancreatic neuroendocrine neoplasms

Pancreatic neuroendocrine neoplasms (PNENs) are biologically and clinically heterogeneous. Here, we use a multi-omics approach to uncover the molecular factors underlying this heterogeneity. Transcriptomic analysis of 84 PNEN specimens, drawn from two cohorts, is substantiated with proteomic profiling and identifies four subgroups: Proliferative, PDX1-high, Alpha cell-like and Stromal/Mesenchymal. The Proliferative subgroup, consisting of both well- and poorly differentiated specimens, is associated with inferior overall survival probability. The PDX1-high and Alpha cell-like subgroups partially resemble previously described subtypes, and we further uncover distinctive metabolism-related features in the Alpha cell-like subgroup. The Stromal/Mesenchymal subgroup exhibits molecular characteristics of YAP1/WWTR1(TAZ) activation suggestive of Hippo signaling pathway involvement in PNENs. Whole-exome sequencing reveals subgroup-enriched mutational differences, supported by activity inference analysis, and identifies hypermorphic proto-oncogene variants in 14.3% of sequenced PNENs. Our study reveals differences in cellular signaling axes that provide potential directions for PNEN patient stratification and treatment strategies.

Predictive Significance of an Optimized Panel for Basal-like Breast Cancer: Results from the Canadian Cancer Trials Group MA.5 and MA.12 Phase III Clinical Trials

PURPOSE

Accurate IHC biomarkers incorporating nestin positivity or inositol polyphosphate-4-phosphate (INPP4B) loss have recently been optimized to identify the basal-like intrinsic breast cancer subtype regardless of estrogen, progesterone, or Her2 status. We examined the predictive capacity of these basal biomarkers in the CCTG MA.5 chemotherapy and MA.12 endocrine therapy trials.

EXPERIMENTAL DESIGN

Formalin-fixed paraffin embedded blocks of primary tumors from patients randomized in the two trials were used to build tissue microarrays. IHC staining for nestin and INPP4B followed published methods and REMARK criteria. A prespecified statistical plan tested the hypothesis that patients with basal breast cancer (nestin⁺ or INPP4B^-) would not benefit from anthracycline substitution in MA.5 or from tamoxifen in MA.12.

RESULTS

Nestin positivity or INPP4B loss was observed in 110/453 (24%) interpretable samples from MA.5 and 47/366 (13%) from MA.12, and was associated with high grade, younger age, estrogen receptor negativity, triple-negative, core basal, and PAM50 basal-like subtypes. In the MA.5 trial, patients assigned as basal experienced lower benefit from anthracycline versus nonanthracycline adjuvant chemotherapy [HR, 1.49; 95% confidence interval (CI), 0.72-3.10] when compared with non-basal (nestin^- and INPP4B⁺) cases where there was a higher benefit from anthracyclines (HR, 0.75; 95% CI, 0.54-1.04; P _interaction = 0.01). In the MA.12 trial, patients assigned as basal did not demonstrate a benefit from adjuvant tamoxifen versus placebo (HR, 0.48; 95% CI, 0.12-1.86; P = 0.29), whereas nonbasal cases displayed significant benefit (HR, 0.66; 95% CI, 0.45-0.98; P = 0.04), although the interaction test was not significant.

CONCLUSIONS

The nestin/INPP4B IHC panel identifies women with basal breast cancers who benefit from nonanthracycline chemotherapy but not endocrine adjuvant treatments.

Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run

We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.

Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run

We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.

AB0280 THE INFLUENCE OF TARGET THERAPY AS WELL AS GLUCOCORTICOIDS TAPERING ON DISEASE FLARE IN SYSTEMIC LUPUS ERYTHEMATOSUS: RESULTS FROM A PROSPECTIVE CHINESE COHORT

Background:

Treat-to-target in systemic lupus erythematosus (SLE) has been proposed for 7 years and several recommendations were developed [1]. In these recommendations, prevention of flares should be a realistic target. Meanwhile, ‘remission’ or ‘low disease activity’ was recommended as the treatment target and minimizing glucocorticoids (GC) dose or withdrawal if possible was suggested in the maintenance treatment. However, would target therapy and GC tapering/withdrawal influence disease flare?

Objectives:

To investigate the frequency and determinants of disease flare, especially the influence of target therapy as well as GC tapering on flare in Chinese lupus patients.

Methods:

The baseline and follow-up data of all consecutive patients in a prospective longitudinal lupus cohort from January 2017 to June 2020 were collected. The lupus low disease activity state (LLDAS) was defined as in Golder et al., 2019[2]. The criteria for remission were from DORIS definitions [3]. Flare was assessed using the SELENA-SLEDAI flare index [4].

Results:

We enrolled 185 patients with disease duration at recruitment of 2.3 (0.8–7.7) years. During the 26.2 (12.5-34.5) months of follow-up, 73 (39.5%) patients experienced 95 flares, including 70 mild/moderate and 25 severe flares. The incidence of flare per patient-year was 0.27. Kaplan-Meier analyses showed that compared with those who never achieved LLDAS or DORIS, the patients who achieved the target at least once had a higher flare free survival rate; meanwhile, the patients with prednisone withdrawn had significantly lower flare free rate compared with those with small dose of GC maintained (≤7.5mg/d) (Figure 1A), but among the patients with different prednisone maintain doses (7.5~5mg, 5~2.5mg, and ≤2.5mg) there was not significant difference (Figure 1B). Cox regression analysis showed that younger age at disease onset and lower Complement 3 (C3) level at recruitment were independent risk factors for flare and achieving LLDAS or DORIS ≥50% of visits was independent protective factor (Table 1).

Conclusion:

In this Chinese prospective SLE cohort, age at disease onset, C3 level at recruitment and therapeutic target achieving influenced disease flare independently and significantly. GC tapering in appropriate patients and with appropriate pace did not increase the flare rate, but prednisone withdrawal may induce more disease exacerbation, which needs to be confirmed by large prospective studies.

References:

[1]Van Vollenhoven R F, et al. Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis, 2014. 73(6): 958-967

[2]Golder, V., et al. Lupus low disease activity state as a treatment endpoint for systemic lupus erythematosus: a prospective validation study. The Lancet Rheumatology, 2019. 1(2): p. e95-e102.

[3]van Vollenhoven R, et al. A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS). Ann Rheum Dis. 2017. 76(3): 554–561.

[4]Petri M, et al. Classification and definition of major flares in SLE clinical trials. Lupus. 1999. 8(8): 685-691.

Table 1.

