Prognostic factors and survial of advanced renal cell carcinoma with predominant sarcomatoid histology

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Background: Sarcomatoid renal cell carcinoma (SRCC) is known to have aggressive clinical course and poor response to treatment. Very limited data of clinical feature, prognostic factor, and survival are available for advanced disease with predominant sarcomatoid histology. We evaluated clinical features, response to treatment, and prognostic factors for survival.

Methods: Between 2001 and 2010, 30 patients with metastatic or recurrent RCC with predominant sarcomatoid histology (sarcomatoid component 30% or more for resected kidney or exclusive sarcomatoid carcinoma on needle biopsy) were treated at our institution. We reviewed these patients' records to identify clinical and pathologic features which could affect survival. The role of nephrectomy and systemic therapy on patient outcome was also investigated.

Results: There were 20 male and 10 female patients with a median age of 58 years (range, 43–83). Twenty patients had initially metastatic disease and 16 patients (53%) had ECOG performance status (PS) of 0–1. The most frequent metastatic site was lung (57%) followed by bone (43%) and distant lymph nodes (23%). Fourteen (70%) out of 20 patients with initially metastatic disease underwent primary nephrectomy and six patients also underwent metastasectomy. The median % of sarcomatoid component was 80% (range, 30–100%). All patients (N=10) who received immunotherapy had progressive disease as their best response and only one out of 5 patients treated with sunitinib or everolimus had a partial response. With a median follow-up duration of 22 months, the median survival was 3.6 months (95% CI, 0∼7.5) with 6-month survival rate of 43%. Only ECOG PS had impact on survival (P<0.001: ECOG=0, 14.1 months; ECOG=1, 7.4 months; ECOG=2, 3.2 months, and ECOG=3, 1.64 months). Survivals for initially metastatic disease were not significantly different whether patients underwent nephrectomy or not (2.0 months vs. 3.4 months, HR=0.62, 95% CI, 0.16–2.44 after correcting for potential prognostic factors).

Conclusions: Patients with SRCC have a fulminant clinical course and the majority of patients had disease progression irrespective of any treatment. Only performance status dose have impact on overall survival.

No significant financial relationships to disclose.

Does hepatorenal syndrome affect the result of liver transplantation? Clinical observations

Hepatorenal syndrome (HRS) is a reversible, functional renal failure that occurs in patients with advanced hepatic failure. However, the reported rates of complete recovery of renal function and patient survivals after orthotopic liver transplantation (OLT) are variable. The aim of this study was to compare the outcomes after OLT between patients with HRS and those without HRS (no-HRS). We established exclusion criteria to select study patients who underwent OLT in a single center between January 2005 and October 2008. The exclusion criteria included the following: (1) malignancy, (2) <18 years of age, (3) other than primary OLT, (4) ABO mismatch or hemophilia, (5) no liver cirrhosis, and (6) survival >1 month after OLT. We selected 71 subjects, including 8 HRS and 63 no-HRS patients. No significant differences were observed in the estimated glomerular filtration rate (eGFR) between the 2 groups except for a lower eGFR on the day of and 1 month after OLT in the HRS group: 108.3 ± 40.5 versus 31.4 ± 14.1 mL/min and 85.4 ± 15.0 versus 57.3 ± 12.1 mL/min (P = .000 and P = .014, respectively). The renal function of 6/7 HRS patients who survived >1 year improved. The 1-year patient survival rate after OLT in HRS patients was similar to that without HRS: 95% versus 86% (P = .37). We concluded that HRS had minimal effects on patient survival and return of acceptable renal function.

Significance of Viral Reactivation in Hepatitis B Virus Carriers with Early Breast Cancer Receiving Anthracycline- or Taxane-Containing Chemotherapy

Background :It is known that cancer patients in healthy hepatitis B viral (HBV) carrier status are prone to develop hepatic dysfunction during cytotoxic chemotherapy. The objectives of this study were to determine the frequency of healthy HBV carrier status and subsequent viral reactivation resulting in hepatic dysfunction during cytotoxic chemotherapy, and its significance in early breast cancer patients.Methods :Among 3,433 patients with operable breast cancer diagnosed at the National Cancer Center, Korea between January 2001 and March 2009, 3,337 patients were tested for HBsAg. Retrospectively, medical records were reviewed for 139 (4.2%) patients who were positive for HBs Ag.Results :Of 139 patients, 112 patients received anthracycline or taxane based neoadjuvant (n=25) or adjuvant (n=87) combination chemotherapy. Prophylactic lamivudine therapy was administered in 33 patients (29.5%).Thirty of 112 (26.8%) patients developed reactivation of HBV with deterioration of hepatic function during chemotherapy. The rate of reactivaton was not different with or without further taxane therapy (43% vs. 44%, p=0.408).Although there was no significant difference in the rate of chemotherapy delay between two groups, the incidence of early termination of planned chemotherapy was higher in B viral reactivation group (23.3% vs. 4.9%, p=0.008). Within a median follow-up duration of 39 mo (range 1 mo to 95 mo), the rate of disease recurrence was comparable between two groups (10% vs. 18.3%, p=0.390).Lamivudine prophylaxis decreased the rate of HBV reactivation without statistical significance (15.1% vs. 35.4%, p=0.101). Despite more patients without prophylaxis developed G 3/4 AST/ALT elevation (40% vs. 84%, p=0.068), the majority of patients recovered to G 1/2 AST/ALT level within 12 months with anti-viral or supportive treatment (0% vs. 14.3%, p=1.00). One patient without lamivudine prophylaxis developed fulminant hepatic failure after 3rd cycles of neo-adjuvant chemotherapy and received living donor liver transplantation. After that, she received radical mastectomy and maintained adjuvant anti-hormonal therapy.Conclusions :Although lamivudine prophylaxis in HBV healthy carrier decreased the rate of viral reactivation during neo- or adjuvant chemotherapy, the majority of patients irrespective of prophylaxis recovered hepatic function in a year with conservative treatment. Early detection and intensive supportive care are as important as anti-viral prophylaxis in HBV healthy carrier when treated with cytotoxic chemotherapy.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1113.

