Validation of UBE2C protein as a prognostic marker in node-positive breast cancer

Background:

We recently identified and validated UBE2C RNA as a prognostic marker in 252 node-positive (N+) breast cancers by means of a microarray study. The aim of this study was to validate UBE2C protein as a prognostic marker in N+ breast cancer by immunohistochemistry (IHC).

Methods:

To this end, 92 paraffin-embedded blocks were used. The impact of UBE2C IHC value on metastasis-free survival (MFS) and overall survival (OS) was evaluated and compared with Ki-67 and Nottingham prognostic index (NPI) performances.

Results:

In accordance with genomic data, UBE2C IHC had a significant impact both on MFS and OS (hazard ratio=6.79 – P=0.002; hazard ratio=7.14 – P=0.009, respectively). Akaike information criterion proved that the prognostic power of UBE2C IHC was stronger than that of Ki-67 (and close to that of NPI). Furthermore, multivariate analyses with NPI showed that, contrary to Ki-67 IHC, UBE2C IHC remained an independent factor, both for MFS (adjusted P=0.02) and OS (adjusted P=0.04).

Conclusion:

We confirmed that UBE2C protein measured by IHC could be used as a prognostic marker in N+ breast cancer. The potential predictive interest of UBE2C as a marker of proteasome activity needs further investigations.

The orl rat with inherited cryptorchidism has increased susceptibility to the testicular effects of in utero dibutyl phthalate exposure

Phenotype results from interactions between genetics and environment, but for most environmental chemical exposures, such interactions are theoretical. The phenotypic response of the testis to in utero dibutyl phthalate (DBP) exposure was compared between two strains of Long-Evans (LE) rats, the orl substrain with inherited cryptorchidism and an outbred (wt) strain. orl and wt LE rats were exposed daily between gestational day (GD) 12 and GD21 to DBP dose levels ranging from 50 to 200 mg/kg by oral gavage and sensitive phthalate testicular end points examined at either GD19, GD21, or postnatal day (PND) 21. At 50 mg/kg DBP, GD19 expression of Cyp17a1, Insl3, and Scarb1 was significantly reduced in orl but not wt testis. At GD21, statistically significant differential strain effects (orl more sensitive than wt) were observed for testicular expression of Scarb1 at 50 and 200 mg/kg DBP and Star at 200 mg/kg DBP. Similarly, DBP exposure disproportionately increased GD21 seminiferous cord diameters and numbers of multinucleated germ cells in the orl strain. At PND21, body weight-corrected testis weights were lowered significantly by DBP exposure at all dose levels in the orl strain but not in wt rats. While the frequency of undescended testes after 200 mg/kg DBP exposure in the orl strain appeared increased, these data were not statistically significant. These results demonstrated enhanced sensitivity of the orl rat to phthalate exposure as compared to its parent strain, a potentially important model of the effects of gene-environment interaction on development of male reproductive malformations.

Altered expression of muscle- and cytoskeleton-related genes in a rat strain with inherited cryptorchidism

Development of the fetal gubernaculum is a prerequisite for testicular descent and dependent on insulin-like 3 and androgen, but knowledge of downstream effectors is limited. We analyzed transcript profiles in gubernaculum and testis to address changes occurring during normal and abnormal testicular descent in Long Evans wild-type (wt) and cryptorchid (orl) fetuses. Total RNA from male wt and orl gubernacula (gestational days [GD]18-20), wt female gubernacula (GD18), and testis (GD17 and 19) was hybridized to Affymetrix GeneChips. Statistical analysis of temporal, gender, and strain-specific differences in gene expression was performed with the use of linear models analysis with empirical Bayes statistics and analysis of variance (gubernaculum) and linear analysis (testis). Overrepresented common gene ontology functional categories and pathways were identified in groups of differentially expressed genes with the Database for Annotation, Visualization, and Integrated Discovery. Transcript profiles were dynamic in wt males between GD18-19 and GD20, comparatively static in orl GD18-20 gubernaculum, and similar in wt and orl testis. Functional analysis of differentially expressed genes in wt and orl gubernaculum identified categories related to metabolism, cellular biogenesis, small GTPase-mediated signal transduction, cytoskeleton, muscle development, and insulin signaling. Genes involved in androgen receptor signaling, regulated by androgens, or both were overrepresented in differentially expressed gubernaculum and testis gene groups. Quantitative reverse transcription polymerase chain reaction (RT-PCR) confirmed differential expression of genes related to muscle development, including Myog, Tnnt2, Fst, Igf1, Igfbp5, Id2, and Msx1. These data suggest that the orl mutation results in a primary gubernacular defect that affects muscle development and cytoskeletal function and might alter androgen-regulated pathways.

