Abstract P3-03-35: Prevalence and risk factors associated with development of lymphedema after axillary lymph node dissection among breast cancer patients: Single center retrospective study

Background: Lymphedema in breast cancer is one of the most important complications, and causes symptoms of arm swelling, heaviness and limited movement. Once lymphedema has occurred, it is difficult to cure. Nowadays, treatment with axillary lymph node dissection (ALND) has been decreasing among breast cancer patients as a result of the ACOSOG Z0011, AMAROS and IBCSG 23-01 trials. However, some cases require ALND for ALN metastasis. ALND increases the risk of lymphedema and detracts from quality of life, but the surgical procedure based on anatomical landmarks has not been changed for several decades. The upper borderline for ALND might cause injury to lymph ducts from arms, and incidence and risk factors for lymphedema after ALND are still unclear. Our aim was to identify prevalence and risk factors associated with development of lymphedema after ALND among breast cancer patients.

Methods: This retrospective study was based on data collected from 178 breast cancer patients who underwent ALND in Nagasaki University Hospital, Japan, between 2005 and 2017. Lymphedema was defined as symptomatic arm swelling with >2 cm difference in circumference of the arm compared with that of the contralateral arm. We classified the patients with and without lymphedema, and compared them regarding surgical and pathological findings. Univariate and multivariate analyses were performed to evaluate the risk factors, using the χ2 test, Student's t-test and Cox logistic regression analysis.

Results: Prevalence of lymphedema was 16% (28/178 patients) and mean time interval from surgery to development of lymphedema was 463 days. In univariate analysis, there was a significant difference in postmastectomy radiation therapy (PMRT) (p = 0.02) and the number of patients with >18 dissected ALNs (p = 0.02). Body mass index (p = 0.6), administration of docetaxel (p = 0.2), and smoking (p = 0.07) did not significantly increase lymphedema. In multivariate analysis, PMRT (p = 0.01) and dissection of >18 ALNs (p = 0.001) significantly increased the risk of lymphedema, whereas smoking did not (p = 0.4).

Conclusion: Our study suggested that PMRT and number of dissected ALNs were risk factors for lymphedema. Aggressive and empiric ALND might be associated with axillary lymph duct damage. Therefore, we plan to introduce axillary reverse mapping using indocyanine green to reduce the risk of lymphedema in breast cancer patients who undergo ALND.

Citation Format: Hara Y, Otsubo R, Inamasu E, Matsumoto M, Yano H, Sakimura C, Kuba S, Yamanouchi K, Eguchi S, Nagayasu T. Prevalence and risk factors associated with development of lymphedema after axillary lymph node dissection among breast cancer patients: Single center retrospective study [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 P3-03-35.

Extraction Mechanism of Ferric and Manganese Ions with Aqueous Two-phase System Formed by Ionic Liquid and Polyethylene Glycol

In this work, we employed an aqueous two-phase system formed by an ionic liquid and polyethylene glycol for the separation of Fe(III), which is the most commonly used metal in the world, and Mn(II), which is currently used in many industries. We found that the extraction mechanisms of Fe(III) and Mn(II) were strongly influenced by the concentration of the hydrochloric acid that dissolved the metal salt. The ion pair reaction was the predominant mechanism that generated the Fe(III) and Mn(II) extractions. At a lower concentration of hydrochloric acid, metal ions were extracted because of the reaction between a metal cation and a dodecylsulfonate anion. At a higher concentration of hydrochloric acid, the reaction between a metal chlorocomplex anion and a hexylmethylimidazolium cation also proceeded. The aqueous two-phase system, composed of ionic liquid and polyethylene glycol, is promising for metal separation based on the difference in the affinity of metal with alkyl-sulfonate in a low HCl concentration and in the stability constant of metal chlorocomplex in a high HCl concentration. The maximum extractability of Fe(III) and Mn(III) was 57.8 and 75.3 %, respectively, with 0.3 mol dm–3 hydrochloric acid concentration.

Thermoelectric properties of dispersant-free semiconducting single-walled carbon nanotubes sorted by a flavin extraction method

Flavin extraction method realized an improved power factor by easy removal of the dispersant from semiconducting SWNT sheet.

