Abstract P2-01-19: Sphingosine-1-phosphate affects tumor-associated macrophages in breast cancer patients

Background: Tumor-associated macrophages (TAMs) are considered to be one of the key players in the tumor microenvironment, which regulates cancer invasion and metastases. TAMs can be divided into two phenotypes with opposite functions. While M1 macrophages are known to exert anti-tumor activity by promoting pro-inflammatory effects and immune responses such as intereukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), M2 macrophages influence an anti-inflammatory response, wound healing, and pro-tumorigenic properties. A bioactive lipid mediator, sphingosine-1-phosphate (S1P) has emerged as a key regulatory molecule in cancer progression. We previously demonstrated that S1P generated by sphingosine kinase 1 (SPHK1), is a crucial mediator of breast cancer-induced angiogenesis and lymphangiogenesis, and promotes its metastasis. In particular, we found that SPHK1 is highly expressed in HER2 negative breast cancer, and the patients who developed lymph node metastasis demonstrated significantly higher levels of S1P (J Surg Res 2016). Although we have previously reported the role of S1P in recruitment of TAMs in vivo (Cancer Res 2018), its relevance in patients is yet to be uncovered. Here, we test our hypothesis that S1P signaling affects TAMs in human patients with breast cancer.

Materials and Methods: The expression level of each enzyme-encoding gene involved in S1P production was evaluated by retrieving RNA sequencing and gene expression quantification data using the Genomics Data Commons (GDC) data portal of the The Cancer Genome Atlas cohort. Gene expression levels were derived using normalization methods provided in the DESeq2 package. We compared the difference in expression levels of tumor associated macrophage related genes, including CD68, CD163, IL-6, andTNF-α between SPHK1-high breast tissue, and SPHK1-low breast tissue in the group of HER2 negative or positive patients. Unpaired t-tests were performed to compare expression differences between SPHK1-high and SPHK1-low breast tissue. All tests were two-sided and P values < 0.05 were considered statistically significant.

Results: CD68, pan-macrophage marker, is significantly increased in SPHK1-high breast cancer tissues both in HER2 negative and positive breast cancer patients (p=<0.001, <0.01). CD163 which is a scavenger receptor that is regarded as highly specific for M2 macrophages is significantly increased in SPHK1-high breast cancer tissues in HER2 negative breast cancer patients, but not in HER2 positive breast cancer patients (p=<0.001, 0.2). IL-6, which characterize M1 phenotype is significantly increased in SPHK1-high breast cancer tissues both in HER2 negative and positive breast cancer patients (p=<0.001, <0.001). TNF-α, which also characterizes M1 phenotype, is significantly increased in SPHK1-high breast cancer tissues in HER2 negative breast cancer patients, but not in HER2 positive breast cancer patients (p=<0.001, 0.05).

Conclusion: Our results suggest that S1P affects TAMs in breast cancer patients, which implicate the important roles of S1P in the complicated immune system related to tumor progression. Our results also indicate that S1P have a large role in HER2 negative breast cancer patients. Further investigations are needed to understand the underlying mechanisms.

Citation Format: Tsuchida J, Nagahashi M, Moro K, Ikarashi M, Koyama Y, Sakata J, Kobayashi T, Kameyama H, Qi Q, Yan L, Takabe K, Wakai T. Sphingosine-1-phosphate affects tumor-associated macrophages in breast cancer patients [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 P2-01-19.

Abstract P3-06-15: Young breast cancer patients demonstrate worse survival associated with aggressive oncogene expression but not with mutation load, tumor heterogeneity or pro-tumor immune cell infiltrations

INTRODUCTION: Young breast cancer patients have more aggressive subtypes and higher mortality rates. This study investigates the biologic, immunologic, and oncogenic differences between Young (≤40 yo) and Non-Young (>40 yo) patients with breast cancer.

MATERIALS/METHODS: The Cancer Genome Atlas (TCGA; n=1095) and the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC; n=1894) were used for analysis. Gene Set Enrichment Analysis (GSEA) was performed on breast cancer patients in TCGA. We calculated mutation load using both TCGA and METABRIC. We also calculated the Cytolytic Activity Score (CYT), Mutant-Allele Tumor Heterogeneity (MATH), T-Cell Receptor (TCR)-Richness, and Ki67 mRNA expression in TCGA.

RESULTS: There were 97 and 116 Young patients and 994 and 1788 Non-Young patients in the TCGA and METABRIC databases respectively. Young patients had a lower DFS (p=0.012) in TCGA. Young patients had a lower DSS (p<0.001) in METABRIC. There were less Stage I (13.5% vs 17.3%) and II (54.2% vs 58.3%) patients and more Stage III (31.2% vs 22.4%) patients in the Young group. There were more basal-like subtypes in the Young in TCGA (17.8% vs 16.1%) and METABRIC (28.4% vs 9.3%). Mutation load in TCGA was lower in the Young (p=0.030), but not significantly different in the METABRIC database. MATH, which reflects tumor heterogeneity, was not significantly different between the groups. These results were unexpected since Young patients have a higher proportion of basal-like subtype which is known to be rich in mutations and more immunogenic. In TCGA, Young patients were found to have higher amounts of activated dendritic cells (p=0.049). In METABRIC, Young patients had higher amounts of Plasma cells (p=0.016), CD4 memory-activated T-cells (p<0.001), NK resting cells (p=0.015), and M1 Macrophages (p=0.002). We also found that regulatory T-cells (p=0.029), activated NK cells (p=0.016), M2 Macrophages (p<0.001), and resting Mast cells (p=0.006) were lower in the Young. This unexpectedly showed that anti-tumor immune cells were more enriched in Young patients. Indeed, the CYT, which reflects tumor killing activity, and TCR-Richness, which reflects T-cell function, were both significantly higher in Young patients (p=0.034, p=0.004, respectively), which was opposite from what we expected due to its biological aggressiveness. GSEA was then used to analyze the TCGA database to clarify gene sets that are enriched in Young patients. Of the 50 Hallmark gene sets analyzed, 4 gene sets were found to be enriched in Young patients; G2M Checkpoint (p=0.002), Hallmark MYC Targets V1 (p=0.004), HALLMARK E2F Targets (p=0.035), and Hallmark Unfolded Protein Response (p=0.038). Ki67 which reflects cell proliferation was significantly higher in Young vs Non-Young patients (p=0.004).

