4332Benefit of sinus rhythm restoration in acute decompensated heart failure patients with atrial tachyarrhythmia treated with landiolol

Background

Atrial tachyarrhythmias (ATA), such as atrial fibrillation / atrial tachycardia are frequently observed in patients with acute decompensated heart failure (ADHF). Because ATA leads to clinical deterioration and worsen HF, the conversion and prevention of ATA is important of ADHF with ATA. Landiolol, an ultrashort-acting intravenous beta-1 blocker, was developed and has been used for the treatment of ATA.

Purpose

We evaluated the acute effect of landiolol treatment on heart rate or blood pressure (BP), also the rates and benefits of sinus rhythm (SR) restoration among AHF patients with ATA treated with landiolol.

Methods

We studied 67 consecutive HF patients with ATA (age: 67±12 years, 36 male) treated with landiolol from 2015 to December 2017 at our University Hospital. They were compared with 50 paired subjects, matched for gender, age and baseline BP who developed HF with ATA from HIJ-HF 2 study (consisted of HF patients hospitalized between 2013 and 2014).

Results

At the start of landiolol treatment, mean left ventricular ejection fraction (LVEF) was 41±14%. The median maintenance dose of landiolol was 3.0 (1.0–12.0) μ/kg/min and the median treatment duration of landiolol was 5 (1–24) days. After 6 hours from administration of landiolol, mean HR decreased significantly from 140±18 to 100±21 bpm (p<0.05), whereas BP was not difference during landiolol treatment. Sinus rhythm was restored spontaneously in 15 (22%), and by electrical or pharmacological cardioversion in 5 (7%) during a treatment with intravenous landiolol. Furthermore, sinus rhythm was restored in 22 patients using additional rhythm control treatment, such as amiodarone or catheter ablation after intravenous landiolol treatement. Eight patients experienced in-hospital death. Forty-one (69%) of 59 patients discharged alive were in SR. During the follow-up period of 16±12 months, 4 patients died and 12 patients experienced rehospitalization due to worsening HF after hospital discharge. There was a significant higher rate of death or HF rehospitalization in patients without SR restoration than patients with SR restoration (44% vs. 20%, p<0.05) (Figure A). Compared with 50 paired subjects from HIJ-HF 2 study, those who treated with landiolol developed a significant higher rate of SR restoration (68% vs. 20%, p<0.05) (Figure B).

Figure 1

Conclusion

This study demonstrated that landiolol treatment was effective for both rate control and conversion to sinus rhythm in ADHF patient with ATA. We should consider that the benefits of rhythm control in ADHF patients with ATA during and after landiolol treatment.

Altered metabolic regulation owing to gsp1 mutations encoding the nuclear small G protein in Saccharomyces cerevisiae

Nutrient metabolism is regulated for adaptation to, for example, environmental alterations, cellular stress, cell cycle, and cellular ageing. This regulatory network consists of cross-talk between cytoplasmic organelles and the nucleus. The ras-like nuclear small G protein, Ran, functions in nuclear-cytosolic transport and regulatory signal transmission. In yeast, some genes involved in the Ran system in yeast are required for growth on glycerol medium. Growth deficiency, due to mutations in the GSP1 gene, which encodes Ran, is allele specific. Specifically in this study, the gsp1-1894 cells lost mitochondria, and could not grow on media containing glycerol, galactose or maltose. However, the gsp1-1894 cells grew better on a high salt medium (1 M NaCl) and had increased expression levels of GPD1-lacZ. Furthermore, disruption of the HOG1 gene suppressed their growth deficiency on glycerol medium. These findings suggest that altered activation of Hog1 in the gsp1-1894 cells resulted in the loss of mitochondria and inhibition of glycerol metabolism. Growth deficiency of the gsp1-1894 cells on galactose medium was further suppressed by high dosage of the SIP2 DNA, which encodes the cytosolic β subunit of AMPK. This suggests that higher cytosolic activity of AMPK is required for the utilization of an alternative carbon source in gsp1-1894 cells.

Regional differences in facial skin blood flow responses to thermal stimulation

PURPOSE

The facial skin blood flow (SkBF) shows regional differences in the responses to a given stimulation. The facial SkBFs, especially in the eyelid and nose exhibit unique response to physiological and psychological stimuli, but the mechanisms inducing those regional differences remain unclear. To investigate whether the regional differences in the local control of vasomotion in facial vessels correspond to the regional differences in facial SkBF response, we monitored the relative change of facial SkBF to regional thermal stimulation. We hypothesized that heat stimulation dilates the cutaneous vessels in the eyelid, while cold stimulation constricts those in the nose, which was based on previous findings METHODS: A thermal stimulator was used to apply temperature increase (from 20 to 40 °C at 2 °C/min) and decrease (from 40 to 20 °C at 2°C/min) in a randomized order to the right eyelid, nose, right cheek, and forehead of 14 healthy young males. The facial SkBF was measured for 10 s using laser-speckle flowgraphy when temperatures of 20 °C, 30 °C, and 40 °C had been applied for 30 s in both trials.

RESULTS

The SkBF in the eyelid did not change significantly during any thermal stimulation, and the nasal SkBF did not decrease significantly during cold stimulation. The SkBFs in the cheek and forehead increased significantly with the applied temperature.