Determinants of disease flare by multivariate Cox regression analyses

Model 1(LLDAS) ΔModel 2(RONT) ΔModel 3(Complete RONT) ΔHR95%CIP valueHR95%CIP valueHR95%CIP valueAge at disease onset (years)†0.970.95-0.990.0040.970.95-0.990.0030.970.95-0.990.003Anti-dsDNA positive at recruitment1.340.82-2.180.2171.120.68-1.850.6491.190.73-1.960.486C3 (mg/L) at recruitment0.9980.997-0.9990.0040.9980.997-0.9990.0070.9980.997-1.0000.010Minimum prednisone dose during follow- up (mg/d)0.980.90-1.080.7161.010.94-1.080.7471.040.97-1.110.243Therapeutic target achieved≥50% of observationsΔ0.600.39-0.940.0010.540.34-0.870.0110.680.51-0.920.011

Δ In the three hazard models, the different target achievement status were included respectively.

RONT: Clinical remission on treatment; Complete RONT: Complete remission on treatment.

Disclosure of Interests:

None declared

POS1481-HPR SEXUAL EXPERIENCE IN MALE PATIENTS WITH ANKYLOSING SPONDYLITIS: RESULTS FROM A CROSS-SECTIONAL STUDY OF 113 PATIENTS

Background:

The expression and experience of sexuality is a key part of an individual self-identity1, so it is essential for both healthy individuals and patients. Patients with ankylosing spondylitis (AS) may be susceptible to sexual issues due to disease activity, dysfunction and comorbid emotional problems. However, sexuality, especially sexual experience, are rarely paid attention in patients with AS.

Objectives:

Our study aims to assess sexual experience in male patients with AS, and analyze the factors affecting sexual experience.

Methods:

This is a cross-sectional study. A total of 113 patients with AS and 46 healthy people were investigated, matched according to age and body mass index. The Sexual Experience Questionnaire is used to assess male sexual experience. Linear regression analysis is used to explore the contributions of clinical variables to worse sexual experience.

Results:

There is a significant difference in the total sexual experience score between AS patients and healthy controls (41.92±8.83 vs 46.98±8.10, P=0.0013). Also, patients with AS have a worse score in all dimensions of sexual experience, including erectile function, individual satisfaction and couple satisfaction, comparing to healthy people. In the regression model after controlling for the effects of age, disease duration and body mass index, disease activity (BASDAI), function (BASFI), mobility (BASMI, chest expansion and finger-floor distance), health index (ASAS HI), sleep quality (PSQI) and psychological status (HADS, HADS-A and HADS-D) are significant determinants of sexual experience, including erectile function (except for chest expansion), individual satisfaction (except for BASMI) and couple satisfaction (except for BASMI). See Table 1 for details.

Table 1.

Multivariable regression analysis of association between sexual experience and clinical outcomes

IndependentSexual experience total scoreErectile functionIndividual satisfactionCouple satisfactionβ (95%CI)Pβ (95%CI)Pβ (95%CI)Pβ (95%CI)PPain total-0.09 (-0.25, 0.07)0.28-0.27 (-0.58, 0.03)0.073-0.51 (-0.91, -0.100.014-0.15 (-0.32, 0.02)0.077BASDAI1.35 (-2.24, -0.45)0.003-0.42 (-0.75, -0.09)0.014-0.72 (-1.16, -0.28)0.001-0.21 (-0.40, -0.02)0.028BASFI-1.80 (-2.59, -1.01)<0.001-0.62 (-0.91, -0.32)<0.001-0.89 (-1.28, -0.50)<0.001-0.30 (-0.47, -0.13)0.001BASMI-1.04 (-2.01, -0.07)0.036-0.47 (-0.82, -0.12)0.008-0.48 (-0.96, 0.001)0.051-0.09 (-0.29, 0.12)0.413Chest expansion1.60 (0.24, 2.96)0.0210.50 (-0.004, 0.99)0.0520.74 (0.07, 1.42)0.0320.36 (0.08, 0.64)0.011Finger-floor distance-0.20 (-0.33, -0.07)0.003-0.07 (-0.11, -0.02)0.009-0.10 (-0.17, -0.03)0.003-0.04 (-0.06, -0.01)0.011ASAS HI-1.27 (-1.64, -0.91)<0.001-0.42 (-0.55, -0.28)<0.001-0.62 (-0.80, -0.43)<0.001-0.24 (-0.32, -0.16)<0.001PSQI-0.60 (-1.11, -0.09)0.021-0.19 (-0.38, -0.004)0.045-0.28 (-0.54, -0.03)0.03-0.13 (-0.23, -0.02)0.019HADS-0.53 (-0.76, -0.29)<0.001-0.18 (-0.27, -0.09)<0.001-0.24 (-0.36, -0.13)<0.001-0.10 (-0.15, -0.05)<0.001HADS-A-0.86 (-1.30, -0.42)<0.001-0.28 (-0.44, -0.12)0.001-0.42 (-0.63, -0.20)<0.001-0.17 (-0.26, -0.07)<0.001HADS-D-0.99 (-1.45, -0.53)<0.001-0.35 (-0.52, -0.19)<0.001-0.44 (-0.67, -0.21)<0.001-0.20 (-0.29, -0.10)<0.001

Conclusion:

Worse sexual experience is associated with increased disease activity, decreased function, poor mobility, decreased health index, poor sleep quality and psychological status. Therefore, special attention to worse sexual experience in patients with AS is essential to assess disease-related suffering and develop new patient management strategies.

References:

[1]Hill J, Bird H, Thorpe R. Effects of rheumatoid arthritis on sexual activity and relationships. Rheumatology (Oxford), 2003. 42(2):280-6.

Disclosure of Interests:

None declared

Phospho-Ser784-VCP Is Required for DNA Damage Response and Is Associated with Poor Prognosis of Chemotherapy-Treated Breast Cancer

Spatiotemporal protein reorganization at DNA damage sites induced by genotoxic chemotherapies is crucial for DNA damage response (DDR), which influences treatment response by directing cancer cell fate. This process is orchestrated by valosin-containing protein (VCP), an AAA+ ATPase that extracts polyubiquinated chromatin proteins and facilitates their turnover. However, because of the essential and pleiotropic effects of VCP in global proteostasis, it remains challenging practically to understand and target its DDR-specific functions. We describe a DNA-damage-induced phosphorylation event (Ser⁷⁸⁴), which selectively enhances chromatin-associated protein degradation mediated by VCP and is required for DNA repair, signaling, and cell survival. These functional effects of Ser⁷⁸⁴ phosphorylation on DDR correlate with a decrease in VCP association with chromatin, cofactors NPL4/UFD1, and polyubiquitinated substrates. Clinically, high phospho-Ser⁷⁸⁴-VCP levels are significantly associated with poor outcome among chemotherapy-treated breast cancer patients. Thus, Ser⁷⁸⁴ phosphorylation is a DDR-specific enhancer of VCP function and a potential predictive biomarker for chemotherapy treatments.

