Cigarette smoking and other risk factors for kidney cancer death in a Japanese population: Japan Collaborative Cohort Study for evaluation of cancer risk (JACC study)

BACKGROUND

Cigarette smoking is the largest single recognized cause of human cancers. In Western countries, many epidemiologists have reported risk factors for kidney cancer including smoking. However, little is known about the Japanese population.

MATERIALS AND METHODS

We evaluated the association of smoking with the risk of kidney cancer death in the Japan Collaborative Cohort (JACC) Study. Participants included 46,395 males and 64,190 females. The Cox proportional hazards model was used to determine age-and-sex adjusted relative risks.

RESULTS

A total of 62 males and 26 females died from kidney cancer during the follow-up of 707,136 and 1,025,703 person-years, respectively. Heavy smokers (Brinkman index >1200), fondness of fatty foods, hypertension, diabetes mellitus (DM), and obesity were suggested to increase the risk of renal cell carcinoma while walking was suggested to decrease the risk. Even after controlling for age, sex, alcohol drinking and DM, heavy smoking significantly increased the risk.

CONCLUSIONS

The present study suggests that six factors including smoking may increase and/or reduce the risk of kidney cancer in the Japanese population. Because of the small number of outcomes, however, we did not evaluate these factors after adjusting for all possible confounding factors. Further studies may be needed to confirm the findings in this study.

Clinical characteristics and oncological outcomes of testicular cancer patients registered in 2005 and 2008: the first large-scale study from the Cancer Registration Committee of the Japanese Urological Association

OBJECTIVES

To describe the clinical and pathological characteristics and oncological outcomes of testicular cancer diagnosed in Japan, we report the results of the testicular cancer registration carried out by the Japanese Urological Association.

METHODS

Testicular cancer survey was conducted by the Japanese Urological Association in 2011 to register newly diagnosed testicular cancers in 2005 and 2008. The survey included details such as age, presenting symptoms, physical examination findings, tumor markers, histopathology, clinical stage, initial treatment and clinical outcomes.

RESULTS

We analyzed 1121 cases of testicular primary germ cell tumor among 1157 registered patients. The median age was 37.0 years. Seminomas and non-seminomatous germ cell tumors accounted for 61.9% and 38.1%, respectively. Measurements of tumor markers were documented in 98.6% of the patients; however, there was an unsatisfactory uniform measurement of human chorionic gonadotropin, which made it difficult to evaluate the International Germ Cell Consensus Classification in all patients. The 1- and 3-year overall survival rates from the entire cohort were 98.3% and 96.8%, respectively. According to the International Germ Cell Consensus Classification, 3-year overall survival rates in the good, intermediate, and poor prognosis group were 99.1%, 100% and 79.9%, respectively.

CONCLUSIONS

The present report is the first large-scale study of the characteristics and survival of testicular cancer patients in Japan based on multi-institutional registry data, and showed a good prognosis even in an advanced stage. The improved survival attributed substantially to accurate diagnosis and effective multimodal treatment.

Fifteen-second skin icing using a frozen gel pack is effective for reducing goserelin injection pain

OBJECTIVE

The efficacy of skin icing to reduce the pain of goserelin injection has been reported. We investigated the optimal icing time with a frozen gel pack and its effectiveness.

METHODS

Abdominal skin temperatures of 49 healthy volunteers were measured after application of the frozen gel pack for 10, 15 and 30 s, and it was decided that a 15-second icing was adequate. For 55 consecutive patients who received goserelin (10.8 mg) injection, pain was evaluated employing a visual analog scale (VAS). The first injection was administered routinely. A second injection was administered after skin icing in 27 of 55 patients who wanted to try icing. At the time of the third injection, all patient decided whether they were to receive icing or the routine method.

RESULTS

After icing, VAS scores decreased in 20 of 27 patients. At the third injection, 18 patients requested icing.

CONCLUSION

When a patient complains of injection pain, the icing method should be considered for pain reduction.

Commensal microbiota modulate murine behaviors in a strictly contamination-free environment confirmed by culture-based methods

BACKGROUND

There is increasing evidence suggesting the existence of an interaction between commensal microbiota, the gut and the brain. The aim of this study was to examine the influence of commensal microbiota on the host behaviors in a contamination-free environment, which was verified by culture-based methods.