Prognostic Factors for Locoregional Recurrence in Operable Breast Cancer Patients Treated with Preoperative Systemic Chemotherapy

Background: We aimed to evaluate the clinicopathologic factors affecting locoregional recurrence (LRR) in potentially operable breast cancer patients receiving preoperative systemic chemotherapy (PST).Methods: We reviewed the records of 316 breast cancer patients treated with PST (doxorubicin/cyclophosphamide, 101; docetaxel /capecitabine, 103; paclitaxel/gemcitabine, 43; doxorubicin/docetaxel, 69) followed by surgery and adjuvant radiotherapy between 2002 and 2006. The majority of patients had clinical positive axillary lymph nodes. To define the prognostic factors for LRR, age, clinical stage, hormone receptor (HR) and HER2 status, clinical and pathologic response, type of operation, pathological characteristics including tumor size, tumor grade, nodal status, number of positive axillary nodes, size of metastatic lymph node and status of resection margin and tumor multiplicity before and after PST were analyzed.Results: Overall 52 patients (16.5%) in the primary tumor and 87 patients (27.5%) in the axillary nodes achieved a pathologic complete response (pCR), and 206 patients (65.2%) underwent breast conserving surgery (BCS). With a median follow-up of 52.4 month (range: 4.7 - 89.4), total 18 (5.7%) patients developed LRR; 2 of 110 (1.8%) patients with mastectomy vs. 16 of 206 (7.7%) patients with BCS (p=0.04). Other significant factors in the univariate analysis were clinical T stage, HR status, clinical response and tumor multiplicity. A pCR in the primary tumor or node was not a prognostic factor for LRR in this study. In multivariate analysis, clinical T stage (T3/4, HR 7.8; 95% CI, 2.33-26.24; P=0.001), hormone receptor status (negative, HR 6.2; 95% CI, 1.91-20.22; P=0.002) and type of surgery (BCS, HR 9.5; 95% CI, 1.97-46.37; P=0.005) were independent prognostic factors. Among patients with BCS, advanced clinical T stage (HR 12.4; 95% CI, 3.45-44.56; P&lt;0.001), negative hormone receptor (HR 4.74; 95% CI, 1.33-16.96; P=0.02), non-responding disease (HR 6.54; 95% CI, 1.07-40.12; P=0.04) and multiple tumors (HR 4.36; 95% CI, 1.06-17.90; P=0.04) developed more frequent LRR.Conclusions: Significantly more patients with advanced clinical T stage, negative HR status and BCS developed LRR in operable breast cancer treated with PST. Moreover, in patients with BCS after PST, clinically non-responding disease and multiple tumors showed unfavorable prognosis besides the larger tumors and negative hormone receptor.Partly supported by NCC Grant No 0610240

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1095.

New HER2 Assay Using Trastuzumab for the Selection of Trastuzumab Responding Breast Cancer: The Positivity Is Significantly Associated with Pathologic Complete Response after Preoperative Chemotherapy

Background:The evaluation of HER2 status is required for trastuzumab therapy in breast cancer. Although there are a few methods for an evaluation of HER2 status, theoretically the better method would be to check trastuzumab uptake itself in the tumor after trastuzumab administration. Therefore, we developed a different HER2 test (QHerceptest) using trastuzumab to improve an accuracy in the selection of patient for trastuzumab therapy.Patients and Methods:31 patients with HER2 positive (IHC 3+: 19 and IHC 2+ with FISH positive: 12) early breast cancer who were enrolled in a phase II preoperative paclitaxel, gemcitabin and trastuzumab (PGH) combination chemotherapy trial were evaluated. The pre-chemotherapy tumor specimens were obtained from the breast mass (n=24) or metastatic lymph nodes (n=7). After completing 6 cycles of PGH therapy, all patients underwent breast conserving surgery or mastectomy. We applied trastuzumab and Quantum dot conjugated goat anti-human IgG (QD-IgG, 655nm, Invitrogen) in the process of immunuhistochemistry for HER2 using formalin-fixed paraffin embedded specimen. After antigen retrieval, trastuzuamb was applied followed by QD-IgG. The result of QHerceptest was scored as negative, weak positive, moderate positive, or strong positive, and its relative uptake (RU) were quantified by imaging analysis program (Q-IHC, http://www.bio-miblab.org).Results:The uptake of trastuzumab by QHerceptest was heterogenous, varying between 1.3% to 193.7%. Twenty one of 31 (67.7%) patients achieved pathologic complete response (pCR): 11 of 12 patients (91.7%) with QHerceptest strong positive tumors, 6 of 9 patients (66.7%) with QHerceptest moderate positive tumors, and 4 of 7 patients (57.1%) with QHerceptest weak positive tumors, and none of 3 patients (9.4%) with QHerceptest negative tumors (p=0.0203). Besides, RU was significantly different between non-pCR and pCR groups (43.9±38.3, 80.8±47.1, p=0.0396)Conclusion:We developed a new HER2 assay using trastuzumab and applied to clinical specimen. This assay showed heterogenous trastuzumab uptake in this patient population. Although the data need to be verified by further study, the assay could possibly eliminate patients among HER2 positive breast cancer who will not get benefit by trastuzumab .This study was supported by NCC Grant No 0710292-2 and NCC Grant No 0610240.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6050.