The immune microenvironment and relation to outcome in patients with advanced breast cancer treated with docetaxel with or without gemcitabine

Preclinical studies suggest that some effects of conventional chemotherapy, and in particular, gemcitabine, are mediated through enhanced antitumor immune responses. The objective of this study was to use material from a randomized clinical trial to evaluate whether patients with preexisting immune infiltrates responded better to treatment with gemcitabine + docetaxel (GD) compared to docetaxel alone. Formalin fixed, paraffin-embedded breast cancer tissues from SBG0102 phase 3 trial patients randomly assigned to treatment with GD or docetaxel were used. Immunohistochemical staining for CD8, FOXP3, LAG3, PD-1, PD-L1 and CD163 was performed. Tumor infiltrating lymphocytes (TILs) and tumor associated macrophages were evaluated. Prespecified statistical analyses were performed in a formal prospective-retrospective design. Time to progression was primary endpoint and overall survival secondary endpoint. Correlations between biomarker status and endpoints were evaluated using the Kaplan–Meier method and Cox proportional hazards models. Biomarker data was obtained for 237 patients. There was no difference in treatment effect according to biomarker status for the whole cohort. In planned subgroup analysis by PAM50 subtype, in non-luminal (basal-like and HER2E) breast cancers FOXP3 was a significant predictor of treatment effect with GD compared to docetaxel, with a HR of 0.22 (0.09–0.52) for tumors with low FOXP3 compared to HR 0.92 (0.47–1.80) for high FOXP3 TILs (P_interaction = 0.01). Immune biomarkers were not predictive of added benefit of gemcitabine in a cohort of mixed breast cancer subtypes. However, in non-luminal breast cancers, patients with low FOXP3+ TILs may have significant benefit from added gemcitabine.

Value of Ultrasound-Guided Biopsy in Evaluating Internal Mammary Lymph Node Metastases in Breast Cancer

OBJECTIVES

This retrospective study aimed to assess the value of a real-time, ultrasound-guided biopsy in evaluating internal mammary lymph nodes (IMLNs) in breast cancer.

METHODS

Patients who were diagnosed with breast cancer and underwent real-time, ultrasound-guided core-needle biopsy (CNB) or fine-needle aspiration (FNA) in suspected IMLN metastasis were retrospectively analyzed. Patient information and ultrasonographic images were reviewed and correlated with pathology results.

RESULTS

Of the 164 IMLNs that were subjected to CNB, 131 were positive for metastasis by histopathologic confirmation, 8 were negative, and 25 were insufficient. By FNA, 84 IMLNs were regarded as positive for metastasis, 4 were negative, and 4 were insufficient. In total, there were 215 (83.98%) metastatic IMLNs, 12 benign IMLNs, and 29 unconfirmed by histopathology. There were statistically significant differences in the success of puncture sampling and detection of IMLN metastasis between the CNB and FNA groups (P < .05). There were no significant complications reported after FNA or CNB, including bleeding, nerve injury, infection, pneumothorax, or hemothorax.

CONCLUSIONS

Our study showed that ultrasonography accurately detected nodes that were likely to be malignant IMLNs, and that real-time, ultrasound-guided CNB and FNA are accurate and valuable techniques for the determination of status in breast cancer patients. Moreover, performing ultrasound-guided CNB and FNA on suspicious IMLN metastasis does not have additional severe complications.

Immune Checkpoint Profiles in Luminal B Breast Cancer (Alliance)

BACKGROUND

Unlike estrogen receptor (ER)-negative breast cancer, ER-positive breast cancer outcome is less influenced by lymphocyte content, indicating the presence of immune tolerance mechanisms that may be specific to this disease subset.

METHODS

A supervised analysis of microarray data from the ACOSOG Z1031 (Alliance) neoadjuvant aromatase inhibitor (AI) trial identified upregulated genes in Luminal (Lum) B breast cancers that correlated with AI-resistant tumor proliferation (percentage of Ki67-positive cancer nuclei, Pearson r > 0.4) (33 cases Ki67 > 10% on AI) vs LumB breast cancers that were more AI sensitive (33 cases Ki67 < 10% on AI). Overrepresentation analysis was performed using WebGestalt. All statistical tests were two-sided.

RESULTS

Thirty candidate genes positively correlated (r ≥ 0.4) with AI-resistant proliferation in LumB and were upregulated greater than twofold. Gene ontologies identified that the targetable immune checkpoint (IC) components IDO1, LAG3, and PD1 were overrepresented resistance candidates (P ≤ .001). High IDO1 mRNA was associated with poor prognosis in LumB disease (Molecular Taxonomy of Breast Cancer International Consortium, hazard ratio = 1.43, 95% confidence interval = 1.04 to 1.98, P = .03). IDO1 also statistically significantly correlated with STAT1 at protein level in LumB disease (Pearson r = 0.74). As a composite immune tolerance signature, expression of IFN-γ/STAT1 pathway components was associated with higher baseline Ki67, lower estrogen, and progesterone receptor mRNA levels and worse disease-specific survival (P = .002). In a tissue microarray analysis, IDO1 was observed in stromal cells and tumor-associated macrophages, with a higher incidence in LumB cases. Furthermore, IDO1 expression was associated with a macrophage mRNA signature (M1 by CIBERSORT Pearson r = 0.62 ) and by tissue microarray analysis.

CONCLUSIONS

Targetable IC components are upregulated in the majority of endocrine therapy-resistant LumB cases. Our findings provide rationale for IC inhibition in poor-outcome ER-positive breast cancer.

