Grade 3 Status Dominates Prognosis in Breast Cancer

Background: Histological grading (HG) is probably the most important clinico-pathological parameter that will provide information about tumour intrinsic characteristics and aggressiveness. HG is included in prognostic guidelines for treatment decision making such as St Gallen, Nottingham Prognostic Index and Adjuvant!Online. Grade 3 (G3) Breast cancer (BC) is associated with poor prognosis in terms of survival and recurrence. G3 BC reflects independent biological entities rather than being the end of the spectrum of cancer progression. Our aim is to establish the clinical relevance of HG as prognostic factor in a specific cohort of BC patients and define its relation with survival and recurrence endpoints.Method: This is a retrospective cohort analysis from 1489 operable Breast Cancer patients attending the Oncology Service at Singleton Hospital, Wales, UK between 1996 and 2002.HG was recorded for 1339 cases and outcome data were available on 1213 cases. Correlation of clinical variables with Overall Survival (OS), Distant Disease Free Survival (DDFS) and Disease Free Survival (DFS) was performed using Cox regression model.Results:The median follow-up for the cohort was 5.43 years (range 0.09 to 10.14 years) Patients were characterised according to age, HG, tumour size (TNM-T), nodal status, ER status and systemic treatment received (polychemotherapy/tamoxifen). Independent Cox regression models for each endpoint were developed based on univariate analyses. Multivariate analysis results are presented in Figure 1.Subgroup analysis of G3 cases showed a younger population: median age G3 59.4y vs G1/G2 62.9 y p:< 0.001); 47.5% of G3 cases were ER positive against 94.5% of Grade 1/2 (p < 0.001). Patients with G3 tumours died more rapidly from all causes (median time to death 2.22 vs 3.42 y, p <0.001) and from BC (median time to death from BC 2.22 y vs 3.82 y in G1/G2, p <0.001) than other HG. Similarly, G3 also relapsed quicker both distantly, (median time 1.64 vs 2.54 y G1/G2 (p<0.04) and locally, median time to relapse 1.6 vs 2.35 y for G1/G2 (p<0.036). There was also a significant association between grade and tumour size (median G1/G2 1.7cm vs G3 2.2cm(p< 0.001); and nodal involvement and tumour size, median 1.5cm N-ve, 2.2 cm N+ve (p< 0.001).Conclusion: Patients with G3 tumours tended to be younger, had a more advanced TNM staging at diagnosis and relapsed and died more rapidly than other histological grades. In our cohort, G3 tumours were adversely associated with OS, DDFS and DFS with a stronger association with these endpoints than node positivity. It is perhaps time to reconsider the HG as a prognostic factor as important as nodal status for the selection of adjuvant chemotherapy regimens.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6005.

Molecular Heterogeneity of Grade 3 Breast Cancer

Background: Histological grade (HG) is one the main prognostic factors used in clinical practice, along with nodal status and tumour size, for the classification of patients into different prognostic groups that support the clinical decision making process and to tailor adjuvant treatment according to specific risk of death or relapse. The aim of this study was to examine the effect of Grade in prognosis in an unselected series of breast cancers, and to examine copy number alteration (CNA) specifically in Grade 3 (G3) breast cancer and its relationship to nodal status (N-ve/N+ve) and clinical outcome, to seek genetically determined markers of prognosis for treatment tailoring in this poor prognosis group.Method: We established a clinical database of 1489 operable Breast Cancer patients attending the Oncology Service at Singleton Hospital, Wales, UK between 1996 and 2002. HG was known for 1339 of these cases, and outcome in 1213, with a median of 5.32 years (range 0.09 - 10.14 years) follow-up. From the 466 G3 cases of primary breast cancer, we analysed 81 cases using 1Mb BAC array CGH for genomic copy number alterations. Spatial normalisation, circular binary segmentation and the CGHcall algorithm was used to generate CGH profiles. Unsupervised hierarchical clustering, supervised, correlation and survival analyses were carried out using packages and tests within the R statistical platform.Results: Patients were characterised according to grade, ER and nodal status. Kaplan Meier analysis for overall survival (OS) and disease specific survival (DFS) confirmed the poor prognosis of G3 (Cox proportional hazards regression, Wald-test p-value << 0.05). The majority of G1 (98%) and G2 (93%) cases were ER +ve, whereas 52.5% G3 cases were ER-ve. ER status was known for 316 of the 466 G3 cases, and ER negativity was significantly associated with a decreased OS (p-value 0.02), but not DFS (p-value: 0.13). Similarly N+vity also showed significant correlation with both OS and DFS (p-values < 0.05). BAC aCGH analysis showed significant copy number gains on chromosomes 1,4,5,7,11 and 21 in N+ve and losses on chromosomes 1,6 and 10 in N-ve G3. One region of chromosome 1 (1p36 – 1p35) in particular was lost in N0 but gained in N+ve, and this was significantly associated with ER-ve/N+ve cases (FDR p-value < 0.05). BAC aCGH profiles did not significantly associate with ER status in G3 disease. Two clusters, delineated on unsupervised hierarchical cluster analysis, correlated with OS. Neither correlated with nodal or ER status, indicating that further analysis may discover genes of prognostic potential within these profiles.Conclusion HG was significantly associated with clinical outcome and ER status. Genomic copy number analysis (CNA) in G3 breast cancer revealed significant associations between DNA alterations and nodal status and OS. The study is currently being extended to investigate the relationship between specific CNA and clinical outcome in G3 disease.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5167.