METHODS

Open-field and marble-burying tests were used to analyze anxiety-like behaviors and locomotor activity in gnotobiotic BALB/c mice with a common genetic background in a sterile isolator. The monoamine levels in several regions of the brain were measured in germfree (GF) mice and commensal fecal microbiota-associated mice (EX-GF).

KEY RESULTS

A 24-h exposure to the environment outside the sterile isolators rendered GF mice less anxious than those not contaminated, while there was no change in the locomotion. EX-GF mice, the gnotobiotic mice with normal specific pathogen-free microbiota, were less anxious and active than GF mice using open-field and marble-burying tests. The norepinephrine, dopamine, and serotonin turnover rates were higher in the EX-GF mice than in the GF mice in most regions of the brain, suggesting that monoaminergic neurotransmission might increase in the EX-GF mice comparing the GF mice. Monoassociation with Brautia coccoides reduced the anxiety level, but it did not affect the locomotor activity. In contrast, colonization with Bifidobacterium infantis decreased the locomotor activity, while having little effect on the anxiety level.

CONCLUSIONS & INFERENCES

These results strongly support the current view that gut microorganisms modulate brain development and behavior.

Everolimus treatment-associated interstitial lung disease (ILD) as a prognostic factor in Japanese patients with metastatic renal cell carcinoma

e15531

Background: Interstitial lung disease (ILD) is one of the adverse events during treatment with everolimus for metastatic renal cell carcinoma (mRCC). Japanese study of everolimus treatment-associated ILD as a prognostic factor is rare. Methods: We retrospectively assessed the incidence and outcome of ILD in mRCC patients treated with everolimus. Between April 2010 and August 2012, 25 cases were treated with everolimus after the failure of one or two TKIs in our institute. All adverse events were graded in accordance with NCI CTCAE, version 3.0. Results: A total of 25 patients received treatment with everolimus and included 18 male and 7 female patients ranging in age from 21 to 84 years (median 62). According to MSKCC risk criteria, 6 cases were at favorable risk, 16 cases were at intermediate risk, and 3 cases were at poor risk. The median treatment term was 4 months (range 2-17 months). SD was reported in 19 cases and PD in 6 cases. Progression free survival was 3.5 months and overall survival was 12 months. ILD was found in 7 cases (28%). One was G1, five were G2, and one was G3. Corticosteroid therapy was initiated in 3 cases. In 5 of 7 ILD cases, everolimus was re-challenged. In our series, patients with ILD showed significantly better progression free survival than those without ILD (PFS was 8 months vs 3 months. Log-rank, P<0.001). There were no significant differences between the two groups in overall survival (12 months in patients with ILD vs 10 months in patients without ILD. Log-rank, NS). Conclusions: Everolimus appears to have been effective and well-tolerated in our institute. Re-challenge with everolimus was feasible after improving everolimus-induced ILD in cases of grade 1-2. To confirm these findings, the efficacy and AE profile of everolimus in Japanese patients should be investigated.

Incidence and outcome of interstitial lung disease (ILD) with everolimus treatment for metastatic renal cell carcinoma

427

Background: Interstitial lung disease (ILD) is known as one of the adverse events during treatment with everolimus for metastatic renal cell carcinoma (mRCC). Methods: We retrospectively assessed the incidence and outcome of ILD in mRCC patients treated with everolimus. From April 2010 to August 2012, 25 cases were treated with everolimus after failure of one or two TKIs in our institute. All adverse events were graded in accordance with NCI CTCAE, version 3.0. Results: A total of 25 patients received treatment with everolimus. They included 18 male and 7 female patients ranging in age from 21 to 84 years (median 62). According to MSKCC risk criteria, 6 cases were at favorable risk, 16 cases were at intermediate risk, and 3 cases were at poor risk. Median treatment term was 4 months (range 2-17 months). SD was in 19 cases and PD was in 6 cases. Progression free survival was 3.5 months and overall survival was 12 months. ILD was found in 7 cases (28%). 1 was G1, 5 were G2 and 1 was G3. Corticosteroid therapy was initiated in 3 cases. In 5 of 7 ILD cases, everolimus was re-challenged. In our series, patients with ILD showed significantly better progression free survival than those without ILD (PFS was 8 months vs. 3 months. Log-rank, p < 0.001). There were no significant different between the 2 groups in over all survival (12 months in patients with ILD vs. 10 months in patients without ILD. Log-rank, NS). Conclusions: Everolimus appears to be effective and well-tolerated in our institute. Re-challenge of everolimus was feasible after improving of everolimus-induced ILD in cases of grade 1-2.

