Erythrocyte sedimentation rate and anaemia are independent predictors of survival in patients with clear cell renal cell carcinoma

Background:

The 1997 international consensus conference on renal cell cancer (RCC) prognosis suggested erythrocyte sedimentation rate (ESR), alkaline phosphatase (ALP), and anaemia as prognostic biomarkers, but most studies reviewed were limited by small sample sizes.

Methods:

The Cox proportional hazards model was used to evaluate whether ESR, ALP, haemoglobin (Hb), and haematocrit (Hct) could predict survival outcomes in 1307 patients with clear cell RCC (ccRCC) who underwent nephrectomy during 1994–2008.

Results:

During a median follow-up of 43 months, we found that the patients with preoperative high levels of ESR, had a 2.10-fold (95% confidence interval (CI): 1.21–3.67) greater risk of dying from RCC compared with patients with low levels (normal range). Patients with preoperative anaemia, assessed by Hb and Hct, had a 3.11-fold (95% CI: 1.17–8.25) and 6.20-fold (95% CI: 2.30–16.72) greater risk of dying from other illnesses, respectively, compared with patients without anaemia. ALP levels were not associated with ccRCC patients' survival. These associations for ESR and anaemia were more pronounced in patients with body mass index (BMI) <25 compared with patients with BMI ⩾25 kg m⁻².

Conclusion:

Preoperative high ESR, but not ALP, was a significant predictor for cancer-specific survival among ccRCC patients. Anaemia increases the risk of death from other illness.

P5-13-19: Borderline Estrogen and Progesterone Receptor Expression and Efficacy of Anti-Estrogen Therapy Analyzed by Subpopulation Treatment Effect Pattern Plot Analysis

Background: The American Society of Clinical Oncology (ASCO) and the College of American Pathologists (CAP) recently recommended that estrogen receptor (ER) and progesterone receptor (PR) values be considered positive in the evaluation of breast cancer specimens if there are at least 1% positive tumor nuclei by immunohistochemisty (IHC) scoring. This change constitutes a lower cutoff value than the 5% or 10% widely used in the past and increases the number of patients that can now be treated with anti-estrogen therapy, a therapy which carries significant treatment efficacy and a favorable toxicity profile. Despite the new recommendation however, it remains unclear if patients whose tumors display borderline ER and/or PR expression truly benefit from anti-estrogen therapy.

Methods: We examined a total of 608 patient samples from the OHSU Knight Cancer Institute Breast Cancer Tissue Repository for which we have quantitative ER and PR information and their clinical outcome. Of those, 282 patients did not receive any systemic treatment and 165 received anti-estrogen therapy (the majority tamoxifen). Cytosolic steroid hormone receptors were quantitated by conventional steroid binding assay and Scatchard plot analysis or by enzyme-linked immunoassay system. For immunoassays, human estrogen receptor (ER) and progesterone receptor (PR) kits were obtained from Abbott Laboratories and assays were conducted according to manufacturer's specification. We performed subpopulation treatment effect pattern plot (STEPP) analysis to explore the presence of interaction between treatment effects and quantitative ER and PR levels. Clinical outcome used in this study includes 5-year overall survival and 5-year breast cancer free interval.

Results: Multi-variate analysis finds neither ER nor PR expression adjusted by treatment status is associated with either overall survival (P= 0.20, median follow up of 63 months) or breast cancer free interval (P= 0.82, median follow up of 60 months). For both ER and PR, there is no interaction between treatment outcome (5 year survival probability) and levels of hormone receptor expression based on Kaplan-Meier estimate (P=0.36 and P= 0.65, respectively). Patients with borderline ER expression appear to benefit from anti-estrogen therapy while patients with borderline PR expression appear to have worse outcome with anti-estrogen therapy.

Conclusions: Though descriptive in nature, our STEPP analysis provides support for the recommendation by ASCO and CAP to lower the cutoff for ER positivity in breast cancer specimens. There is overall no interaction between the level of hormone receptor and treatment benefit for all patients from low ER to high ER. Therefore, treatment will benefit all patients including those with low ER levels. Extending hormone therapies to the group of patients whose tumors express borderline PR values, however does not seem to confer therapeutic benefit. More study is needed to determine the benefits of offering anti-estrogen therapy to patients whose tumors express low PR.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-13-19.