CONCLUSIONS

These findings indicate that a large regional variation exists in facial skin blood flow response to local heating or cooling and that the regional variation did not correspond to the unique SkBF responses in the previous studies.

Abstract P1-11-01: Oral care evaluation to prevent oral mucositis in estrogen receptor positive metastatic breast cancer patients treated with everolimus (Oral Care-BC): A randomized controlled phase III trial

Introduction

Oral mucositis is a clinically significant complication of mucotoxic cancer therapy. The incidence of oral mucositis (any grade) as an adverse drug reaction of everolimus is 58%, while an analysis of Asian people has reported its occurrence as 81%.This study hypothesizes that the occurrence of oral mucositis will reduce with professional oral care (POC) administered prior to everolimus treatment.

Method:

This was a randomized, multi-center, open-label, phase III study, to evaluate the efficacy of POC in preventing mucositis induced by everolimus in postmenopausal, estrogen receptor (ER)-positive, metastatic breast cancer patients. Patients were randomized into POC and control groups (1:1 ratio). All patients received everolimus with exemestane and continued the everolimus until disease progression. In the POC group, patients were subjected to teeth surface cleaning, scaling and tongue cleaning, before initiating everolimus, and continued to receive weekly POC from dentist or oral surgeons throughout the 8 weeks of treatment. In the control group, patients brushed their own teeth and gargled with 0.9% sodium chloride solution or water. The primary end-point was to measure the incidence of all grades of oral mucositis. Target accrual was 200 patients with a 2-sided type I error rate of 5% and 80% power to detect 25% risk reduction. This trial has been registered at ClinicalTrials.gov, number NCT 02069093.

Result:

Between May 26, 2014 and Dec 28, 2017, we enrolled 174 women from 31 institutions; 168 were evaluable for efficacy but 5 were excluded (had not received the protocol treatment [n=4]; no efficacy data [n=1]). In 8 weeks, the incidence of grade 1 oral mucositis was significantly different between the POC group (76.5%, 62 of 81 patients) and control group (89.7%, 78 of 87 patients) (p=0.035). The incidence of grade 2 (severe) oral mucositis was also significantly different between the POC group (34.6%, 28 of 81 patients) and control group (54%, 47 of 87 patients) (p= 0.015). As a result of oral mucositis, 18 (22.2%) patients in the POC group and 28 (32.2%) in the control group had to undergo everolimus dose reduction.

Conclusion:

POC reduced the incidence and severity of oral mucositis in patients receiving everolimus and exemestane. This could be a new standard in oral care for patients undergoing this treatment.

Primary Analysis: Incidence Probability of Oral Mucositis POC Group (n=81) Controll (n=87)P-valuneOral Mucositis over Grade1n% n% Yes6276.5 7889.70.035No1923.5 910.3        Risk Difference, % (95% CI)-11.83 (-22.80, -0.85)    POC: Professional oral Care

Citation Format: Niikura N, Nakatukasa K, Amamiya T, Watanabe K-i, Hata H, Kikawa Y, Taniike N, Yamanaka T, Mitsunaga S, Nakagami K, Adachi M, Kondo N, Horii K, Hayashi N, Naito M, Kashiwabara K, Yamashita T, Umeda M, Mukai H, Ota Y. Oral care evaluation to prevent oral mucositis in estrogen receptor positive metastatic breast cancer patients treated with everolimus (Oral Care-BC): A randomized controlled phase III trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-01.

Abstract P2-08-59: Different predictive and prognostic impact of intra-tumor heterogeneity, tumor biology, and microenvironment in triple negative breast cancer

Background

Intra-tumor heterogeneity, tumor biology, and microenvironment in triple negative breast cancer (TNBC) has been reported to be predictive and prognostic factors. However, it is not well known how these factors are correlated each other according to response to chemotherapy and their prognosis. The aim of this study was to assess the predictive and prognostic impact of these factors in TNBC.

Method

Biopsy samples before neoadjuvant chemotherapy (NAC) from 59 TNBC patients who underwent surgery after NAC from 2001 to 2007 were retrospectively assessed. For tumor biology, tumors were classified as Hormonal related luminal androgen receptor (LAR) if &gt;10% staining of AR, Basal-like if positive for cytokeratin 5/6 and EGFR, and Others. Claudin 1 and p16 expression levels were assessed for intra-tumor heterogeneity. and stromal tumor-infiltrating lymphocytes (Str-Tils) levels for tumor-microenvironment were also assessed as low for ≤10%, Intermediate for 10-49%, and high for &gt;50%.The predictive and prognostic impact of clinicopathological factors including age, nuclear grade (NG), lymph node status, were also assessed. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method and were compared between groups using the log-rank test.