Prognosis of Metaplastic Breast Cancer: Poorer Than the Rest of Triple-Negative Breast Cancer

Background: The biologic behavior of metaplastic breast cancer (MBC) has not been well elucidated due to its rarity and heterogeneity. This study was designed to assess the clinical and tumor characteristics and outcomes of MBC patients as compared with invasive ductal carcinoma (IDC) in general and the triple-negative (TN) subtype.Materials and methods: This study included 35 MBC and 2,839 IDC patients diagnosed at the National Cancer Center, Korea between 2000 and 2008. We, retrospectively, reviewed the clinicopathologic characteristics and clinical outcomes.Results: The mean age was 47.4 years for MBC group and 48.3 years for IDC group. The MBC group presented with larger tumors (≥ T2, 78.8% vs 41.0%; P&lt;0.001), higher histologic grade (grade 3, 92.0% vs 44.6%; P&lt;0.001), fewer ER and PgR positivity (ER+, 14.3% vs 69.0% ; P&lt;0.001 and PgR+, 25.7% vs 66.1%; P&lt;0.001), higher Ki-67 expression (35.5%±26.2% vs 20.6% ±19.8%; P=0.024) and more TN subtypes (48.6% vs 11.9%; P&lt;0.001) than IDC group. Excluding de novo stage IV patients, 14 of 32 (43.7%) MBC patients and 260 of 2782 (9.4%) IDC patents developed disease recurrence with a median follow-up of 36.2 months (range, 4.9-117.8 months). MBC was a poor prognostic factor for disease recurrence in univariate and multivariate analysis (HR 5.19; 95% CI, 2.04-13.18; P=0.001). MBC patients demonstrated aggressive pathologic features and experienced more disease recurrence (HR 4.77; 95% CI, 1.99-11.44; P=0.001) even when compared with 330 patients with TN subtype.Conclusions:Patients with metaplastic breast carcinoma appeared to have inherent aggressive tumor biology with poorer clinical outcomes than those with IDC in general and TN subtype.Partly supported by NCC Grant No 0610240

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4057.

Single Nucleotide Polymorphisms of CYP19A1, rs10459592 and rs4775936 Predict Clinical Benefit of Letrozole in Patients with Metastatic Breast Cancer

BackgroundThe CYP19A1 gene encodes the enzyme aromatase, which is involved in the production of estrogen in various tissues. We evaluated the efficacy of an aromatase inhibitor, letrozole in metastatic breast cancer patients according to DNA polymorphisms of the aromatase gene CYP19A1.Patients and methodsPatients (n=113) with hormone receptor positive metastatic breast cancer were treated with letrozole. Monthly GnRH agonist was added in premenopausal patients. DNA was isolated from peripheral blood samples and was genotyped for 50 polymorphisms of CYP19A1 by iPLEX Gold assay based on matrix-associated laser desorptional ionization, time-of-flight mass spectrometry.ResultsAmong 50 examined single nucleotide polymorphisms (SNP), 10 SNPs were revealed as monomorphic for Korean population. After trimming of the data using HWE test, rs10459592 (T/G) and rs4775936 (C/T), which were located in exon I.6 of CYP19A, were significantly associated in an over-dominant model with higher disease control rate (CR+PR+SD≥ 6months) (HR=2.82 [95% CI 1.21-6.59], p=0.0149; HR=2.62 [95% CI 1.12-6.10], p=0.0238, respectively). In linkage disequilibrium analysis, these were strongly linked (D'=1.0, r2=0.936), and subsequent haplotype analysis showed a statistical significance with regard to higher disease control rate (HR=2.61 [95% CI 1.12-6.1], p=0.0238). Median time to progression (TTP) with a median follow-up of 85.7 months (range 9.7-107.4 months) was improved in patients having over-dominant form of rs10459592 without statistical significance (median 7.74 months [95% CI 6.48-9.00] vs. median 12.07 months [95% CI 8.87-15.26], p=0.147). In multivariate analysis, rs10459592 (HR=2.81 [95% CI 1.12-7.06], p=0.027) was an independent factor affecting disease control rate besides age (HR=1.06 [95% CI 1.01-1.12], p=0.019) and HER2 positivity (HR=0.25 [95% CI 1.12-7.06], p=0.027).ConclusionIn patients with hormone responsive metastatic breast cancer treated with aromatase inhibitor, letrozole, the presence of SNPs in the exon I.6 of CYP19A1, rs10459592 and rs4775936 were significantly associated with improved treatment efficacy. Although further study is needed, our data present possible candidate markers for the letrozole treatment in metastatic breast cancer. (NCC grant number 0910320-1)

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2117.