RET rearrangements in post-Chernobyl papillary thyroid carcinomas with a short latency analysed by interphase FISH

Tissue samples from 13 post-Chernobyl childhood thyroid tumours that occurred within a short period of time (4–8 years) after the Chernobyl accident have been investigated by interphase FISH analysis for rearrangements of RET. In all, 77% of cases showed RET/PTC rearrangements and a distinct intratumoural genetic heterogeneity. The data were compared to findings on 32 post-Chernobyl PTCs that occurred after a longer period of time (9–12 years) after the accident. In none of the cases from either group were 100% of cells positive for RET rearrangement. In addition, the pattern of RET-positive cells was different in the two groups (short vs longer latency). A significant clustering of aberrant cells could be detected in the long-latency subgroup, whereas the aberrant cells were more homogeneously distributed among the short-latency tumours. The findings suggest that oligoclonal tumour development occurs in post-Chernobyl PTCs. This pattern of different clones within the tumour appears to become more discrete in cases with longer latencies, suggesting either outgrowth of individual clones or development of later subclones with time.

The relationship between articular cartilage degeneration and bone changes of the first metatarsophalangeal joint

Plain-film radiography is commonly used in the assessment of joints affected by osteoarthritis. It has been shown that the condition of articular cartilage in the knee, when grossly assessed, does not always correlate well to the radiographic evaluation of the joint. The aim of this study was to determine whether a relationship existed between the radiographic appearance of the subchondral bone and the morphological condition of the articular cartilage surfaces of the first metatarsophalangeal joint. Forty-nine pairs of cadaveric metatarsals and their respective proximal phalanges were studied in order to determine the correlation between articular cartilage degeneration and radiographic grade using a modified Kellgren-Lawrence scale. The relationship between cartilage degeneration and age, gender, osteophytes, metatarsal length, and measured angles (proximal articular set angle, distal articular set angle, intermetatarsal angle) was also investigated. It was found that there was a significant correlation between radiographic grade and cartilage degeneration on both the metatarsal head and the base of the proximal phalange (r2 = .2038 and .1733, respectively). However, while useful in the clinical setting, bony changes of the first metatarsophalangeal joint, as seen radiographically, fail to provide a full representation of the level of cartilage degeneration on the articular surfaces of this joint.

Micellar electrokinetic capillary chromatography for therapeutic drug monitoring of carbamazepine and its main metabolites

In carbamazepine (CBZ) therapy the concomitant monitoring of concentrations of CBZ and its metabolites is strictly recommended, primarily to avoid toxic side effects. Currently, clinical routine monitoring of CBZ is accomplished by high-performance liquid chromatography or immunological methods. In this study a micellar electrokinetic capillary chromatographic (MECC) method was developed for routine drug monitoring of CBZ and its main metabolites, carbamazepine 10,11-diol and carbamazepine 10,11-epoxide, in human serum or plasma samples. The MECC method enabled baseline separation of all analytes within 2.5 min. The assay revealed sufficient precision and sensitivity and the results of either an automated HPLC or the MECC chromatography assay were in good agreement (r=-0.97). The maximum deviation for CBZ was 0.26 microM.