CONCLUSIONS: Both TCGA and METABRIC cohorts demonstrated that Young patients have more basal-like subtype and significantly worse survival. Our results support the notion that Young patients have more aggressive cancer not because of mutations, tumor heterogeneity or immune cell infiltrations, but because of aggressive oncogene expressions.

Citation Format: Young JS, Asaoka M, Katsuta E, Kawaguchi T, Qi Q, Liu S, Yan L, Takabe K. Young breast cancer patients demonstrate worse survival associated with aggressive oncogene expression but not with mutation load, tumor heterogeneity or pro-tumor immune cell infiltrations [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 P3-06-15.

Estimation on Formation Time of Thrombus

OBJECTIVES

To observe the changes of the formation time of venous thrombus in rats, and to provide new ideas and methods for the estimation on thrombus formation time of the forensic cases died from thrombosis.

METHODS

Totally 80 rats were randomly divided into 10 groups （0 h, 3 h, 6 h, 12 h, 1 d, 3 d, 1 week, 2 weeks, 3 weeks and 4 weeks after operation）. A vein thrombosis model was established by the "narrow" method. The processes of thrombosis, organization, recanalization and the features of change on hemosiderin and calcium salt were observed by HE stain, Perls stain and Von Kossa stain. The expression changes of CD61, α-SMA and CD34 were observed by immunohistochemical staining technique.

RESULTS

Platelets adhered to the exposed blood vessel intima 3 h after operation, and platelet trabeculae were formed by the repeated accumulation of platelets 1 d after operation. The thrombus organization formed through the fibroblasts from vessel wall that grew into the interior of the thrombus 3 d after operation. Endothelial cells covered the surface of thrombus and then the new blood vessels were reformed, and the vessels were reconstructed. The expression of CD61 upregulated at the stages of the thrombus formation （3 h） and thrombus reformation （4 weeks）, and reached the peak 1 d after thrombus formation. The release of hemosiderin and the initial expression of α-SMA were detected 3 d later. Calcium deposit and expression of CD34 were observed 1 week later.

CONCLUSIONS

The hemosiderin, calcium salt, CD61, α-SMA and CD34 show time-dependent changing characteristics, which is expected to provide a reference for the estimation on thrombus formation time of the forensic cases died from thrombosis.

Abstract P2-05-14: Young breast cancer patients (<40 yo) have unfavorable subtypes, higher stage and worse survival

BACKGROUND:

Over the last 40 years, the incidence of breast cancer in young women in the U.S. has been relatively low and stable, but the absolute number of young women with breast cancer is increasing because of the growing population. Some epidemiological studies have shown that breast cancer diagnosed before age 40 have significantly worse overall 5-year survival. Disease free survival is also inferior in young women, and they have more aggressive cancers in general. This study aims to validate these findings using genomic analysis of large databases.

MATERIALS AND METHODS:

The Cancer Genome Atlas (TCGA; n= 1095) and the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC; n=1894) were used for analysis. We divided the database into the Young (<40 yo) and Non-Young (>40 yo) cohorts, based on age at diagnosis. The following analysis will give the TCGA and METABRIC results in each category, respectively.

RESULTS:

There were 8.9% (98) and 6% (116) patients who were found to be Young. In the Young cohort, 69.5% (64) and 37.9% (44) were ER(+), whereas 77.9% (742) and 79.5% (1415) in the Non-Young cohort were ER(+). Further, 60.8% (56) and 31.9% (37) were PR(+) in the Young cohort, compared to 68.4% (641) and 54.4% (972) in the Non-Young cohort. Her2(+) cancers were noted in 22.2% (12) and 25% (29) in the Young cohort, whereas 22.6% (152) and 11.6% (207) were Her2(+) in the Non-Young cohort. Our group developed a pipeline to calculate PAM50 from the RNA-Seq dataset. Utilizing this calculated PAM50 in TCGA, we found that there were less Luminal A and B patients in the Young cohort, 41.6% (42) and 17.8% (18) compared to 49.7% (377) and 22.9% (174) in the Non-Young cohort. This was also the case in METABRIC where 17.2% (20) and 9.5% (11) were Luminal A and B, compared to 36.9% (659) and 25.2% (450) in the Non-Young group. In contrast, there were more basal-like subtypes in the Young group, 17.8% (18) and 28.4% (33), as compared to the Non-Young group, 16.1% (122) and 9.3% (166). These results agree with previous epidemiological studies that showed that hormone receptor positive tumors increase and basal-like subtypes decrease with age. The number of Stage I patients was lower in Young patients 13.5% (13) and 25.3% (22), than in Non-Young patients 17.3% (169) and 34.4% (453). Similarly, there were less Stage II patients in the Young 54.2% (52) and 58.6% (51) compared to 58.3% (569) and 56.9% (749) in the Non-Young. This reverses in Stage III where the incidence is increased in the Young at 31.2% (30) and 16.1% (14) compared to 22.4% (219) and 7.7% (101) in the Non-Young. Young patients had a lower median disease-free survival than Non-Young patients (NA vs 214.7 mo, p=0.027); however, there was no statistical significance in median survival. Young patients had a lower median disease-specific survival than non-young patients of 221.1 months vs 282.6 months (p=0.00123) in METABRIC.

