Cryptorchidism: medium- and long-term follow-up

AIM

Cryptorchidism represents the most frequent male genital anomaly in paediatric population and may potentially interfere with fertility and determine neoplastic testicular diseases. We wanted to evaluate the correlation between age at orchiopexy and follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone levels in adulthood, determining the long-term complications of surgical treatment.

METHODS

Fifty-seven patients (mean age 19 years, range 18-27) surgically treated for cryptorchidism in pediatric age were included in a medium and long-term follow-up (10-19 years). We divided this population into four groups: A) monolateral cryptorchidism operated on before 36 months of age (15); B) monolateral cryptorchidism operated on over 36 months (32); C) bilateral cryptorchidism operated on before 36 months (5); and D) bilateral cryptorchidism operated on over 36 months (5). All patients underwent andrological examination, testosterone, FSH and LH dosage, measurement of testicular volume and spermiogram.

RESULTS

Significant different FSH levels were found between group A and C and between A and D (P<0.01), while groups A and D presented also different mean testicular volume (P<0.01). In addition group D showed an abnormal morphology of spermiogram. The main complications found in follow-up were hydrocele (17,5%), varicocele (8,7%) and epididymal cysts (3.6%).

CONCLUSION

Monolateral cryptorchidism is associated with normal fertility when treated early (group A). Subjects in Group D, on the contrary, have a rise of FSH, a reduction of testicular volume and semen abnormalities. The long-term follow-up of these patients can also detect associated.

Side effects associated with ultrarapid cytochrome P450 2D6 genotype among women with early stage breast cancer treated with tamoxifen

BACKGROUND

The side effects of tamoxifen, a drug widely used for the treatment and the prevention of recurrence in patients with estrogen receptor positive breast cancers (ER+), have been reported in clinical trials, but to date no information is available on their possible association with an increased enzymatic activity of CYP2D6 (ultra-metabolizers, UMs). The aim of this study was therefore to evaluate the association between the presence of multiple functional CYP2D6 alleles and the occurrence of side effects.

METHODS

61 women with ER+ breast cancer receiving tamoxifen monotherapy were investigated in order to assess the relationships between CYP2D6 UM phenotype and side effects. Genotyping of 16 CYP2D6 polymorphisms was performed using a new DNA microarray technology.

RESULTS

A highly significant difference was detected (41.2% of difference, 95% CI 6 - 61%, Fisher's exact test, p = 0.030) between the numbers of Ultrarapid Metabolizer patients (UM; high activity) with two or more adverse drug reactions to tamoxifen (7/9; 77.8%), compared to the number of Extensive Metabolizers (EM; normal activity), Intermediate Metabolizers (IM; reduced activity), and Poor Metabolizers (PM; no activity) with at least two side effects (19/52, 36.5%). A similar difference was also observed comparing the two groups (UM vs EM-IM-PM) for the number of side effects (median and inter quartile range, IQR: AM/EM/IM 1, IQR 0-2 vs. ULTRA 2, IQR 2-4; Mann-Whitney p = 0.005).

CONCLUSIONS

Our results suggest a new association between CYP2D6 gene duplication and side effects to tamoxifen, indicating a possible role of CYP2D6 in their occurrence.

P3-07-04: Does Omission of Axillary Dissection after a Positive Sentinel Node Biopsy Influence Indication to Adjuvant Chemotherapy in Operable Breast Cancer Patients?

Introduction: Based on the recently published ACSOG Z0011 study (JAMA 2011;305:569), axillary dissection (AD) may be avoided in breast cancer (BC) patients with a clinically negative axilla and a positive sentinel lymph node (SLN) biopsy receiving breast conserving surgery (BCS). Because the number of positive axillary lymph nodes (ALN) is a widely accepted prognostic marker, we evaluated the potential impact of omission of AD on indication to adjuvant chemotherapy (ACT).