Results

A median overall survival period of the 59 patients was 98 month(6 -172 month).Eighteen (30.5%) were classified in LAR, 16 (27.1%) in Basal-like, and 25 (42.4%) in Others. According to response to NAC, 10 patients (16.9%) achieved pathologic complete response (pCR). These biological classifications were not associated with pCR rate (p=0.135). high-p16 had significantly high pCR rate (p=0.046).However, Str-Tils level was not associated with pCR rate. Patients with lymph node metastasis had significantly low pCR rate (p=0.017).In terms of their prognosis, age&lt;50 had significantly shorter OS and DFS than that of age&gt;50 (OS: p=0.023, DFS: p=0.027). NG3 had a trend of short OS compared to NG 1 or 2 (NG 1 vs 3, OS: p=0.053, and NG 2 vs 3, OS: p=0.073). There were no difference of their prognosis among three tumor biology classifications except Basal-like had significantly shorter OS than that of LAR (LAR vs Basal OS:p=0.041, DFS:p=0.574, LAR vs Others OS:p=0.407, DFS:p=0.866, Basal vs Others OS:p=0.162, DFS:p=0.713).Claudin 1 and p16 expression levels were not associated with OS and DFS. Low-Str-Tils had a trend of shorter OS and DFS than that of intermediate- or high-Str-Tils (low vs int; OS:p=0.085, DFS:p=0.026, low vs high; OS:p=0.062, DFS:p=0.055).In multivariate analysis, age&lt;50 was only independent prognostic factor (p&lt;0.05).

Conclusion

We showed that intra-tumor heterogeneity, tumor biology, and microenvironment had different predictive and prognostic impact in TNBC. These results might suggest the strategy of additional targeting treatment to non-pCR patients.

Citation Format: Hayashi N, Nakamura M, Kobayashi D, Suzuki K, Yamauchi H. Different predictive and prognostic impact of intra-tumor heterogeneity, tumor biology, and microenvironment in triple negative breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-59.

Abstract P2-14-17: Long-term oncologic safety of nipple-sparing mastectomy with immediate reconstruction

Background

Nipple-sparing mastectomy (NSM) is an alternative procedure to skin-sparing mastectomy (SSM) for selected patients who undergo immediate reconstruction. However, the evidence of long-term oncologic safety of NSM has not been established. In this study, we aimed to compare the prognosis of breast cancer patients who underwent NSM to those who underwent SSM with immediate reconstruction.

Methods

The clinicopathological factors including recurrence site, pathologic stage, nipple-tumor distance, histological type, lymphovascular invasion, margin status, ER, PgR and HER2 status of stage 0–III primary breast cancer patients who underwent NSM or SSM with immediate primary reconstruction with tissue expander from our breast center database was retrospectively assessed. Patients with a nipple tumor distance of &lt;1 cm who underwent NSM were excluded. 190 patients who underwent NSM and 729 patients who underwent SSM were included in the analysis. All patients underwent MRI or US before treatment. Nipple-tumor distance was mainly measured by MRI.

Results

The median follow-up period was 71 months (range: 10 - 131 months) for the NSM group and 79 months (range: 9 - 140 months) for the SSM group. There were no significant difference of clinicopathological factors between the NSM group and the SSM group, except of the larger diameter of tumor in the SSM group. NSM was performed for 60 patients (32%) with stage 0, 71 patients (37%) with stage I, and 59 patients (31%) with stage II/III. SSM was performed for 185 patients (26%) with stage 0, 268 patients (37%) with stage I, and 276 patients (37%) with stage II/III. Local recurrence was found in 11 (5.8%) patients in the NSM group and in 44 (6.0%) patients in the SSM group. In the NSM group, only one (0.5%) patient had local recurrence in the nipple areola complex. In terms of DFS and overall survival (OS) rate, there was no difference between the NSM group and the SSM group (DFS; 89.5% vs 89.2%, HR, 1.044; p = 0.8992; 95% CI, 0.5116–1.9519, and OS; 98.4% vs 96.4%, HR, 0.963; p = 0.9116; 95% CI, 0.473–1.793). According to breast cancer subtype, in the NSM group, all of the 11 patients (100%) who developed local recurrence in the NSM group was hormone receptor (HR)-positive/HER2-negative breast cancer. 29 of the 44 patients (65.9%) who developed local recurrence in the SSM group was HR-positive/HER2-negative, 6 patients (13.6%) was HR-negative/HER2-positive, and 7 patients (15.9%) was triple-negative breast cancer. Among patients who had received neoadjuvant chemotherapy, the NSM group (3 of 14 patients, 21.4%) had a trend for higher local recurrence rate than the SSM group 7 of 116 patients (6.0%) (p = 0.0813). However, no local recurrence in the nipple areola complex was observed for the NSM group. In addition, there was no difference of OS between the NSM group (92.9%) and the SSM group (90.5%) (HR, 0.903; p = 0.9943; 95% CI, 0.049-4.739).

Conclusions

Our results suggested that NSM with immediate reconstruction might be safe as well as SSM for breast cancer with the nipple–tumor distance of &gt;1 cm with respect to their prognosis and local control regardless of breast cancer subtype or invasiveness. Further studies with a large sample size to assess the risk of local recurrence for NSM after neoadjuvant chemotherapy.

Citation Format: Yamashita Y, Hayashi N, Nagura N, Kajiura Y, Yoshida A, Takei J, Suzuki K, Tsunoda H, Yamauchi H. Long-term oncologic safety of nipple-sparing mastectomy with immediate reconstruction [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-17.

Abstract P2-08-31: Predictive and prognostic value of stromal tumor-infiltrating lymphocytes before and after neoadjuvant therapy in triple negative and HER2-positive breast cancer

Background: Lymphocyte predominant breast cancer subgroup, defined as ≥ 50% stromal tumor-infiltrating lymphocytes (sTILs), is associated with high pathological complete response (pCR) rate after neoadjuvant therapy (NAT) and favorable outcome. In a cohort of triple negative (TNBC) and HER2+ breast cancer (BC) patients treated with NAT, we aimed to assess the predictive and prognostic value of pre- and post-NAT sTILs and the information provided by the change in sTILs during NAT.