Incidence of Neonatal Hyperthyroidism Among Newborns of Graves' Disease Patients Treated with Radioiodine Therapy

BACKGROUND

The serum thyrotropin receptor antibody (TRAb) titers of Graves' disease (GD) patients are known to increase after radioiodine (RAI) therapy, and they can remain high for years. The incidence of neonatal hyperthyroidism (NH) among newborns of mothers with GD who conceived after RAI therapy has not been previously reported. The aims of this study were to investigate the incidence of NH among newborns of mothers who conceived within two years after RAI therapy, and to identify predictors of NH.

METHODS

GD patients (n = 145) who conceived within two years after RAI therapy were retrospectively reviewed, and information regarding their newborns was collected.

RESULTS

Of the 145 pregnant women, 54 (37%) were treated with antithyroid drugs or potassium iodide for maternal hyperthyroidism during the first trimester. There were eight newborns with NH, resulting in an incidence of 5.5%. Seven of the eight mothers whose newborns had NH were treated with antithyroid drugs or potassium iodide during their pregnancy. The incidence of NH among the newborns of mothers who conceived within 6-12 months after RAI therapy was 8.8%, within 12-18 months was 5.5%, and within 18-24 months was 3.6%. Multivariate analysis revealed that the TRAb values in the third trimester were the only risk factor for NH. The cutoff TRAb value in the third trimester for predicting NH was 9.7 IU/L (reference value <2.0 IU/L).

CONCLUSIONS

The incidence of NH among newborns of mothers who conceived within two years after RAI therapy was 5.5%. The fetuses of pregnant GD patients whose TRAb value is high in the third trimester should be carefully followed by an obstetrician during pregnancy, and the newborns should be carefully followed by a pediatrician after birth.

Thromboxane Generation in Patients with Essential Hypertension or Cerebrovascular Disease and Effect of Oral Aspirin

The ability of platelets to synthesize thromboxane B2 (TxB2) from arachidonic acid (AA) or prostaglandin H2 (PGH2) was studied in 26 control subjects, 40 patients with essential hypertension, 20 patients with cerebrovascular disease (CVD) not taking aspirin and 11 patients with CVD taking aspirin. The activity of platelets to form TxB2 from AA or PGH2 was measured using 1 — 14C arachidonic acid or 1—14C PGH2 as a substrate. There was no significant difference in TxB2 generation from AA or PGH2 among the platelets collected from the control subjects, hypertensive patients and CVD patients not taking aspirin.

In CVD patients taking aspirin, marked suppression was observed in TxB2 synthesis from AA, but no suppression in TxB2 synthesis from PGH2. At least 750 mg aspirin per day were required for nearly complete suppression of TxB2 generation from AA.

Prognostic value of sequencing-based minimal residual disease detection in patients with multiple myeloma who underwent autologous stem-cell transplantation

Background

Most patients with multiple myeloma (MM) are considered to be incurable, and relapse owing to minimal residual disease (MRD) is the main cause of death among these patients. Therefore, new technologies to assess deeper response are required.

Patients and methods

We retrospectively analyzed 125 patients with MM who underwent high-dose melphalan plus autologous stem-cell transplantation (ASCT) to detect MRD in autograft/bone marrow (BM) cells using a next-generation sequencing (NGS)-based method and allele-specific oligonucleotide-polymerase chain reaction (ASO-PCR).

Results

NGS-based method was applicable to 90% and this method had at least one to two logs greater sensitivity compared to ASO-PCR. MRD negative by NGS [MRD^NGS(−)] (defined as <10⁻⁶) in post-ASCT BM cases (n = 26) showed a significantly better progression-free survival (PFS) (96% at 4 years, P < 0.001) and overall survival (OS) (100% at 4 years, P =0.04) than MRD^NGS(+) in post-ASCT BM cases (n = 25). When restricting the analysis to the 39 complete response cases, patients who were MRD^NGS(−) (n = 24) showed a significantly better PFS than those that were MRD^NGS(+) (n = 15) (P =0.02). Moreover, MRD^NGS(−) in post-ASCT BM cases (n = 12) showed significantly a better PFS than MRD^NGS(+) cases (n = 7) where MRD was not detected by ASO-PCR (P = 0.001). Patients whose autografts were negative by NGS-based MRD assessment (<10⁻⁷) (n = 19) had 92% PFS and 100% OS at 4 years post-ASCT. Conversely, the NGS-based MRD positive patients who received post-ASCT treatment using novel agents (n = 49) had a significantly better PFS (P = 0.001) and tended to have a better OS (P= 0.214) than those that were untreated (n = 33).