Patients and methods: Among 1497 patients operated at our Institution over 10 years, we identified 321 patients fulfilling the inclusion criteria of the ACSOG Z0011 study (BCS plus SLNB, cT1-2, cN0 breast cancer and 1 to 2 positive SLN). All patients underwent AD. Each case, which was anonymized, was reviewed by our breast team in two rounds. In the first round, patient age, histopathology, linfovascular invasion, tumor grade, hormone receptor, HER2, and ki67 status and number of positive SN nodes (micro and/or macrometastatic) were available. In the second round, the information on ALN was added. At each round, the panel chose between three indications: 1) Recommend ACT; 2) Discuss ACT; 3) No ACT. Results: SN was micrometastatic in 145 (45%) and macrometastatic in 176 patients (55%). ALD revealed non-SNs metastases in 96 patients (30%). Forty-four of these patients had &gt;3 positive ALN (range 4–24). Indications at round 1 and 2 are summarized below.

P2-12-31: Moderate Immunohistochemical Expression of HER2 (2+) without HER2 Gene-Amplification Is a Negative Prognostic Factor in Early Breast Cancer

Purpose: We sought to evaluate whether moderate HER2 immunohistochemical (IHC) expression (2+ and no HER2/amplification) identifies early breast cancer (EBC) with a distinct prognostic profile.

Methods: A total of 1295 women (median age 58, range 22–94) undergoing surgery for EBC from Jan 1995 to Sept 2009 were retrospectively reviewed. All patients had undergone HER2 testing by the HercepTest and, when needed, by fluorescence in-situ hybridization (FISH). All tests were carried on at our Institutional Surgical Pathology laboratory. The impact of HER2 status on disease-free survival (DFS) was corrected for other clinical and pathological potential covariates by Cox Proportional Regression Analysis.

Results: A total of 494 (38%), 486 (38%), 119 (9%) and 196 (15%) of the patients had HER2 0+, 1+ 2+ and positive (3+ or FISH+) tumors, respectively. Sixty-one of 196 patients with HER2−positive EBC received adjuvant trastuzumab. A total of 298 DFS events occurred at median follow-up of 59 months (4-137 months). By using HER2 0+ status as reference, multivariate analysis revealed that HER2 2+ expression was associated with a significant increase in the risk of a DFS event (HR 2.303, 95% C.I. 1.501−3.533, p&lt;0.001), whereas HER2 1+ was not (HR 0.976, 95% C.I. 0.698−1.365, p=0.889). We performed exploratory two-group comparisons by further classifying tumors according to hormone-receptor status (cutoff for ER and PgR positivity ≥10% of stained cells). Results are summarized in the table. HER2 2+ expression was associated with worse prognosis in both ER and/or PgR positive and ER/PgR negative tumors. In the latter group, HER2 2+ expression was associated with a particularly high rate of DFS events, with a 60-month projected DFS of 20%. Furthermore, while DFS curves plateaued at 60 months for HER2−positive tumors (with and without adjuvant trastuzumab) and for ER/PgR negative tumors with HER2 0/1+ expression, hormone receptor positive/HER2 2+ tumors displayed a particularly high rate of late relapses (beyond 60 months). Results did not change using a 1% cutoff to define ER and PgR positivity.

Conclusion: Moderate HER2 positivity (IHC 2+/FISH negative) identifies EBC patients at increased risk of a DFS event, regardless of hormone receptor status. Due to suggestions from large randomized trials that the benefits of trastuzumab may not be limited to HER2−positive tumors, patients with HER2 2+ EBC are ideal candidates for studies testing this hypothesis.

Multivariate Hazard Ratios, corrected by age, lymph-node status, tumor diameter, tumor grade, proliferation (Ki 67 index) and receipt of adjuvant chemotherapy

Raloxifene induces cell death and inhibits proliferation through multiple signaling pathways in prostate cancer cells expressing different levels of estrogen receptor α and β