Single Nucleotide Polymorphism (SNP) in RASSF1 and Clinical Outcomes of Breast Cancer Patients Treated with Neoadjuvant Docetaxel/Doxorubicin Chemotherapy

PurposeThe tumor suppressor gene RASSF1 (Ras association domain family member 1) regulates cell cycle, progression, apoptosis, and microtubule stability, and is inactivated by promoter hypermethylation in breast cancer. We analyzed the SNPs in RASSF1 and their predictive and prognostic value in stage II or III breast cancer patients who received neoadjuvant docetaxel/doxorubicin chemotherapyMethodsA total of 139 stage II or III breast cancer patients who received neoadjuvant docetaxel/doxorubicin chemotherapy were enrolled in this study. The patients received three cycles of neoadjuvant chemotherapy followed by curative surgery, and received additional three cycles of docetaxel/doxorubicin chemotherapy as an adjuvant. Germline DNA from peripheral blood mononuclear cells was extracted. The genotypes were performed using Illumina GoldenGate® Assay. We analyzed 3 SNPs in RASSF1 genes: rs3213621 T&gt;C in 3'UTR, rs2073499 G&gt;A in intron, and rs2073498 C&gt;A in exon 3 Ala133Ser.ResultsThe overall radiologic response rate (RR) for neoadjuvant chemotherapy was 79.8% and 10 patients (7.2%) achieved a pathologic complete remission (pCR). None of the SNPs were correlated with radiologic RR or pCR rate. SNP in intron of RASSF1 (rs2073499) was associated with relapse free survival (RFS). RFS was longer in GA/AA genotype than GG genotype (Hazard ratio [HR]=0.374, p=0.034) After adjusting age and hormone status, prognostic value of RASSF1 SNP remained significant (HR=0.393, p=0.050). Other two SNPs were not significantly associated with RFS.ConclusionsThe GA/AA genotype in SNP of RASSF1 (rs2073499) is associated with significantly longer RFS than the GG genotype. Further research is warranted to identify the biologic characteristics of RASSF1.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6061.

Perceptions of the effectiveness of ethical guidelines: an international study of physicians

The intent of ethics is to establish a set of standards that will provide a framework to modify, regulate, and possibly enhance moral behaviour. Eleven focus groups were conducted with physicians from six culturally distinct countries to explore their perception of formalized, written ethical guidelines (i.e., codes of ethics, credos, value and mission statements) that attempt to direct their ethical practice. Six themes emerged from the data: lack of awareness, no impact, marginal impact, other codes or value statements supersede, personal codes or values dictate, and ethical guidelines are useful. Overall, codes were valued only when they were congruent with existing personal morality. The findings suggest the need to re-evaluate the purpose, content, and delivery of codes for them to improve their function in promoting ethical conduct.

Imaging considerations for in vivo 13C metabolic mapping using hyperpolarized 13C-pyruvate

One of the challenges of optimizing signal-to-noise ratio (SNR) and image quality in (13)C metabolic imaging using hyperpolarized (13)C-pyruvate is associated with the different MR signal time-courses for pyruvate and its metabolic products, lactate and alanine. The impact of the acquisition time window, variation of flip angles, and order of phase encoding on SNR and image quality were evaluated in mathematical simulations and rat experiments, based on multishot fast chemical shift imaging (CSI) and three-dimensional echo-planar spectroscopic imaging (3DEPSI) sequences. The image timing was set to coincide with the peak production of lactate. The strategy of combining variable flip angles and centric phase encoding (cPE) improved image quality while retaining good SNR. In addition, two aspects of EPSI sampling strategies were explored: waveform design (flyback vs. symmetric EPSI) and spectral bandwidth (BW = 500 Hz vs. 267 Hz). Both symmetric EPSI and reduced BW trended toward increased SNR. The imaging strategies reported here can serve as guidance to other multishot spectroscopic imaging protocols for (13)C metabolic imaging applications.

Association between P53 expression or TP53 codon 72 polymorphism and prognosis in patients with operated invasive breast cancer

e22175

Background: The present study analyzed the impact of p53 expression and TP53 codon 72 polymorphism on the prognosis in patients with operated invasive breast cancer. Methods: Two hundred thirty-four patients with ductal breast cancer who underwent surgery with curative intent were enrolled in the present study. The tumor expressions of p53, ER, PR, and HER2 were graded immunohistochemically and TP53 codon 72 polymorphism was determined by a PCR-RFLP assay using genomic DNA extracted from paraffin-embedded tissue. Results: The median age was 49 (range, 24–82) years, and 134 (57.3%) patients were premenopause at the time of diagnosis. Pathologic stages after surgery were as follows: stage I (n=77, 32.9%), stage II (n=110, 47.0%), and stage III (n=47, 20.1%). Tumor overexpression of p53 protein was observed in 59 (25.2%) patients and was associated with an unfavorable relapse-free survival (RFS) in an univariate analysis adjusted to age, stage, and menstrual status. In a multivariate analysis, p53 overexpression was an independent prognostic factor for RFS (HR=2.36; 95% CI=1.09–5.13; p=0.030). However, no associations were observed between the genotype of TP53 codon 72 polymorphism and survival or clinicopathologic characteristics. Conclusions: Overexpression of p53 protein can be considered as a prognostic factor for RFS in the breast cancer patients after surgery.