Conclusions

Low level MRD detected by NGS-based platform but not ASO-PCR has significant prognostic value when assessing either the autograft product or BM cells post-ASCT.

Clinical course of thyroid function and thyroid associated-ophthalmopathy in patients with euthyroid Graves' disease

Background

Euthyroid Graves’ disease (EGD) is a rare condition defined as the presence of thyroid-associated ophthalmopathy (TAO) in patients with normal thyroid function. Due to the rarity of this disease, only a limited number of studies and case reports are available for further evaluation of the characteristics of the disease. The aim of this study was to examine the changes in the thyroid function, thyrotropin receptor antibodies (TRAb) and eye symptoms, and then determine whether TRAb is related to TAO in EGD patients. TRAb in this study was defined as including both thyrotropin-binding inhibitory immunoglobulin (TBII) and thyroid-stimulating immunoglobulin (TSAb).

Patients and methods

Medical records of patients diagnosed with EGD were reviewed. Ophthalmologists specializing in TAO examined the eyes of all subjects.

Results

Of the 58 patients diagnosed with EGD, 24.1% developed hyperthyroidism, while 3.4% developed hypothyroidism. A total of 72.4% of the 58 patients remained euthyroid throughout the entire follow-up period. At the initial presentation, TBII and TSAb were positive in 74.5% and 70.5%, respectively. Ophthalmic treatments were administered to 30 (51.7%) out of the 58 patients. A significant spontaneous improvement of the eye symptoms was found in 28 of the EGD patients who did not require eye treatments. EGD patients exhibited positive rates for both TBII and TSAb, with the number of the TRAb-positive patients gradually decreasing while the eye symptoms spontaneously improved over time. There were no correlations found between TRAb at initial presentation and the eye symptoms.

Conclusion

TBII and TSAb were positive in about 70% of EGD patients at their initial visit. Thyroid functions of EGD patients who have been euthyroid for more than 6.7 years may continue to remain euthyroid in the future.

Does Shortened Application Time Affect Long-Term Bond Strength of Universal Adhesives to Dentin?

OBJECTIVE

This study evaluated the effect of shortened application time on long-term bond strength with universal adhesives.

METHODS AND MATERIALS

Three universal adhesives were used: Clearfil Universal Bond (CU, Kuraray Noritake Dental Inc, Tokyo, Japan), Scotchbond Universal Adhesive (SB, 3M ESPE, St Paul, MN, USA) or G-Premio Bond (GP, GC Corp, Tokyo, Japan). Sixty molars were cut to expose midcoronal dentin and prepared with a regular diamond bur. Each adhesive was applied either according to the manufacturer's instruction or with shortened time. Specimens were stored in distilled water at 37°C for 24 hours and then cut into resin-dentin sticks. Microtensile bond strength (μTBS) was tested after either 24 hours or 1 year of water storage. Data were analyzed by the three-way ANOVA and Duncan tests ( α=0.05). Fracture modes were analyzed under a scanning electron microscope (SEM). One dentin stick per group was selected after fracture mode analysis and further observed using transmission electron microscopy (TEM). Six additional dentin discs were prepared and conditioned with each adhesive under the different application time to observe the adhesive-smear layer interaction by SEM.

RESULTS

Shortened application time affected the μTBS ( p<0.001) while storage time did not affect bond strength ( p=0.187). A significant effect of shortened application time on μTBS was observed in the CU at 1 year and in the GP at both storage times.

CONCLUSIONS

One-year storage time had no effect on the μTBS of universal adhesives to bur-cut dentin. The performance of universal adhesives can be compromised when applied using a shortened application time.

Seasonal Changes in Serum Thyrotropin Concentrations Observed from Big Data Obtained During Six Consecutive Years from 2010 to 2015 at a Single Hospital in Japan

BACKGROUND

This study analyzed big data for serum thyrotropin (TSH), free triiodothyronine (fT3), and free thyroxine (fT4) concentrations in patients who had attended the outpatient clinic of Ito Hospital (Tokyo, Japan) during a recent six-year period (between January 1, 2010, and December 31, 2015) in order to investigate for seasonal changes.