[Management of side effects of everolimus treatment for metastatic renal cell carcinoma]

Treatment with everolimus is known to prolong progression-free survival in patients with renal cell carcinoma resistant against tyrosine-kinase inhibitor therapy. The side effects must be known for more effective use of this drug. Information of side effects was collected from a randomized controlled study, the early post-marketing phase vigilance and from our own experience. Interstitial lung disease (ILD) was a potentially severe side effect. Incidence of ILD was relatively large compared with that of other target therapy agents. Infections, thrombocytopenia, stomatitis and others were experienced as other side effects. However, there were few uncontrollable side effects. Management of side effects of everolimus can be improved by obtaining sufficient knowledge.

Significance of serum tumor necrosis factor-related apoptosis-inducing ligand as a prognostic biomarker for renal cell carcinoma

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is endogenously expressed in immune cells and contributes to immunosurveillance for cancer. TRAIL induces apoptosis preferentially in various cancer cells, including renal cell carcinoma (RCC) cells. In this study, the serum TRAIL level was examined using an enzyme-linked immunosorbent assay in 52 healthy controls and in 84 RCC patients prior to surgery and its significance as a biomarker was evaluated. The median serum TRAIL level was lower in RCC patients compared to the healthy controls (55.9 vs. 103.1 pg/ml; P=0.019). RCC with lymph node metastasis (N1-2), distant metastasis (M1), stage III-IV, or microscopic venous invasion was associated with decreased serum TRAIL levels (P=0.032, 0.067, 0.020 and 0.011). When comparing serum TRAIL levels in the same RCC patients prior and subsequent to surgery (n=11), the levels were significantly higher after surgery (P=0.031). The cause-specific survival rate was significantly higher in RCC patients with high serum TRAIL levels compared to those with low serum TRAIL levels (P=0.0451). TRAIL was estimated to contribute 64 and 13% of the lymphocyte-mediated cytotoxicity against human RCC ACHN and Caki-1 cells, respectively. These data suggest that the serum TRAIL level may be useful as a prognostic biomarker in RCC patients.

High mobility group protein AT-hook 1 (HMGA1) is associated with the development of androgen independence in prostate cancer cells

BACKGROUND

We previously reported that the level of high mobility group protein AT-hook 1 (HMGA1) is low in androgen-dependent prostate cancer (PCa) cells (LNCaP), but is high in androgen-independent PCa cells (DU145 and PC-3) and that HMGA1 is a strong candidate gene playing a potential role in the progression of PCa. These findings have prompted us to evaluate the effect of HMGA1 on developing androgen independency, which is associated with the progression of PCa.

METHODS

Expression of HMGA1 in PCa cells and mouse tissues was examined by Western blot. In order to examine the effect of HMGA1 on cell growth under androgen-deprived condition, we transfected HMGA1 into LNCaP cells, and siRNA into both DU145 and PC-3 cells, respectively.

RESULTS

Androgen-deprivation induced an increase in the level of HMGA1 in LNCaP cells in vitro and in vivo, but did not in normal prostate tissue. Overexpression of HMGA1 maintained the cell growth of LNCaP under androgen-deprived condition. Furthermore, knockdown of HMGA1 suppressed the cell growth of DU145 and PC-3.

CONCLUSIONS

These data suggest that elevated expression of HMGA1 is associated with the transition of PCa cells from androgen-sensitive to androgen-independent growth and plays a role in the cell growth of androgen-independent PCa cells.