Cryptococcus gattii in the United States: clinical aspects of infection with an emerging pathogen

BACKGROUND

Cryptococcus gattii (Cg) has caused increasing infections in the US Pacific Northwest (PNW) since 2004. We describe this outbreak and compare clinical aspects of infection in the United States among patients infected with different Cg genotypes.

METHODS

Beginning in 2005, PNW state health departments conducted retrospective and prospective passive surveillance for Cg infections, including patient interviews and chart reviews; clinical isolates were genotyped at the US Centers for Disease Control and Prevention (CDC). We examined symptom frequency and underlying conditions in US patients with Cg infection and modeled factors associated with death.

RESULTS

From 1 December 2004 to July 2011, 96 Cg infections were reported to the CDC. Eighty-three were in patients in or travelers to the PNW, 78 of which were genotypes VGIIa, VGIIb, or VGIIc (outbreak strains). Eighteen patients in and outside the PNW had other molecular type Cg infections (nonoutbreak strains). Patients with outbreak strain infections were more likely than those with nonoutbreak-strain infections to have preexisting conditions (86% vs 31%, respectively; P < .0001) and respiratory symptoms (75% vs 36%, respectively; P = .03) and less likely to have central nervous system (CNS) symptoms (37% vs 90%, respectively; P = .008). Preexisting conditions were associated with increased pneumonia risk and decreased risk of meningitis and CNS symptoms. Nineteen (33%) of 57 patients died. Past-year oral steroid use increased odds of death in multivariate analysis (P = .05).

CONCLUSIONS

Clinical differences may exist between outbreak-strain (VGIIa, VGIIb, and VGIIc) and nonoutbreak-strain Cg infections in the United States. Clinicians should have a low threshold for testing for Cg, particularly among patients with recent travel to the PNW.

Pregabalin reduces post-operative pain after mastectomy: a double-blind, randomized, placebo-controlled study

BACKGROUND

Pregabalin is used for the treatment of neuropathic pain and has shown analgesic efficacy in post-operative pain. The aim of this randomized, double-blinded, placebo-controlled trial (Clinical Trials.gov ID NCT00938548) was to investigate the efficacy and safety of pregabalin for reducing post-operative pain in patients after mastectomy.

METHODS

Eighty-four women scheduled for elective mastectomy were randomly assigned to groups that received either pregabalin (75 mg) or placebo, 1 h before surgery and 12 h after the initial dose. Assessments of pain [verbal numerical rating scale (VNRS), at rest and with arm abduction] and side effects were performed at 1, 6, 24 and 48 h post-operatively. After discharge from the hospital, pain was assessed by telephone interview at post-operative 1 week and 1 month.

RESULTS

VNRS scores for pain at rest were lower in the pregabalin group (n=42) than the placebo group (n=42) at 1, 24 and 48 h post-operatively (P<0.05). VNRS scores for pain with arm abduction were lower in the pregabalin group (n=42) than the placebo group (n=42) at 1 and 24 h, and 1 week post-operatively (P<0.05). Incidences of side effects such as nausea and vomiting, headache, dizziness and blurred vision were similar in both groups.

CONCLUSION

Perioperative administration of pregabalin for a single day (75 mg twice daily) was easy, safe and effective in reducing post-operative pain in patients undergoing mastectomy.

The Effect of Self-Implantation on the Interdiffusion in Amorphous Si/Ge Multilayers

Artificial amorphous Si/Ge multilayers of equiatomic average composition with a repeat length around 60 Å have been prepared by ion beam sputtering. Implantation with 29Si led to a decrease in the intensity of the X-ray diffraction peaks arising from the composition modulation, which could be used for an accurate measurement of the implantation-induced mixing distance. Subsequent annealing showed no difference between the interdiffusivity in an implanted and unimplanted sample.