Exclusive high dose rate brachytherapy (HDR-BT) for early stage non-small cell lung carcinoma: Results of a retrospective study in 226 patients

7688

Objective: To evaluate efficacy and toxicity of HDR BT in non operable endobronchial carcinoma from a retrospective multicentric study. Patients and Methods: Criteria for selection: non small cell carcinoma accessible to fiberoptic bronchoscopy, no extrabronchial extension on CT, contraindication to surgery and external radiation therapy (ERT). Statistical analysis: survival curves calculated with the Kaplan-Meier method and compared with the Logrank test; Cox model to evaluate in uni and multivariate analysis the impact on survival and complications of these parameters: location of tumor: lobar or segmental vs main stem bronchus, previous ERT vs no, total dose:= 30 Gy vs less, dose per fraction:= 5 Gy vs more, number of catheter(s):1 vs = 2. Results: Between 1991 and 2006, 226 patients from 9 radiotherapy departments were included. Main characteristics of tumors: squamous-cell histology: 96%, stage Tis: 60, T1: 153, T2: 9, Tx 4; lobar or segmental location: 91%. 51 patients (22.5%) had received ERT for previous lung cancer(s). Characteristics of HDR BT were: total dose = 30 Gy: 70%, dose per fraction = 5 Gy: 66%, 1 catheter: 46%. Dose was prescribed at 1 cm from the radius. Mean follow-up was 30.4 months (9- 116). Histologic evaluation was performed at 3 months in 137 patients. 92% had a complete response. 128 patients were died: intercurrent disease 45, local failure 35, complications 13. Two and 5-year survival: overall: 57%, 29%; specific (death of lung cancer) 81%, 56%; local- relapse free (LRF) 68%, 50%. Toxicity included 1.3% pneumothorax, hemoptysis 6.6% (5% fatal), bronchitis 20%. In univariate analysis: overall, specific and LRF survival were better for lobar or segmental location vs main stem bronchus (p=0.0001), overall and specific survival were higher with no previous ERT (p=0.006). In multivariate analysis, lobar or segmental location was associated with improved overall (p=0.0001) and LRF (p=0.003) survival. LRF survival was better in patients treated with = 2 catheters (p=0.007). No factor influence frequency of complications. Conclusion: This large retrospective study confirmed that HDRBT is efficient and safe in medically inoperable patients particulary with lobar or segmental endobronchial carcinoma.

No significant financial relationships to disclose.

Lésions de métaplasie cylindriques atypiques (MCA) diagnostiquées par macrobiopsies assistées par aspiration : opportunité d’une exérèse chirurgicale ?

OBJECTIVE

FEA lesions group two histological types: columnar cell hyperplasia with atypia (CCHA) and columnar cell change with atypia (CCA). The increasing use of VAB has resulted in increased detection of isolated FEA lesions. The aim of this study was to define the best management possible for these patients: which cases may not need excision?

MATERIAL AND METHODS

From our database of 780 VABs carried out from 2000 to 2004, 59 patients with FEA were diagnosed. Cases in which no surgery was performed or all features were not available were excluded, thus excluding 19 cases. Forty patients with FEA were included. We reviewed clinical and mammographic characteristics, histological biopsy, and the corresponding surgically excised tissue features.

RESULTS

VAB yielded 25 cases of CCHA and 15 cases of CCA. Surgery revealed seven ductal carcinoma cases (four invasive, three in situ); nine benign lesions, and 24 with atypia (19 FEA and six atypical ductal hyperplasia). We found two features related to the risk of cancer: the presence and the size of hyperplasia. All carcinomas were found within the CCHA lesions. No cancer was yielded when size was less than 10 mm within CCA lesions and lesions that were totally removed.