CONCLUSION: We used large datasets to examine survival in very young breast cancer patients (<40 yo) vs older patients and found that young patients are likely to have unfavorable subtypes, higher stage, and a lower overall survival and DFS as compared to their older counterparts. Further analysis with genomics is needed.

Citation Format: Young JS, Kawaguchi T, Yan L, Qi Q, Liu S, Takabe K. Young breast cancer patients (<40 yo) have unfavorable subtypes, higher stage and worse survival [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 P2-05-14.

Abstract P1-07-31: Integrated transcriptomics analyses identify novel three microRNAs signature to predict poor prognosis and metastasis in breast cancer

Backgrounds: MicroRNA (miRNA) play a crucial role in cancer progression, and altered miRNA expression has been demonstrated to be associated with breast cancer. MiRNA is also known to be stably detectable not only in tissue but peripheral circulation; therefore it could be a feasible and potential biomarker of breast cancer in clinical settings. However, few studies have been reported to identify promising miRNA profiles as predictive biomarker using statistically satisfied large cohorts of breast cancer patients. The aim of this study is to identify miRNA signature that can predict patient survival utilizing integrated and unbiased transcriptomics analyses.

Methods: Integrated and unbiased transcriptomics approach was conducted on genomic and clinicopathological information of 2580 breast cancer patients. We utilized The cancer Genome Atlas (TCGA) to identify miRNA signature that could significantly associated with clinical relevance including prognosis and metastatic information, followed by validation analyses with the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) and Gene Expression Omnibus (GEO)

Results: A novel risk scoring model including three miRNAs signature (miR-19a, miR-93, and miR-106a) was identified using Cox model. This miRNA score was able to extract the patient population with extremely poor prognosis in TCGA (5-yr overall survival rate, 49.2 %, p=0.0005). This result was validated with another three completely independent cohorts with microarray dataset accompanied with sufficient clinical information and miRNA expression (GSE19536, n=96, p=0.0009; GSE22220, n=210, p=0.0003; METABRIC, n=1223, p=0,0023). Interestingly, the subtype stratification with PAM-50 classification using bioinformatics pipeline demonstrated that this miRNA score could predict poor overall or disease-free survival especially in the population with luminal A, B or normal like subtype (p=0.0300 and p=0.0001, respectively). In addition, competing risk analysis for tumor recurrences demonstrated that the risk scoring using three miRNAs signature could be significantly associated with bone metastasis (p=0.0052). Finally, Gene Set Enrichment Analysis (GSEA) identified that high risk score using three miRNAs associated significantly with several critical gene sets related to metastatic formation such as angiogenesis (p <0.0001), epithelial mesenchymal transition (EMT) (p = 0.0155), focal adhesion (p <0.0001), TGF-beta signaling pathway (p = 0.0025), and ECM receptor interaction (p = 0.0068).

Conclusions: We demonstrated a promising miRNAs signature score system for predicting extremely poor prognosis and metastatic potentiality in breast cancer using novel integrated transcriptomics concept.

Citation Format: Takabe K, Kawaguchi T, Yan L, Qi Q, Peng X, Young J, Liu S. Integrated transcriptomics analyses identify novel three microRNAs signature to predict poor prognosis and metastasis in 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 P1-07-31.

Abstract P5-07-07: Prognostic relevance of microRNA-155 and microRNA-21 in breast cancer patients

Introduction

MicroRNAs (miRNAs) are short noncoding RNA sequences that degrade or prevent the translation of their target messenger RNA (mRNA). Altered regulation of miRNAs is implicated in different cellular processes. Some miRNAs, such as miRNA-155 (miR155) and miRNA-21 (miR21), are implicated in both immunity and cancer progression. Previous studies show that both miR155 and -21 are oncogenic, as their overexpression promotes invasion, proliferation and migration of breast cancer cells in vitro. Their overexpression within patient cohorts (n= 40-173 patients) reveals a worse prognosis for miR21 and varying associations with prognosis for miR155. By using the Cancer Genome Atlas (TCGA), which contains data from over a thousand patients, we want to clarify whether high expression of miR155 or -21 is associated with an improved or worse survival within breast tumor samples. Because both miR155 and -21 are described as oncogenic, we hypothesize that high expression of these miRNAs would portend a worse survival.

Methods

Within the breast cohort, 1052/1097 patients within TCGA contained both clinical and miRNA sequence data, acquired via the Genomic Data Common (GDC) data portal. The patients were separated into a high and low expression group for both miR155 and miR21, and associations with overall survival were obtained using the Cox proportional hazard model. Furthermore, a sub-analysis was conducted based on estrogen, progesterone and Her-2 receptor status (ER, PR, Her-2) as well as TNM staging (AJCC 7th edition).

Results

General patient characteristics within the breast cancer cohort of TCGA included: 70% Caucasian, 73% >50 years old, 75% with TNM stage I and II breast cancers, 74% ER positive, and 33% Her-2 positive. We unexpectedly found that miR155 and miR21 high expression was associated with an improved survival (p=0.05 and 0.038 respectively). In the sub-analysis, a positive association with survival was seen for miR155 high expression in ER negative, and Stage I-II breast cancers (p=0.025, 0.0013 respectively), but not in Stage III-IV. The sub-analysis for miR21 found an association with improved survival for miR21 high expression in ER negative, and stage I-II patients (p=0.033, 0.0015 respectively), but not in Stage III-IV. Although not statistically significant, a trend towards improved survival was found in ER and PR positive subgroups, for both miR155 and -21. For the Her-2 negative subgroup, there was a trend for improved survival in miR155 high expression, but not in miR21 high expression. Knowing that ER negative tumors can attract more immune cells, and that miR155 and -21 can be expressed in immune cells and tumor associated fibroblasts respectively, we speculate that their high expression was concentrated within cells from the tumor microenvironment rather than the cancer cells.