Materials and methods: Two-hundred and nine consecutive patients (n=80 TNBC; and n=129 HER2+) who received NAT between 2001 and 2009 in our institution were evaluated. Pre-NAT sTILs were assessed on biopsy sample (baseline) and post-NAT sTILs on surgical specimens just for non-pCR patients. sTILs level was categorized as low 0-9%, intermediate 10-49%, and high ≥50%. The change in sTILs during NAT was calculated as the absolute difference between pre- and post-NAT sTILs. We evaluated the association of pre-NAT sTILs and pCR, and the association between pre- and post-NAT sTILs, and their change with relapse-free survival (RFS).

Results: Overall pCR rate was 37.8% (31.3% for TNBC, 41.2% for ER+/HER2+BC, 42.3% for ER-/HER2+BC). In each subtype, pre-NAT low sTILs group was significantly associated with lower pCR rate. During the median follow-up period of 98 months, 44 recurrences (21.1%) were observed. For TNBC, low pre-NAT sTILs group was associated with higher recurrence risk compared with int/high sTILs (HR=4.675 [2.013-10.859], p&lt;0.001). For only non-pCR patients, both pre- and post-NAT sTILs were significantly associated with RFS. The risk of recurrence was higher in the group with low pre-NAT sTILs (HR=5.333 [1.731-16.427], p=0.004), and the group of low post-NAT sTILs (HR=4.271 [1.498-12.173], p=0.007). Patients with the change of sTILs increase during NAT were not associated with RFS, compared with decrease or equal group (log-rank p=0.163). In multivariate analysis including both pre- and post-NAT sTILs, only pre-NAT sTILs retained significance (HR=3.844 [1.190-12.421], p=0.024). Low post-NAT sTILs group showed only a borderline significant association with shorter RFS (HR=2.836 [0.951-8.457], p=0.061), but it suggests that both pre- and post-NAT sTILs might provide independent prognostic information. In ER+/HER2+BC, low pre-NAT sTILs were associated with short RFS (p=0.036), but this association was not significant when only non-pCR patients were considered. In ER−/HER2+BC, sTILs were not significantly associated with RFS.

Conclusion: In TN and HER2+ BCs, tumors with low pre-NAT sTILs have a low likelihood to achieve a pCR (predictive marker). In TNBC, low pre-NAT sTILs were associated with higher recurrence risk. In non-pCR TNBC patients, both low pre- and post-NAT sTILs were associated with shorter RFS. These results suggest that sTILs information should be taken into account when additional post-surgery treatments are considered in non-pCR patients.

Citation Format: Ochi T, Giampaolo B, Murai M, Nozaki F, Kobayashi D, Iwamoto T, Niikura N, Suzuki K, Yamauchi H, Hayashi N. Predictive and prognostic value of stromal tumor-infiltrating lymphocytes before and after neoadjuvant therapy in triple negative and HER2-positive breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-31.

Abstract P5-18-05: Clinicopathological characteristics and prognosis of young patients with ductal carcinoma in situ

Background: The peak age at diagnosis of breast cancer differs between patients in Asian countries (40 - 50 years), and those in Western countries (60 - 70 years). With the increasing use of screening mammography, the incidence of ductal carcinoma in situ (DCIS) has increased significantly in younger Asian women. Nevertheless, our knowledge of the clinicopathological features and prognosis in young patients with DCIS is relatively limited. We aimed to compare the clinicopathological features of younger patients with that of older patients with DCIS and to evaluate their prognostic factors.Methods: A total of 1445 women were diagnosed with DCIS between the years 2005 and 2015. Patients with the past history of breast cancer and managed without surgery were excluded. The young age group included patients &lt;50 years of age, whereas the old age group included patients ≥50 years of age at diagnosis. We compared the clinicopathological characteristics [tumor size, surgery type, estrogen receptor (ER) and progesterone receptor (PgR) status, HER2 status, nuclear grade, margin status, radiotherapy, endocrine therapy, family history of breast cancer, and screening presentation or presentation with symptoms] and prognosis [disease-free survival (DFS), and overall survival (OS)] between the groups. DFS included the following events: contralateral breast cancer, loco-regional, and distant recurrences. DFS and OS were estimated using the Kaplan–Maier method. The risk factors associated with events were estimated using the log-rank test for univariate analysis. P values &lt; 0.05 were considered statistically significant.Result: Among the 1445 patients diagnosed with DCIS, 1281 were included in this study. The median age at diagnosis was 47 years (range, 22-87 years). The median follow-up time was 72 months (range, 1-162 months). ER and/or PgR status was positive in 1133 patients (88%). HER2 status was positive in 289 patients (23%). Premenopausal status was noted in 867 patients (68%). The median tumor size was 3.0 cm. Of 1281, 202 (18%) patients received endocrine therapy, 846 (66%) received breast conserving surgery, and 724 (86%) received radiation therapy. There were 765 patients (60%) in the young group. Significantly more patients in the young group had low nuclear grades, were ER and/or PgR positive, were HER2 receptor negative, underwent mastectomy, presented with symptoms, and had close/positive margins. Fifty-eight (4.5%) events occurred: 41 (3.2%) contralateral breast cancers, 19 (1.5%) loco-regional recurrences, and one (0.1%) distant metastasis. No death due to breast cancer was reported. On multivariate analysis, the young group (hazard ratio: 2.24, 95% CI: 1.01 - 4.95, P = 0.04), and presentation with clinical symptoms (hazard ratio: 2.09, 95% CI: 1.07-4.10, P = 0.03) significantly correlated with worse DFS. OS was not significantly different between the groups.Conclusion: This was the largest study with young patients with DCIS in the Asian population. We found that age at diagnosis was a significant independent factor associated with DFS. While genetic background also requires consideration, women with DCIS at &lt;50 year of age may require intensive surveillance. This result requires confirmation with longer follow-up.