CONCLUSION

We recommend surgical excision when CCHA greater than 10 mm is found on the VAB or it is incompletely removed. CCA lesions or CCHA less than 10 mm or totally removed may obviate systematic surgery.

Failure of shortening and inversion of the perinatal gubernaculum in the cryptorchid long-evans orl rat

PURPOSE

Failure of testicular descent occurs in about 65% of spontaneously cryptorchid Long-Evans orl rats. Development of the fetal gubernaculum is dependent on expression of leucine rich G protein coupled receptor (also known as G protein coupled receptor affecting testicular descent) and its ligand, insulin-like 3. We studied testicular descent and mRNA expression of insulin-like 3 and leucine rich G protein coupled receptor in Long-Evans orl and Long-Evans wild-type rats during perinatal development.

MATERIALS AND METHODS

Long-Evans orl and Long-Evans wild-type males obtained at gestational days 18 to 21 and day of birth were preserved in RNAlater for at least 24 hours. The size and position of the testes, kidneys and gubernacula were determined by microdissection and image analysis. Leucine rich G protein coupled receptor mRNA expression was analyzed in fetal gubernacula (gestational days 18 to 21) using real-time reverse transcriptase polymerase chain reaction with SYBR Green detection. Insulin-like 3 mRNA expression in fetal testis (gestational days 18 and 20) was determined by semiquantitative reverse transcriptase polymerase chain reaction.

RESULTS

Testicular position was similar in Long-Evans orl and Long-Evans wild-type fetal rats. However, gubernacula were narrow (p < 0.001) and elongated (p < or = 0.01) in Long-Evans orl compared to Long-Evans wild-type fetuses at all time points. Inversion of both gubernacula occurred by the day of birth in 45% of Long-Evans orl and 100% of Long-Evans wild-type males (p < 0.001). Leucine rich G protein coupled receptor mRNA expression decreased with age and, similar to insulin-like 3 mRNA, was not consistently different between strains.

CONCLUSIONS

These data suggest that the impaired shortening of the Long-Evans orl gubernaculum may interfere with the timing and quality of its inversion at birth, leading to failure of testicular descent in some newborn males. However, fetal testicular descent and the expression of leucine rich G protein coupled receptor and insulin-like 3 mRNA appear to be normal in this strain.

Evaluation of FDG PET in early axillary lymph node response to neoadjuvant chemotherapy in locally advanced breast cancer patients

10500

Background: Regional axillary lymph node status has remained the single most independent variable to predict prognosis both in terms of disease recurrence and survival. This study aimed to prospectively assess sequential FDG PET findings as early predictors of axillary lymph node response to neoadjuvant chemotherapy in locally advanced breast cancer patients. Methods: A total of 255 attenuation-corrected scans were obtained from 51 patients. Images were acquired with a PET/CT scanner (GE Discovery LS) following administration of FDG (5 MBq/kg) at baseline, and after the first, second, third, and sixth course of chemotherapy. Clinical examination and US were used to assess the size of axillary lymph nodes. PET data were interpreted using standardized uptake values (SUV) corrected or not for partial volume effects. Changes in the SUV were considered as surgical/histopathological responses. Results: This study focused on axillary lymph node staging, therefore, primary breast tumor data were not considered in the analysis. The sensitivity, specificity, and accuracy of axillary node staging was higher with PET (75%, 87%, 80%) than with clinical examination and US (50%, 78%, 63%, and 50%, 83%, and 65%, respectively), and even the more so when PET images were corrected for partial volume effects (86%, 83%, 84%). Significant differences between absolute FDG uptake values in responders and non-responders were observed at baseline (p < 0.05). While FDG uptake did not vary much in non-reponders, as confirmed by histopathology, it markedly decreased to baseline levels in responders (p < 10−5). Fifty percent of baseline SUV was considered the best cut-off value to distinguish responders from non-responders. The sensitivity, specificity, negative predictive value, and accuracy of FDG PET after one course of chemotherapy were respectively, 96%, 75%, 95%, and 84%. Tumor response assessment by clinical examination or US was never statistically significant whatever the cut-off. Conclusions: The pathological status of regional axillary lymph nodes in locally advanced breast cancer patients can be accurately predicted after one course of neoadjuvant chemotherapy based on FDG PET images.