Abstract PS18-06: Proteomic analysis of breast cancer formalin-fixed paraffin-embedded clinical specimens identifies biologically-important subtypes with distinct clinical outcomes

Background: Genomic classification of breast cancer has advanced breast cancer diagnosis and outcomes. However, extensive heterogeneity still exists beyond their DNA or RNA profiles. Newer classifications based on protein profiling are being developed to investigate the molecular oncology of breast cancers at the level where most drugs act. Using a recently-developed technology, we performed global proteomic profiling of 300 breast cancer specimens linked to outcome data. Methods: Sections of 75 samples from each PAM50 intrinsic subtype (Luminal A, Luminal B, Her2-enriched, Basal-like; n = 300) were macrodissected and analyzed using the Single-Pot Solid-Phase enhanced Sample Preparation Clinical Tissue Proteomics, a highly sensitive 11-sample multiplex massspectrometry protocol applicable to formalin-fixed, paraffin embedded (FFPE) specimens. This methodology enables comprehensive quantification of protein expression for classifier and biomarker discovery. Patients were diagnosed during 2008-2013 (n = 178, dataset I) and 1986-1992 (n = 122, dataset II). Results: In-depth proteomic analysis measured 9088 proteins in total, including 4214 proteins quantified in every sample. Consensus clustering of 174 evaluable cases in dataset I identified four distinct groups based on expression values for 1054 highly variant proteins. Cluster 3 (n = 47, mostly basal-like with HER2-Enriched) displayed the most favorable recurrence free survival (RFS) when compared to other clusters (HR = 0.22, 95%CI [0.08-0.63], p = 0.005). This cluster was enriched for immune related pathways including antigen processing and presentation and type I & II interferon signaling, and displayed high tumor infiltrating lymphocyte counts, characterizing this cluster as “immune hot”. In contrast, cluster 2 (n = 50, mostly basal-like) exhibited the poorest RFS (HR = 2.88, 95%CI [1.45-5.70], p = 0.002) and was enriched for proteins related to stromal and extracellular matrix with few immune related peptides. Cluster 1 (n = 34, luminal B and HER2-Enriched) was associated with lipid metabolism, whereas cluster 4 (n = 43, mostly HER2-Enriched with luminal A and luminal B) had a profile enriched for extracellular matrix, blood coagulation and complement activation. Conclusions: Global proteomic analysis on FFPE specimens can characterize the heterogeneity of breast cancer in a reliable and clinically-applicable high throughput manner. Our methodology identifies protein candidates that potentially serve as therapeutic targets and could be adapted to archived clinical specimens from other tumors.

Citation Format: Karama Asleh, Gian Luca Negri, Sandra E. Spencer Miko, Shane Colborne, Christopher S. Hughes, Xiu Q. Wang, Dongxia Gao, C. Blake Gilks, Stephen K.L. Chia, Torsten O. Nielsen, Gregg B. Morin. Proteomic analysis of breast cancer formalin-fixed paraffin-embedded clinical specimens identifies biologically-important subtypes with distinct clinical outcomes [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS18-06.

[Sex Estimation of Typical Adult Vertebrae Morphology in Central China Based on CT Technique]

Abstract

Objective The morphological data of the second thoracic vertebra and the third lumbar vertebra were measured by computerized tomography （CT）. The sex differences were analyzed and the discrimination equation was obtained. Methods The data of 274 adults （203 cases from experimental group and 69 cases from validation group） from central China were collected. Four linear data （maximum transverse length of vertebral body, maximum longitudinal length of vertebral body, maximum transverse length of vertebral foramen, maximum longitudinal length of vertebral foramen）, one angle data （angle between spinous processes） and two area （vertebral foramen area, total cross-sectional area of vertebral body） data of the second thoracic vertebra and the third lumbar vertebra were collected, respectively. Then three ratios ［maximum transverse length/　maximum longitudinal length of vertebral body, maximum transverse length/ maximum longitudinal length of vertebral foramen, vertebral foramen area/ （total cross-sectional area of vertebral body-vertebral foramen area）］ and one angle （angle between spinous processes） were obtained. The discriminant equation was established for sexual discriminant analysis. Results The morphology of the second thoracic vertebra and the third lumbar vertebra was related with gender. Four single index discriminant formulae and eleven multi-index discriminant formulae were established. The 69 validation group samples were substituted into the formula for testing, and the maximum discriminant accuracy rate of the single-index discriminant formula was 75%. The maximum discriminant accuracy rate of multi-index discriminant formula was 83%. Conclusion It is feasible to conduct individual sex analysis by the morphological indexes of second thoracic vertebra and the third lumbar vertebra. The indexes have important application values in practice.

Effects of IL-1β and IL-18 induced by NLRP3 inflammasome activation on myocardial reperfusion injury after PCI

OBJECTIVE

To investigate the effect of nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome in the serum levels of interleukin-1β (IL-1β) and interleukin-18 (IL-18) in patients with myocardial reperfusion injury after the percutaneous coronary intervention (PCI).

PATIENTS AND METHODS

Twenty healthy controls (control group) and forty patients (treatment group) were recruited in this study. The enzyme-linked immunosorbent assay (ELISA) was used to measure the serum levels of IL-1β and IL-18 at various time points in both the control and treatment groups. Data processing and analysis were performed using the Statistical Product and Service Solution (SPSS) 22.0 software (IBM Corp, Armonk, NY, USA). Pearson's correlation coefficient test was applied in all data analyses. A difference was statistically significant when p<0.05.

RESULTS

The levels of IL-1β and IL-18 in the treatment group were significantly higher than those in the control group (p<0.05). The IL-1β level in the treatment group peaked at 0.5 h after PCI and then, gradually decreased. The multiple regression analysis showed that IL-1β level was positively correlated with levels of LDL-C and IL-18 (p<0.05, r=0.527 and 0.955 respectively), and negatively correlated with the HDL-C level (p<0.05, r=-0.34).

CONCLUSIONS

The levels of IL-1β and IL-18 significantly rose in patients with myocardial ischemia-reperfusion injury after PCI.

Stroma vs epithelium-enhanced prognostics through histologic stratification in pancreatic ductal adenocarcinoma

The mixture of epithelial and stromal components in pancreatic ductal adenocarcinoma (PDAC) may confound sequencing-based studies of tumor gene expression. Virtual microdissection has been suggested as a bioinformatics approach to segment the aforementioned components, and subsequent prognostic gene sets have emerged from this research. We examined the prognostic signature from the epithelial gene set of one such study using laser capture microdissected (LCM) epithelial samples. We also examined this gene set in matched stromal samples to determine whether prognostic findings were specific to the epithelium. LCM samples from 48 long-term and 48 short-term PDAC survivors were obtained. The resultant epithelial and stromal components were subjected to direct mRNA quantification using a 49 gene published PDAC classifier. Component-specific unsupervised hierarchical clustering was used to derive groups and survival differences were quantified. Immunohistochemical validation of particular genes was performed in an independent cohort. Clustering in the epithelial component yielded prognostic differences in univariable analysis (P = .02), but those differences were not significant when controlled for other clinicopathologic covariates (P = .06). Clustering in the stromal component yielded prognostic differences that persisted in the presence of other clinicopathologic covariates (P = .0005). Validation of selected genes in the epithelium (KRT6A-negative prognostic [P = .004]) and stroma (LY6D-improved prognostic [P = .01] and CTSV-negative prognostic [P = .0002]) demonstrated statistical independence in multivariable analysis. Although the genes used in this study were originally identified as being representative of the epithelial component of PDAC, their expression in the stroma appears to provide additional information that may aid in improved prognostication.

