RAB7A phosphorylation by TBK1 promotes mitophagy via the PINK-PARKIN pathway

Removal of damaged mitochondria is orchestrated by a pathway involving the PINK1 kinase and the PARKIN ubiquitin ligase. Ubiquitin chains assembled by PARKIN on the mitochondrial outer membrane recruit autophagy cargo receptors in complexes with TBK1 protein kinase. While TBK1 is known to phosphorylate cargo receptors to promote ubiquitin binding, it is unknown whether TBK1 phosphorylates other proteins to promote mitophagy. Using global quantitative proteomics, we identified S72 in RAB7A, a RAB previously linked with mitophagy, as a dynamic target of TBK1 upon mitochondrial depolarization. TBK1 directly phosphorylates RAB7AS72, but not several other RABs known to be phosphorylated on the homologous residue by LRRK2, in vitro, and this modification requires PARKIN activity in vivo. Interaction proteomics using nonphosphorylatable and phosphomimetic RAB7A mutants revealed loss of association of RAB7AS72E with RAB GDP dissociation inhibitor and increased association with the DENN domain-containing heterodimer FLCN-FNIP1. FLCN-FNIP1 is recruited to damaged mitochondria, and this process is inhibited in cells expressing RAB7AS72A. Moreover, nonphosphorylatable RAB7A failed to support efficient mitophagy, as well as recruitment of ATG9A-positive vesicles to damaged mitochondria. These data reveal a novel function for TBK1 in mitophagy, which parallels that of LRRK2-mediated phosphorylation of the homologous site in distinct RABs to control membrane trafficking.

Elevated plasma ferritin in elderly individuals with high neocortical amyloid-β load

Ferritin, an iron storage and regulation protein, has been associated with Alzheimer's disease (AD); however, it has not been investigated in preclinical AD, detected by neocortical amyloid-β load (NAL), before cognitive impairment. Cross-sectional analyses were carried out for plasma and serum ferritin in participants in the Kerr Anglican Retirement Village Initiative in Aging Health cohort. Subjects were aged 65-90 years and were categorized into high and low NAL groups via positron emission tomography using a standard uptake value ratio cutoff=1.35. Ferritin was significantly elevated in participants with high NAL compared with those with low NAL, adjusted for covariates age, sex, apolipoprotein E ɛ4 carriage and levels of C-reactive protein (an inflammation marker). Ferritin was also observed to correlate positively with NAL. A receiver operating characteristic curve based on a logistic regression of the same covariates, the base model, distinguished high from low NAL (area under the curve (AUC)=0.766), but was outperformed when plasma ferritin was added to the base model (AUC=0.810), such that at 75% sensitivity, the specificity increased from 62 to 71% on adding ferritin to the base model, indicating that ferritin is a statistically significant additional predictor of NAL over and above the base model. However, ferritin's contribution alone is relatively minor compared with the base model. The current findings suggest that impaired iron mobilization is an early event in AD pathogenesis. Observations from the present study highlight ferritin's potential to contribute to a blood biomarker panel for preclinical AD.

[Influence on compliance of subcutaneous immunotherapy in patients with allergic rhinitis by We-Media management]

Objective:To investigate the influence on compliance of sublingual immunotherapy (SLIT) in patients with allergic rhinitis by We-Media management.Method:One hundred and eighty patients of allergic rhinitis were randomly divided into We-Media management group (Group A 90 cases) and telephone management group (Group B 90 cases). All of patients were treated with SLIT. In the group A, the doctor-patient WeChat and/or QQ group were formed. The specific duty doctor acted as group leader, made monthly plans, sent SLIT related knowledge more than 3 times a week and assessed patient reported outcomes. In the group B, the patients were conductd on-the-spot demonstration and explanation and followed up by telephone once three month. The statistical analysises were made on the rates and reason of dropouts on the first, third, sixth, ninth, twelfth post-treatment months in two groups.Result:The rates of dropouts in group A and group B were 13.3%(12/90) and 32.2%(29/90) respectively in the first year. The statistical difference were noticeable between group A and group B(P=0.003). Most dropouts were happened in the first 3 months, group A 41.7%(5/12) and group B 51.7%(15/29) respectively. It had no statistically significant(P=0.558). Two major reasons of dropouts were no improvement of symptoms and lack of confidence.Conclusion:Percentage of dropouts in SLIT patients through telephone management was comparatively high, which can be significantly improved by We-Media management. We-Media management has more advantage,especially during long-term follow-up.