Citation Format: Seki A, Matsuda N, Kajiura Y, Kobayashi D, Hayashi N, Tsunoda H, Suzuki K, Yoshida A, Takei J, Yamauchi H. Clinicopathological characteristics and prognosis of young patients with ductal carcinoma in situ [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-18-05.

Association between transforming growth factor-β1 -509 C>T variants and hepatocellular carcinoma susceptibility: a meta-analysis

The transcriptional activity of transforming growth factor-β (TGF-β) is increased in subjects with hepatocellular carcinoma (HCC). Recent studies have indicated that the -509C genotype in hepatitis B virus (HBV)-infected subjects and the -509T genotype in hepatitis C virus (HCV)-infected subjects can increase the transcriptional activity of the TGF-β1 gene. We conducted a meta-analysis to clarify whether these two hepatitis viruses affect the association between TGF-β1 C-509T variants and HCC susceptibility. Using data derived from 8 case-control studies available in the PubMed database (5 with Asian and 3 with Caucasian populations), including 1,427 cases and 3,735 controls [1,610 patients with chronic liver disease and 2,125 healthy controls], we calculated pooled odds ratios with corresponding 95% confidence intervals. We used dominant (TT + CT vs. CC), recessive (TT vs. CC + CT), and co-dominant (TT vs. CC and CT vs. CC) genetic models. An overall analysis showed no association between the TGF-β1 C-509T variants and HCC susceptibility for all models. In contrast, a subgroup analysis, based on the infecting hepatitis viruses, provided the following results. Among the cases and controls with chronic liver disease, the TGF-β1 C-509T variants were significantly associated with decreased HCC susceptibility for two models with HBV-infected subjects, whereas the variants were significantly associated with increased HCC susceptibility for one model with HCV-infected subjects. Among the cases and healthy controls, there was a significant association between the TGF-β1 C-509T variants and increased HCC susceptibility for two models involving HCV-infected subjects. Among the cases and the entire control group, the same results were obtained for all genetic models with HCV-infected subjects. Although further data accumulation is required, our results suggest that these two hepatitis viruses affect the association between TGF-β1 C-509T variants and HCC susceptibility in opposite manners.

Impaired residual renal function predicts denosumab-induced serum calcium decrement as well as increment of bone mineral density in non-severe renal insufficiency

Denosumab treatment of osteoporotic patients, except those with severe renal insufficiency, reduced cCa levels. Low baseline cCa, low estimated glomerular filtration rate, and high bone turnover increased the risk of lower cCa, while increasing bone mineral density. Pretreatment with antiresorptive agents was beneficial in reducing the risk of hypocalcemia.

INTRODUCTION

Although denosumab-induced hypocalcemia has been frequently observed in patients with chronic kidney disease (CKD) stages 4-5D being treated with denosumab for osteoporosis, few studies have assessed the risk factors for serum-corrected calcium (cCa) reductions in patients with non-severe renal insufficiency. This study assessed the risk factors for reduced cCa concentration following denosumab administration and analyzed factors predictive of changes in bone mineral density (BMD).

METHODS

Seventy-seven osteoporotic patients, not including those with CKD stages 4-5D, were treated with 60 mg denosumab once every 6 months. Biochemical parameters and BMD were analyzed from prior to the initial dose until 1 month after the second dose.

RESULTS

Following the first administration of denosumab, cCa levels decreased, reaching a minimum on day 7. Multiple linear regression analyses showed that baseline cCa, estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m², tartrate-resistant acid phosphatase-5b (TRACP-5b), and bone alkaline phosphatase (BAP) or pretreatment with antiresorptive agents were significant factors independently associated with the absolute reduction in cCa from baseline to day 7 (ΔcCa_0-7 days). ΔcCa_0-7 days after the second dose of denosumab was significantly lower than that after the first dose. After 6 months of denosumab treatment, both LS-BMD and FN-BMD significantly increased from baseline. LS-BMD and FN-BMD correlated significantly with baseline TRACP-5b or BAP and eGFR, respectively.

CONCLUSIONS

Both low eGFR and high bone turnover were independent risk factors for denosumab-induced cCa decrement, and for increases in BMD. Pretreatment with antiresorptive agents may reduce the risk of hypocalcemia.