METHODS

The serum TSH concentrations were reviewed for all 135,417 patients aged >20 years. Patients with any thyroid diseases were included, irrespective of whether they were receiving drug therapy. In total 1,637,721 serum samples were analyzed for TSH, 1,626,269 for fT3, and 1,669,381 for fT4.

RESULTS

It was observed that the TSH concentrations showed annual changes during the six-year period. They decreased during the summer, while they increased during the winter. The TSH concentrations were negatively correlated with the daily temperatures (Spearman rank correlation coefficient -0.4486; p < 0.0001). The same applied for the correlation between fT3 concentrations and daily temperatures.

CONCLUSIONS

The fact that the TSH concentrations show annual changes in areas where the temperature ranges during the year are rather wide should be borne in mind for interpretation of results.

ADAMTS13 activity and genetic mutations in Japan

Thrombotic thrombocytopenic purpura (TTP), a life threatening disease, can be induced by congenital or acquired deficiency of plasma metalloprotease ADAMTS13. Since the publication of the first genetic analysis in patients with congenital ADAMTS13 deficiency in 2001, more than 100 genetic defects in the ADAMTS13 gene have been reported worldwide. Genetic analysis in patients with ADAMTS13 deficiency has greatly contributed to the understanding of the etiology of TTP. A rapid and quantitative assay method for the plasma ADAMTS13 activity was developed recently in 2005 and opened a new area of TTP research – namely genetic research using a general population to evaluate age and gender differences of ADAMTS13 activity as well as phenotype – genotype correlations of genetic polymorphisms and estimation of a homozygote or a compound heterozygote ADAMTS13 deficiencies. The Japanese general population study included 3616 individuals with an age between 30 – 80 years confirming other studies that while ADAMTS13 activity decreased with age, VWF antigen increased and VWF antigen levels are lowest in blood group O indviduals, whereas ADAMTS13 activity levels were not associated with the AB0 blood group. 25 polymorphisms with a minor allele frequency of more than 0.01 were found, among them 6 missense mutations and 19 synonymous mutations, except P475S missense polymorphisms that was only idenitified in an East Asian population, characterized by reduced ADAMTS13 activity. Prevalence of congenital ADAMTS13 deficiency in the Japanese population was estimated about one individual in 1.1 × 106 to be homozygote or compound heterozygote for ADAMTS13 deficiency. So far more than 40 mutations in Japanese congenital TTP patients were found, but R193W, Q449*, C754Afs*24 (c.2259delA) and C908Y were identified in more than four patients suggesting the precipitaion of these mutations in the Japanese population.

Long-Term Outcomes of 107 Cases of Primary Thyroid Mucosa-Associated Lymphoid Tissue Lymphoma at a Single Medical Institution in Japan

CONTEXT

Thyroid mucosa-associated lymphoid tissue (MALT) lymphoma is a type of extranodal lymphoma with a favorable prognosis.

OBJECTIVE

To provide information on long-term outcomes that would facilitate establishment of the optimal management strategy for thyroid lymphoma.

DESIGN, SETTING, AND PARTICIPANTS

Medical records of 107 patients (median age 67 years, 20 males, 87 females) who were diagnosed with localized thyroid MALT lymphoma stage IE or IIE at Ito Hospital were retrospectively reviewed.

MAIN OUTCOME MEASURE

Overall and event-free survival (EFS).

RESULTS

Initial treatments included radiation therapy (RT) alone (n = 58), combined modality therapy (CMT) (n = 48), or chemotherapy alone (n = 1). All 107 patients responded to the treatment, six of whom experienced relapse. Only one patient died of lymphoma. The 5-year overall survival (OS) and EFS rates were 94% [95% confidence interval (CI), 87% to 97%] and 92% (95% CI, 85% to 95%), respectively, and the 10-year OS and EFS rates were 91% (95% CI, 83% to 95%) and 84% (95% CI, 74% to 90%), respectively. Of the 106 patients with information available on adverse events, 71 patients (67%) developed hypothyroidism after primary thyroid lymphoma treatment. The CMT group showed additional chemotherapy-induced adverse reactions in the form of neutropenia, neuropathy, constipation, and pneumonia. The 5-year OS rates of patients treated with CMT and RT were 93% (95% CI, 81% to 98%) and 94% (95% CI, 84% to 98%), respectively.