Clinical analysis of introduction chemotherapy for advanced germ cell tumors at Japanese high-volume center

e15099

Background: Recently, cure rate of advanced testicular cancer even with poor prognostic factors have much improved. Inadequate treatment, however, may lead the patients "difficult-to-treat" situation. The aim of this study is to assess the results of the induction therapy at the Japanese single high volume center. Methods: We assessed clinical outcomes about 82 cases of advanced germ cell tumors that had induction chemotherapy at our hospital from Jun, 1998 until Dec, 2010. Results: Median age was 58 year-old (range:17-34y.o.). Seminoma was found in 16 cases (19.5%) and non-seminoma in 66 cases (80.5%), regarding primary histology. Clinical stageII was 37 cases, stageIIIA, IIIB, IIIC was 8, 24, 13 cases, respectively. IGCCC showed good in 41 cases (50%), intermediate 25 (30.5%), poor 15 (19.5%). BEP therapy was done in 74 (90.3%), EP 5 (6.1%), VIP 2 (2.4%) and PVB 1 (1.2%). Median cycles of induction therapy was 4 (range 1~5). Complete response was observed in 14 cases (17.1%), partial response with marker normalization in 58.5%, partial response without marker normalization in 12.2%, progressive disease in 8.5% including 4 cases of growing teratoma. RPLND after induction therapy was performed in 55 patients. Necrosis was found in 56.4%, teratoma only in 27.3% and viable cancer in 16.3%. Patients with salvage chemotherapy were 22 (27.5%) cases. Five- and 10-year overall survival was 93.3% and 89.6%, respectively. Clinical outcomes at 63 months of median follow-up was as follows; no evidence of disease 73 cases (89.0%), alive with disease 1case (2.4%) and death 7 cases (8.6%). Stratified by IGCCC, 5-year overall survival was 97.6% in good prognosis, 96.0% in intermediate prognosis and 79.0% in poor prognosis. Causes of death were as follows; pancreatic juice leakage after RPLND in 1 case, cerebral infarction in 1 case, cerebral bleeding in 1 case, traffic accident in 1 case, and cancer death in 3 cases. Conclusions: Clinical outcomes at Japanese high volume center were good, especially in good and intermediate prognosis. It was very clear that improvement of poor prognosis, especially high tumor volume, was required.

The usefulness of serum X-linked inhibitor of apoptosis protein (XIAP) for predicting recurrence of renal cell carcinoma

e15055

Background: The X-linked Inhibitor of Apoptosis protein (XIAP) is associated with cell survival by blocking caspase-mediated apoptosis. We have reported the expression and prognostic value of XIAP in human prostate cancer using prostate tissue microarrays (Clin Cancer Res 2007). The expression and prognostic significance of XIAP in renal cell cancer (RCC) has been rarely studied. To our knowledge, no report on the serum XIAP levels from RCC patients has been published. In this study, we examined serum XIAP levels of RCC patients and normal individuals and evaluated its utility as biomarker. Methods: Peripheral blood samples were obtained from 99 patients (68 men and 31 women, median age; 60.7 years [36-85]) with RCC before surgery. All the patients underwent radical or partial nephrectomy. Blood samples were also collected from 52 healthy controls. The histological grade was as follows: grade 1; n= 5, grade 2; n=72, grade 3; n= 22. The serum XIAP levels were measured by a sandwich enzyme-linked immunosorbent assay. Cut off value was calculated by ROC analysis. Results: The serum XIAP levels in patients with RCC were higher than those of normal control individuals (328.3 pg/ml vs 156.2 pg/ml, p<0.001). At a median follow up of 33 months (1-105M), tumor with low serum XIAP showed significantly longer progression free survival (PFS) than those with high serum XIAP in grade 1-2 group (p<0.001). Conclusions: Serum XIAP level is associated with recurrence and prognosis. These results suggest that it may be used as a novel prognosticator and a potential target for renal cell cancer diagnosis and therapy.

Oncological outcomes of the prostate cancer patients registered in 2004: report from the Cancer Registration Committee of the JUA

OBJECTIVES

In 2001, the Cancer Registration Committee of the Japanese Urological Association initiated a data collection of prostate cancer patients into a computer-based database. The aim of the present study is to report the clinical and pathological characteristics and outcomes of prostate cancer patients diagnosed in 2004 in Japan.