A rare e14a3 BCR/ABL fusion transcript in acute lymphoblastic leukemia patient treated with CAR-modified T-cell therapy

E14a3 breakpoint cluster region (BCR)/ABL proto-oncogene 1, non-receptor tyrosine kinase (ABL) fusion transcript is rare in Philadelphia chromosome positive disease, particularly in acute lymphoblastic leukemia (ALL). Recently an e14a3 fusion transcript was detected by multiple laboratory examinations, and the patient was suffering from ALL. Except for the BCR/ABL fusion gene, in the present study the patient additionally had an IKAROS family zinc finger 1 deletion which, has been confirmed as a significant adverse prognosis factor. Following 2 rounds of chemotherapy, the patient presented cytological remission; however, the patient then relapsed 2 months later. They then received chimeric antigen receptor modified (CAR-modified) T-cell therapy and achieved complete remission. CAR-modified T-cell therapy is a powerful novel therapy which, exhibited great potential for treating refractory ALL, regardless of the existence and form of the BCR/ABL fusion transcript.

Safety, quality and effect of complete mesocolic excision vs non-complete mesocolic excision in patients with colon cancer: a systemic review and meta-analysis

AIM

The application of complete mesocolic excision (CME) in colon cancer is controversial. We performed a meta-analysis to compare the safety, quality and effect of CME with non-complete mesocolic excision (NCME) in patients with colon cancer.

METHOD

We searched PubMed, ScienceDirect, the Cochrane Library and Scopus to identify studies comparing CME with NCME in colon cancer. We focused on three study outcome areas: safety (operation time, blood loss, complications, mortality); quality (large bowel length, distance from the tumour to the high vascular tie, area of mesentery, total lymph nodes); and effect (long-term survival).

RESULTS

A total of 8586 patients from 12 studies were included in the meta-analysis. CME was associated with greater intra-operative blood loss [weighted mean difference (WMD) 79.87, 95% CI: 65.88-93.86], more postoperative surgical complications (relative risk 1.23, 95% CI: 1.08-1.40), longer large bowel resection (WMD 47.06, 95% CI: 10.49-83.62), greater distance from the tumour to the high vascular tie (WMD 17.51, 95% CI: 15.16-19.87), larger area of mesentery (WMD 36.09, 95% CI: 18.06-54.13) and more lymph nodes (WMD 6.13, 95% CI: 1.97-10.28) than NCME. CME also had positive effects on 5-year survival [hazard ratio (HR) 0.33, 95% CI: 0.13-0.81], 3-year survival (HR 0.58, 95% CI: 0.39-0.86) and 3-year survival for Stage III disease (HR 0.69, 95% CI: 0.60-0.80) compared with NCME.

CONCLUSION

Limited evidence suggests that CME is a more effective strategy for improving specimen quality and survival but with a higher complication rate.

Abstract P5-16-29: Nanoparticle albumin-bound paclitaxel as neoadjuvant chemotherapy of breast cancer: A meta-analysis

Background: Nanoparticle albumin-bound paclitaxel (nab-Paclitaxel), a novel solvent-free taxane-based regimen, was hypothesized to have enhanced drug transport to tumors, shorter infusion schedules and no need for premedication. The value of nab-Paclitaxel in neoadjuvant systemic therapy (NST) for breast cancer remains uncertain. We performed a meta-analysis to assess efficacy and toxicity of nab-Paclitaxel compared to conventional taxane regimens (paclitaxel, docetaxel) within randomized clinical trials.

Methods: A systematic search was performed using the medical subject heading (MeSH) terms ''breast neoplasms'', as well as (1) breast cancer; AND (2) nab-Paclitaxel OR nanoparticle paclitaxel; AND (3) neoadjuvant OR preoperative OR primary systemic in both Pubmed databases and proceedings of oncologic meetings including ASCO, ESMO and SABCS. Pooled rates of pathological complete response(pCR), odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using fixed-effect or random-effect model to determine the effect of neoadjuvant nab-paclitaxel.