Inflammatory pseudotumor of the anterior orbit. A symptom in allergic granulomatous angiitis (Churg-Strauss syndrome)

Allergic granulomatosis accompanied by angiitis (Churg-Strauss syndrome) constitutes an unusual disorder which is characterized clinically by bronchial asthma and hypereosinophilia, accompanied by systemic symptoms of histopathologically and by necrotizing vasculitis, extravascular granulomas and tissue infiltration by eosinophils. We report a case of a 4 year-old child presenting with acute pneumonia and deteriorated general condition. The biopsy of an inflammatory pseudotumor of the right anterior orbit revealed necrotizing vasculitis, extravascular epitheloid granuloma and eosinophilic tissue infiltration. These are characteristic changes of allergic granulomatous vasculitis (Churg-Strauss syndrome. Laboratory findings were characterized by blood eosinophilia, increased IgE value and the presence of antineutrophil cytoplasmic ant antibodies (p-ANCA). Local and systemic manifestations quickly regressed after parenteral application of corticosteroids. Two exacerbations of inflammatory pseudotumor occurred after reduction of the corticosteroid dosage. Systemic vasculitic syndromes are rare in childhood. Orbital manifestations in Churg-Strauss syndrome in childhood have never been reported.

Tunica vaginalis blanket wrap to prevent urethrocutaneous fistula: an 8-year experience

An 8-year review of hypospadias repair in patients with a meatus proximal to the coronal margin is reported. Fistula rates were compared among 4 groups: 1) loupe magnification, 2) tunica vaginalis blanket wrap tissue interposition with loupe magnification, 3) operating microscope magnification and 4) tunica vaginalis blanket wrap tissue interposition in conjunction with operating microscope magnification. Rate of fistula formation with loupe magnification alone was 20%, microscope magnification alone was 12% and tunica vaginalis blanket wrap interposition with loupes was 9%. When tunica vaginalis blanket wrap tissue interposition was used in conjunction with intraoperative microscopy no fistulas resulted.

Preparation and use of polyphosphate-modified zirconia for purification of nucleic acids and proteins

Polyphosphates of chain lengths between 3 and 100 were coupled to porous zirconia particles and used for affinity chromatography of nucleic acids and proteins. It is demonstrated that single-stranded RNA and DNA are strongly retained on the polyphosphate-modified zirconia support, while double-stranded DNA is only weakly bound if at all. Protein separation on this packing can be performed by applying both high-performance liquid chromatography and batch procedures. The results show that polyphosphate-modified zirconia is a useful affinity packing for immobilization and purification of biomacromolecules.

Functional morphology of the nictitating membrane in the domestic cat

Morphological differences between the corneal and palpebral surfaces of the nictitating membrane of the domestic cat were examined using histology, histochemistry and the scanning electron microscope. Both surfaces are covered by one or two layers of epithelial cells. The epithelium contains numerous goblet cells, particularly on the palpebral side. These cells revealed binding sites for six lectins as well as positive PAS reactivity, and alcianophilia at both pH 2.5 and pH 3.5. Numerous lymph follicles located on the corneal side make the epithelium look like lymphoepithelial tissue. Accumulations of lymphatic tissue may also be found on the palpebral side. Scanning electron micrographs showed microvilli on the epithelial surfaces. The function of the cat nictitating membrane is discussed on the basis of our findings and those of other authors. Movements of the nictitating membrane alternate between active and passive phases of gliding. The membrane as a whole effectively protects the nasal portion of the bulb from dust, dehydration and pathogens.

Working women: economic and social considerations

The social, political, and economic forces that have drawn women into the labor force are complex and interrelated. This chapter presents four major concerns of working women: gender wage differentials, working hours and flexible schedules, nonwage compensation, and working conditions. Women are a relatively recent phenomenon in the work-for-wages market, and their specific economic concerns are not well understood by society. As their numbers increase in the workplace, these concerns will assume greater importance.