MiRNA-191 functions as an oncogene in primary glioblastoma by directly targeting NDST1

OBJECTIVE

Glioblastoma is identified as the most aggressive primary brain tumor. Growing evidence has demonstrated that aberrant expression of miR-191 has oncogenic potentiality in many cancers. However, the effects and the underlying mechanisms of miR-191 in the development of glioblastoma remain largely unknown. The aim of this study was to elucidate the pathobiological functions of miR-191 expression by targeting N-deacetylase/N-sulfotransferase 1 (NDST1) in human glioblastoma.

PATIENTS AND METHODS

The miR-191 level in human glioblastoma tissues and four cell lines was examined using quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). Animals study and MTT (3-(4,5-dimethyl thiazol-2-yl)-2,5-diphenyl tetrazolium bromide) assay were used to examine the effects of miR-191 on human glioblastoma proliferation. Western blot and Luciferase reporter were used to confirm that miR-191 could regulate NDST1 expression.

RESULTS

We found that the miR-191 expression was upregulated in human glioblastoma tissues and cells. MiR-191 over-expression was sufficient to promote human glioblastoma cells growth in vivo and in vitro. We also found that miR-191 directly targeted NDST1 and negatively regulated the NDST1 expression in human glioblastoma cells.

CONCLUSIONS

In summary, our finding suggested that miR-191 acted as an important regulator in promoting glioblastoma cell proliferation in vivo and in vitro, and this cellular function may be because of its negative regulation of NDST1.

Single- and Multifraction Stereotactic Radiosurgery Dose/Volume Tolerances of the Brain

PURPOSE

As part of the American Association of Physicists in Medicine Working Group on Stereotactic Body Radiotherapy investigating normal tissue complication probability (NTCP) after hypofractionated radiation therapy, data from published reports (PubMed indexed 1995-2018) were pooled to identify dosimetric and clinical predictors of radiation-induced brain toxicity after single-fraction stereotactic radiosurgery (SRS) or fractionated stereotactic radiosurgery (fSRS).

METHODS AND MATERIALS

Eligible studies provided NTCPs for the endpoints of radionecrosis, edema, or symptoms after cranial SRS/fSRS and quantitative dose-volume metrics. Studies of patients with only glioma, meningioma, vestibular schwannoma, or brainstem targets were excluded. The data summary and analyses focused on arteriovenous malformations (AVM) and brain metastases.

RESULTS

Data from 51 reports are summarized. There was wide variability in reported rates of radionecrosis. Available data for SRS/fSRS for brain metastases were more amenable to NTCP modeling than AVM data. In the setting of brain metastases, SRS/fSRS-associated radionecrosis can be difficult to differentiate from tumor progression. For single-fraction SRS to brain metastases, tissue volumes (including target volumes) receiving 12 Gy (V12) of 5 cm³, 10 cm³, or >15 cm³ were associated with risks of symptomatic radionecrosis of approximately 10%, 15%, and 20%, respectively. SRS for AVM was associated with modestly lower rates of symptomatic radionecrosis for equivalent V12. For brain metastases, brain plus target volume V20 (3-fractions) or V24 (5-fractions) <20 cm³ was associated with <10% risk of any necrosis or edema, and <4% risk of radionecrosis requiring resection.

CONCLUSIONS

The risk of radionecrosis after SRS and fSRS can be modeled as a function of dose and volume treated. The use of fSRS appears to reduce risks of radionecrosis for larger treatment volumes relative to SRS. More standardized dosimetric and toxicity reporting is needed to facilitate future pooled analyses that can refine predictive models of brain toxicity risks.

[Nursing strategies for the facial skin injuries caused by wearing medical-grade protective equipment]

For effective resistance to virus attack and infection and reducing virus transmission chance, it is extremely important for the medical staff and related workers to have their own safe protection. The paper summarizes the occurrence causes, common locations, and prevention ways about the device related pressure ulcers on the face resulted from wearing medical-grade protective equipment for a long working time. The paper proposes the prevention and nursing strategies for device related pressure ulcers and other related skin injuries during application of medical-grade protective equipment. The paper aims to provide reference for the prevention and nursing of device related pressure ulcers and related skin diseases for clinical medical staff, especially to the respectable personnel in front line of fighting against coronavirus disease 2019.