Results: Twenty-one studies with 2357 patients were included, 3 of which (GeparSepto[1], ETNA[2], Showa trial[3]) were randomized clinical trials. The aggregate pCR rate (ypT0/is ypN0) was 32% (95% CI 25-38%) in unselected breast cancer patients and was 14%(95% CI 11-17%), 41%(95% CI 38-45%), 54%(95% CI 43-66%) in hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-), triple negative breast cancer(TNBC), HER2+ patients, respectively. Within the HER2+ population, pCR rate was 61%(95% CI 47-74%) for HR- and 40%(95% CI 28-52%) for HR+ tumors. Regarding randomized clinical trials, the probability of achieving pCR was significantly higher in the nab-paclitaxel group than in the conventional taxanes group (OR=1.383, 95%CI 1.141-1.676, p=0.001). A funnel plot of the effect size for each randomized trial against the precision showed no asymmetry, which indicating no potential publication bias. In the safety analysis (GeparSepto[1], ETNA[2]), hematological toxic effects were generally equivalent in nab-paclitaxel and paclitaxel group. For non-hematological toxic effects, all grades and grade≥ 3 peripheral sensory neuropathy occurred more frequently with nab-paclitaxel compared to paclitaxel (all grades, OR=2.090, 95%CI 1.016-4.302, p=0.045; grade≥ 3, OR=3.766, 95%CI 2.324-6.100, p<0.001). Hypersensitivity was more common with paclitaxel than nab-paclitaxel at any grade and grade≥ 3. Other non-hematological toxic effects did not significantly differ between two groups.

Conclusion: nab-Paclitaxel is an effective antitumor drug in NST of breast cancer, especially for TNBC and HER2+ tumors, in terms of pCR. Exchange of nab-Paclitaxel for conventional taxanes could significantly improve pCR rate with reasonable toxicities.

Clinical trial information: 1.Lancet Oncol.2016,17:345-56.; 2.J Clin Oncol.2016,34(suppl; abstract 502).; 3.J Clin Oncol.2015,33(suppl; abstract 136).

Citation Format: Zong Y, Wu J, Shen K. Nanoparticle albumin-bound paclitaxel as neoadjuvant chemotherapy of breast cancer: A meta-analysis [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-16-29.

Abstract P5-16-07: Non-anthracycline-containing docetaxel plus cyclophosphomide was inferior to docetaxel, anthracycline and cyclophosphomide in neoadjuvant treatment of triple negative or HER2 positive breast cancer: Long term follow-up result from NATT study

This abstract was not presented at the symposium.

[Clinical-based study of ovarian cancer patients with and without BRCA1/2 genes mutation: clinical features and pedigree analysis]

Objective: To compare the clinical and histological features and prognosis of patients with ovarian cancer from different genetic background, and to make further understanding of the genetic model of BRCA genes used pedigree analysis. Methods: There were 71 patients from 67 independent families enrolled in our study from Apr. 2000 to Jun. 2009 in Peking Union Medical College Hospital. All exons of BRCA1/2 genes were analyzed using denaturing high-performance liquid chromatography(DHPLC) followed by direct sequencing, and clinical features of patients were compared by statistical analysis. Pedigree analysis of two families with BRCA genes mutation were performed. Results: The mutation rate of BRCA genes was 28% (20/71). The frequency of BRCA1 and BRCA2 gene mutation was 23% (16/71) and 6% (4/71), respectively (P=0.004). Histology types of patients with and without BRCA genes mutation were different. The onset age between patients with and without BRCA genes mutation was similar (52.6 versus 54.6 years old, P=0.393), and tend to be early-onset breast or ovarian cancer in high-risk group. There was no significant difference of platinum-resistant rate, disease free survival and overall survival rate between patients with and without BRCA genes mutation (all P>0.05). According to the pedigree analysis, up to 100% of female offspring inherited pathogenic mutations, and male offspring could be a mutation carrier. Conclusions: The genetic screening and clinical intervention should be performed as early as possible for the members from families at risk of hereditary ovarian cancer. Genetic consulting is important for patients with high-grade papillary serous adenocarcinoma of ovary. It is still unknown that whether the patients with BRCA gene mutations have better prognosis than sporadic ones, and further perspective, randomized controlled trial is still needed.