Brachial artery blood flow dynamics during sinusoidal leg cycling exercise in humans

To explore the control of the peripheral circulation of a nonworking upper limb during leg cycling exercise, blood flow (BF) dynamics in the brachial artery (BA) were determined using a sinusoidal work rate (WR) exercise. Ten healthy subjects performed upright leg cycling exercise at a constant WR for 30 min, followed by 16 min of sinusoidal WR consisting of 4‐min periods of WR fluctuating between a minimum output of 20 W and a maximum output corresponding to ventilatory threshold (VT). Throughout the protocol, pulmonary gas exchange, heart rate (HR), mean arterial blood pressure (MAP), blood velocity (BV), and cross‐sectional area of the BA, forearm skin BF (SBF), and sweating rate (SR) were measured. Each variable was fitted to a sinusoidal model with phase shift (θ) and amplitude (A). Nearly all variables closely fit a sinusoidal model. Variables relating to oxygen transport, such as VO₂ and HR, followed the sinusoidal WR pattern with certain delays (θ: VO₂; 51.4 ± 4.0°, HR; 41.8 ± 5.4°, mean ± SD). Conversely, BF response in the BA was approximately in antiphase (175.1 ± 28.9°) with a relatively large A, whereas the phase of forearm SBF was dissimilar (65.8 ± 35.9°). Thus, the change of BF through a conduit artery to the nonworking upper limb appears to be the reverse when WR fluctuates during sinusoidal leg exercise, and it appears unlikely that this could be ascribed exclusively to altering the downstream circulation to forearm skin.

Aging decreases CO2 reactivity in the retinal artery, but not in the ocular choroidal vessels; a cross-sectional study

BACKGROUND

The CO2 reactivity is often used to assess vascular function, but it is still unclear whether this reactivity is affected by aging.

OBJECTIVE

To investigate the effects of aging on the CO2 reactivity in ocular and cerebral vessels, both of which are highly sensitive to hypercapnia, we compared the CO2 reactivity in the retinal artery (RA), retinal and choroidal vessels (RCV), optic nerve head (ONH), and middle cerebral artery (MCA) between young and middle-aged subjects.

METHODS

We measured the CO2 reactivity in 14 young and 11 middle-aged males using laser-speckle flowgraphy during a 3-min inhalation of CO2-rich air.

RESULTS

The CO2 reactivity in the RA and ONH were lower in the middle-aged group than in the young group, but no significant effect of age was observed in the RCV or MCA. The CO2 reactivity in the RA and ONH were correlated significantly with age, whereas those in the RCV or MCA were not.

CONCLUSIONS

These findings suggest that there are regional differences in the effect of age on the CO2 reactivity among not only ocular and cerebral vessels, but also the retinal and choroidal vessels, even though these vessels are in neighboring areas.

Objective and Subjective Eating Speeds Are Related to Body Composition and Shape in Female College Students

Eating speed reportedly relates to body composition and shape. Little is known about the relationship between the objectively assessed eating speed and the body composition and shape. This study examined relationships between eating speed as assessed both objectively and subjectively, and body composition and shape. The following variables of body composition and shape were measured in 84 female college students: body mass, relative body fat mass (%Fat), body mass index (BMI), and circumferences of the waist, abdomen and hip. After measuring the body composition and shape, subjects consumed a 174-kcal salmon rice ball. The following chewing variables were measured by observing videotape recordings of the subjects' faces: number of chews per bite, total number of chews, total meal duration, number of bites, and chewing rate. The subjects were categorized into three groups (fast, moderate and slow) according to their own subjective assessments of the actual eating speed. In objective assessments of the eating speed, the total number of chews and the total meal duration were significantly negatively correlated with the body mass, %Fat, BMI, and circumferences of the waist, abdomen and hip. In subjective eating-speed assessments, the body mass, %Fat, BMI, and circumferences of the waist, abdomen and hip were greater in the fast eating group than in the slow eating group. Both the objectively and subjectively assessed eating speeds are related to the body composition and shape. The present study supports that fast eating may relate to gains in body mass and/or fat mass.

Possible association of oestrogen and Cryba4 with masticatory muscle tendon-aponeurosis hyperplasia

OBJECTIVE

Masticatory muscle tendon-aponeurosis hyperplasia, which is associated with limited mouth opening, progresses very slowly from adolescence. The prevalence rates of this disease are higher among women than among men, suggesting oestrogen involvement. As parafunctional habits are frequently observed, mechanical stress is likely involved in the pathogenesis and advancement of this disease. To elucidate the pathological condition, we examined the effect of oestrogen on tenocyte function and the relationship between mechanical stress and crystallin beta A4 (Cryba4), using murine TT-D6 tenocytes.

MATERIALS AND METHODS

Cell proliferation assays, RT-PCR, real-time RT-PCR, Western blot analysis and mechanical loading experiments were performed.

RESULTS

The physiological dose of oestrogen increased the levels of scleraxis and tenomodulin in TT-D6 tenocytes. In contrast, forced expression of Cryba4 inhibited scleraxis expression in these cells. Surprisingly, oestrogen significantly promoted cell differentiation in the Cryba4-overexpressing TT-D6 tenocytes. Moreover, tensile force induced Cryba4 expression in these tendon cells.

CONCLUSION

Oestrogen and Cryba4 may be associated with the progression of masticatory muscle tendon-aponeurosis hyperplasia.

Fluid intake restores retinal blood flow early after exhaustive exercise in healthy subjects

PURPOSE

It remains unclear whether rehydration restores retinal blood flow reduced by exhaustive exercise. We investigated the effect of fluid intake on retinal blood flow after exhaustive exercise.