Conclusion

Using TCGA as a large validation cohort, we found that high expression of miR155 and miR21 was associated with an improved survival, which was contrary to what we predicted. Future experiments using computational biology to determine the cell type composition within the TCGA tumor samples will be performed in an effort to determine whether the tumor microenvironment influenced the survival patterns we observed in the high expression groups of miR155 and -21.

Citation Format: Kim SY, Kawaguchi T, Yan L, Young J, Qi Q, Takabe K. Prognostic relevance of microRNA-155 and microRNA-21 in breast cancer patients [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 P5-07-07.

Abstract P5-07-08: Survival relevance of tamoxifen sensitivity-related microRNAs, miR-342 and miR-221/222, in breast cancer patients

BACKGROUND: MicroRNAs (miRNAs) are small noncoding RNAs, which regulate the expression of target genes post-transcriptionally by RNA interference. They have emerged as one of the crucial regulators of cancer progression. Some miRNAs are reported to be related to the response of breast cancer to tamoxifen (TAM). In this study, we investigated whether the levels of TAM-resistant miRNA (miR-221/222) and TAM-sensitive miRNA (miR-342) translate to breast cancer patient survival, using multiple large databases.

MATERIALS AND METHODS: The Cancer Genome Atlas (TCGA; n=1049), Gene Expression Omnibus (GEO; GSE19536 n=96, GSE22220 n=210), and Molecular Taxonomy of Breast Cancer International Consortium (METABRIC; n=2509) datasets were used and Gene Set Enrichment Analysis (GSEA) was performed.

RESULTS: MiR-342 was identified as a TAM-sensitive miRNA, and miR-221/222 were identified as TAM-resistant miRNAs by literature search. Patients with high expression of miR-342 were shown to have better survival in TCGA (OS, p=0.02; DFS, p=0.03, respectively) and in two other independent GEO cohorts (OS, p=0.02 and p=0.0007, respectively) as well as in the METABRIC cohort (OS, miR-342-3p, p=0.006; miR-342-5p, p=0.00009). By subtype analyses, high expression of miR-342 was significantly associated with better survival in ER-positive patients (p=0.04), but not in ER-negative or triple negative patients in the TCGA cohort. This association was not observed in the METABRIC cohort. Within TCGA cohort, expression of TAM-resistant miR-221/222 did not significantly impact survival. Unexpectedly, increased expression of miR-221 was shown to have increased overall survival in all patients (p=0.00904) as well as in ER-negative patients (p=0.0479) and non-triple negative patients (p=0.0106) within the METABRIC cohort. On the other hand, low expression of miR-222 was associated with increased survival of all patients (p=0.00802) as well as in non-triple negative patients (p=0.041). Lastly, GSEA demonstrated that lower miR-342 expression was significantly seen in TAM-resistant gene sets, and higher miR-342 expression was seen TAM-sensitive gene sets, but miR-221/222 did not show any significant enrichment with TAM-resistant or TAM-sensitive gene sets. Taken together with survival data, expression levels of miR-342 reflect its TAM-sensitivity related function, however, that of miR-221/222 reflect other functions in breast cancer patients.

CONCLUSION: For the first time, we used “big data” from the TCGA, GEO and METABRIC cohorts to analyze multiple miRNAs with respect to TAM sensitivities and its survival impact. We demonstrated that expression of miR-342 reflected the sensitivity of the cancer cells to TAM sensitivity, however, that of miR-221/222 reflected other functions in breast cancer patients.

Citation Format: Young JS, Kawaguchi T, Yan L, Qi Q, Liu S, Takabe K. Survival relevance of tamoxifen sensitivity-related microRNAs, miR-342 and miR-221/222, in breast cancer patients [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 P5-07-08.

Abstract P6-06-06: Immunogenomics approach elucidating clinical significance of DNA repair genes and tumor infiltrating immune cells in breast cancer

Backgrounds: Evading the immune system is one of the Hallmarks of Cancer. Indeed, tumor infiltrating immune cells has been shown to play critical roles in suppression of cancer progression. Genetic aberration of DNA repair genes is known to increase immunogenicity in breast cancer. However, the patient survival relevance of tumor infiltrating immune cells in regard to DNA repair genes has not yet elucidated in large cohort of breast cancer patients. We hypothesized that DNA repair gene deficiency is related to increased global genomic instability that leads to increased mutation burden, which recruits infiltrating immune cells to tumor microenvironment that result in better prognosis of breast cancer.

Patients and Methods: Integrated and unbiased transcriptomics approach was conducted on genomic and clinicopathological information of 3614 breast cancer patients. We utilized The cancer Genome Atlas (TCGA) and the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) to evaluate the association between the aberration of DNA repair genes and tumor infiltrating immune cell composition in breast cancer tumors, as well as its significant clinical relevance, utilizing bioinformatics and biostatistics pipelines.

Results:Low expression level of double-strand break repair genes; BRCA1, PRKDC, and RECQL4,demonstrated significantlybetter prognosis in TCGA cohort (p=0.018, p=0.036, and p=0.0002, respectively). This result was consistent in METABRIC cohort (p=0.021, p=0.00021, and p<0.000001, respectively). Utilizing CIBERSORT system that estimate the fraction of 22 immune cell types, we found that low expression of BRCA1 significantly associated with high levels of CD8 positive cell composition in both cohorts (TCGA, p=4.67E-08; METABRIC, p=0.0038), which implicate that tumor infiltrating lymphocytes are attracted to BRCA1 low expressing tumors. Further, low expression of BRCA1 showed significantly better survival in HER2 positive subtype population, but not in the other populations (TCGA, p=0.027; METABRIC, p=0.13). Finally, significantly poor prognosis was observed in breast cancers low in immune-response markers; PD-1, PD-L1, TIM3, LAG3, and CTLA4, in combination with high expression of BRCA1 (p=0.0016, p=0.0041, p=0.015, p=0.0041, and p=0.0043, respectively), which is in agreement with the dogma that intact DNA repair induce less immune-response that result is worse survival.