[Clinical analysis of hypersensitivity reaction of platinum in ovarian cancer and cervical cancer patients]

Objective: To investigate the incidence, risk factors, management and prognosis of hypersensitivity reaction (HSR) of platinum-based chemotherapy in patients of ovarian cancer and cervical cancer. Methods: Cases from Peking Union Medical College Hospital from Jan. 2013 to Jan. 2016 were checked for patients' data of epithelial ovarian cancer treated with carboplatin/paclitaxel (every 3 weeks) and patients of cervical cancer treated with concurrent radiochemotherapy using cisplatin (every week). General characters, pathological features, treatment and prognosis of patients were analyzed to determine the severity, symptoms, outcomes and risk factors of HSR. Results: (1) Prevalence of HSR: there were 860 cases of ovarian cancer and 580 cases of cervical cancer, among which HSR occurred in 8.8% (76/860) and 5.9% (34/580) patients, respectively. (2) Grading for HSR: most HSR were grade 1 or 2, with 78.9%(60/76) in ovarian cancer and 82.4%(28/34) in cervical cancer patients. In ovarian cancer patients, there were 7 cases of grade 1 HSR and 53 cases of grade 2 HSR, and in cervical cancer patients, there were 11 cases of grade 1 HSR and 17 cases of grade 2 HSR. (3) Symptoms of HSR: most of HSR happened during intravenous infusion of platinum agents, with 98.7% (75/76) in ovarian cancer and 97.1% (33/34) in cervical cancer patients. In ovarian and cervical cancer patients, most common symptom were tight chest and dyspnea, which happened in 92.1% (70/76) and 97.1% (33/34) patients, respectively. Secondary common symptom were skin reactions, which happened in 53.9% (41/76) and 88.2% (30/34) patients respectively. (4) Treatment after HSR: of 76 ovarian cancer cases with HSR, there were no significant difference in the ratio of HSR recurrence among patients of different treatment after HSR (χ²=0.517, P=0.915): 1 of 4 patients applying prior chemotherapy, 4 of 13 cases receiving desensitization, 3 of 11 cases separating medicine, 2 of 11 patients switching to cisplatin. In 34 cervical cancer cases of HSR, there were also no significant difference in the ratio of HSR recurrence among patients of different treatment after HSR (χ²=0.079, P=1.000): 2 of 9 patients applying prior chemotherapy, 3 of 17 cases receiving desensitization. (5) Risk factors of HSR and patients prognosis: in ovarian cancer patients of HSR, risk factors included relapse (P=0.010), courses of chemotherapy reaching seven or nine for patients of primary treatment or reaching six or seven for recurrent patients (all P<0.05). There were no significant risk factors for cervical cancer patients of HSR (all P>0.05). HSR had no impact on the progression- free survival for ovarian cancer (P=0.144) or cervical cancer (P=0.782). Conclusions: In ovarian cancer patients treated with carboplatin and cervical cancer patients treated with concurrent radiochemotherapy using cisplatin, most HSR of platinum are mild and favorable outcomes. Relapse and longer chemotherapy courses are risk factors for HSR of carboplatin for epithelial ovarian cancer.

The efficacy of high-intensity, focused ultrasound treatment for non-neoplastic epithelial disorders of the vulva

Non-neoplastic epithelial disorders of the vulva (NNEDV) are common types of vulval lesions. Although corticosteroids represent a first-line treatment for NNEDV, concerns exist about the safety associated with long-term topical corticosteroid use. Recently, several clinical trials have identified high-intensity focused ultrasound (HIFU) as a promising treatment modality for NNEDV. The aim of this multi-center, randomized, controlled clinical trial was to investigate the efficacy of HIFU therapy in women with NNEDV based on histological alterations. We enrolled patients who were clinically diagnosed with NNEDV. They were randomized into 2 treatment groups: 1) halcinonide for 3 months or 2) HIFU once. A total of 123 patients were biopsied both prior to and after the therapy, and 62 and 61 patients were assigned to the HIFU and halcinonide groups, respectively. The histological changes were then analyzed. After the treatments, the therapeutic effects were observed in both groups. Comparing the diagnosis and alterations in lichenoid and sclerotic patterns and in chronic inflammation, we found statistically significant differences. Furthermore, when compared with the halcinonide group, the HIFU group exhibited enhanced curative effects that were statistically significant (P = 0.039). Based on the histological evidence from this randomized, controlled trial, HIFU represents an effective method for the treatment of NNEDV.