No significant financial relationships to disclose.

Randomized phase II study of gefitinib alone or with simvastatin in previously treated advanced non-small cell lung cancer (NSCLC)

8057

Background: Statins reduce not only serum cholesterol levels but also mevalonate synthesis by inhibiting HMG-CoA reductase. Mevalonate is a precursor of several cellular major products including dolichol, geranylpyrophosphate (GPP) and farnesyl-pyrophosphate (FPP). Dolichol has a stimulatory effect on DNA synthesis and is linked to several tumor cell proteins. GPP and FPP cause isoprenylation of Ras and Rho those regulate signal transduction of several membrane receptors crucial for cell proliferation, differentiation, and apoptosis, which result in resistance to gefitinib. Thus depletion of mevalonate metabolites may enhance gefitinib activity in NSCLC. This study compared gefitinib alone with gefitinib plus simvastatin in patients with recurrent NSCLC after at least one chemotherapy. Methods: Between May 2006 and September 2008, 107 patients (51% male, 74% adenocarcinoma, 50% never-smoker, 54% more than two prior regimens) were randomly assigned to gefitinib alone (250 mg/d orally, n=53) or gefitinib plus simvastatin (250mg/d and 40 mg/d orally, respectively, n=54). A cycle was considered as 4 weeks of treatment. Therapy was continued until disease progression or intolerable toxicities. The primary end point was to assess response rate. Secondary end points included time to progression and survival. Median follow-up was 10.1 months. Results: Efficacy was similar for gefitinib and gefitinib plus simvastatin groups. Objective tumor response rates (RR) were 31.5% (95% CI, 19.1 to 43.9) and 32.1% (95% CI, 19.5 to 44.7); median PFS were 1.9 and 2.0 months; and median OS were 9.5 and 12.7 months, respectively. In subgroup analysis, gefitinib plus simvastatin showed a trend for higher RR than gefitinib alone in non-adenocarcinoma group (38.5% vs. 7.7%, p=0.08). Adverse events at both arms were generally mild (grade 1 or 2) and consisted mainly of skin reactions. Conclusions: Gefitinib combined with simvastatin did not improved efficacy compared to gefitinib alone in this unselected patient population, but showed a trend for higher efficacy in non-adenocarcinoma patients. Although it is preliminary, gefitinib combined with simvastatin showed slightly increased OS. Updated survival data will be presented.

No significant financial relationships to disclose.

Prognostic significance of preoperative serum tumor markers in the patients with curatively resected advanced gastric cancers

e15515

Background: We evaluated the prognostic significance of preoperative tumor markers, carcinoembryonic antigen (CEA), carbohydrate antigen 19–9 (CA19–9), and carbohydrate antigen 72–4 (CA72–4), in the patients with curatively resected advanced gastric cancers (AGC). Methods: Preoperative serum tumor markers were available for 667 patients who had been enrolled in a phase III trial of adjuvant chemotherapy (AMC0201). We compared the relapse free survival (RFS) and overall survival (OS) according to patient's pre-treatment clinical characteristics and serum tumor markers by using log rank test and Cox proportional hazard model. Results: Of total 667 patients, 3 year RFS rate and OS rate were 67.4% and 75.0%, respectively. Postoperative pathologic stage was II in 353 (52.9%), IIIA in 202 (30.3%), IIIB in 61 (9.1%), and IV (M0) in 51 (7.6%). CEA, CA19–9, CA72–4 were elevated pre-operatively in 64 of 665 patients (9.6%), 75 of 664 patients (11.3%), and 121 of 639 patients (18.9%), respectively. After the median follow-up of 38.4 months, 209 patients (31.3%) had recurrence, and 164 patients (24.6%) died. In the univariate analysis, location of tumor, type of surgery, Borrmann type, TNM stage, the elevation of CEA and CA72–4 level were significant prognostic factors for RFS and OS. In the multivariate analysis, serum CA72–4 was independent significant prognostic factor for RFS and OS as well as tumor location, Borrmann type, and stage Conclusions: Pre-operative serum CEA and CA72–4 levels were independent prognostic factors as well as clinical characteristics of pathologic stage, tumor location and Borrmann type in patients with curatively resected AGC.

No significant financial relationships to disclose.

Deformation of a LCD glass-panel by alignment process in nanoimprint lithography

Deformation of a LCD glass-panel during the alignment is analyzed for a UV-nanoimprint lithography process. In UV-nanoimprint processes for manufacturing LCD panels, a glass-panel should be aligned with respect to the position of fiducial marks on imprint mold and the target glass. The alignment process will place the nano-patterns on the mold into the designated position in the glass-panel. Usually, viscoelastic resin is laminated between the mold and glass-panel. The resin is solidified by ultra-violet light and is designed to be nano-patterns. Thus, shear force would be induced on the panel during alignment process. The shear force can cause deformation of glass-panel, which ultimately causes misalignment of nano-patterns. Thus, deformation analysis for the glass-panel in the alignment process is essential to enhance the accuracy and to reduce alignment cost in nano-imprint. In this work, deformation of the glass panel from the viscous force is calculated by using 'ALGOR' package. The mechanism of misalignment of nano-patterns due to the deformation is analyzed. Finally, the effect of misalignment is discussed, and the experimental results are also presented.