Conclusions: We conclude that our immunogenomics approach identify the interplay between DNA repair genes, especially gene expression of BRCA1, and tumor infiltrating immune cells, and it could have significant prognostic relevance in breast cancer.

Citation Format: Takabe K, Kawaguchi T, Yan L, Peng X, Qi Q, Okano M, Young J, Liu S. Immunogenomics approach elucidating clinical significance of DNA repair genes and tumor infiltrating immune cells in 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 P6-06-06.

[Perioperative stroke effectively treated by an acute stroke team including anesthesia department: a case report]

Perioperative stroke is cerebral infarction occurring in the perioperative period. The incidence of perioperative stroke in non-cardiac, and non-neurologic surgery is about 0.7%, but the mortality can be as high as 26% to 40%. The outcome of the patients with perioperative stroke can be disastrous. Here we report a case of perioperative ischemic stroke that occurred after surgery of lumbar decompression and pedical screw fixation. A 76-year-old female admitted to our hospital because of lumbar spinal stenosis. Her medical history included hypertension and diabetes for ten years. Her personal history included a smoking history of 60 years by 2 cigarettes per day, not quitting. Her carotid artery ultrasound showed multiple low echo plaques on the right side and multiple high echo plaques on the left side of the carotid artery, but without distinct stenosis. Other examinations and tests showed no distinct abnormality. She went on a lumbar decompression and pedical screw fixation uneventfully. The blood loss was 400 mL and autologous blood transfusion 150 mL. The arterial blood pressure (ABP) maintained during 100-130 mmHg/60-80 mmHg (1 mmHg=0.133 kPa). Sixty minutes after she recovered from general anesthesia, the patient developed symptoms of slurred speech and right limbs weakness. The anesthesio-logist evaluated the patient immediately with National Institute of Health Stroke Scale (NIHSS). The NIHSS score was 11 and a stroke was highly suspected. The acute stroke team was therefore initiated and fast responded. Within 4 h, digital subtraction angiography (DSA) was proceeded, which showed the M1 segment of the left middle cerebral artery was occluded and the local stenosis of her right middle cerebral artery was up to 80%. After the successful embolectomy by Solitaire stent, the left middle cerebral artery reflowed and the forward blood flow was thrombolysis in myocardial infarction (TIMI) grade 3. The patient was discharged after 33 days after the surgery with a NIHSS of 9. Our case provides an example that an acute stroke team that included the department of anesthesiology can be beneficial to the patients' perioperative strokes. During the perioperative period, anesthesiologists should be included into the acute stroke team, because anesthesiologists and anesthesia nurses might be first observers of those early onset strokes. Our case also put forward this thought that a standard peri-operative stroke evaluation tool, like NIHSS, should be discussed and applied to facilitate and accelerate the initiation of perioperative acute stroke team.

PRAS40 promotes NF-κB transcriptional activity through association with p65

PRAS40 has been shown to have a crucial role in the repression of mammalian target of rapamycin (mTOR). Nonetheless, PRAS40 appears to have an oncogenic function in cancer cells. Whether PRAS40 mediates signaling independent of mTOR inhibition in cancer cells remains elusive. Here PRAS40 overexpression in lung adenocarcinoma and cutaneous melanoma was significantly correlated to worse prognosis. And we identified an unexpected role for PRAS40 in the regulation of nuclear factor (NF)-κB signaling. P65, a subunit of the NF-κB transcription factor complex, was confirmed to associate with PRAS40 by glutathione S-transferase co-precipitation. Importantly, we found that PRAS40 can enhance NF-κB transcriptional activity in a manner dependent upon PRAS40–P65 association. Furthermore, we found that a small p65-derived peptide can disrupt the PRAS40–P65 association and significantly decrease NF-κB transcriptional activity. These findings may help elucidate the pleiotropic functions of PRAS40 in cells and suggest a novel therapeutic strategy in cancer patients with high expression of PRAS40 and NF-κB.

[Ventilator-associated pneumonia among premature infants <34 weeks' gestational age in neonatal intensive care unit in China: a multicenter study]

Objective: To investigate the incidence and pathogen distribution of ventilator-associated pneumonia (VAP) among preterm infants admitted to level Ⅲ neonatal intensive care units (NICU) in China. Method: A prospective study was conducted in 25 level Ⅲ NICU, enrolling all preterm infants <34 weeks gestational age admitted to the participating NICU within the first 7 days of life from May 2015 to April 2016. Chi-square test, t test and Mann-Whitney U test were used for statistical analysis. Result: A total of 7 918 patients were enrolled, within whom 4 623(58.4%) were males. The birth weight was (1 639±415) g and the gestational age was (31.4±2.0) weeks; 4 654(58.8%) infants required non-invasive mechanical ventilation and 2 154(27.2%) required intubation. Of all the mechanically ventilated patients, VAP occurred in 95 patients. The overall VAP rate was 7.0 episodes per 1 000 ventilator days, varying from 0 to 34.4 episodes per 1 000 ventilator days in different centers. The incidence of VAP was 9.6 and 6.0 per 1 000 ventilator days in children's hospitals and maternity-infant hospitals respectively, without significant differences (t=1.002, P=0.327). Gram-negative bacilli (76 strains, 91.6%) were the primary VAP microorganisms, mainly Acinetobacter baumannii (24 strains, 28.9%), Klebsiella pneumonia (23 strains, 27.7%), and Pseudomonas aeruginosa (10 strains, 12.0%). Conclusion: The incidence of VAP in China is similar to that in developed counties, with substantial variability in different NICU settings. More efforts are needed to monitor and evaluate the preventable factors associated with VAP and conduct interventions that could effectively reduce the occurrence of VAP.