Raloxifene (RAL), a selective estrogen receptor (ER) modulator (SERM) seems to induce apoptosis in both androgen-dependent and -independent prostate cell (PC) lines via activation of ERβ and an antagonistic effect on ERα. In this study, we evaluated the effects of RAL on epithelial PC growth using the two following in vitro models: the androgen-dependent cell line EPN which expressed both ERs; and a stabilized epithelial cell line derived from a prostate cancer specimen (CPEC), which expressed low levels of ERβ and lacked ERα. In EPN cells, there was an increase in the pre-G1 apoptotic peak and a reduction in the S phase of the cell cycle with G0/G1 arrest after E2 or RAL treatment; bcl-2 mRNA and Bcl-2 protein levels were significantly reduced, while activated caspase-3 and Par-4 levels increased significantly after either E2 or RAL treatment; in addition, c-myc transcript was inhibited after 10(-6)  M RAL treatment. A dose-dependent increase of metallothionein II gene RNA level was also induced by RAL in EPN. In CPEC, there was only a weak apoptotic peak associated with caspase-3 activation and Par-4 increase after either E2 or RAL treatment; while c-myc transcript level increased. RAL induced a rapid but transient phosphorylation of ERK 1/2 in EPN cells but generated a sustained effect in CPEC. These findings suggest that RAL effects on PC growth control in vitro are cell-specific, depending on ERβ or ERβ/ERα relative expression levels. Moreover, this study demonstrated that RAL affected both transcriptional regulation and non-genomic signals, which resulted in the modulation of multiple signaling pathways of apoptosis and of cell cycle progression.

Abstract PD10-07: Hormone-Receptor Expression and Activity of Trastuzumab-Based Therapy in HER2-Positive Advanced Breast Cancer Patients

Background: Hormone receptors (HR) and the human epidermal growth factor receptor 2 (HER2) are key biological factors in breast cancer. Gene expression profile studies indicate that HER2-positive/HR-positive and HER2-positive/HR-negative tumors fall into two distinct subtypes. These two subtypes carry a different prognosis in the absence of HER2-targeting. Furthermore, a relationship has been documented between increasing HR expression and reduced chemoresponsiveness. Despite these differences, HER2-positive abvanced breast cancer patients are usually treated with a unified approach of combining chemotherapy with an HER2-targeting agent, regardless of HR status. We studied the association between hormone receptor (HR) expression and the clinical outcome of women with HER2-positive advanced breast cancer receiving chemotherapy plus trastuzumab.

Methods: The effect of HR expression on overall response rate (ORR) and progression-free survival (PFS) to trastuzumab-based treatment was studied by univariate and multivariate analysis. HR positivity was defined as 1% or more tumor cells positive for the estrogen (ER) and/or for the progesterone (PgR) receptor by immunohistochemistry. For both ER and PgR, we studied different thresholds to identify levels of expression associated with the clinical outcomes of interest.

Results: 227 consecutive advanced breast cancer patients receiving trastuzumab plus chemotherapy between June 1999 and November 2008 at two Institutions were retrospectively analyzed. One hundred eleven patients (49%) had HR-positive tumors. Compared with low or no expression, high expression of ER (30% or more) predicted reduced probability of tumor response to trastuzumab plus chemotherapy (multivariate odds ratio 0.422, 95% confidence interval-C.I. 0.222-0.803, p = 0.009). In patients with HR-positive tumors the addition of maintenance endocrine therapy to trastuzumab after the completion of chemotherapy was associated with a significant increase in progression-free survival (hazard ratio-HR 0.521, 95% C.I. 0.3325-0.836, p = 0.007). Patients with HR-positive tumors not receiving maintenance endocrine therapy had similar PFS than patients with HR-negative tumors (HR 0.914, 95% C.I. 0.654-1.279, p = 0.601). In patients not receiving maintenance endocrine therapy, high ER expression (30% or more cells) was associated with non-significant trend towards reduced risk of progression, compared with patients with low or absent ER expression (HR 0.747, 95% C.I. 0.516-1.081, p = 0.122). Conclusions: Our results suggest a predictive role of HR expression in HER2-positive tumors. Further investigation in this patient subset is warranted to optimize the use of HER2-targeting agents, chemotherapy and endocrine therapy.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD10-07.