Orientational and Microstructural Evolution During Epitaxial Growth of Cu on Si(001) by Sputter Deposition

Epitaxial Cu thin films have been grown on H-terminated Si(OOl) substrates at room temperature by D.C. ion-beam sputter deposition in ultrahigh vacuum. The development of orientation and microstructure during epitaxial growth from the initial stages of Cu growth up to Cu thicknesses of few hundred nm has been investigated. Analysis by in-situ reflection high energy electron diffraction, thin film x-ray diffraction, and plan-view and cross-sectional transmission electron microscopy indicates that the films are well textured with Cu(001)∥ Si(001) and Cu[100]∥ Si[110]. Interestingly, it is found that a distribution of orientations occurs at the early stages of Cu epitaxy on Si(001) surface, and that a (001) texture emerges gradually with increasing Cu thickness. The effect of silicide formation and deposition conditions on the crystalline quality of Cu epitaxy is also discussed.

The Effect of Ion Implantation on the Interdiffusion in Si/Ge Amorphous Artificial Multilayers

Amorphous Si/Ge artificial multilayers have been implanted with Si and B at liquid nitrogen temperature, and partially ion mixed with Ar at different temperatures. In all cases, the square of the mixing length was found to be proportional to the dose. Annealing of Si-implanted samples showed that after relaxation the diffusivity appeared unaffected by the implantation process. Annealing of the B-implanted samples showed an enhancement of the diffusivity at the higher dose. The diffusive component of the square of the mixing length in the Ar-ion mixed samples has an Arrhenius-type temperature dependence, with an activation enthalpy of 0.22 eV.

Composition- and Temperature-Dependence of Ion Mixing in Amorphous Si/Ge Artificial Multilayers

Amorphous Si/Ge artificial multilayers with a repeat length of around 60A have been partially mixed with 1.5 MeV Ar+ ions at temperatures in the range 77–673K. The change in the intensity of the first X-ray diffraction peak resulting from the composition modulation is used to determine the mixing lengths. The diffusive component of the square of the mixing length, at a given dose, is independent of the dose rate and has an Arrhenius-type temperature dependence, with activation enthalpies between 0.19 and 0.22 eV, depending on the average composition.

Treatment outcome and safety of docetaxel as the third-line chemotherapy in advanced gastric cancer after progression or after failure of FOLFOX and FOLFIRI-based sequential chemotherapy

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Background: We performed multicenter retrospective study to evaluate the activity and the safety of a docetaxel as the third-line chemotherapy in advanced gastric cancer (AGC) patients who had undergone oxaliplatin (FOLFOX) and irinotecan (FOLFIRI)-based chemotherapy regimens.

Methods: Thirty-eight patients with AGC previously treated were eligible for this study. Patients received docetaxel 30 mg/m2 +/- cisplatin 30 mg/m2 IV on day 1, 8 or docetaxel 60 mg/m2 +/- cisplatin 60 mg/m2 IV on day 1 every 3 weeks until disease progression, and responses were assessed after every two cycles according to RECIST criteria and toxicity was evaluated by NCI-CTC.

Results: Thirty-two out of 38 patients were evaluable for response. A total of 95.1 cycles of chemotherapy (median 2, range 0.5–7) were administered. Relative dose intensities of docetaxel and cisplatin were 93.4% and 87.8%, respectively. The overall response rate was 15.6% and the disease control rate was 50%. With a median follow-up duration of 3.1 months (range 0.3-14.3 months), 36 patients had disease progression, and 34 patients had died at the time of analysis. The median progression-free survival was 1.8 months (95% CI, 1.3–2.3 months). The median overall survival was 3.1 months (95% CI, 2.3–3.9 months). Grade 3 or 4 hematologic toxicities included neutropenia in thirteen patients (38.3%), febrile neutropenia in four patients (11.7%). and thrombocytopenia in one patient (2.9%). Other grade 3 or 4 toxicities included neuropathy in three patients (8.8%) and mucositis in two patients (5.9%). There were three treatment-related deaths (8.8%) caused by infection associated with neutropenia.