METHODS

Blood flow in the inferior (ITRA) and superior temporal retinal arterioles (STRA) was measured before and after incremental cycling exercise until exhaustion in 13 healthy males. After the exercise, the subjects rested without drinking (control condition: CON) or with drinking an electrolyte containing water (rehydrate condition: REH) and were followed up for a period of 120 min. To assess the hydration state, the body mass was measured, and venous blood samples were collected and plasma volume (PV) was calculated.

RESULTS

Body mass decreased in CON after the trial [- 1.1 ± 0.1% (mean ± SE), p < 0.05]. PV was lower in CON than in REH during recovery. The ITRA and STRA blood flows decreased immediately after exercise from the resting baseline (ITRA; - 23 ± 4% in REH and - 30 ± 4% in CON, p < 0.05). The ITRA blood flow recovered baseline level at 15 min of recovery in REH (- 9 ± 3%, p = 0.5), but it remained reduced in CON (-14 ± 3%, p < 0.05). The STRA blood flow was higher in REH than in CON at 15 min (2 ± 3 vs. - 5 ± 3%, p < 0.05).

CONCLUSIONS

The results of this study suggest that the reduction in retinal blood flow induced by exhaustive exercise can be recovered early by rehydration.

Temporal Effect of Muscle Contraction on Respiratory Sinus Arrhythmia

The purpose of this investigation was to compare the heart rate variability at respiratory frequency (HRVRF) in muscle contractions during the inspiratory phase with that during the expiratory phase. Eight volunteers performed pedaling on a cycle ergometer, twice a cycle of respiration (4 sec) against a load of 0.25 Nm/kg BW, of which the timing was adjusted to twice during the inspiration phase (I), once during the expiration, once during the inspiration (El), or twice during the expiration phase (E). Spectral analysis was applied to the R-R intervals of each condition. The amplitude of HRVRF in E was less than half of I (9 ± 2 msec versus 23 ±2 msec). The results indicate that the timing of muscle contraction can affect the heart rate variability even at the frequency band of respiration.

Abstract P1-17-09: Leptomeningeal disease in ER+HER2- metastatic breast cancer patients: A review of the cases in a single institute over a 14-year period

Background: Leptomeningeal disease (LMD) is a pattern of central nervous system (CNS) metastasis that occurs in metastatic breast cancer (MBC) patients (pts). Some reports have revealed that it occurs more frequently in pts with estrogen receptor-positive (ER+), HER2-MBC than in pts with other subtypes. However, in such ER+HER2-MBC pts, LMD mainly occurs in the terminal stage of the disease; thus, the details of LMD have not been well described.

Methods: We reviewed the medical records of ER+HER2-MBC pts who were treated from 2002 to present, with the aim of assessing the incidence, background and outcomes of LMD. Statistical analyses were performed using the chi-squared test, Kaplan-Meyer method, log-rank test and a multivariate COX regression analysis.

Results: We identified a total of 369 ER+HER2-MBC pts, and 102 (27.6%) developed CNS metastasis. LMD developed in 32 (8.7%) pts, with the median time to LMD of 778 days (95% confidence interval [CI] 335-1221; range 0-3757 days) from the diagnosis of MBC. In most cases (28, 87.5%), LMD was accompanied by bone metastasis, and 24 pts (75.0%) showed metastasis to the skull. Thirteen pts (40.6%) had accompanying brain metastasis (BM) at the diagnosis of LMD. The majority of the pts had symptoms (25, 78.1%), and their accompanying extra-CNS lesions showed progression (23, 71.9%). Palliative radiotherapy (RT) was introduced in 27 pts (84.4%), with 4 pts (12.5%) receiving whole CNS RT. The intrathecal injection of methotrexate was introduced to one patient. The median overall survival (OS) from the diagnosis of LMD was 104 days (95% CI 38-170); however, when limited to pts without BM (N = 19), the median OS was 146 days (95%CI 79-213). All of the pts died, and the causes of death were as follows: CNS lesion progression, n=10 (31.3%); cachexia, n=9 (28.1%); respiratory failure, n=8 (25.0%); hepatic failure, n=4 (12.5%) and infection, n=1 (3.1%). There was no significant relationship between the time to LMD and OS after the diagnosis of LMD (Spearman's ρ=0.55, not significant). The multivariate analysis did not reveal any specific factors—such as the patient age, the presence of any symptom(s) at the diagnosis of LMD, the distribution of extra-CNS lesion(s) or the control of extra-CNS lesion(s)—that affected OS after the diagnosis of LMD.

As a control, 70 ER+HER2-MBC pts who developed BM without LMD (BM-only group) within the same observation period were analyzed. The median time to BM was 611 days (95%CI 404-818), and it did not differ from that of pts with LMD (LMD-group) to a statistically significant extent (P &gt;0.1). The BM-only group showed superior OS after the diagnosis of their CNS lesions in comparison to LMD-group (median, 295 days and 104 days, respectively, P &lt;0.001). At the diagnosis of the CNS lesion, the LMD-group showed a higher rate of CNS symptoms (P &lt;0.01), a lower rate of liver metastasis (P &lt;0.05), a higher rate of bone metastasis (P &lt;0.05) and a higher rate of skull metastasis (P &lt; 0.01).