[Effect of application of pulse contour cardiac output monitoring technology on delayed resuscitation of patients with extensive burn in a mass casualty]

OBJECTIVE

To investigate the effect of the application of pulse contour cardiac output (PiCCO) monitoring technology on delayed resuscitation of patients with extensive burn in a mass casualty.

METHODS

The clinical data of 41 patients injured in Kunshan dash explosion hospitalized in the First Affiliated Hospital of Soochow University, the 100th Hospital of the People's Liberation Army, and Suzhou Municipal Hospital were retrospectively analyzed. The patients were divided into traditional monitoring group (T, n=22) and PiCCO monitoring group (P, n=19) according to the monitoring technic during delayed resuscitation. The input volumes of electrolyte, colloids, and water of patients in the two groups within 2 hours after admission, the first, second, and third 8 hours post injury (HPI), and the first 24 HPI were recorded. The fluid infusion coefficients of patients in the two groups within 2 hours after admission, the first, second, and third 8 HPI, and the first, second, third, and fourth 24 HPI were calculated. The urine volume, mean arterial pressure (MAP), and central venous pressure (CVP) of patients in the two groups at post injury hour (PIH) 8, 16, 24, 48, 72, and 96 were recorded. The blood lactate, base excess, hematocrit (HCT), and platelet count of patients in the two groups at PIH 24, 48, 72, and 96 were recorded. Complications and death of patients in the two groups were recorded. Data were processed with analysis of variance for repeated measurement, Chi-square test, t test, and Wilcoxon test. The deviations between figure 2 and the fluid infusion coefficients of the first or second 24 HPI, and the deviations between figure 1 and the fluid infusion coefficients of the second, third or fourth 24 HPI were calculated, and the three groups deviations were analyzed by Pearson correlation analysis.

RESULTS

(1) The input volumes of electrolyte of patients in group P were significantly more than those in group T within the first 8 and 24 HPI (with Z values respectively -3.506 and -2.654, P<0.05 or P<0.01), and the input volumes of electrolyte of patients in the two groups were similar within the other time periods (with Z values from -1.871 to -0.680, P values above 0.05). The input volumes of colloid of patients in group P were significantly less than those in group T within the second, third 8 HPI, and the first 24 HPI (with Z values from -4.720 to -2.643, P<0.05 or P<0.01), and the input volumes of colloid of patients in the two groups were similar within the other time periods (with Z values respectively -2.376 and -2.303, P values above 0.05). The input volumes of water of patients in the two groups were similar within each time period (with Z values from -1.959 to -0.241, P values above 0.05). (2) The fluid infusion coefficients of patients in group T within 2 hours after admission, the first, second, and third 8 HPI, and the first, second, third, and fourth 24 HPI were respectively (0.59±0.18), (0.70±0.23), (0.94±0.24), (0.74±0.14), (2.38±0.44), (1.70±0.56), (1.35±0.67), and (0.92±0.46) mL·kg(-1)·%TBSA(-1,) and the values in group P were respectively (0.59±0.29), (0.82±0.37), (0.86±0.38), (0.59±0.24), (2.27±0.85), (2.13±0.68), (1.59±3.78), and (1.46±0.56) mL·kg(-1)·%TBSA(-1). The fluid infusion coefficients of patients in the two groups were similar within 2 hours after admission, the first, second 8 HPI, and the first, third 24 HPI (with t values from -1.262 to 0.871, P values above 0.05). The fluid infusion coefficient of patients in group P was significantly lower than that in group T within the third 8 HPI (t=2.456, P<0.05), and the fluid infusion coefficient of patients in group P were significantly higher than that in group T within the second and fourth 24 HPI (with t values respectively -2.234 and -3.370, P<0.05 or P<0.01). There was obviously negative correlation between the deviations of figure 2 and the fluid infusion coefficient of the first 24 HPI and that of the second 24 HPI (r=-0.438, P<0.01). There was no obvious correlation between the deviations of figure 1 and the fluid infusion coefficient of the second 24 HPI and that of the third 24 HPI (r=0.091, P>0.05). There was obviously positive correlation between the deviations of figure 1 and the fluid infusion coefficient of the second 24 HPI and that of the fourth 24 HPI (r=0.695, P<0.01). (3) The urine volumes and MAP of patients in the two groups were similar at each time point (with Z values from -1.884 to 0, P values above 0.05). The CVP of patients in group P were significantly higher than that in group T at PIH 16, 24, 48, and 72 (with Z values from -4.341 to -2.213, P<0.05 or P<0.01), and the CVP of patients in the two groups were similar at the other time points (with Z values respectively -0.132 and -1.208, P values above 0.05). The blood lactate of patients in group P was significantly higher than that in group T at PIH 72 (Z= -2.958, P<0.01) , and the blood lactate of patients in the two groups were similar at the other time points (with Z values from -1.742 to -0.433, P values above 0.05). The base excess of patients in group P were significantly lower than that in group T at PIH 24, 48, 72, and 96 (with Z values from -4.970 to -4.734, P values below 0.01). The HCT of patients in the two groups were similar at PIH 24, 48, 72, and 96 (with Z values from -2.239 to -0.196, P values above 0.05). There were significant differences in the platelet count of patients in the two groups at PIH 24, 72, and 96 (with Z values from -4.578 to -2.512, P<0.05 or P<0.01). (4) There were 15 cases in group T accompanied by complications, and 7 cases died, while 13 cases in group P accompanied by complications, and 9 cases died. The occurrence of complications and death of patients in the two groups were similar (with χ(2) values respectively <0.001 and 1.306, P values above 0.05).