Adaptive radiotherapy based on statistical process control for oropharyngeal cancer

PURPOSE

The purpose of this study is to quantify dosimetric changes throughout the delivery of oropharyngeal cancer treatment and to investigate the application of statistical process control (SPC) for the management of significant deviations during the course of radiotherapy.

METHODS

Thirteen oropharyngeal cancer patients with daily cone beam computed tomography (CBCT) were retrospectively reviewed. Cone beam computed tomography images of every other fraction were imported to the Velocity software and registered to planning CT using the 6 DOF (degrees of freedom) couch shifts generated during patient setup. Using Velocity "Adaptive Monitoring" module, the setup-corrected CBCT was matched to planning CT using a deformable registration. Volumes and dose metrics at each fraction were calculated and rated with plan values to evaluate interfractional dosimetric variations using a SPC framework. T-tests between plan and fraction volumes were performed to find statistically insignificant fractions. Average upper and lower process capacity limits (UCL, LCL) of each dose metric were derived from these fractions using conventional SPC guidelines.

RESULTS

Gross tumor volume (GTV) and organ at risk (OAR) volumes in the first 13 fractions had no significant changes from the pretreatment planning CT. The GTV and the parotid glands subsequently decreased by 10% at the completion of treatment. There were 3-4% increases in parotid mean doses, but no significant differences in dose metrics of GTV and other OARs. The changes were organ and patient dependent. Control charts for various dose metrics were generated to assess the metrics at each fraction for individual patient.

CONCLUSIONS

Daily CBCT could be used to monitor dosimetric variations of targets and OARs resulting from volume changes and tissue deformation in oropharyngeal cancer radiotherapy. Treatment review with the guidance of a SPC tool allows for an objective and consistent clinical decision to apply adaptive radiotherapy.

[Effect of using scenario infiltration joint interactive training mode for junior nurse training in the prevention and treatment of pressure sore]

Objective: To explore the application effect of scenario infiltration joint interactive training mode for junior nurse training in the prevention and treatment of pressure sore. Methods: A total of 118 junior nurses starting to work in the First Affiliated Hospital of Air Force Medical University from July 2017 to July 2018 met the inclusion criteria and were divided into routine training (RT) group and scenario infiltration joint interactive training (SIJIT) group using the random number table for prospective randomized controlled trial. There were 2 males and 57 females, aged (23.9±1.2) years in RT group and 3 males and 56 females, aged (23.5±1.3) years in SIJIT group. Before the training, nurses in both groups received theory and practical tests for the prevention and treatment of pressure sore with a homemade theory test paper and operation requirements designed by the training group. The training content was drawn up in 3 themes according to the weak points shown in the test. Nurses in RT group were trained in a large classroom with the help of multimedia teaching technique, and one lesson of 2 h targeting one theme was given once a week.Nurses in SIJIT group were trained by using the SIJIT mode, with online self-study for 2 weeks and then multimedia theory and practical teaching, and interaction in scene. After the training, theoretical and practical tests were conducted again in nurses of two groups. Satisfaction scores of nurses for the training mode, training effect, and curriculum design and answers to open questions about the degree of training satisfaction were investigated through homemade questionnaire for satisfaction degree. Homemade training contents and requirements questionnaire designed by the training group was used to understand the demands of nurses for training contents and requirements in 2 groups. Data were statistically analyzed with chi-square test and independent sample t test. Results: (1) The theoretical and practical scores on the prevention and treatment of pressure sore before the training were (78±11) and (83±10) points respectively in RT group, similar to (79±11) and (84±10) points in SIJIT group (t=0.522, 0.615, P>0.05). The theoretical and operational scores on prevention and treatment of pressure score of nurses after the training were (90±8) and (92±5) points in SIJIT group, significantly higher than (82±10) and (85±9) points in RT group (t=4.581, 5.259, P<0.01). (2) The satisfaction degree scores for training mode, curriculum design, and training effect of nurses in SIJIT group were significantly higher than those in RT group (t=5.169, 7.976, 4.463, P<0.01). Nurses in the 2 groups were satisfied with the curriculum content, and unsatisfied with the curriculum time and the ways of test. (3) The top demand of the training nurses for curriculum content was the treatment of phase Ⅱ-Ⅲ pressure sore, accounting for 81.36% (96/118). Conclusions: The SIJIT has flexible training mode, and reasonable curriculum design and content, which significantly improves the theoretical and operational levels on prevention and treatment of pressure sore of the training nurses and receives recognition of the training nurses.