Effect of Lonicera japonica extract on lactation performance, antioxidant status, and endocrine and immune function in heat-stressed mid-lactation dairy cows

Here, we examined the effects of Lonicera japonica extract (LJE) on lactation performance, antioxidant status, and endocrine and immune function in heat-stressed mid-lactation dairy cows. Twenty-four healthy Chinese Holstein mid-lactation dairy cows, all with similar milk yield (30.0 ± 1.0 kg/d), parity (2.5 ± 0.3), and days in milk (105 ± 5 d) were allocated to 4 groups using a randomized complete block design: a negative control group (without LJE supplementation; CON) and groups that received LJE at 14, 28, and 56 g/d. The experiment lasted 10 wk over a hot summer, with a pre-feeding period of 2 wk. Cows were exposed to heat stress, as the average temperature-humidity index was greater than 72. The results showed that LJE had no effect on respiration rate; however, it reduced the rectal temperature of dairy cows experiencing heat stress in both a linear and quadratic manner; the lowest (39.03°C) was recorded for the LJE-28 group, lower than the CON group. Supplementation with LJE did not affect dry matter intake, milk yield, or milk composition. The majority of biochemical parameters in serum were unaffected by supplementation with different amounts of LJE; the exception was creatinine, which was reduced quadratically. Compared with the CON group, serum triiodothyronine concentrations increased significantly in the LJE-28 group. Addition of LJE to the diet increased thyroxine concentrations quadratically; values peaked at 18.62 ng/mL in the LJE-28 group. Furthermore, supplementation with increasing amounts of LJE quadratically increased the activity of glutathione peroxidase and total antioxidant capacity in serum but decreased concentration of malondialdehyde. Although we detected no differences in the concentrations of IgA, IgM, or cytokines, dairy cows in the LJE-28 group had higher IgG and IL-4 concentrations than did cows in the CON group. Supplementation with LJE increased concentrations of IgG and IL-4 in the serum quadratically but decreased that of IL-2. Finally, heat shock protein 72 concentrations in the serum tended to fall quadratically as the amount of LJE increased. In summary, LJE had no negative effects on lactation performance but helped to alleviate heat stress by improving antioxidant status and promoting endocrine and immune functions. Supplementation with LJE at 28 g/d is recommended for lactating dairy cows experiencing heat stress during hot summers.

[Interpretation for the group standards in guidelines for personal protection against coronavirus disease 2019 for diseases control person]

As an emerging infectious disease, the COVID-19 threatened the safety of personnel in the prevention and control during the COVID-19 pandemic. Beijing Association of Preventive Medicine organizes the Beijing CDC and other organizations drafted the group standard entitled "Guidelines for personal protection against coronavirus disease 2019 for diseases control person (T/BPMA 0002-2020)" , according to years of scientific research on personal protection. Based on the principles of emphasizing the scientific, normative and safe nature, the standard was drafted to put forward the reasonable selection and correct use of personal protective equipment for disease control personnel, as well as the procedures for personal protective equipment. The standard provided a standardized basis for ensuring the safety of disease control personnel in contacting and handling of the new coronary pneumonia outbreaks with high risks.

Evaluation of glucocorticoid-induced TNF receptor (GITR) expression in breast cancer and across multiple tumor types

Glucocorticoid-induced TNF receptor (GITR) is an emerging immunotherapy target that is expressed at high levels on regulatory T cells. Agonistic anti-GITR antibodies have anti-tumor activity in cancer mouse models, and recent phase 1 trials have demonstrated their safe pharmacological profile. However, there is limited knowledge on the relationship between GITR expression and the tumor microenvironment. GITR protein expression was assayed by immunohistochemistry on 3992 breast cancer surgical excision specimens assembled into tissue microarrays and scored visually by a pathologist for GITR expression on tumor-infiltrating lymphocytes and on carcinoma cells. GITR expression by the malignant cells was further surveyed in gastrointestinal stromal tumor (N = 713), lung carcinoma (N = 705), pancreatic cancer (N = 486), ovarian cancer (N = 445), bladder cancer (N = 88), prostate cancer (N = 88), testicular cancer (N = 76), melanoma (N = 75), renal cell carcinoma (N = 68),  epithelioid sarcoma (N = 53), and neuroendocrine tumors (N = 41). In breast cancer, GITR expression on tumor-infiltrating lymphocytes (12.4%) correlated with other immune response biomarkers (PD-L1+ on tumor cells, and PD-1+, LAG-3+, TIM-3+ lymphocytes; p < 0.001), and T-cell markers (CD8+, FOXP3+; p < 0.001). GITR+ carcinoma cells were observed in 6.0% of breast cancer cases and correlated with worse relapse-free survival (p = 0.015). Among the additional tumor types examined, cancers with GITR+ malignant cells included bladder cancer (5.7%), primary (but not metastatic) melanoma (4.5%), and ovarian cancer (3.2%); no expression was identified among examined sarcomas. To our knowledge, this is the first immunohistochemistry study to report the frequency and pattern of GITR expression in a large breast cancer cohort, or to report membranous GITR expression on malignant cells. The co-infiltration of GITR with other immune biomarkers and T-cell markers supports a potential role for anti-GITR agents in combination immunotherapies. In addition, GITR expression on carcinoma cells could imply the existence of a novel cancer immune evasion strategy worthy of further investigation.

Correction to: Mismatch repair protein loss in breast cancer: clinicopathological associations in a large British Columbia cohort

In the original publication of the article, the funding statement was published incompletely. The corrected funding statement should read as below.

