Comparative analysis of lifestyle factors, screening test use, and clinicopathologic features in association with survival among Asian Americans with colorectal cancer

Background:

Colorectal cancer (CRC) diagnoses and disease-specific survival (DSS) vary between ethnic groups in the United States. However, few studies have assessed differences among Asian subgroups.

Methods:

The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients with invasive CRC between 1988 and 2008. Differences in clinicopathologic features, and DSS rates were compared among Asian subgroups. The California Health Interview Survey was used to examine risk factors and screening patterns for CRC.

Results:

The study included 359 374 patients with 8.4% Asian. Patients in all Asian subgroups were younger (median: 68 years) at diagnosis than non-Hispanic white (NHW) patients (median: 72 years). Most Asian subgroups, except Hawaiians, had better DSS than NHW patients although Asian subgroups had more advanced disease than NHW. Indian/Pakistani patients had a higher 5-year DSS than other Asian subgroups. Obesity proportions were lower in Asian subgroups (<50.2%) than in NHW (59.8%). Vietnamese men and Korean women had the lowest proportions of CRC screening. Advance tumour stages were highly associated with worse DSS in each ethnicity group. High tumour grades were associated with worse DSS in NHW, Filipino, and Chinese. Older age at diagnosis was associated with worse DSS in most ethnicity groups except Hawaiian and Vietnamese.

Conclusion:

Disparities exist between Asians and NHW with CRC, and among various Asian subgroups. Differences in cancer clinicopathologic features, patients' behavioural habits, lifestyle, and screening patterns may explain some differences in CRC survival observed among ethnic groups.

Significance of neonatal body indices in identifying fetal macrosomia

OBJECTIVE

To explore the significance of neonatal body indices in identifying macrosomic infants, we compared the neonatal birth weight, body length, head circumference, chest circumference, neonatal body indices, Quetelet index (QI), Kaup Index (KI), head circumference to chest circumference ratio (HC/CC) and maternal fasting blood glucose (BG) for both diabetic and healthy mothers.

STUDY DESIGN

This is a retrospective study of 177 macrosomic neonates, 100 having been born to normal mothers and 77 to diabetic mothers. Multiple regression analyses were done between neonatal body indices and maternal fasting BG.

RESULT

Fetal QI and KI indices of macrosomic infants of diabetic mothers were higher compared with those born to healthy mothers, whereas the HC/CC was the reverse. The multiple regression equation used to compare neonatal physical development indices to maternal fasting BG was BG=6.959+0.031QI-(4.482 × HC/CC). QI and HC/CC had linear relationships to maternal fasting BG (P<0.05). As birth weight had no direct correlation with maternal fasting BG, it was not introduced into the regression equation.

CONCLUSION

Higher QI and KI along with lower HC/CC may be a predictor of macrosomia due to maternal diabetes when compared with birth weight alone.

Successful treatment of giant condyloma acuminatum with combination retinoid and interferon-γ therapy

Giant condyloma acuminatum, or Buschke-Löwenstein tumour, is a unique variant of anogenital warts. It is characterized by locally aggressive behaviour but rarely metastasizes. Many treatment strategies such as radical surgery, radiation and chemotherapy have been used to treat it but their efficacy is often poor and the recurrence rates are high. We report a case of 16-year-old girl who was treated with oral retinoid combined with intramuscular interferon-γ. All lesions cleared within three months. During a follow-up period of more than two years, no recurrence has developed. This relatively painless, non-scarring treatment may represent a novel therapeutic option.

Observation of the (Λ)(7)He hypernucleus by the (e, e'K+) reaction

An experiment with a newly developed high-resolution kaon spectrometer and a scattered electron spectrometer with a novel configuration was performed in Hall C at Jefferson Lab. The ground state of a neutron-rich hypernucleus, (Λ)(7)He, was observed for the first time with the (e, e'K+) reaction with an energy resolution of ~0.6 MeV. This resolution is the best reported to date for hypernuclear reaction spectroscopy. The (Λ)(7)He binding energy supplies the last missing information of the A = 7, T = 1 hypernuclear isotriplet, providing a new input for the charge symmetry breaking effect of the ΛN potential.