METHODS

Overall, 11,385 patients from 239 institutions were registered into the database. After excluding 1105 patients because of insufficient data, duplication or insufficient follow up, 10,280 patients were eligible for the analysis. Most of them (10,198, 99.2%) were Japanese and 1195 (11.6%) had metastatic disease at the time of diagnosis. The mean and median follow up was 53.2 months and 61.5 months, respectively.

RESULTS

The 5-year overall and prostate cancer-specific survival rate was 89.7% and 94.8%, respectively. The 5-year prostate cancer-specific survival rate of M0 and M1 disease was 98.4% and 61.1%, respectively. For 8424 cases of organ-confined or regional disease, Japanese urologists used as the initial treatment hormone ablation therapy alone (3360, 39.9%), radical prostatectomy (3140, 38.1%), radiation therapy (1530, 18.2%) and watchful waiting (394, 4.7%) including active surveillance or palliative observation.

CONCLUSIONS

This is the first large population report of survival data in Japanese prostate cancer patients. In Japan, the disease population, survival period with metastatic disease and ratio of patients having hormone ablation therapy differ from those in Western countries.

Abstract 73: The transfection of high mobility group protein AT-hook 1 (HMGA1) is associated with the development of androgen independency in prostate cancer cells

The level of HMGA1 is low in androgen-dependent prostate cancer cell line (LNCaP), but is high in androgen-independent prostate cancer cell lines (DU145, PC-3). We have reported that the level of HMGA1 expression in prostate cancer cells is correlated with the extent of chromosomal aberrations (Can Res, 2002) and that transfection of HMGA1 into prostate cancer cell lines induces unbalanced chromosomal rearrangement and expression of matrix metalloproteinase 2 (Prostate, 2004). This suggests that HMGA1 is a strong candidate gene playing a potential role in the progression of prostate cancer. These findings have prompted us to evaluate the effect of HMGA1 on androgen independency, which is associated with the progression of prostate cancer. The androgen-dependent LNCaP cell line was induced to an androgen-independent subline (LN95) by being maintained for long term in the absence of androgen. The absence of androgen induced a 2.5-fold increase in the level of HMGA1 in the LN95 cell line. Androgen deprivation in vitro for 4 days as well as that for 8 days in vivo induced significant increase in the level of HMGA1 in parental LNCaP. On the other hand, the level of HMGA1 in normal prostate of mice 4 days and 11 days after castration as well as sham operation was almost undetectable. The cell proliferation rates of LNCaP cell transfected with HMGA1a vector (LN-H1) and LNCaP cell transfected with control empty vector (LN-EV) were determined with various concentrations (0-1nM) of dihydrotestosterone (DHT) by WST-8 assay in order to examine the effect of HMGA1 on androgen sensitivity. The expression of HMGA1 protein in LNH1 was confirmed to be 3.2-fold as high as that in LNEV. In low concentration (0-0.01 nM) of DHT, LNEV cell could not keep proliferation over day 6, while LNH1 could maintain proliferation over day 6. The cell proliferation rate at day 8 of LN-H1 grown in low concentration (0-0.01 nM) of DHT was about 2-fold higher than that of LN-EV. In contrast, both LN-H1 and LN-EV cells grew equally well in higher concentrations (0.1-1 nM) of DHT and could also keep proliferation over day6. Suppression of HMGA1 in DU145 and PC-3 by siRNA decreased cell proliferation rate and colony formation ability by 40% and 10-fold, respectively, in androgen-deprived medium. These data suggest that HMGA1 is associated with the transition of prostate cancer cells from androgen-sensitive to androgen-independent growth and plays a role in the cell growth of androgen-independent prostate cancer cells.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 73. doi:1538-7445.AM2012-73

The usefulness of serum X-linked inhibitor of apoptosis protein (XIAP) for predicting recurrence of renal cell carcinoma

396

Background: The X-linked Inhibitor of Apoptosis protein (XIAP) is associated with cell survival by blocking caspase-mediated apoptosis. We have reported the expression and prognostic value of XIAP in human prostate cancer using prostate tissue microarrays (Clin Cancer Res 2007). The expression and prognostic significance of XIAP in renal cell cancer (RCC) has been rarely studied. To our knowledge, no report on the serum XIAP levels from RCC patients has been published. In this study, we examined serum XIAP levels of RCC patients and normal individuals and evaluated its utility as biomarker.