[A study on the relationship between insufficient sleep and obesity among children and adolescents in China]

Objective: To analyze the relationship between insufficient sleep and obesity or central obesity in Chinese Han children and adolescents aged 9-18 years. Methods: A total of 172 710 students who participated in the 2014 Chinese National Survey on Students Constitution and Health with complete data of sleep duration and physical examination, were selected as study subjects. Insufficient sleep was defined, according to the amount of sleep for pediatric populations recommended by the American Academy of Sleep Medicine. Obesity and central obesity of children and adolescents were judged by experts from the Group of China Obesity Task Force and Health Industry Standards in China. Differences between groups were compared by using the t test or χ(2) test. Logistic regression method was applied to assess the relationship between insufficient sleep and obesity or central obesity. Results: In 2014, numbers of students with insufficient sleep, obesity and central obesity among Chinese Han children and adolescents aged 9-18 years appeared as 133 410 (77.2%), 11 145 (6.5%), and 12 603 (17.8%), respectively. Among the students with insufficient sleep, 8 358 (6.3%) were with obesity and 12 244 (17.9%) were with central obesity. The prevalence of obesity and central obesity among boys with insufficient sleep was higher than that in girls. Pupils with insufficient sleep showed the highest prevalence of obesity and central obesity. After controlling for potential confounders, the risk of obesity appeared an increase of 14.5% (OR=1.145, 95%CI: 1.092-1.200) and the risk of central obesity increased by 12.7% (OR=1.127, 95%CI: 1.078-1.178) in students with insufficient sleep, when compared with those with adequate sleep. Compared with those whose daily sleep duration was less than 6 hours, the ones who slept 7-10 hours per day showed significantly reduction on the risk of obesity and central obesity in students. Conclusions: Insufficient sleep significantly increase the risk of obesity and central obesity in children and adolescents while adequate sleep of 7-10 hours per day would reduce the risk of obesity and central obesity in students.

AB0148 ANALYSIS OF DIFFERENTIALLY EXPRESSED GENES AND MICRORNAS OF B CELLS IN PRIMARY SJOGREN’S SYNDROME BY RNA SEQUENCING

Background:

Primary Sjogren’s syndrome (pSS) is a chronic autimmune disease mainly characterized by the inflammation of exocrine glands. There two key insights into pSS pathogenesis, which included “IFN signature” and hyperactivity of B cells. mRNA and microRNA (miRNA) are very important to control the gene expression.

Objectives:

In this research, we analyzed the differentially expressed genes (DEG) and miRNA of B cells in pSS patients by RNA-sequencing. And we aim to preliminarily screen out some special miRNAs and target gene loci that may be involved in transcription regulation of B cells of pSS.

Methods:

Peripheral blood samples from 3 pSS patients and 3 age-matched healthy controls (HC) were collected. CD19+B cells were sorted by Magnetic cell sorting method. Total RNA was extracted and cDNA of transcriptome or miRNA analysis were prepared and RNA-sequencing was performed to screen the DEG and miRNA. The GO Terms was used to uncover the biological function of DEGs, and the KEGG pathway enrichment was used to find out the related signal pathway. The mRNA-miRNA conjoint analysis was also performed.

Results:

There were a total of 73 significantly DEGs in B cells of pSS patients compared to HC, including 51 upregulated DEGs (such asIFI44L,IFI44,IFIT1,IFITM1,IFIT3,IFIT2,IRF7,IFI6andISG15)and 22 downregulated DEGs (such asESR2andEGR1). GO Terms and KEGG pathway analyses showed that most of the upregulated DEGs were enriched in IFN signaling and IFN regulatory pathway, and also showed the relationship with microbial infection, such as influenza A virus, hepatitis C virus, measles and herpes simplex virus.

There were five significantly differentially expressed miRNAs, including hsa-miR-4485-3p, hsa-miR-144-5p, hsa-miR-144-3p, hsa-miR-451a, hsa-miR-4732-3p. GO Terms and KEGG pathway analyses showed that most of the target genes which regulated by those miRNAs were enrichment on herpes simplex virus and TGF-β signaling pathway.

DEG and differentially expressed miRNAs conjoint analysis showed that the target DEGs which regulated by those miRNAs participated in cytoskeleton formation and modification of DNA or RNA, such asRASD2,CKAP4,SPARS2L METTL.

Conclusion:

There were 51 upregulated DEGs and 22 downregulated DEGs in B cells of pSS patients. GO Terms and KEGG pathway analyses showed that most of the upregulated DEGs were enriched in IFN related signaling pathway, and also showed the significant relationship with microbial infection.

Conjoint analysis showed that the target DEGs which regulated by differentially expressed miRNAs participated in cytoskeleton formation and modification of DNA or RNA. There maybe more than one regulatory methods lead to DEGs in B cells of pSS patients.

Disclosure of Interests:

None declared

OP0093 FREQUENCIES AND PREDICTORS OF THE LUPUS LOW DISEASE ACTIVITY STATE AND REMISSION IN TREATMENT-NAÏVE PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS -- A REAL-WORLD COHORT STUDY

Background:

After the introduction of treat-to-target strategy in systemic lupus erythematosus (SLE), Lupus Low Disease Activity State (LLDAS) and definitions of remission in SLE (DORIS) were developed and validated. Several studies had demonstrated that the achievement and maintenance of LLDAS or DORIS was associated with good prognosis.

Objectives:

To evaluate the attainability of LLDAS and DORIS in a treatment-naïve cohort of SLE.

Methods:

LDAS5 was defined as LLDAS with a prednisone dose ≤5 mg/d. There were 4 definitions in DORIS: clinical remission on treatment (RONT), complete RONT, clinical remission off treatment (ROFT) and complete ROFT. The treatment-naïve patients from Peking University First Hospital SLE cohort were enrolled. The time to each state and their annual cumulative probabilities were estimated by Kaplan-Meier approach. The frequencies of patients who achieved each component of LLDAS or DORIS during follow-up were determined.

Results:

A total of 218 treatment-naïve patients were included, with a median follow-up of 4.48 years. Respectively, 190 (87.2%), 160 (73.4%), 148 (67.9%), 94 (43.1%), 23 (10.6%) and 18 (8.3%) patients achieved LLDAS, LLDAS5, clinical RONT, complete RONT, clinical ROFT and complete ROFT at least once during the follow-up time. The median time to LLDAS, LLDAS5, clinical RONT and complete RONT were 1.4, 2.3, 2.6 and 4.7 years, respectively.

Table 1.

Frequencies, time to achieve and annual cumulative probabilities of each state by Kaplan-Meier approach

StatesAchieved patientsNumber (%)Time to achieve(years)Cumulative probabilities of achievement (%)Year 1Year 2Year 3Year 4Year 5LLDAS190 (87.2)1.418.869.786.789.192.6LLDAS5160 (73.4)2.36.940.763.376.082.3Clinical RONT148 (67.9)2.65.536.156.168.876.6Complete RONT94 (43.1)4.74.122.637.545.350.4Clinical ROFT23 (10.6)NA1.42.95.46.710.6Complete ROFT18 (8.3)NA0.92.54.84.88.8Table 2.