Conclusion: Our retrospective analysis at a single institute revealed that the prognosis of LMD in pts with ER+HER2-MBC was still extremely poor. The data suggest that LMD is distinct from BM in terms of its pathology and response to therapy.

Citation Format: Watanabe J, Mitsuya K, Hayashi N, Nakasu Y. Leptomeningeal disease in ER+HER2- metastatic breast cancer patients: A review of the cases in a single institute over a 14-year period [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-17-09.

Abstract P3-01-03: The loss of lymph node metastasis after neoadjuvant chemotherapy in patients with cytologically proven node-positive primary breast cancer

Purpose:While the sensitivity to neoadjuvant chemotherapy (NAC) depends on breast cancer subtype, it has been reported that over 30% of patients with node-positive breast cancer achieved an axillary pathologic complete response (pCR) after NAC. However, axillary lymph node dissection (ALND) still remains as a standard treatment because of the difficulty of assessment of lymph node (LN) status after NAC. ALND will be omitted if axillary LN status is accurately assessed. Our purpose of this study was to predict the loss of axillary LN metastasis after NAC in primary breast cancer patients.

Patients and Methods: Among 997 consecutive patients who underwent surgery after NAC from January 2006, to December 2016, 279 patients with cytologically proven node-positive were included in this analysis. All patients were assessed using CT or PET-CT, and ultrasonography (US) before NAC. LN status after NAC was assessed by US. Patients with cT4 tumor, and supra/subclavicular and parasternal LN metastasis were excluded. Clinical LN status after NAC (ycN) was compared to pathological LN status (ypN) on surgical specimen. The association between LN status and clinicopathological factors including nuclear grade (NG), tumor size, the use of trastuzumab, and breast cancer subtypes, was assessed.

Result: Of the 279 patients with LN-positive before NAC, 166 patients (59.5%) had ER+/HER2- tumor, 51 patients (18.3%) had ER+/HER2+ tumor, 33 patients (11.8%) had ER-/HER2- tumor, and 29 patients (10.4%) had ER-/HER2+ tumor. 179 patients (64.2%) had ycN0 and 102 patients (36.6%)had ypN0. There was significant difference of rate of the loss of LN metastasis after NAC; 37 of 166 patients (22.3%) with ER+/HER2- tumor, 24 of 51 patients (47.1%) with ER+HER2+ tumor, 19 of 33 patients (57.6%) with ER-HER2- tumor, and 22 of 29 patients (75.9%) with ER-HER2+ tumor, (p&lt;0.01).The accuracy of assessment of the loss of LN metastasis by US (ycN0/ypN0) was high in 20 of 25 patients (80.0%) with ER-/HER2+ tumor and in 14 of 19 patients (73.4%) ER-/HER2- tumor compared to ER+ tumor; 21 of 39 patients (53.8%) with ER+/HER2+ tumor and 34 of 96 patients (35.4%) with ER+/HER2- tumor (p&lt;0.01). For patients with ycN0/ypN+, the median number of residual LN metastasis was 1 in ER-/HER2+ tumor (range:1-2) and ER-/HER2- tumor (range:1-3), and 2 in ER+/HER2+ tumor (range:1-6) and ER+/HER2- tumor (range:1-14). Among patients with ER-/HER2+ tumor, there was association between the loss of LN metastasis and the use of trastuzumab (p&lt;0.01). There was no association between the loss of LN metastasis and NG or tumor size.

Conclusion: Our results showed patients with ER-/HER2+ tumor and cytologically proven LN metastasis who received NAC with trastuzumab might have the loss of LN metastasis if assessed as ycN0 by US after NAC, whereas, the patients in ER+ tumor have a high risk to have residual LN metastases after NAC even if assessed as ycN0. Further studies are warranted the prognostic impact of the omission of ALND for these populations.

Citation Format: Namura M, Hayashi N, Tsunoda H, Yoshida A, Takei J, Suzuki K, Nakamura S, Yamauchi H. The loss of lymph node metastasis after neoadjuvant chemotherapy in patients with cytologically proven node-positive primary breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-01-03.

The relationship of waist circumference and body mass index to grey matter volume in community dwelling adults with mild obesity

Objective

Previous work has shown that high body mass index (BMI) is associated with low grey matter volume. However, evidence on the relationship between waist circumference (WC) and brain volume is relatively scarce. Moreover, the influence of mild obesity (as indexed by WC and BMI) on brain volume remains unclear. This study explored the relationships between WC and BMI and grey matter volume in a large sample of Japanese adults.

Methods

The participants were 792 community-dwelling adults (523 men and 269 women). Brain magnetic resonance images were collected, and the correlation between WC or BMI and global grey matter volume were analysed. The relationships between WC or BMI and regional grey matter volume were also investigated using voxel-based morphometry.

Results

Global grey matter volume was not correlated with WC or BMI. Voxel-based morphometry analysis revealed significant negative correlations between both WC and BMI and regional grey matter volume. The areas correlated with each index were more widespread in men than in women. In women, the total area of the regions significantly correlated with WC was slightly greater than that of the regions significantly correlated with BMI.

Conclusions

Results show that both WC and BMI were inversely related to regional grey matter volume, even in Japanese adults with somewhat mild obesity. Especially in populations with less obesity, such as the female participants in current study, WC may be more sensitive than BMI as a marker of grey matter volume differences associated with obesity.