SAT0646-HPR PATTERN AND INFLUENTIAL FACTORS IN PROMOTING TREAT-TO-TARGET (T2T) FOR FOLLOW-UP OF ANKYLOSING SPONDYLITIS (AS) PATIENTS WITH A RHEUMATOLOGIST-PATIENT INTERACTIVE SMART SYSTEM OF DISEASE MANAGEMENT (SSDM): A COHORT STUDY FROM CHINA

Background:

Ankylosing Spondylitis Disease Activity Score (ASDAS) is adopted to evaluate the degree of disease activity and the inflammatory response in AS patients. ASDAS score <= 1.3 represents inactive disease status and achievement of T2T. SSDM is a mobile application for disease management.

Objectives:

To evaluate the patterns of T2T and related influential factors among AS patients after applying SSDM in the real world.

Methods:

AS Patients were trained to master SSDM by healthcare professionals (HCPs) and to conduct ASDAS self-assessments. Patients were also required for repeating self-assessments after leaving the hospital. After entry by patients, data can be synchronized to the SSDM terminal of authorized rheumatologists. Based on these data, the patients can apply for consultation to their physicians and rheumatologists can provide medical advices to their patients.

Results:

From Jan 2015 to Jan 2020, 17,870 AS patients enrolled in SSDM with the mean age of 34.62±10.98 years old and the median disease duration of 3.58 years. Among them, 1,127 AS patients from 150 hospitals were followed up for more than 6 months through SSDM. The results at baseline and in final follow up were summarized in Table 1.

Table 1.

The T2T results at baseline and in final follow up.

Baseline\Final follow-upn%x <= 1.3%1.3 < x <= 2.1%2.1 < x <= 3.5%3.5 < x%x <= 1.331527.95%20665.40%7423.49%268.25%92.86%1.3 < x <= 2.134030.17%13840.59%11433.53%7522.06%133.82%2.1 < x <= 3.536332.21%9526.17%10629.20%13336.64%297.99%3.5 < x1099.67%2422.02%2522.94%4238.53%1816.51%Total1,127100%46341.08%31928.31%27624.49%696.12%

The rate of T2T achievers were 27.95% (315/1,127) at baseline, and improved significantly to 41.08% (463/1,127) after 6 months follow up, p<0.01. Among T2T achievers at baseline, 65.40% (206/315) maintained T2T, 34.60% (109/315) relapsed. Of patients who didn’t achieve T2T at baseline, only 31.65% (257/812) achieved T2T after 6 months follow up.

The impact of the online interaction between patients and physicians and the frequency of self-assessment for ASDAS on T2T has been analyzed. Compared with 544 patients who didn’t interact online with their physicians and self-assessed less than 3times, 104 patients with online interaction and monthly assessments achieved significant higher improvement rate of T2T (9.19% vs 23.08%, p<0.01). The more frequent of the self-assessments being performed by patients, the higher improvement of T2T rate will be. The improvement of T2T rate(y) was positively correlated with times of self-assessment for ASDAS(x) independently. The regression equation as “y = 0.0304x + 0.0521”, r = 0.9107, p<0.01 (Figure 1).

Figure 1.

Conclusion:

Significant improvement was observed under applying SSDM through empowering AS patients. After proactive disease management via SSDM for more than 6 months, patients with ASDAS<=1.3 score at baseline had a significantly higher retention rate of inactive disease activity. The patients who performed more frequent self-assessments had lower probability of relapse and higher rate of T2T. Online interaction between patients and physicians contributed to promote the improvement rate of T2T. SSDM is a valuable tool for long term follow-up through empowering patients.

Acknowledgments:

SSDM was developed by Shanghai Gothic Internet Technology Co., Ltd.

Disclosure of Interests:

None declared

0588 Ring Pulse Oximeter for Screening of Moderate to Severe OSA: A Pilot Study

Introduction

To evaluate the utility of the ring pulse oximeter for screening of OSA in adults.