Methods: Peripheral blood samples were obtained from 99 patients (68 men and 31 women, median age; 60.7 years [36–85]) with RCC before surgery. All the patients underwent radical or partial nephrectomy. Blood samples were also collected from 52 healthy controls. The histological grade was as follows: Grade1; n= 5, Grade2; n=72, Grade3; n= 22. The serum XIAP levels were measured by a sandwich enzyme-linked immunosorbent assay. Cut off value was calculated by ROC analysis.

Results: The serum XIAP levels in patients with RCC were higher than those of normal control individuals (328.3 pg/ml vs 156.2 pg/ml, P<0.001). At a median follow up of 33 months (1-105M), tumor with low serum XIAP showed significantly longer progression free survival (PFS) than those with high serum XIAP in Grade 1-2 group (P<0.001).

Conclusions: Serum XIAP level is associated with recurrence and prognosis. These results suggest that it may be used as a novel prognosticator and a potential target for renal cell cancer diagnosis and therapy.

Abstract 606: Expression and role of high mobility group protein AT-hook 1 (HMGA1) in human renal cell carcinoma

Even though molecular targeted therapy has improved the clinical outcome of metastatic renal cell carcinoma (mRCC) patients, complete response is rarely observed. Identification of molecules possessing significant molecular functions in mRCC is mandatory for developing new therapeutic modalities for mRCC. High mobility group protein AT-hook 1 (HMGA1) is overexpressed in many types of cancer cells, but is not or at very low levels expressed in normal adult tissues. Expression of HMGA1 has been reported to be associated with metastatic potential and progression of cancer. We have reported that transfection of HMGA1 into prostate cancer cell lines induces chromosomal rearrangement (Cancer Res, 2002) and expression of matrix metalloproteinase 2 (Prostate, 2004) suggesting that HMGA1 may play an important role in the progression of prostate cancer. In this study, we examined expression and function of HMGA1 in human renal cell carcinoma (RCC). Expression of HMGA1 in six human RCC cell lines, Caki-1, ACHN, NC 65, RCC-4, 786-O, and A498, was examined by immunoblot and immunohistochemistry. The expression level of HMGA1 detected by immunoblot was Caki-1=ACHN&gt;NC65&gt;786-O, while RCC-4 and A498 barely expressed HMGA1. Immunohistochemistry showed nuclear localization of HMGA1 in these cell lines. Expression of HMGA1 in renal tumor tissue and normal kidney tissue from the same patients who underwent radical nephrectomy was examined by immunoblot. Immunoblot of surgical samples of 41 cases of RCC revealed that HMGA1 is not expressed in normal kidney tissues from all the cases. On the other hand, immunoblot showed that expression of HMGA1 was observed in 1 out of 23 (4%) non-metastatic cases (M0) compared to 6 out of 18 (33%) metastatic cases (M1) (P=0.031), and 3 out of 29 (10%) G1-2 cases compared to 4 out of 9 (44%) G3 cases (P=0.041). Colony formation assay and flowcytometry were performed using Caki-1 after transfecting with siRNA to knock down HMGA1. Knock-down of HMGA1 expression in Caki-1 cells by siRNA remarkably suppressed colony formation (control siRNA 86.0±5.3 vs HMGA1 siRNA 7.3±1.5, P&lt;0.001)and also induced apoptosis associated with increased subG1 fraction (control siRNA 1.9% vs HMGA1 siRNA 34.6%). These findings suggest that HMGA1 might be correlated with histological grade and metastatic potential of RCC associated with enhanced anti-apoptotic mechanism. No expression in normal kidney tissues, preferential expression in renal tumor tissues of metastatic cases, and remarkable suppression of colony formation by siRNA suggest that HMGA1 might be a potential target molecule for novel therapeutic modalities of mRCC.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 606. doi:10.1158/1538-7445.AM2011-606