Patients who achieved each component of LLDAS or DORIS during follow-up

ComponentsNumber (%)SLEDAI-2K ≤4, with no activity in major organ systems (renal, central nervous system, cardiopulmonary, vasculitis, fever), and no haemolytic anaemia or gastrointestinal active213 (97.7)Clinical SLEDAI-2K =0210 (96.3)PGA ≤1217 (99.5)PGA <0.5199 (91.3)Serology (anti-dsDNA and complement) negative148 (67.9)Prednisone dose ≤7.5 mg/day201 (92.2)Prednisone dose ≤5 mg/day171 (78.4)No prednisone dose40 (18.3)No prednisone dose and Immunosuppressants32 (14.7)

Conclusion:

Our data confirmed that LLDAS is an attainable early treatment target for SLE. Though with more difficulty, RONT can be achieved in two-thirds of our patients. ROFT may not be an ideal treatment target at present as it is only attained in few patients.

References:

[1]Franklyn, K. et al. Ann Rheum Dis. 2016 Sep;75(9):1615-21.

[2]van Vollenhoven, R. et al. Ann Rheum Dis. 2017 Mar;76(3):554-561.

Disclosure of Interests:

None declared

AB0376 DETERMINANTS AND PROTECTIVE EFFECTS OF A LOW DISEASE ACTIVITY STATE IN SYSTEMIC LUPUS ERYTHEMATOSUS: RESULTS FROM A PROSPECTIVE CHINESE COHORT

Background:

The concept of treat to target in systemic lupus erythematosus has moved forward in recent years. The Lupus low disease activity state (LLDAS) defined by the Asia-Pacific Lupus Collaboration (APLC) in 2016 has been validated prospectively in the APLC cohort itself and retrospectively in multiple other cohorts.

Objectives:

The concept of treat to target in systemic lupus erythematosus has moved forward in recent years. The Lupus low disease activity state (LLDAS) defined by the Asia-Pacific Lupus Collaboration (APLC) in 2016 has been validated prospectively in the APLC cohort itself and retrospectively in multiple other cohorts. The aim of this study was to investigate the frequency and determinants of achieving LLDAS, and the influence of LLDAS on short term outcomes including disease flare and damage accrual in Chinese lupus patients.

Methods:

The baseline and follow-up data of all consecutive patients in a longitudinal lupus cohort from January 2017 to December 2018 were collected prospectively. SLEDAI-2K, PGA and disease flare were assessed at each follow-up visit, and further compared to the previous routine clinical visits. Irreversible disease damage was captured using the SLICC damage index and the short form (36) health survey for health-related quality of life was completed annually.

Results:

One hundred and forty-nine patients were enrolled, with the median disease duration at recruitment of 2.4 (0.9–8.2) years, and median follow-up of 15.4 (10.1-18.2) months. By the end of the study, 104 (69.8%) patients achieved LLDAS at least once; 59 patients achieved LLDAS for≥50% of observations. Multivariate logistic regression analysis showed that age at disease onset< 30 years (OR=0.05, 95%CI [0.01-0.59], p=0.017), 24-hour urine total protein (UTP) level at recruitment (OR=0.9992, 95%CI [0.9987-0.9998], p=0.007), and C3 level (OR=1.004, 95%CI [1.001-1.008], p=0.024) had independent associations with achieving LLDAS for≥50% of all observations (Table 1). During follow-up, 56 (37.6%) patients experienced disease flare including 14 (9.4%) patients with severe flare. Kaplan-Meier analyses showed significant differences in flare rates according to whether LLDAS was achieved and the percentage follow-up time in LLDAS (Figure 1). Multivariate cox analysis revealed that the percentage time of time in LLDAS was an independent negative determinant of disease flare (HR=0.18, 95% CI [0.07-0.48], p=0.001) (Table 2). There were 16 (15.0%)/107 patients who had damage accrual after one year of follow-up. Multivariate logistic analysis showed a tendency for achieving LLDAS during follow-up being protective for damage accrual (OR=0.27, 95%CI [0.07-1.00], p=0.050).

Conclusion:

In this Chinese early disease cohort, LLDAS was an attainable goal in clinical practice. Age at onset, UTP and C3 level at recruitment influenced achievement of LLDAS. LLDAS was negatively associated with disease flare and damage accrual; this needs to be confirmed by future longer follow-up.

Acknowledgments:

The data in this cohort was collected and recorded using the framework of the lupus low disease activity status (LLDAS) study from the Asia-Pacific Lupus Collaboration (APLC).

Disclosure of Interests:

Yanjie Hao: None declared, Lanlan Ji: None declared, Dai Gao: None declared, Yong Fan: None declared, Eric F. Morand Grant/research support from: AstraZeneca, Consultant of: AstraZeneca, Speakers bureau: AstraZeneca, Mandana Nikpour: None declared, Zhuoli Zhang: None declared

THU0120 OVERLAPPING SJOGREN’S SYNDROME AND ULTRASOUND REMISSION, FUNCTIONAL DISABILITY AND MANAGEMENT IN RHEUMATOID ARTHRITIS PATIENTS: A PROPENSITY SCORE MATCHED REAL-WORLD COHORT FROM 2009 TO 2019

Background:

Rheumatoid arthritis (RA) patients with Sjogren’s syndrome (SS) are often referred to as more severe synovitis.

Objectives:

We intend to clarify the impact of overlapping SS on ultrasound remission, functional ability improvement and clinical decision-making in RA patients in a real-world cohort from 2009 to 2019.

Methods:

The medical records of RA patients in our medical center from 2009 to 2019 were reviewed. Cox proportional hazards models of ultrasound remission and health assessment questionnaire (HAQ) improvement were conducted in both the 1-to-1 nearest propensity score matched (PSM) and unmatched cohorts between those RA patients with SS (RA-SS) and without (RA-noSS) to correct critical confounders. Four kinds of PSM methods were used and the corresponding average treatment effect on the treated (ATT) was calculated to clarify the effect of overlapping SS on distinguishable characteristics or drug prescription in RA patients.

Results:

A total of 1100 RA patients were included in the study, of which 133 (12.1%) overlapped with SS. Among 256 patients consisting of 128 RA-SS and 128 RA-noSS after 1-to-1 nearest PSM, overlapping SS was associated with a 44%, 32% lower probability of reaching ultrasound remission, no-functional disability in RA patients, respectively. More prevalent interstitial lung disease (ILD), leukopenia, hypergammaglobulinemia, rheumatoid factor (RF) positivity, higher erythrocyte sedimentation rate (ESR) and more hydroxychloroquine (HCQ) usage, less biologic disease-modifying anti-rheumatic drugs (bDMARDs) prescription were confirmed to be correlated with overlapping SS by the robust PSM.