Transferability of Newly Developed Pear SSR Markers to Other Rosaceae Species

A set of 120 simple sequence repeats (SSRs) was developed from the newly assembled pear sequence and evaluated for polymorphisms in seven genotypes of pear from different genetic backgrounds. Of these, 67 (55.8 %) primer pairs produced polymorphic amplifications. Together, the 67 SSRs detected 277 alleles with an average of 4.13 per locus. Sequencing of the amplification products from randomly picked loci NAUPy31a and NAUpy53a verified the presence of the SSR loci. When the 67 primer pairs were tested on 96 individual members of eight species in the Rosaceae family, 61.2 % (41/67) of the tested SSRs successfully amplified a PCR product in at least one of the Rosaceae genera. The transferability from pear to different species varied from 58.2 % (apple) to 11.9 % (cherry). The ratio of transferability also reflected the closer relationships within Maloideae over Prunoideae. Two pear SSR markers, NAUpy43c and NAUpy55k, could distinguish the 20 different apple genotypes thoroughly, and UPGMA cluster analysis grouped them into three groups at the similarity level of 0.56. The high level of polymorphism and good transferability of pear SSRs to Rosaceae species indicate their promise for application to future molecular screening, map construction, and comparative genomic studies among pears and other Rosaceae species.

Abstract P5-01-16: Value of ultrasonography appearance of breast mass in prediction of histologic type

Objective to determine the relationship of sonographic features to the histological typing and grading of breast mass.

Methods: 292 breast masses were prospectively evaluated with ultrasonography. Sonographic features included irregular shape, microlobulation, spiculated margin, halo, posterior attenuation, microcalcification, ductal distortion. Lesion morphology was analyzed and correlated with histopathologic results, which included tumor typing and grading. Then we make a retrospective analysis and evaluation of patients scanned completely by qualitative and semi-quantitative methods. All patients have signed the informed consent form before the test, together with the recognition of the Ethics Committee.

Resuls: Among these masses, there are breast cancer accounted for 45.89% (134/292), A rounded or lobular mass was strongly associated with ductal carcinoma in situ(DCIS), poorly differential invasive ductal carcinoma(IDC), or some of the specific invasive cancer. Mastitis accounted for 8.22% (24/292), fibroadenoma accounted for 43.84% (128/292), and phyllodes tumor accounted for 2.05% (6/292). In 134 breast cancer cases, 92.70% (127/134)have obviously sonographic features with justled growth was found around the turmor with lamellar necrosis in different extents and lympholeukocytic infiltration, microlobulation, speculated margin, halo, posterior attenuation, microcalcification, ductal distortion, with justled growth was found around the turmor, neoplastic cell array showed as massive nest, patchy and satin ribbon structure, and the membrane of tumor cells was unsharpness with less cytoplasma, round or oval nucleus, great heteromorphism, higher karyoplasmic ratio and common nuclear mitotic figures. Other 7 cases with fibrous tissue hyperplasia under microscope show a regular shape. In fibroadenoma, phyllodes tumor and mastitis team, they shows unobviously sonographic features and the cell morphology contrast with breast cancer are quite different.

Conclusions:Ultrasonography appearance of breast masses is related to pathologic characteristics and can be a predictor of histopathologic pattern preoperatively.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-01-16.

Abstract P3-12-03: Combined targeting of HER2 and VEGFR2 for effective treatment of HER2-amplified breast cancer brain metastases

Brain metastases remain a serious obstacle in the treatment of patients with human epidermal growth factor receptor-2 (HER2)-amplified breast cancer. Unlike HER2-amplified breast tumors growing in extra-cranial locations, brain metastases do not respond well to HER2 inhibitors and are often the reason for treatment failure. One of the major challenges in studying brain metastases is the lack of preclinical models. We developed a HER2-amplified mouse model of brain metastasis using an orthotopic xenograft of BT474 cells in mice. As seen in patients, the HER2 inhibitors trastuzumab and lapatinib failed to contain brain metastatic tumor growth.

Based on previous findings from our laboratory suggesting a role of vascular endothelial growth factor (VEGF) in the resistance of HER2-overexpressing breast cancer brain metastases to trastuzumab, we combined HER2 inhibitors with the anti-VEGFR2 antibody DC101. The combination of either trastuzumab and DC101 or lapatinib and DC101 significantly slowed metastatic tumor growth in the brain, and resulted in a striking improvement in overall survival. The benefit is due largely to an anti-angiogenic effect. The combination of anti-HER2 and anti-VEGFR2 therapy reduced both the total and functional microvascular density in the brain metastatic tumors. Moreover, tumor tissues under combination therapy showed a marked increase in necrosis.