CONCLUSIONS

Long-term outcomes of localized thyroid MALT lymphoma are favorable with all initial treatment modalities.

Changes in dermal structure and skin oxidative stress in overweight and obese Japanese males after weight loss: a longitudinal observation study

BACKGROUND/PURPOSE

Previous studies have reported decreased dermal echogenicity and increased skin oxidative stress in overweight males. However, it is unknown whether these skin parameters of overweight and obese people are similar to those of individuals exhibiting a normal body weight following weight loss. The purpose of this study was to (1) compare the changes in the dermal structure parameters and levels of skin oxidative stress before and after weight loss in overweight and obese people in Japan and (2) to clarify how these aspects changed when body weight would be reduced to normal body weight.

METHODS

Male volunteers with a body mass index of ≥25 kg/m² were recruited. The dermal structure was visualized and dermal echogenicity and thickness were measured using ultrasound scanners. The mRNA expression level of heme oxygenase-1 in the hair follicles was quantitatively analyzed as a marker of skin oxidative stress.

RESULTS

When overweight individuals in their 20s to 30s reduced their weight to normal, decreased dermal thickness in the abdominal region was observed in 50% of the subjects; however, no increase in dermal echogenicity was observed. A decrease in dermal thickness and an increase in dermal echogenicity in the thighs was observed in 83.3% of the subjects. No decrease in the level of dermal oxidative stress was observed.

CONCLUSION

The dermal structure in the thighs of overweight young individuals can be improved to the level of the structure in those of normal body weight individuals following weight loss.

Sialic Acid-Binding Immunoglobulin-Like Lectin1 as a Novel Predictive Biomarker for Relapse in Graves' Disease: A Multicenter Study

BACKGROUND

There are currently no reliable biomarkers to predict relapse in Graves' disease (GD). In the present study, we investigated novel diagnostic biomarkers to predict the long-term remission of or relapse in GD.

METHODS

A DNA microarray analysis was performed to examine gene expression in the peripheral leukocytes of a frequently relapsing patient with GD and a patient in long-term remission after the discontinuation of antithyroid drugs (ATDs). Based on the DNA microarray analysis, we focused on Sialic acid-binding immunoglobulin-like lectin1 (SIGLEC1) as a candidate novel biomarker to predict GD relapse. Three hundred and fifty-eight patients with GD in the thyroid clinics of four different hospitals in Japan were included in a cross-sectional study to establish whether SIGLEC1 mRNA levels distinguish GD relapse experience from long-term remission. An additional 55 patients with GD were enrolled in a prospective study to clarify whether SIGLEC1 mRNA levels at ATD discontinuation predict GD relapse.

RESULTS

SIGLEC1 mRNA levels were significantly higher in patients with GD relapse experience than in those in long-term remission. Based on the receiver operating characteristic analysis, we found that high SIGLEC1 mRNA levels (≥258.9 copies) significantly distinguished GD relapse experience from long-term remission (p < 0.0001; sensitivity 66.7%, specificity 70.1%). In the prospective study, when the optimal cutoff value from the receiver operating characteristic curve analysis was applied to SIGLEC1 mRNA positivity at ATD discontinuation, SIGLEC1-positive patients (≥258.9 copies) showed a significantly higher cumulative risk of relapse than SIGLEC1-negative patients (<258.9 copies) (p = 0.022, the log-rank test).

CONCLUSIONS

SIGLEC1 mRNA levels have potential as a novel predictive biomarker for GD relapse.

Response to Lefebvre et al

Congenital scoliosis (CS) is a common vertebral malformation with incidence of up to 1 of 1000 births worldwide. Recently, TBX6 has been reported as the first disease gene for CS: about 10% of CS patients are compound heterozygotes of rare null mutations and a common haplotype composed by 3 SNPs in TBX6. Lefebvre et al in this journal reported that 2 patients with spondylocostal dysostosis (SCD), a rare skeletal dysplasia affecting spine and ribs also have TBX6 mutations: 1 carried the microdeletion and a rare missense variant, and another 2 rare missense variants. We investigated the pathogenicity of the 3 missense variants in SCD by a luciferase assay. The results were negative for the proposal of Lefebvre et al. We consider these 2 SCD patients are more probably compound heterozygotes of null mutations and a common risk haplotype just as CS patients with TBX6 mutations.