Triple negative phenotype: not affecting survival in young patients with operable breast cancer

Abstract #1083

Purpose: To investigate the clinicopathological characteristics and outcomes of triple negative breast cancer in young patients.&#x2028; Experimental Design: We analyzed 1,498 patients with primary invasive breast cancer who underwent surgery between January 2000 and December 2003. Patients were divided into those &lt; 40 and ≥ 40 years old and into triple negative and non-triple negative groups.&#x2028; Results: A total of 326 (21.8%) were aged &lt; 40; relative to patients ≥ 40 years old, the younger group showed larger tumor size, higher lymph node positivity, and elevated Ki-67 index. Recurrence-free survival (RFS; P = 0.0002) and overall survival (OS; P = 0.0483) were significantly lower in the younger group. Three hundred seventy four patients (25.0%) had the triple negative phenotype, and of which 93 (24.9%) were &lt; 40 years old. Univariate survival analysis showed that the triple negative phenotype was not a prognostic factor for either RFS or OS in the younger group. In the older group, however, the triple negative phenotype was a significant prognostic factor for both RFS (P = 0.0103) and OS (P = 0.0081) by univariate analysis, and it remained a significant prognostic factor for OS by multivariate analysis (hazard ratio, 1.9; 95% confidence interval, 1.09-3.44; P = 0.025). When the non-triple negative group was subdivided into luminal and HER2 subtypes, the HER2 subtype showed the worst OS in both age groups (P &lt; 0.001), followed by the triple negative group. However, the difference between the HER2 subtype and the triple negative group was significant only in the younger group (P = 0.0064), but not in the older group (P = 0.1446).&#x2028; Conclusions: Triple negative phenotype did not affect survival in patients &lt; 40 years old, because of the markedly poorer survival of non-triple negative tumors of the HER2 subtype in this age group.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1083.

Metaplastic breast carcinoma: clinicopathologic features and prognostic value of triple-negativity

Abstract #1085

Backgroud Metaplastic breast carcinomas (MBC) are a rare type of breast cancer comprising &lt;1% of all invasive breast cancers and are generally characterized by hormone receptor and human epidermal growth factor receptor 2 (HER2) negativity. There is a paucity of information on prognosis according to hormone receptor and HER2 expression for these rare tumors. The aim of this study was to compare the clinical features and prognosis, between triple negative metaplastic carcinoma (TNMC) and non-triple negative metaplastic carcinoma (NTNMC).&#x2028; Material and Methods We retrospectively analyzed MBC patients treated at Seoul National University Hospital between 1996 and 2006. Pathologic, immunohistochemical findings and clinical outcome information were reviewed.&#x2028; Results fifty-one patients were identified. The median age at presentation was 45.8 years (range: 27.3-83.8). Median tumor size at diagnosis was 3.0 cm (range: 0.8-12.0). 34 cases (66.7%) were node-negative, 16 (31.4%) node-positive, and 1 (2.0%) were missing. Estrogen receptor (ER)/progesterone receptor (PR) yielded negative results in 49 cases (96.1%) and 48 cases (94.1%), respectively. HER2 overexpression by immunohistochemistry was negative in 41 of 51 (80.4%). At median follow-up of 40.8 months, the 5-year overall survival rate and disease free survival were 73.9% and 64.9%, respectively. Non-triple negativity (p=0.031) correlated significant with overall survival in multivariate analysis.&#x2028; Of the 51 patients, 39 (76.5%) were TNMC, and 12 (23.5%) were NTNMC. In TNMC and NTNMC group, median ages were 45.6 and 51.5 years and tumor sizes were 3.0 cm and 3.0 cm, respectively. There were 12 patients (30.8%) in TNMC and 4 patients (33.3%) in NTNMC for lymph node metastasis. Two groups did not differ significantly by age, tumor size, or nodal status. Positive rates for ER, PR and HER2 were 16.7%, 25% and 83.3% in NTNMC. The 3-year overall survival rates in TNMC and NTNMC were 91.4% and 61.9%, respectively (p=0.029). As regards to 3-years disease-free survival, there was no statistically significant difference between TNMC and NTNMC (p=0.694, 75.8% versus 75.0%).&#x2028; Discussion MBC mainly has triple negative features. However, in subgroup analysis of MBC, non-triple negative group displayed a poor prognosis compared with triple negative group, which is contrary to the case of invasive ductal carcinoma of breast. Further research exploring mechanism of this result.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1085.