Methods

87 adults were monitored by a ring pulse oximeter and PSG simultaneously during a nocturnal in-lab sleep testing. 3% oxygen desaturation index (ODI3); Mean oxygen saturation(MSpO2), Saturation impair time below 90% (SIT90) derived from an automated algorithm of the ring pulse oximeter. Meanwhile, the parameters of PSG were scored manually according to the AASM Manual. Correlation and receiver operator characteristic curve analysis were used to measure the accuracy of ring pulse oximeter and its diagnostic value for moderate to severe OSA (AHI≥15).

Results

Among the 87 participants, 18 cases were AHI&lt;5, 17 cases were diagnosed with mild OSA (AHI:5-14.9), 25 cases were diagnosed with moderate OSA (AHI:15-29.9) and 27 cases were diagnosed with severe OSA (AHI≥30). There was no significant difference between PSG and ring pulse oximeter in regard to ODI3 (23.4±23.5 vs 24.7 ± 21.7), and SIT90 (1.54%, range 0.14%-8.99% vs. 3.20%, range 0.60%, 12.30%) (P&gt;0.05], Further analysis indicated that two parameters from the oximeter correlated well with that derived from PSG (r=0.889, 0.567, respectively, both p&lt;0.05). Although MSpO2 correlated significantly (r=0.448, P&lt;0.05), the difference was remarkable [95.9%, range 94.0% to 97.0% vs. 94.5%, range 93.3% to 95.7%, p&lt;0.05]. Bland-Altman plots showed that the agreement of these three parameters was within the clinical acceptance range. The ROC curve showed that the sensitivity and specificity of the ring pulse oximeter when the oximeter derived ODI3 ≥12.5 in the diagnosis of moderate to severe OSA were 82.7% and 74.3%, respectively.

Conclusion

The pilot study indicated that ring pulse oximeter can detect oxygen desaturation events accurately, therefore to be used as a screening tool for moderate to severe OSA.

Support

The study was supported by the National Natural Science Foundation of China (No. 81420108002 and NO. 81570083).

[Strategy of nursing care on the face skin injuries caused by wearing medical-grade protective equipment]

For effective resistance to virus attack and infection, reducing virus transmission chance, it is extremely important for the medical staff and related workers to have their own safe protection. This paper summarizes the development causes, common locations, and prevention ways about the device related pressure injuries on the face resulted from wearing medical-grade protective equipment for a long working time. The paper proposes the nursing strategy for device related pressure injuries and other nursing strategy is proposed to take care efficiently the device related pressure injuries. Meantime, a corresponding nursing strategy is also suggested to deal with the correlative skin diseases during the application of medical-grade protective equipment. These paper aims to provide reference for the prevention of device related pressure injuries and the care of skin-related diseases for clinical working staff, especially to the respectable personnel in front line of fighting against Corona virus disease 2019.

[Genotype and phenotype of children with KCNA2 gene related developmental and epileptic encephalopathy]

Objective: To investigate the genotype and phenotype of children with KCNA2 gene related developmental and epileptic encephalopathy (DEE). Methods: Clinical data including the manifestations and electroencephalogram of 8 children with KCNA2 variants treated in the Department of Pediatrics, Peking University First Hospital from March 2017 to June 2019 were collected and analyzed retrospectively. Results: Among the 8 epileptic patients with KCNA2 variants, 5 were males and 3 were females. The age of onset was from 1 day to 11 months. The age at last follow-up ranged from 4 months to 86 months. Two variants including c.1214C>T (loss-of-function) and c.1120A>G (gain-and loss-of-function) were identified. The variant of c.1214C>T was found in six patients (case 1-6). For these patients, the age of onset was from 5 to 11 months and they were characterized by multiple seizure types. All had focal seizures and had normal development before seizure onset with developmental regression after seizure onset. The first electroencephalogram showed epileptic discharges in Rolandic region in two, epileptic discharges in Rolandic region combined with generalized discharge in one, generalized discharge with posterior predominance in two (combined with or transferred to Rolandic region during the course) and epileptic discharges in posterior region combined with generalized discharge in one. And in 5 of them the Rolandic discharges developed into epileptic electrical status (ESES) during sleep. All the six patients were still treated with a combination of multiple antiepileptic drugs. Two of them had seizure controlled at 80 months and 68 months, respectively. The variant of c.1120A>G were identified in two of eight patients (case 7 and 8) and they had seizure onset on the 1st day after birth. Their epileptic seizures were frequent and difficult to control. They had remarkably developmental delay and microcephaly since birth. One case (case 8) had a wide forehead. They had frequent seizures up to the last follow-up. In case 7, the early electroencephalogram showed epileptic discharges in temporal region, and interictal electroencephalogram at 3 months of age showed multifocal discharge with posterior and temporal region predominance. In case 8, the early electroencephalogram was normal and electroencephalogram showed burst suppression at 2 months of age, and it developed epileptiform discharge in posterior region at 1 year of age. Conclusions: KCNA2 gene variants can lead to DEE with multiple seizures types. Among them, loss-of-function c.1214C>T is the most common, and these patients have seizure onset at infancy with Rolandic discharges tended to develop into to ESES pattern. The variant of c.1120A>G is a gain-of- and loss-of-function variant, patients with c.1120A>G have seizure onset in neonatal period, the phenotype overlaps with the former but is more severe.