Conclusions: Salvage docetaxel chemotherapy in AGC patients failed in oxaliplatin and irinotecan-based treatment is not recommend routinely. However, selected patients with good performance status and sufficient albumin levels may have derived some survival benefits from salvage chemotherapy.

No significant financial relationships to disclose.

Effects of epsilon4 on object recognition in the non-demented elderly

Previously we reported that apolipoprotein E (ApoE) epsilon4 negatively affects performance in the novel-image-novel-location (NINL) object recognition test in healthy non-demented elderly human study participants. In this study, the participants were invited to return for testing sessions 6 and 18 months after the baseline session. Using a longitudinal study design, effects of epsilon4 on NINL test performance were assessed in study "dropouts", participants that did not return for the second and/or third session(s), and "finishers", participants that returned for all sessions. There were effects of epsilon4 on dropout rates and NINL total scores as well as sub-scores in both dropouts and finishers. NINL total score was a predictor of epsilon4 participant dropout. Compared to non-epsilon4 dropouts, epsilon4 dropouts had lower NINL scores. In contrast, epsilon4 finishers had higher NINL scores than non-epsilon4 finishers. Thus, the NINL test could be a valuable tool in detecting pre-clinical signs of age-related cognitive impairments, particularly those associated with epsilon4 risk.

Expression of Androgen Receptor in Breast Cancer

Background: Androgen receptor (AR) is one of biomarkers and its role in breast cancer is still unclear. The aim of this study was to investigate the relationship between AR expression and clinicopathological factors in breast cancer patients.Patients and Methods: AR was consecutively evaluated in 413 primary breast cancers from whole sections of surgically resected specimens using immunohistochemical staining from January 2008 to March 2009. The associations between AR expression and clinicopathological parameters were analyzed. Tumors with 10% or more nuclear stained cells were considered as positive for AR expression. The differences between variables were calculated by chi-square test and Fisher's exact test was used when appropriate.Results: The median age at diagnosis was 49 years (range, 26-84). AR was found in 72.7% (48/66) of in-situ carcinoma and in 72.9% (253/347) of invasive carcinoma. Overall expression rates of AR were 72.9%, which were higher than those of ER and PR expression, 68.5% and 62.0%, respectively. AR was significantly expressed in patients with no elevated preoperative serum cancer antigen 15-3 (CA 15-3) levels (p = .042), smaller tumor size (p = .035), lower histologic grade (p &lt; .001), ER-positive (p &lt; .001), progesterone receptor-positive (p &lt; .001), and non-triple-negative breast cancer (p &lt; .001). Metaplastic, medullary, and mucinous types carcinomas showed less AR expression (p = .030). Although it was statistically not significant, patients with younger age (≤ 35 years), axillary lymph node involvements, and higher stage showed higher rates of AR negativity. In ER-negative tumors, AR expression was significantly correlated with HER-2 over-expression (p &lt; .001). In ER-positive tumors, however, there was no relationship between AR expression and HER-2 over-expression (p &gt; .05).Conclusions: AR is expressed in a significant number of breast cancers and is associated with favorable tumor differentiation and smaller tumor size. These results might suggest that AR may be an independent prognostic factor in breast cancer. AR may also be associated with growth factor signaling and be useful therapeutic target in ER-negative tumors.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4156.

Clinical and Prognostic Features of Infiltrating Lobular Carcinoma of the Breast in a Korean Series