Remarkable complete pathologic response rate after preoperative paclitaxel, gemcitabine, and trastuzumab chemotherapy in HER2 positive stage II/III breast cancer: a phase II multicenter study

Abstract #5105

Background: Preoperative paclitaxel (P) and gemcitabine (G) combination therapy given on D1/D8 every 3 weeks (wks) for 4 cycles was well tolerated and effective in stage II/III breast cancer (BC) in our previous phase II study, with an 18% pathological complete response (pCR) rate. Adding trastuzumab (H) to the preoperative chemotherapy increases both of the clinical and pathological response rates in HER2 positive BC patients (pts). Thus far, the highest pCR rate reported in the literature was obtained with anthracycline-based regimens in combination with trastuzumab. This study evaluated whether non-anthracycline combination chemotherapy with PGH could improve the pCR rate in HER2 positive BC. Methods: HER2 positive, stage II/III BC pts with cytologically confirmed axillary lymph node (LN), ≥ 18 years of age, with adequate organ function, and good performance status were eligible. No prior therapy was allowed. Pts received H intravenously (iv) at 4 mg/kg on D1 of the first cycle with subsequent weekly doses of 2 mg/kg in combination with P 80 mg/m2 and G 1,200 mg/m2, iv, on D1/D8 every 3 wks for 6 cycles. Within 2 wks postoperatively, patients received H 6 mg/kg every 3 wks for 11 cycles with tamoxifen or an aromatase inhibitor for 5 years if indicated. All pts received postoperative radiation therapy. Initial evaluation included sonogram and MRI of the breast, MUGA scan, or echocardiogram, and PET-CT. Results: All 53 planned pts were enrolled between April 2007 and February 2008. The median age was 43 years (range, 26–61 years), the median primary tumor size by sonogram was 5.3 cm (range, 2.0 to &gt; 12 cm) with 89 % ≥ stage IIIA, 42% T3/T4, and 28% N3. Twenty four tumors (45%) were multiple and 20 tumors (38%) were ER positive. By May 2008, 47 patients completed surgery with a 74% breast conservation rate. Twenty-eight of 47 (60%; 95% CI, 45-72) patients achieved pCR in both the tumor and lymph node, with 68% (32/47; 95% CI, 54-80) pCR in the primary tumor, and 77% (36/47; 95% CI, 63-86) pCR in the axillary LN. Median metastatic focus in 21 positive LNs (n=11 pts) was 1 mm (range, &lt;1–13mm). Grade III/IV adverse events (AE) were neutropenia (53%), febrile neutropenia (4%), and transient elevation of AST/ALT (9%). After 6 cycles of PGH chemotherapy, all patients maintained above normal LVEF. Conclusions: A remarkably high pCR was obtained by non-anthracyline based PGH combination therapy for HER2 positive stage II/III breast cancer. This combination is well tolerated with mild degree of AEs.&#x2028; Supported by NCC Grant No 0610240-3. Trastuzumab, paclitaxel, and gemcitabine were supplied by Roche, CJ Cheiljedang CO., and Eli Lilly and CO., respectively.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5105.

Ki-67 gives additional prognostic information on St Gallen 2007 and Adjuvant! Online risk categories in early breast cancer

Abstract #1086

Purpose: We sought to determine the significance of Ki-67, one of the tumor cell proliferation indexes, as a useful prognostic factor in early breast cancer.&#x2028; Patients and Methods: 1,080 consecutive patients with stage I or II breast cancer operated between 1998 and 2003 were enrolled. Patients were categorized based on the 2007 St. Gallen consensus and Adjuvant! Online. The expression of Ki-67 in the tumor was assayed using immunohistochemistry (cut-off value: 10%).&#x2028; Results: Univariate analysis revealed that tumor size, lymph node involvement, histologic grade, estrogen receptor, progesterone receptor, bcl-2, and Ki-67 (≥10%) were significant for both overall survival (OS) and distant metastasis-free survival (DFS). Of them, lymph node involvement and high Ki-67 expression were identified as independent prognostic factors for OS at multivariate analysis. The survivals of intermediate- and high-risk groups according to 2007 St Gallen consensus were further separated by Ki-67 expression level (5-yr DFS rate=93.3% vs 86.6% for Ki-67&lt;10% and ≥10%, respectively in intermediate-risk group (p=.001); 5-yr DFS rate=83.1% vs 61.5% for Ki-67&lt;10% and ≥10%, respectively in high-risk group (p=.006)). The survivals of low- and high-risk groups according to Adjuvant! Online were further separated by Ki-67 expression level [5-yr DFS rate=97.8% vs 89.5% for Ki-67&lt;10% and ≥10%, respectively in low-risk group (p=.010); 5-yr DFS rate=90.4% vs 82.6% for Ki-67&lt;10% and ≥10% in high-risk group (p=.005)).&#x2028; Conclusion: Ki-67 was an independent prognostic factor for DFS and OS in early breast cancer, and could give additional prognostic information on the risk grouping by 2007 St Gallen consensus and Adjuvant! Online.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1086.