CONCLUSIONS

On the basis of traditional burn shock monitoring index, the effect of fluid resuscitation in patients with severe burn monitored by PiCCO technology is not so good and still needs further clinical research.

[The clinical analysis of instrumentation failure after corrective surgery for thoracolumbar focal kyphosis]

OBJECTIVE

To analyze the etiology of instrumentation failure after corrective surgery for thoracolumbar focal kyphosis, and make suggestion for treatment.

METHODS

Retrospective study for 8 patients with thoracolumbar focal kyphosis who underwent surgical treatment and suffered instrumentation failure from June 2005 to December 2011 was made. The surgical procedures included pedicle subtraction osteotomy (PSO), anterior opening-posterior closing osteotomy and correction (AOPC), and posterior vertebral column resection (VCR). The reasons of instrumentation failure were analyzed and revision surgeries were performed.

RESULTS

The incidence of instrumentation failure was 6.3%. The average occurrence time was 22.5 months after surgery. Except one had failure in 3 months after surgery, all cases happened after 1 year. In this series, there were 5 cases with post-tuberculosis, 2 cases with post-traumatic kyphosis and 1 case with congenital kyphosis. For the surgical procedure, 7 cases underwent VCR and 1 case AOPC. After the instrumentation failure, all cases had back pain, and 3 of them had combined neurological symptoms. The reasons or risk factors of instrumentation failure included non-fusion of bone graft, VCR procedure, sink of the titanium mesh, insufficiency of anchor sites, and more severe kyphosis. All the 8 cases were treated with revision surgery and got good results.

CONCLUSIONS

The instrumentation failure of thoracolumbar focal kyphosis is relatively late occurred, and can develop with various reasons. Positive revision surgery is suggested for the instrumentation failure, and good results can be expected.

[Clinical analysis of 67 cases of surgical site infection after spine surgery]

OBJECTIVE

To investigate the treatment of surgical site infection(SSI) after spine surgery.

METHODS

Sixty-seven patients (aged 20-77 years with mean age of 51 years) with etiologically-confirmed surgical site infection after spine surgery in Peking University Third Hospital between July 2004 and December 2012 were retrospectively analyzed. There were 39 male and 28 female patients; 47 lumbar infections, 4 thoracic infections, 7 lower cervical infections and 8 upper cervical infections; 64 early infections and 3 delayed infections; 23 superficial infections and 44 deep infections; 47 monomicrobial infections and 20 polymicrobial infections. Ninety-six strains of bacteria were identified from the bacterial culture of 67 patients. Sixty strains were gram-positive pathogenic bacteria (62.5%), and the top three species were Staphylococcus aureus, S. epidermidis and Enterococcus faecalis. The remaining 36 strains were gram-negative pathogenic bacteria (37.5%), and the 3 species most predominant were Escherichia coli, Enterobacter cloacae, and Acinetobacter baumannii. All the patients with SSI were administered antibiotics. Debridement and irrigation-suction was performed if little symptomatic improvement was achieved in two-to-three days of antibiotics treatment, patients underwent 1-5 times of debridements (mean 1.5 times).

RESULTS

One patient was dead of MRSA septicemia, whom manifested as high fever, alalia and incision swelling when the infection occurred. The patient underwent polymicrobial of pulmonary infection and urinary tract infection during the period of hospitalization, and finally died of multiple organ failure. Sixty-six cases had wound healed, and they were followed up for 25-117 months (average 70 months), no recurrence of infection was found at last follow-up. Among the 65 cases of internal fixation, 56 cases reserved the implants, while implants were removed in other 9 cases for controlling infection.

CONCLUSION

Reasonable antibiotics and irrigation-suction are effective methods for managing surgical site infections after spine surgery and prevent removal of implants.

Circulating DNA for detection of gastric cancer

OBJECTIVE

Gastric cancer (GC) is one of the most common malignant tumors worldwide, particularly, prevalent in China. Despite the decreasing incidence of GC in China, the 5-year survival rate is still not over 30% yet. Therefore, early diagnosis and therapeutic outcome evaluation of GC remains as the issue to be resolved in a clinical setting.

MATERIALS AND METHODS

Recent studies have found the presence of a certain amount of circulating DNA in the peripheral blood of patients with malignant tumor and shown that these free DNA bear tumor-specific genetic information. The circulating DNA detection includes quantitative and qualitative methods and analysis. Combined monitoring of changes in circulating DNA levels and aberrant alteration of relevant tumor genes is likely to provide comprehensive real-time information to patients.

RESULTS

Under normal conditions, oncogene presents in the form of proto-oncogene such as K-ras, which is in non-carcinogenic status under the influence of tumor suppressor gene. When tumor suppressor gene is damaged or mutated of oncogene itself is induced for instance P53, oncogene is then activated and induces tumorigenesis. However, compared to gene mutation detection, the detection of DNA methylation is relatively more well-developed and stable.

CONCLUSIONS

This article reviews the current status of the research on circulating DNA in the diagnosis, assessment of response to therapy and prognostic evaluation in GC. In addition, the advantage, current issue and prospect of using circulating DNA as tumor marker are also analyzed.

Prognostic nutritional index predicts survival and correlates with systemic inflammatory response in advanced pancreatic cancer

BACKGROUND

Recent studies have implied a prognostic value of the prognostic nutritional index (PNI) in certain types of human cancers. However, the value of PNI for predicting survival in patients with pancreatic cancer remains unknown. The goal of this study was to investigate the predictive significance of PNI in patients with advanced pancreatic cancer.