[Electroclinical characteristics of epilepsy children with midline epileptiform discharges related epileptic negative myoclonus as the first symptom]

Objective: To investigate the electroclinical findings in epilepsy children with epileptic negative myoclonus (ENM) restricted to the lower limb as the first seizure type. Methods: Each retrieved electroencephalogram record performed between March 2011 and March 2018 at the Department of Pediatrics of Peking University First Hospital was searched with "midline" . There were 302 records of 175 patients with "benign" or "functional" midline spikes. A retrospective review of each patient's hospital record was performed. Thirteen patients had ENM restricted to the lower limb as the first seizure type. The clinical and electroencephalogram characteristics of them were analyzed. Results: Thirteen patients manifested ENM restricted to the lower limb as the first seizure type, diagnosed as benign childhood focal epilepsy with vertex spikes (BEVS). Six patients had ENM as the first and only seizure type during the short-time follow-up. Among them, there were 1 male and 5 females. The age at seizure onset was (2.5±0.7) years. One of them had electrical status epilepticus during sleep (ESES) identified on electroencephalogram at theage of 4 years and 8 months. The last follow-up age was (3.8±1.5) years. The remaining 7 patients developed nocturnal focal motor seizures. Among them, there were 4 males and 3 females. The age at seizure onset was (3.5±0.7) years. Two of them were diagnosed as BEVS evolving into benign childhood epilepsy with centrotemporal spikes (BECTS) and 5 were diagnosed as BEVS concurring with BECTS. The age at focal seizures was (4.1±0.6) years. The interval ranged from 1 month to 1 years. Six of 7 patients had electrical ESES with the age of (5.2±1.0) years. All had developmental regression, further diagnosed as atypical benign partial epilepsy (ABPE). The median age at last follow-up was 5.9 years. Five of 13 patients had repeated electroencephalogram records at our apartment, showing that epileptiform discharges in midline regions were significantly reduced either in frequency or amplitude with the improvement of ENM restricted to the lower limb and that independent epileptiform discharges in Rolandic regions from midline regions were noticed with the onset of nocturnal focal seizures. Conclusions: ENM restricted to the lower limb has a close association with vertex (midline) epileptiform discharges. ENM restricted to the lower limb as the first seizure type is a peculiar phenomenon of BEVS. Some patients could evolve into BECTS or overlap with BECTS, and further into ABPE. The age of seizure onset in BEVS with ENM restricted to the lower limb as the first symptom is a little earlier than in BECTS. Ignorance of the close association between midline spikes and ENM restricted to the lower limb may lead to misdiagnosis of these patients.

Safety and Efficacy of Transvenous Embolization of Ruptured Brain Arteriovenous Malformations as a Last Resort: A Prospective Single-Arm Study

BACKGROUND AND PURPOSE

The efficacy and safety of transvenous embolization for brain arteriovenous malformations remains unclear, given the very limited number of cases reported. This prospective study was performed to assess this technique in ruptured AVMs.