Abstract P4-13-12: Everolimus plus trastuzumab and vinorelbine for trastuzumab-resistant, taxane-pretreated, HER2+ advanced breast cancer: Overall survival results from BOLERO-3

Background

PI3K/AKT/mTOR pathway activation due to PTEN loss may lead to trastuzumab (TRAS) resistance. mTOR inhibition has been shown to restore TRAS sensitivity in PTEN-deficient tumors. This provided the rationale for the BOLERO-3 trial which evaluated the combination of everolimus (EVE), an mTOR inhibitor, plus TRAS and a taxane in HER2+ advanced breast cancer (ABC). The addition of EVE to TRAS plus vinorelbine (VNB) led to a statistically significant prolongation of 1.2 months in median progression free survival (PFS) vs TRAS plus VNB in patients with TRAS-resistant and taxane-pretreated, HER2+ ABC (7.0 months vs 5.78 months; hazard ratio, 0.78; p=0.0067). The final overall survival (OS) analysis from this study is presented here.

Materials and methods

BOLERO-3 is a randomized, double-blind, placebo-controlled, phase 3 trial. Women with HER2+ ABC progressing on prior TRAS and taxane therapy were randomized (1:1) to receive either daily EVE (5 mg) or PBO plus weekly TRAS (2 mg/kg) and VNB (25 mg/m2), in 3-week cycles, stratified by previous lapatinib use. The primary endpoint was PFS by local investigator assessment. Overall survival was a key secondary endpoint.

Results

Overall, 569 patients were enrolled; 284 patients received EVE and 285 patients received PBO. As of April 1, 2015, after a median follow-up of 44.7 months, 388 deaths had occurred, 191 (67.3%) in the EVE arm and 197 (69.1%) in the PBO arm. The median OS in the EVE arm vs PBO arm was 23.5 months vs 24.1 months (HR = 0.96; 95% CI, 0.79-1.17; p = 0.3392). In the HR+ subgroup, the median OS with EVE was 23.5 months (vs 25.5 months with PBO; HR = 1.03; 95% CI, 0.79-1.35); in the HR subgroup, the median OS with EVE was 22.9 months (vs 23.1 months with PBO; HR = 0.86; 95% CI, 0.64-1.17). AEs leading to treatment discontinuation were reported in 81 (28.9%) vs 46 (16.3%) patients in the EVE vs PBO arms. Serious adverse events (SAEs) were reported in 122 (43.6%) vs 58 (20.6%) patients in the EVE vs PBO arms. Overall, 14 on-treatment deaths were observed, 7 (2.5%) in the EVE arm and 7 (2.5%) in the PBO arm; on-treatment deaths due to AEs were balanced between treatment arms (0.7% in each treatment arm). Types of post-progression therapies were balanced across both treatment arms.

Conclusions

In BOLERO-3, EVE showed a statistically significant prolongation of PFS. OS was similar in both treatment arms. The safety profile of EVE was comparable to that observed previously with EVE in breast cancer. (Funded by Novartis; BOLERO-3 ClinicalTrials.gov number, NCT01007942.)

Citation Format: Isaacs C, O'Regan R, Xu B, Masuda N, Arena F, Yap Y-S, Papai Z, Lang I, Armstrong A, Lerzo G, White M, Shen K, Zhang Y, Jappe A, Pacaud LB, Taran T, Ozguroglu M. Everolimus plus trastuzumab and vinorelbine for trastuzumab-resistant, taxane-pretreated, HER2+ advanced breast cancer: Overall survival results from BOLERO-3. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-13-12.