Conclusion:

Overlapping SS is associated with a lower probability of reaching ultrasound remission and functional activity improvement, higher prevalence of ILD, leukopenia and hypergammaglobulinemia in RA patients. Weaker interventions such as HCQ may be the mainstream of clinical decision making.

Table.

Hazard Ratios for Ultrasound Remission/No Functional Disability Associated with Overlapping SS

Unmatched cohortMatched cohortUS remissionNo functional disabilityUS remissionNo functional disabilityUnstratified0.63 (0.51, 0.79)0.60 (0.52, 0.70)0.56 (0.42, 0.74)0.68 (0.55, 0.83)Stratified Gender0.62 (0.50, 0.77)0.63 (0.54, 0.74)0.53 (0.40, 0.71)0.66 (0.54, 0.80) Age0.63 (0.51, 0.78)0.60 (0.52, 0.70)0.54 (0.40, 0.72)0.62 (0.50, 0.76) RF0.64 (0.52, 0.80)0.63 (0.54, 0.73)0.56 (0.42, 0.74)0.68 (0.55, 0.83) ACPA0.63 (0.51, 0.79)0.59 (0.50, 0.68)0.57 (0.43, 0.76)0.63 (0.51, 0.78) Seropositivity0.64 (0.52, 0.80)0.63 (0.54, 0.74)0.59 (0.45, 0.79)0.75 (0.61, 0.92) RA duration0.64 (0.51, 0.79)0.61 (0.52, 0.71)0.58 (0.44, 0.77)0.70 (0.57, 0.86) BLDAS28CRP0.64 (0.51, 0.80)0.62 (0.53, 0.72)0.54 (0.41, 0.72)0.66 (0.54, 0.81)

Values are presented as total and stratified Hazard Ratio (95% CI) for ultrasound remission and no functional disability associated with overlapping SS in RA patients according to gender, age, RF/ACPA status, RA duration and DAS28-CRP at 1stvisit. US remission refers to ultrasound GS<2 and PD=0. Unmatched cohort refers to whole sample (n=1100), matched cohort refers to propensity score matched (PSM) patients (n=256). The values are statistically significant at the level of 0.01.

Disclosure of Interests:

None declared

SAT0060 OVERLAPPING SJOGREN’S SYNDROME REDUCES THE PROBABILITY OF REACHING TARGET IN RHEUMATOID ARTHRITIS PATIENTS: A PROPENSITY SCORE MATCHED REAL-WORLD COHORT FROM 2009 TO 2019

Background:

Overlapping Sjogren’s syndrome (SS) is not uncommon in rheumatoid arthritis (RA), and considered as a probable detrimental factor of RA. But data on the impact of overlapping SS on RA therapeutic response is limited.

Objectives:

Our current study aimed to identify the effect in a real-world cohort from 2009 to 2019.

Methods:

The medical records of RA patients who attended the outpatient department of our medical center from 2009 to 2019 were reviewed, and the disease activity based on DAS28-ESR, DAS28-CRP, SDAI and CDAI at each follow-up point were collected. To correct confounders which may affect the therapeutic response between those RA patients with SS (RA-SS) and without (RA-noSS), we compared both the propensity score-matched and unmatched cohorts using the Cox proportional hazards model.

Results:

Among the 1099 RA patients, 129 (11.7%) overlapped with SS validated by positive anti-SSA or pathological minor salivary gland biopsy (MSGB). After propensity score matching based on their baseline characteristics, 126 of 129 RA-SS and 126 of 970 RA-noSS patients were statistically extracted. Overlapping SS was associated with a 29%, 26%, 18%, 22% lower probability of reaching remission in RA patients based on DAS28-ESR, DAS28-CRP, SDAI, CDAI, respectively, which trend kept true for reaching low disease activity (LDA) either. Although overlapping SS had the most significant impact on ESR (HR 0.69, 95%CI 0.61-0.79), other components assessing RA disease activity were also in jeopardy. When stratified by age, RA duration, RF and ACPA status, baseline DAS28-CRP, the trend remained.

Conclusion:

Overlapping SS is associated with a lower probability of reaching target in RA patients, and should be regarded as one of the poor prognostic factors in the management of RA.

Table

Hazard Ratios for Reaching Remission/Low disease activity and Individual Components in RA patients Associated with Overlapping SS

Unmatched cohort(n=1099)Matched cohort(n=252)Trimmed cohort(n=242)Remission Based on Composite Disease Activity ScoreDAS28-ESR0.68 (0.62, 0.75)0.71 (0.62, 0.82)0.74 (0.64, 0.85)DAS28-CRP0.80 (0.74, 0.87)0.74 (0.66, 0.83)0.74 (0.66, 0.83)SDAI0.82 (0.74, 0.91)0.82 (0.70, 0.94)0.83 (0.72, 0.97)CDAI0.77 (0.70, 0.86)0.78 (0.67, 0.91)0.78 (0.67, 0.91)Boolean0.83 (0.75, 0.92)0.80 (0.69, 0.93)0.82 (0.70, 0.95)Remission/LDA Based on Composite Disease Activity ScoreDAS28-ESR0.76 (0.70, 0.82)0.73 (0.65, 0.82)0.74 (0.66, 0.83)DAS28-CRP0.80 (0.74, 0.86)0.76 (0.68, 0.84)0.75 (0.68, 0.84)SDAI0.79 (0.73, 0.85)0.74 (0.66, 0.82)0.74 (0.66, 0.82)CDAI0.78 (0.73, 0.84)0.74 (0.66, 0.82)0.74 (0.66, 0.82)Individual Components of Disease Activity Score28SJC≤10.83 (0.77, 0.89)0.77 (0.69, 0.85)0.76 (0.68, 0.84)28TJC≤10.81 (0.75, 0.87)0.79 (0.70, 0.88)0.78 (0.70, 0.88)PtGA≤10.81 (0.74, 0.89)0.82 (0.71, 0.94)0.82 (0.72, 0.95)PrGA≤10.81 (0.74, 0.88)0.78 (0.69, 0.88)0.79 (0.70, 0.89)ESR≤ULN0.66 (0.61, 0.73)0.69 (0.61, 0.79)0.74 (0.65, 0.84)CRP≤1mg/dL0.84 (0.78, 0.90)0.76 (0.68, 0.84)0.77 (0.69, 0.85)

Disclosure of Interests:

None declared