MATERIALS AND METHODS

Twenty-one consecutive patients with ruptured brain AVMs who underwent transvenous embolization were prospectively followed between November 2016 and November 2018. The Spetzler-Martin grade was I in 3 AVMs (14.3%), II in four (19.0%), III in eleven (52.4%), and IV in three (14.3%). The complete AVM occlusion rate was calculated from 6-month follow-up DSA images. Occurrence of hemorrhage and infarction after embolization was evaluated using CT and MR imaging within 1 month after the operation. The mRS was used to assess the functional outcomes.

RESULTS

Complete AVM nidus obliteration was shown in 16 (84%) of 19 patients with technically feasible AVMs immediately after embolization. One (5%) patient with a small residual nidus after treatment showed complete obliteration at 13-month follow-up. There were 5 hemorrhages and 1 infarction; 4 patients' symptoms improved gradually. The percentage of cases with mRS ≤ 2 rose from 57.1% (12/21) before embolization to 66.7% (14/21) at 1-month follow-up. Both the morbidity and mortality rates were 4.8% (1/21).

CONCLUSIONS

Transvenous embolization can be performed only in highly selected hemorrhagic brain AVMs with high complete obliteration rates, improved functional outcomes, and acceptable morbidity and mortality rates, but it should not be considered as a first-line treatment.

Epileptic negative myoclonus restricted to lower limbs in benign childhood focal epilepsy with vertex spikes

BACKGROUND AND PURPOSE

The aim was to determine the electroclinical findings in benign childhood focal epilepsy with vertex spikes (BEVS) with epileptic negative myoclonus (ENM) restricted to the lower limbs.

METHODS

The electroencephalogram database of Peking University First Hospital and medical records of patients with BEVS and ENM restricted to the lower limbs were reviewed.

RESULTS

Twenty-seven patients with BEVS had ENM restricted to the lower limbs. Twelve started as ENM restricted to the lower limbs. The age at seizure onset ranged from 1.5 to 4.8 years. During the course, half of the 12 patients developed focal sensorimotor seizures and then were diagnosed as benign childhood epilepsy with centrotemporal spikes (BECTS), with BEVS (four cases) and without BEVS (two cases). Five of them had electrical status epilepticus during sleep (ESES) and met the diagnostic criteria of atypical benign partial epilepsy (ABPE). Fifteen of the 27 patients had ENM restricted to the lower limbs during the course. The age at seizure onset ranged from 1.3 to 9.8 years. All had ESES and were diagnosed as ABPE, 11 as ABPE with BEVS and four as ABPE evolving into BEVS.

CONCLUSIONS

Benign childhood focal epilepsy with vertex spikes (BEVS) might represent a specific epileptic syndrome of the continuum of benign childhood focal epilepsy. ENM restricted to the lower limbs was a special phenomenon in BEVS. BEVS could overlap with BECTS or evolve into BECTS and further into ABPE and vice versa. Ignorance of vertex spikes with associated ENM restricted to the lower limbs might lead to a misunderstanding of BEVS, a specific type of benign childhood focal epilepsy.

Abstract P3-13-09: Increased mortality with repeat lumpectomy alone after ipsilateral breast tumor recurrence: A propensity-adjusted, population-based SEER analysis

Background: The benefit of repeat lumpectomy for ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery (BCS) is currently inconclusive. This issue has become even more important as small and isolated recurrent tumors were frequently diagnosed.

Methods: IBTR patients with definitive surgery were identified in the Surveillance, Epidemiology, and End Results registry between 1973 and 2013. The effect of different IBTR surgeries on overall and cancer-specific mortality was assessed using risk-adjusted Cox proportional hazard regression modeling and stratified propensity score matching analysis (PSMA).