Abstract P3-01-13: Risk factors of non-sentinel lymph node metastasis in breast cancer patients with metastatic sentinel lymph node

Objective To study the factors influencing the non-sentinel lymph node(NSLN) status and to assess Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram performance in predicting SLN metastases in a sentinel lymph node(SLN) positive Chinese breast cancer population. Methods Data were collected from breast cancer patients who were diagnosed with pathological positive sentinel lymph node and received further axillary lymph node dissection(ALND) in Shanghai Ruijin Hospital from January 2011 to August 2014. Use MSKCC nomogram to calculate each patient's NSLN metastasis risk score. The receiver operator characteristic curve(ROC curve)and the area under the ROC curve(AUC)was used to assess the predictive accuracy of the model. Results Among the 1147 patients who received sentinel biopsy in our center, 150 SLN positive patients who received ALND were enrolled in this study. By univariate analysis, multifocal breast cancer (P = 0.017), SLN+/SLN ratio (P = 0.010) and axillary lymphadenopathy displayed by ultrasound(P = 0.005) are the influencing factors of NSLN metastases. By multivariate analysis, multifocal breast cancer (OR 7.25, 95% CI 1.73∼30.43, P = 0.007), SLN+/SLN ratio≥0.5 (OR 2.564, 95% CI 1.22∼5.39, P = 0.013) and axillary lymphadenopathy displayed by ultrasound (OR 2.471, 95% CI 1.18∼5.19, P = 0.017) are the independent influencing factors of NSLN metastases. The AUC of MSKCC nomogram in this population is 0.677. Conclusion For breast cancer patients with positive sentinel lymph node, multifocality, SLN+/SLN ratio and axillary lymphadenopathy displayed by ultrasound is related to NSLN metastasis. MSKCC has low accuracy in predicting NSLN status of this population.

Citation Format: Huang J, Chen X, Shen K, Li Y, Chen W, He J, Zhu L, Huang O, Zong Y, Fei X, Jin X. Risk factors of non-sentinel lymph node metastasis in breast cancer patients with metastatic sentinel lymph node. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-01-13.

[Value of C-reactive protein level on transplantation day in predicting early post-transplant infections and outcomes of allogeneic hematopoietic stem cell transplantation]

OBJECTIVE

To investigate the value of C-reactive protein (CRP) on transplantation day in predicting early post-transplant infections and outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODS

We retrospectively analyzed the clinical data of 78 recipients undergoing allo-HSCT. The clinical reference value of CRP on transplantation day was determined, and its sensitivity and specificity for diagnosing bacteremia was analyzed using receiver-operating characteristic curve (ROC). The incidence of transplant-related complications, overall survival, and relapse rate of the patients were analyzed with respect to the CRP level.

RESULTS

The clinical reference value of CRP for diagnosing bacteremia was 23.3 mg/L (AUC=0.735 [95% CI: 0.623-0.848], P=0.001), which had a diagnostic sensitivity and specificity of 0.793 and 0.592, respectively. Compared with the patients with low CRP levels, the patients with high CRP levels tended to have delayed neutrophil reconstitution and platelet engraftment by 0.71 days (P=0.237) and 4.09 days (P=0.048), respectively, and had a significantly higher incidence of bacteremia (17.1% vs 53.5%, P=0.001) and CMV viremia (37.1% vs 72.1%, P=0.003) within 100 days following the transplantation; the incidences of EBV viremia, pulmonary invasive fungal infection, or acute graft versus host disease (aGVHD) showed no significant difference between the two groups (41.9% vs 22.9%, P=0.094; 14.0% vs 5.7%, P=0.285; 51.2% vs 45.7, P=0.656, respectively). During the follow-up for a median of 318 (7-773) days in high-CRP group and for 299 (78-747) days in low-CRP group, the high-CRP group showed a significantly lower 2-year overall survival than the low-CRP group (42.5% vs 78.4%, P=0.022), and tended to have a higher 2-year cumulative relapse rate (52.3% vs 19.8%, P=0.235). Logistic multivariate analysis identified a high CRP level on transplantation day as the independent risk factor for post-transplant bacteremia within 100 days (OR=5.090 [95% CI: 1.115 -23.229], P=0.036).

CONCLUSION

A high CRP level on transplantation day can be indicative of a high risk of early post-transplant bacteremia and CMV viremia and also a poor prognosis following allo-HSCT.

Systemic chemotherapy as a main strategy for liver metastases from gastric cancer

BACKGROUND

Liver metastasis is associated with poor prognosis in gastric cancer. Surgical resection and systemic chemotherapy have been reported to be effective in gastric cancer with liver metastasis (GCLM). However, the best strategy for GCLM has not been established.

METHODS

From May 2009 to July 2014, a consecutive series of GCLM patients in Zhongshan Hospital of Fudan University were studied. Treatment strategies were evaluated with regard to different extents of metastases.