METHODS

A total of 321 consecutive patients with pathologically-confirmed locally advanced or metastatic pancreatic ductal adenocarcinoma (PDAC) were retrospectively recruited between January 2011 and August 2013. The patients were divided into a test set (n = 110) and a validation set (n = 211). We evaluated the association between PNI and overall survival (OS). The relationship between PNI and systemic inflammatory response markers, including the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR) was also assessed. In addition, the associations between PNI and the TNF-α were analyzed.

RESULTS

Kaplan-Meier analyses showed that a low PNI correlated significantly with a shorter OS in patients with advanced pancreatic cancer (190 days for patients with a low PNI vs. 290 days for patients with a high PNI, log-rank = 12.566, P < 0.001). Multivariate analysis identified PNI as an independent prognostic factor for OS (hazard ratio [HR]: 0.627, 95% confidence interval [CI]: 0.453-0.868, P = 0.003). PNI also correlated positively with NLR and PLR and negatively with LMR. Additionally, patients with a low PNI exhibited high levels of TNF-α.

CONCLUSIONS

Our results confirm that PNI is associated with the systemic inflammatory response and can be used to predict survival in advanced pancreatic cancer.

Association of body mass index with disease severity and prognosis in patients with non-cystic fibrosis bronchiectasis

The objective of this observational, multicenter study was to evaluate the association of body mass index (BMI) with disease severity and prognosis in patients with non-cystic fibrosis bronchiectasis. A total of 339 patients (197 females, 142 males) diagnosed with non-cystic fibrosis bronchiectasis by high-resolution computed tomography were classified into four groups: underweight (BMI<18.5 kg/m²), normal weight (18.5≤BMI<25.0 kg/m²), overweight (25.0≤BMI<30.0 kg/m²), and obese (BMI≥30.0 kg/m²). Clinical variables expressing disease severity were recorded, and acute exacerbations, hospitalizations, and survival rates were estimated during the follow-up period. The mean BMI was 21.90 kg/m². The underweight group comprised 28.61% of all patients. BMI was negatively correlated with acute exacerbations, C-reactive protein, erythrocyte sedimentation rate, radiographic extent of bronchiectasis, and chronic colonization by P. aeruginosa and positively correlated with pulmonary function indices. BMI was a significant predictor of hospitalization risk independent of relevant covariates. The 1-, 2-, 3-, and 4-year cumulative survival rates were 94%, 86%, 81%, and 73%, respectively. Survival rates decreased with decreasing BMI (χ²=35.16, P<0.001). The arterial carbon dioxide partial pressure, inspiratory capacity, age, BMI, and predicted percentage of forced expiratory volume in 1 s independently predicted survival in the Cox proportional hazard model. In conclusion, an underweight status was highly prevalent among patients with non-cystic fibrosis bronchiectasis. Patients with a lower BMI were prone to developing more acute exacerbations, worse pulmonary function, amplified systemic inflammation, and chronic colonization by P. aeruginosa. BMI was a major determinant of hospitalization and death risks. BMI should be considered in the routine assessment of patients with non-cystic fibrosis bronchiectasis.

Fyn-phosphorylated PIKE-A binds and inhibits AMPK signaling, blocking its tumor suppressive activity

The AMP-activated protein kinase, a key regulator of energy homeostasis, has a critical role in metabolic disorders and cancers. AMPK is mainly regulated by cellular AMP and phosphorylation by upstream kinases. Here, we show that PIKE-A binds to AMPK and blocks its tumor suppressive actions, which are mediated by tyrosine kinase Fyn. PIKE-A directly interacts with AMPK catalytic alpha subunit and impairs T172 phosphorylation, leading to repression of its kinase activity on the downstream targets. Mutation of Fyn phosphorylation sites on PIKE-A, depletion of Fyn, or pharmacological inhibition of Fyn blunts the association between PIKE-A and AMPK, resulting in loss of its inhibitory effect on AMPK. Cell proliferation and oncogenic assays demonstrate that PIKE-A antagonizes tumor suppressive actions of AMPK. In human glioblastoma samples, PIKE-A expression inversely correlates with the p-AMPK levels, supporting that PIKE-A negatively regulates AMPK activity in cancers. Thus, our findings provide additional layer of molecular regulation of the AMPK signaling pathway in cancer progression.

Is the adiposity-associated FTO gene variant related to all-cause mortality independent of adiposity? Meta-analysis of data from 169,551 Caucasian adults

Previously, a single nucleotide polymorphism (SNP), rs9939609, in the FTO gene showed a much stronger association with all-cause mortality than expected from its association with body mass index (BMI), body fat mass index (FMI) and waist circumference (WC). This finding implies that the SNP has strong pleiotropic effects on adiposity and adiposity-independent pathological pathways that leads to increased mortality. To investigate this further, we conducted a meta-analysis of similar data from 34 longitudinal studies including 169,551 adult Caucasians among whom 27,100 died during follow-up. Linear regression showed that the minor allele of the FTO SNP was associated with greater BMI (n = 169,551; 0.32 kg m(-2) ; 95% CI 0.28-0.32, P < 1 × 10(-32) ), WC (n = 152,631; 0.76 cm; 0.68-0.84, P < 1 × 10(-32) ) and FMI (n = 48,192; 0.17 kg m(-2) ; 0.13-0.22, P = 1.0 × 10(-13) ). Cox proportional hazard regression analyses for mortality showed that the hazards ratio (HR) for the minor allele of the FTO SNPs was 1.02 (1.00-1.04, P = 0.097), but the apparent excess risk was eliminated after adjustment for BMI and WC (HR: 1.00; 0.98-1.03, P = 0.662) and for FMI (HR: 1.00; 0.96-1.04, P = 0.932). In conclusion, this study does not support that the FTO SNP is associated with all-cause mortality independently of the adiposity phenotypes.