Results: Based on the selection criteria, 5098 patients were recruited. Of those, 4048 (79.4%) women underwent mastectomy and 1050 (20.1%) underwent repeat lumpectomy after IBTR. Patients who received repeat lumpectomy had lower grade (23.7% vs 15% for well-differentiated) and smaller recurrent tumor (47% vs 36.2% for ≤ 1 cm) but earlier recurrence (23.9% vs 11.2% for interval times &lt; 48 months) than those who underwent mastectomy. A minority of each group (24.7% of those undergoing repeat lumpectomy and 3% of the mastectomy group) underwent RT after surgery. In multivariable Cox regression analysis, repeat lumpectomy was associated with increased overall mortality (Hazard ratio (HR) = 1.58, 95% CI = 1.353 to 1.844, P &lt; 0.001) and cancer-specific mortality (HR = 1.721, 95% CI = 1.345 to 2.202, P&lt; 0.001). Similar HRs were derived from the PSMA cohort. However, we found no significant difference in overall mortality for women who underwent repeat lumpectomy followed by RT compared with that for those who underwent mastectomy (P= 0.411). Moreover, IBTR patients with small tumors (≤ 1 cm) who underwent repeat lumpectomy with RT rather than without had similar overall and cancer-specific survival rates to those who underwent mastectomy (P= 0.189 and P= 0.604, respectively).

Conclusions: Our investigation suggests that compared with mastectomy, repeat lumpectomy for IBTR is associated with higher overall and cancer-specific mortality under real-world observational conditions. Furthermore, repeat lumpectomy with RT is equivalent to mastectomy with respect to overall mortality and may influence treatment decision making for patients with small IBTR.

Citation Format: Su Y, Guo R, Xue J, Chi Y, Wu J. Increased mortality with repeat lumpectomy alone after ipsilateral breast tumor recurrence: A propensity-adjusted, population-based SEER analysis [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 P3-13-09.

Abstract P6-09-11: NFATC2 suppresses the metastatic cascade in breast cancer patients

For the patients with breast cancer, the pathological status of axillary lymph nodes is one of the most important predictor of prognosis. In recent years, the application of sentinel lymph node biopsy has provided us with an opportunity for the further study on the mechanism of lymph node metastasis in breast cancer. Through detailed pathological examination of sentinel lymph nodes, we can easily find patients who are in the early stage of lymph node metastasis - that is, the tumor cells from the primary tumor, invading the lymph nodes and successfully colonized, but not yet break through the lymph node microenvironment defense to the subsequent lymph node. It is the most important stage during lymph node metastasis.

In the present study, we selected the pairing samples from breast cancer patients with early stage lymph node metastasis to carry out differential genomics research. A total of 182 genes with significant function and involved in significant signal transduction pathways were obtained. Bioinformatics method was used to screen out the mRNA, microRNA and transcription factor in the process of lymph node metastasis of breast cancer. We investigated the role of activated T cells c2 (NFATC2) in the core transcription factors as a target for further clinical and basic research.

The expression of NFATC2 was detected in the tissue microarray prepared from 200 patients with primary breast cancer. After the median follow-up period of 89.5 months, it showed that the prognosis of patients with NFATC2 overexpression was significantly better than that of the control group (p = 0.022). We also measured the expression of NFATC2 in 50 pairs of breast cancer patients with lymph node metastasis. The results showed that the expression of NFATC2 in the primary tumor was significantly higher than that in the matched lymph node, suggesting that in patients with breast cancer, the down-regulate or deficiency of NFATC2 expression may be related with lymph node metastasis. We also attempted to add the expression of NFATC2 as a new parameter in the prediction model of lymph node metastasis based on preoperative clinical and pathological parameters. The area under the ROC curve obtained in the newly established model was 0.767, the expression state of NFATC2 had impact on the performance of the prediction model. Furthermore, when we removed the NFATC2 parameter, it could reduce the area under the ROC curve in the validation group, suggesting that the expression of NFATC2 in the primary tumor may be used as a predictor of the pathological state of axillary lymph nodes.

In vitro and in vivo experiments, we demonstrated that NFATC2 has a significant suppression effect on the proliferation, migration and invasion of breast cancer cells. The potential NFATC2-target genes were determined by RNAseq and Chipseq. Nine differentially expressed genes were found to be regulated by NFATC2 in the Chip-seq analysis and bound to the promoter region of the gene, whereas GRAMD3 and SRGAP2 in the subsequent validation showed a positive correlation with the expression of NFATC2, suggesting that the two genes are likely to have a positive regulatory relationship with NFATC2.

This study clarifies that NFATC2 may represent a therapeutic target for early metastasis breast cancer.

Citation Format: Xue J, Chi Y, Chen J, Wu J. NFATC2 suppresses the metastatic cascade 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 P6-09-11.