Comparable efficacies between premenopausal and postmenopausal metastatic breast cancer patients by letrozole with and without goserelin as first line hormone therapy: a phase II parallel group study

Abstract #6134

Background: The use of goserelin in premenopausal patients(pts) is to produce castrated level of estradiol (E2), and the remaining peripheral E2 production is inhibited by letrozole, which would accomplish comparable clinical outcomes as in postmenopausal metastatic breast cancer (MBC) pts by letrozole alone.&#x2028; Methods: Hormone receptor positive pre- and postmenopausal pts with MBC were eligible. Letrozole 2.5 mg once a day was administered with goserelin 3.6 mg every 4 weeks in premenopausal pts and serial serum E2, FSH, LH were measured. Bone mineral density (BMD) and serum bone turnover markers were also checked (n=34).&#x2028; Results: Among total 78 pts enrolled, 32 pre- and 38 postmenopausal pts were assessed for efficacy and adverse events (AE). The median age was 42 years (range, 32–52) for pre- and 53 years (range, 33–70) for postmenopausal pts. Baseline characteristics were similar in the two groups, except for significantly longer disease free interval in postmenopausal pts (22.2 months vs. 41.2 months, P=0.01). Clinical benefit (CR+ PR+ SD ≥ 24 weeks) rates (62.5% vs. 68.4%, P=0.62), and objective response (CR + PR) rates (28.1 % vs. 23.7%, P=0.79) were comparable between the two groups. Median TTP was 8.6 months vs. 9.6 months (P=0.61) with a median follow-up of 11.6 months and 14.6 months, respectively. In multivariate analysis, strong ER status was significantly associated with clinical benefit rate (P=0.01), and HER2 positivity (P&lt;0.001) and stage IV presentation (P=0.05) with shorter TTP. In premenopausal pts, the mean E2 level was dropped from 62.3 ± 81.8 pg/mL at baseline to 12.3 ± 2.2 pg/mL at week 2. AEs were mild with significantly more hot flushes in premenopausal pts. In premenopausal pts without bisphosphonate treatment, there was a trend of rising serum levels of osteocalcin (OC) (0% vs. 165%, P=0.065), bone alkaline phosphatase (bALP) (0% vs. 28%, P=0.055), and C-telopeptide (CTx) (0% vs. 108%, P=0.095), as well as a significant reduction in both lumbar spine (P=0.044) and femur (P=0.027) BMD. In contrast, in premenopausal pts with bone metastasis on bisphosphonate, there was no significant change in OC, bALP, CTx, and both BMD. In postmenopausal pts without bisphosphonate treatment, no significant change in OC, bALP, CTx, and femur BMD, while in pts with bone metastasis on bisphosphonate treatment, a significant decrease in OC (0% vs. -22%, P=0.050) and CTx (0% vs. -41%, P=0.020) and increase in both BMD (P=0.044, P=0.038 respectively) were observed.&#x2028; Conclusions: Clinical efficacies by letrozole and goserelin therapy in premenopausal MBC pts were comparable to those in postmenopausal pts by letrozole with mild AEs. While a modest increase in both bone formation and resorption especially in premenopausal pts, concurrent bisphosphonate therapy could stabilize bone metabolism in patients even with bone metastasis.&#x2028; Supported by NCC Grant No NCS-0610240-3. Letrozole for premenopausal group was supplied by Novartis.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6134.

Does triple-negative breast cancer (TNBC) have distinct clinicopathologic characteristics and prognostic significance?

21088

Background: Studies have suggested that TNBC, defined by estrogen receptor-negative, progesterone receptor-negative, and HER2-negative, may represent the subset of breast cancer(BC) with different biologic behavior. Here we investigated the clinicopathologic characteristics of TNBC and its prognostic significance in Korean BC patients. Methods: Patients diagnosed as invasive BC and underwent curative surgery at Seoul National University Hospital between Jan. 2000 and Jun. 2003, were reviewed, retrospectively. We excluded the patients whose immunohistochemistry for hormone receptor nor HER2 status had not been evaluated, and who had been treated with adjuvant trastuzumab or neoadjuvant chemotherapy (CT). Clinicopathologic variables (age, T and N stage, endovascular or lymphatic tumor emboli, nuclear and histologic grade, p53, bcl2, Ki67) and 3 year relapse free survival (3YRFS) rate of TNBC were compared with those of non- TNBC. Results: 1,136 patients were eligible for analysis. The median follow-up was 48.7 months. 341 patients underwent breast conserving surgery followed by adjuvant radiotherapy. 249 patients were TNBC and 62.1% of those were node negative. 86.4% of node negative TNBC, 88.3% of node positive TNBC, 53.9% of node negative non-TNBC, and 90.2% of node positive non-TNBC received adjuvant CT. Compared with non-TNBC, TNBC was correlated with younger age (age<35,14.1% vs. 8.2%, p=0.013), higher nuclear and histologic grade(62.2% vs. 23.6%, p=0.001;60.2% vs. 24.6%, p=0.001, respectively); positive staining for p53 (p=0.001) and higher positivity for Ki67 (p=0.001), suggesting the biologic aggressiveness of TNBC. During the follow-up periods, 17.3% of TNBC were relapsed. In particular, 3YRFS in node negative TNBC and non-TNBC were 86% and 96%, respectively (p<0.001). But, in node positive BC, 3YRFS was not different between TNBC and non-TNBC (80.6% vs. 83%, p=0.99). Conclusions: We confirm that TNBC shows more aggressive clinicopathologic characteristics and in particular, higher relapse in node negative BC. Thus, triple-negativity(TN) may be integrated into risk factor analysis in node negative BC. Final results of more detailed molecular analysis for TNBC would be available in the meeting.

No significant financial relationships to disclose.