Preclinical and clinical evidence suggest that the combination of trastuzumab and lapatinib is superior to either agent alone – though this has never been tested in the brain metastatic setting. We consistently observed increased phosphorylation of HER2 in breast tumor cells growing in the brain compared with the mammary fat pad. In addition, while short-term lapatinib treatment significantly reduced HER2 activation in the brain, it could do so only to the level of that observed in the untreated mammary fat pad - and this effect disappeared over time. We hypothesized that more pronounced HER2 inhibition would be beneficial to these brain metastases with increased HER2 activation. We show here a significant growth delay with the combination of the two HER2 inhibitors compared with monotherapy. Moreover, we found a dramatic brain metastatic tumor growth delay in mice treated with both HER2 inhibitors, trastuzumab and lapatinib, and DC101. The triple combination prolonged overall survival 5 times longer than control-treated mice.

Brain metastasis from breast cancer is considered the “final frontier” of breast cancer research and treatment. Our findings support the clinical development of a three-drug regimen of trastuzumab, lapatinib and a VEGF pathway inhibitor for the treatment of HER2-amplified breast cancer brain metastases. While the anti-VEGF antibody bevacizumab in combination with trastuzumab and chemotherapy has shown some promise in HER2-positive metastatic breast cancer patient, there are no data on its efficacy in the context of brain metastases. A clinical trial is now recruiting patients to evaluate the efficacy of bevacizumab in breast cancer patients with active brain metastases, including its combination with trastuzumab in patients with HER2-positive disease. This trial may provide clinical evidence for the approach presented here.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-12-03.

Abstract P4-03-12: diagnostic value and clinical significance of integrin αvβ3 in breast mass

Background: Integrins are cell adhesion molecules that widely exists in cell surface, it is a hetero-dimeric protein bound non-covalently by α, β subunit. It plays the role of mediation during interaction of the αvβ3 and the corresponding receptor in signal transduction pathway, integrin αvβ3 is much richer in the surface of neovascular endothelial cells and tumor cells, while poor in the blood vessels and normal tissues. Therefore, it plays an important role in a variety of malignant tumors of the occurrence, development and metastasis processes. We find tumors constituted with neovascularization earlier by marker of integrin αvβ3.

Materials & Methods: We give patients who consider as breast mass intravenous injection of99mTc-3PRGD2 as a tracer preoperatively by SPECT/CT imaging and treat with surgery within a week, then make pathological examination with tumor tissues removed by needle biopsy. Then we make a retrospective analysis and evaluation of patients scanned completely by qualitative and semi-quantitative methods. All patients have signed the informed consent form before the test, together with the recognition of the Ethics Committee.

Results: From December 2011 to May 2012, a total of 245 patients were scanned and operated with clear paraffin pathological diagnosis by intravenous injection of99mTc −3PRGD2. Among them, a total of 106 patients (167 developing lesions) were positive with radionuclide imaging results, 139 patients were negative. Diseases of 106 patients are divided into four series: breast cancer, inflammation mastitis, phyllodes tumor and partly with fibroadenoma. They have in common that there is a clear flow signal in and around lesions by color Doppler ultrasound.

Discussion: After study on 245 patients, we created a molecular imaging tool to show expression of integration αvβ3 in order to assess tumor angiogenesis. Integrin αvβ3 plays an important role in physiological and pathological processes of malignant tumor, such as inflammation, tumor angiogenesis, invasion and metastasis etc. Therefore, its high expression is easy to find in cancer, mastitis, most of the phyllodes tumor and part of fiber adenoma with peripheral lesions. For patients with clear imaging, we make comprehensive analysis based on their ultrasound, mammography, MRI or CT results, which can generally contributes to the early diagnosis of disease in clinical. The detection of sentinel lymph node should be avoided for the patients with axillary lymph node imaging, who are clearly diagnosed as breast carcinoma with axillary lymph node metastases. These peptides are not only tumor receptor-targeted imaging agents with potential clinical value, but also laid a solid foundation for further development of receptor-targeted radionuclide therapy to solid tumors. The method marked with high expression of integrin αvβ3 in the tumor vascular endothelial cells by99mTc-3PRGD2 and SPECT/CT imaging mode has a broad prospect in the early diagnosis of tumor, lesion detection and efficacy evaluation. In the future, we may also find the new imaging agent with more accuracy and specificity. We believe that there will be more and more breast cancer patients benefit from the technology development of ECT/CT examination.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-03-12.