No significant financial relationships to disclose.

Establishment of a predictive classifier of node-positive breast cancer patients treated by FEC100 chemotherapy using gene expression profiling

13004

Background: In breast cancer treatment, biomarkers providing information about chemotherapy sensitivity are needed. FEC100 combination, frequently prescribed in Europe, is still applied empirically to patients. Our study’s goal was to establish a classifier of sensitivity to this regimen using gene expression data and classical clinicopathologic parameters. Methods: The study retrospectively included 151 patients belonging to the FEC100 arms of two multicentric phase III clinical trials: PACS01 (n = 128) and PEGASE01 (n = 23) (FNCLCC). Patients had unilateral breast cancer, showed no evidence of distant metastasis, were node-positive, aged less than 65-year-old. Median follow-up was 5 years. The number of relapses were respectively 23 and 10. We used cDNA nylon microarrays containing 7,000 genes to analyze gene expression profiles of tumor. Patients were split into a training set and a test set. A 3-step analysis based on Cox regression was applied: 1) elimination of non discriminant genes, 2) robust (resampling) univariate selection of discriminant genes and 3) development of multivariate models combining the discriminant genes, the Nottingham Prognostic Index (NPI) (developed in 2 binary variables) and the hormonal receptors. As a final step, after dichotomization of the retained genes, a risk score was built and applied first on the test set, and then on the whole cohort. Kaplan-Meier curves and logrank tests were performed to assess the new risk score. Results: The new risk score (one gene [G6224] and NPI) permitted to separate patients from the test set in 3 significantly different groups; it was also an improvement on NPI (test set: NPI, p = 0.0005; risk score p = 0.0001 - whole cohort: NPI, p = 2.10−5; risk score, p = 1.10−10). Conclusions: We identified G6224 whose expression combined with NPI showed a good capacity for classifying breast cancer patients who received FEC100 chemotherapy. Our results strengthen the interest of G6224 since it was previously described in various solid tumors as a prognostic biomarker with a tumor-suppressor activity.

No significant financial relationships to disclose.

Randomized clinical trial comparing axillary padding with closed suction drainage for the axillary wound after lymphadenectomy for breast cancer

Background

After axillary lymphadenectomy for breast cancer, a suction drain is routinely inserted into the axilla to prevent seroma formation. This drain is an obstacle to reducing hospital stay after breast-conserving surgery. This was a prospective randomized clinical trial to assess the safety and results of axillary padding without the use of a drain.

Methods

Between May 2001 and August 2003, 100 women were randomly allocated axillary padding without a drain or with the use of an axillary suction drain. Prospective assessments were made of morbidity, pain, shoulder mobility, quality of life and medical costs including length of hospital stay.

Results

Using axillary padding significantly reduced the mean (s.d.) length of hospital stay (1·8(1) versus 4·5(2) days, P &lt; 0·001). Postoperative complications, pain, shoulder mobility and quality of life were similar in the two groups. There was no difference in the duration of the two procedures.

Conclusion

Axillary padding after axillary lymphadenectomy was feasible and safe, without a drain, and shortened hospital stay.

Brown fat in breast cancer patients: analysis of serial 18F-FDG PET/CT scans

PURPOSE

It has recently been suggested that FDG accumulation in the brown adipose tissue varies as a function of age, sex and outdoor temperature. The aim of this study was to assess changes in FDG uptake in brown fat in patients based on serial PET/CT scans and to compare our results with previous findings.

METHODS

Early response to neoadjuvant chemotherapy in 33 female breast cancer patients was assessed by FDG PET. Five PET/CT scans were performed for each patient. PET/CT images were analysed retrospectively. PET scans were considered positive when diffuse, symmetrical, abnormal "USA" (uptake in supraclavicular area) fat was detected.

RESULTS

A total of 163 PET images were analysed. Seventy-four PET scans (45%) revealed abnormal FDG uptake in the supraclavicular area. These foci were present on uncorrected and attenuation-corrected images. FDG uptake was identical on all five scans in only five patients. No significant relationship was found between abnormal FDG uptake and outdoor temperature, age or time interval between chemotherapy and PET. Abnormal FDG uptake in the neck seemed to predominantly occur in patients with a low body mass index (p<0.05). Most significant changes in the PET/CT scan results were observed during chemotherapy with docetaxel (p<0.05). When observed, bilateral uptake in the neck was more intense than background uptake (p<0.00001).