Introduction: Infiltrating lobular carcinoma (ILC) is the second most common histological type of invasive breast cancer (IBC) and accounts for 10% of all IBCs. ILC differs from IDC in many respects including age of patients, tumor size and increased frequency of multifocality and bilaterality. But, the outcome of ILC remains unclear. Therefore, we studied the clinical features and prognosis of patients with ILC and infiltrating ductal carcinoma (IDC). Methods: We analyzed data from 3716 breast cancer pts who were were treated at the Yonsei University Health System between 1984 and 2005. Median follow time is 74 months. The patients were categorized as having ILC or IDC. Results: 95(2.3%) tumors were classified as ILC, 3621 (89.4%) as IDC. In analysis there were no differences of age, tumor size, nodal status and stage between ILC and IDC. However, patients with ILC were significantly more likely to have estrogen positive (79.7% for ILC vs 62.6% for IDC, p=0.003) and HER-2 negative tumors (83.6% for ILC vs 70.8% for IDC, p=0.038) compared to patients with IDC. The frequency of bilateral breast cancers was higher for patients with ILC than for patients with IDC (ILC: 6.8% vs. IDC: 3.5%, p=0.013). The systemic recurrence and local recurrence rates for ILC were similar to IDC. However, the sites of systemic recurrence were different. IDC more commonly metastasized lung than IDC (36.5% for IDC vs 9.1% for ILC). ILC more commonly metastasized to bone and the ovaries than IDC (bone: 72.7% for ILC vs 36.5 % for IDC, ovary: 18.2% for ILC vs 0% for IDC). there were no statistically significant differences in DFS and OS between ILC and IDC. The 5-year DFS was 87.6% for ILC and 78.7% for IDC.(p=0.174) The 5-year OS was 93.6% for ILC and 85.5% for IDC.(p=0.104) Conclusion: In the results of this study, the incidence of ILC was quite low in Korean breast cancer patients. ILC showed different histologic features as bilateral involvement, ER positivity, HER-2 negativity and systemic recurrence sites compared to IDC. But the prognosis of ILC was similar to that of IDC.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3036.

Prognostic Factors for Breast Cancer with 10 or More Lymph Nodes Metastasis

Background: Although the proportion of early breast cancer has been increased, advanced breast cancers of N3 stage still compose about 10% of all breast cancers. The purpose of this study was to investigate factors associated with prognosis of breast cancers with extensive nodal metastasis.Patients and method: Of 3912 invasive breast cancer patients who underwent surgery between April 1986 and May 2006 at Severance Hospital, patients who had 10 or more metastatic lymph nodes without distant metastasis were 304 (7.8%). With 55 months of median follow-up period, their clinicopathologic characteristics, follow-up of survival and the factors associated with disease free survival (DFS) and overall survival (OS) were analyzed.Result: Median age was 46.5 years and median number of positive lymph node was 16 with metastases to supraclavicular lymph nodes in 14 patients (4.6%). Median 5-year DFS rate were 42.4% and OS rate was 47.5%. In the Kaplan-Meier survival analysis, age less than 35 years (19.4% vs. 45.9%; p=0.001), the history of NAC (13.1% vs. 48.8%; p&lt;0.001), T4 stage (15.8% vs. 45.8%, excluding T4d; p&lt;0.001), 20 or more positive lymph nodes (27.0% vs. 50.2%; p&lt;0.001), lymphovascular invasion (20.2% vs. 48.4%; p=0.003), and negative progesterone receptor (32.8% vs. 49.3%; p=0.003) were significantly associated to poor 5-year DFS. For 5-year OS, age less than 35 years (43.8% vs. 59.7%; p=0.033), the history of NAC (28.0% VS. 63.8%; p&lt;0.001), T4 stage (21.1% vs. 61.0%, excluding T4d; p=0.001), 20 or more positive lymph nodes (48.9% vs. 63.8%; p&lt;0.001), and negative progesterone receptor (49.0% vs. 64.2%; p=0.013) were statistically significant. On the multivariate analysis, significant factors associated with poor DFS and OS were 20 or more metastatic lymph nodes (relative risk [RR] =1.598 and p=0.024 for DFS; RR=1.956 and p&lt;0.001 for OS), the history of neoadjuvant chemotherapy (RR=3.163 and p&lt;0.001 for DFS; RR=2.900 and p&lt;0.001 for OS). The contribution of lymphovascular invasion was significant only to DFS on the multivariate analysis.Conclusion: The patients with the same N3 stage show various prognosis. Clinical trial using new therapeutic agents should be applied in advanced breast cancers with high risk, which are predicted to be refractory to conventional adjuvant therapy.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4064.