Spectrum of the cavity-QED microlaser: strong coupling effects in the frequency pulling at off resonance

We report the first experimental observation of the cavity-QED microlaser spectrum, specifically the unconventional frequency pulling brought by a strong atom-cavity coupling at off resonance. The pulling is enhanced quadratically by the atom-cavity coupling to result in a sensitive response to the number of pumping atoms (2.1 kHz per atom maximally). Periodic variation of the pulling due to the coherent Rabi oscillation is also observed as the number of pumping atoms is increased across multiple thresholds.

Application of magnifying endoscopy with narrow-band imaging in diagnosing gastric lesions: a prospective study

BACKGROUND

Magnifying endoscopy with narrow-band imaging (ME-NBI) can more clearly assess the surface pattern and microvascular architecture of gastric lesions.

OBJECTIVE

To evaluate the diagnostic efficacy of ME-NBI in patients with early gastric cancer.

DESIGN

Prospective study.

SETTING

Single academic center.

PATIENTS

This study involved 164 suspected gastric lesions in 146 consecutive patients who underwent ME-NBI for additional differential diagnosis before treatment.

INTERVENTION

ME-NBI findings were classified into 3 groups based on irregularities, absence of surface pattern, and microvascular architecture. All lesions were treated endoscopically or surgically, and ME-NBI diagnosis was compared with histopathological findings.

MAIN OUTCOME MEASUREMENTS

Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of real-time ME-NBI diagnosis were determined.

RESULTS

The sensitivity, specificity, and accuracy of ME-NBI were 97.3%, 84.4%, and 90.2%, respectively, in distinguishing between cancerous and noncancerous lesions and were 92.3%, 89.7%, and 90.4%, respectively, in distinguishing undifferentiated from differentiated adenocarcinoma. ME-NBI accurately predicted depth of invasion in 37 of 39 differentiated adenocarcinomas (95%).

LIMITATIONS

The sample size was relatively small.

CONCLUSIONS

ME-NBI can successfully distinguish between cancerous and noncancerous lesions and between undifferentiated and differentiated adenocarcinomas. Of the 3 patterns on ME-NBI, type A is mainly characteristic of noncancerous lesions, type B is a good indicator of differentiated adenocarcinoma and intramucosal/superficially invasive cancers, and type C is indicative of undifferentiated adenocarcinoma or differentiated cancer with deep submucosal invasion.

Evaluation of plasma and tissue S100A4 protein and mRNA levels as potential markers of metastasis and prognosis in clear cell renal cell carcinoma

OBJECTIVES

To investigate levels of S100A4 protein in plasma and S100A4 mRNA in tumours from patients with clear cell renal cell carcinoma (CCRCC), and correlate these with metastasis, survival and levels of vascular endothelial growth factor (VEGF).

METHODS

Plasma S100A4 and VEGF protein concentrations were measured using enzyme-linked immuno sorbent assays in 39 healthy subjects and 68 consecutive patients with untreated CCRCC. Levels of S100A4 and VEGF mRNA in tumour and matched control (healthy) tissue samples were measured using realtime quantitative reverse transcription- polymerase chain reaction. Findings were analysed with respect to clinico pathological characteristics.

RESULTS

Plasma VEGF concentrations were higher in patients with CCRCC than in healthy subjects. S100A4 and VEGF mRNA levels were up-regulated in CCRCC tumour tissue compared with control tissue samples. Logistic regression analysis revealed that up-regulated tumour S100A4 and VEGF mRNA levels were independent risk factors for the presence of invasion and/or metastasis.

CONCLUSIONS

S100A4 and VEGF are associated with tumour invasion and metastasis, and may be useful prognostic markers in patients with CCRCC. S100A4 and VEGF may represent potential targets for therapeutic intervention.