CONCLUSION

This study shows that FDG uptake in the neck varies as a function of time, that it is unrelated to age or outdoor temperature, and that bilateral uptake is generally intense.

High-performance liquid chromatographic assay with UV detection for measurement of dihydrouracil/uracil ratio in plasma

A rapid, robust and sensitive HPLC method for analysis of uracil (U) and dihydrouracil (UH2) in plasma was developed using solid phase extraction and ultraviolet detection. Separation was achieved with a SymmetryShield RP18 column and an Atlantis dC18 column using a 10 mM potassium phosphate buffer as mobile phase. Compounds were eluted within 15 min without interference. Recovery was 80.4 and 80.6% for U and UH2. Calibration curves were linear from 2.5 to 80 ng/mL for U and 6.75 to 200 ng/mL for UH2. The LLQ was, respectively, 2.5 ng/mL for U, and 6.75 ng/mL for UH2. Within-run and between-run precision were less than 5.94% and inaccuracy did not exceed 7.80%. The overall procedure has been applied to correlate UH2/U ratio with dihydropyrimidine dehydrogenase activity in 165 cancer patients.

[Interstitial brachytherapy of peri-orificial skin carcinomas on the face]

Purpose. - To analyse outcomes after interstitial brachytherapy of facial periorificial skin carcinomas. Patients and methods. - We performed a retrospective analysis of 97 skin carcinomas (88 basal cell carcinomas (BCCs), 9 squamous cell carcinomas (SCCs)) of the nose, periorbital areas and ears from 40 previously untreated patients (group 1) and 57 patients who had undergone surgery (group 2). The average dose was 55 Gy [50-65] in group 1 and 52 Gy [50-60] in group 2 (mean implantation times: 79 and 74 hours respectively). We calculated survival rates and assessed functional and cosmetic results de visu. Results. - Median age was 71 years [17-97]. There were 29 T1, 8 T2, 1 T3 and 2 Tx tumors in group 1. Tumors were<2 cm in group 2. Local control was 92.5% in group 1 and 88% in group 2 (median follow-up: 55 months [6-132]). Five-year disease-free survival was better in group 1 (91% [75-97]) than in group 2 (80% [62-90]), P=0.23. Of the 34 patients whose results were re-assessed, eight presented pruritus or epiphora. One group 2 patient had an impaired eyelid aperture. Cosmetic results were better in group 1 than in group 2, with respectively 72% (8/11) vs 52% (12/23) of good results and 28 (3/11) vs. 43% (10/23) of fair results. Conclusion. - Brachytherapy provided a high level of local control and good cosmetic results for facial periorificial skin carcinomas that pose problems of surgical reconstruction. Results were better for untreated tumors than for incompletely excised tumors or tumors recurring after surgery.

Post-operative care and patient satisfaction after ambulatory surgery for breast cancer patients

AIM

This study aimed to evaluate patient information provided, the management of post-operative symptoms and post-operative care, and patient satisfaction with ambulatory breast surgery over a 1-year period.

METHODS

From January to December 2000, all breast cancer patients undergoing conservative breast surgery were offered surgery as an outpatient procedure at the Ambulatory Surgery Unit.

RESULTS

Two hundred and thirty six patients underwent outpatient surgery. None were readmitted during the first night or the first week. Two hundred and nineteen patients completed a questionnaire. One hundred and sixty nine patients (group 1) underwent wide local excision (WLE) and 50 (group 2), WLE and axillary lymphadenectomy. Patients in group 2 experienced more pain at discharge from the hospital (p < or = 0.01) and during the first week after discharge (p < or = 0.00001) than patients in group 1. The mean overall satisfaction score was 8.97 on a scale of 1-10. Post-operative information provided by the surgeon before discharge from the hospital was rated 8.90 on a scale of 1-10 while information provided by the nurse was rated 9.33 (p < 0.0001).

CONCLUSION

Ambulatory surgery for breast cancer patients is safe and popular with patients, however, post-operative pain presents problem.