RESULTS

A total of 163 patients were included. The overall survival was 10.1 months. Active treatment significantly prolongs the survival of GCLM patients. The overall survival time for patients with liver-limited metastases and extra-hepatic liver metastases was 11.6 mo and 8.7 mo, respectively (P = 0.012). The median survival time for liver-limited disease of H1, H2 and H3 was 14.2, 15.8, and 8.5 months, respectively (H3 vs H2, P = 0.001; H3 vs H1, P = 0.000; H1 vs H2, P = 0.900). Systemic chemotherapy was chosen as the main strategy for the 'extensive' patients with extra-hepatic metastases and H3 type liver-limited metastases. Patients' survival was benefited by multi-line chemotherapy. No differences were shown between systemic chemotherapy and curative resection or palliative resection in H1 and H2 liver-limited metastases (16.0 mo vs 12.0 mo, P = 0.711; 16.0 vs 18.8 months, P = 0.654).

CONCLUSION

Systemic chemotherapy was the main treatment for gastric cancer patients with liver metastases. Curative resection could be considered for highly selected patients.

Ikaros6 is associated with BCR-ABL1 and myeloid-associated antigens but indicates poor prognosis independently in Chinese adult B-cell acute lymphoblastic leukemia

Ikaros6 was specifically associated with clinical and genetic features of acute lymphoblastic leukemia (ALL) and could be used for prediction of inferior survival. The present study aimed to further investigate the correlation between Ikaros6 and other prognostic factors, and to explore the novel prognosis prediction function by combining Ikaros6 and other factors in Chinese adult B-ALL. We examined the expression of Ikaros6 in 108 patients by reverse transcription polymerase chain reaction and confirmed the results by sequencing, gene scanning and real-time PCR. Ikaros6 was associated with BCR-ABL1 (P=0.010) and myeloid-associated antigens (P=0.009), but had an independent negative impact on survival. In multivariable Cox analysis, Ikaros6 was an independent prognostic marker for overall survival (P=0.013, HR=2.140), event-free survival (P=0.016, HR=1.972) and relapse-free survival (P=0.002, HR=3.636). This study indicated closed relation between BCR-ABL1, myeloid-associated antigens and Ikaros6.These three risk factors played an important role in evaluation of prognosis in Chinese adult B-ALL. Furthermore, Ikaros6 is more beneficial for the disease recurrence prediction.

Benefits of fluorine-18 fludeoxyglucose positron emission tomography in secondary cytoreductive surgery for patients with recurrent epithelial ovarian cancer

OBJECTIVE

To investigate the benefits of fluorine-18 fludeoxyglucose positron emission tomography ((18)F-FDG-PET) in patients undergoing secondary cytoreductive surgery (SCRS) for recurrent epithelial ovarian cancer.

METHODS

Patients were identified, and their clinical information was extracted by review of the gynaecologic oncology database of Peking Union Medical College Hospital. (18)F-FDG-PET scan and analysis were performed by nuclear medicine experts at our hospital.

RESULTS

The PET group and the control group of patients evaluated by conventional imaging methods differed significantly with respect to the proportion of patients who underwent complete SCRS and the number of residual lesions (p = 0.002 and 0.006, respectively). A Cox model showed that longer progression-free survival (PFS) correlated significantly with (18)F-FDG-PET evaluation [relative risk (RR) = 0.432; p = 0.001], sensitivity to platinum-based chemotherapies (RR = 0.604; p = 0.034) and resection completeness (RR = 0.679; p = 0.039). Longer overall survival (OS) correlated significantly with sensitivity to platinum-based chemotherapy (RR = 0.317; p = 0.000) and the CA-125 level after two cycles of chemotherapy (RR = 2.663; p = 0.003). Surgical safety and complications did not significantly differ between the two groups of patients.

CONCLUSION

(18)F-FDG-PET is useful for evaluating patients with recurrent epithelial ovarian carcinoma. Patients who undergo PET-guided SCRS have a greater chance of complete tumour resection and a longer PFS.

ADVANCES IN KNOWLEDGE

SCRS guided by PET results in fewer residual lesions. PET-guided SCRS is safe and can prolong PFS and OS in patients with recurrent ovarian cancer.