Nasal OEC transplantation promotes respiratory recovery in a subchronic rat model of cervical spinal cord contusion

Engraftment of nasal olfactory ensheathing cells (OEC) is considered as a promising therapeutic strategy for spinal cord repair and one clinical trial has already been initiated. However, while the vast majority of fundamental studies were focused on the recovery of locomotor function, the efficiency of this cellular tool for repairing respiratory motor dysfunction, which affects more than half of paraplegic/tetraplegic patients, remains unknown. Using a rat model that mimics the mechanisms encountered after a cervical contusion that induces a persistent hemi-diaphragmatic paralysis, we assessed the therapeutic efficiency of a delayed transplantation (2 weeks post-contusion) of nasal OECs within the injured spinal cord. Functional recovery was quantified with respiratory behavior tests, diaphragmatic electromyography and neuro-electrophysiological recording of the phrenic motoneurons while axogenesis was evaluated using immunohistochemistry. We show that 3 months post-transplantation, nasal OECs improve i) breathing movements, ii) activities of the ipsilateral diaphragm and corresponding phrenic nerve, and iii) axonal sprouting in the injury site. We also demonstrate that this functional partial recovery is mediated by the restoration of ipsilateral supraspinal command. Our study brings further evidence that olfactory ensheathing cells could have clinical application especially in tetraplegic patients with impaired breathing movements. This article is part of a Special Issue entitled: Understanding olfactory ensheathing glia and their prospect for nervous system repair.

Evaluation of a Warning System for Controlling Primary Infections of Grapevine Downy Mildew

A warning system based on (i) a model that simulates the development of all cohorts of Plasmopara viticola oospores, from oospore germination to infection; (ii) short-term weather forecasts; and (iii) a mobile phone short message system was tested in Northern Italy, from 2006 to 2008. An unsprayed control was compared with a "Warning A" treatment (WA, fungicides were applied whenever the warning system predicted an infection period), a "Warning B" treatment (WB, fungicides were applied as in the WA treatment but only when the relative dimension of any oospore cohort predicted by the model exceeded a threshold), and a "grower" treatment (fungicides were applied according to a conventional schedule). Average disease incidence on leaves was reduced by up to 90% in sprayed plots compared with unsprayed plots. On bunches, efficacy was always >90% at fruit set; when most berries were touching, efficacy was higher for the WA (96%) than for grower (89%) and WB (85%) treatments. On average, 6.8 fungicide sprays were applied following the grower's schedule; use of the warning system reduced applications by about one-half (WA treatment) or two-thirds (WB treatment). The grower's schedule had an average cost of 337 €/ha; the average saving with the WA and the WB treatments was 174 and 224 €/ha, respectively.

Functional characterization of high levels of meningioma 1 as collaborating oncogene in acute leukemia

Retroviral expression of leukemogenic oncogenes in the murine hematopoietic system is essential but not sufficient to induce acute leukemia. Proviral integration-mediated elevated expression of the meningioma 1 (MN1) oncogene suggested MN1 acting as cooperating event in mixed-lineage leukemia 1 (MLL) and eleven nineteen leukemia (ENL)-induced murine leukemia. Indeed, co-expression of MN1 with MLL-ENL enhanced transformation in vivo, and resulted in a significantly reduced latency for induction of an aggressive acute leukemia when compared with MN1 or MLL-ENL alone. In addition, co-expression of MN1 increased the granulocyte macrophage progenitor cell population with leukemia-initiating properties as shown in secondary transplantation experiments. Gene expression profiling experiments identified putative downstream MN1 targets, of which FMS-like tyrosine kinase 3 (FLT3) and CD34 were upregulated in both MN1-overexpressing murine leukemias and in pediatric acute leukemias with high MN1 levels. Interestingly, small interfering RNA (siRNA)-mediated MN1 knockdown resulted in cell cycle arrest and impaired clonogenic growth of human leukemia cell lines with high MN1 levels. Our work shows for the first time that high MN1 levels are important for the growth of leukemic cells, and that increased MN1 expression can synergize with MLL-ENL and probably other transforming fusion genes in leukemia induction through a distinct gene expression program that is able to expand the leukemia-initiating cell population.

Quantitative detection of pear-pathogenic Stemphylium vesicarium in orchards

ABSTRACT Isolates of Stemphylium vesicarium causing brown spot of pear can be distinguished from nonpathogenic isolates of S. vesicarium from pear or from other hosts on the basis of distinctive amplified fragment length polymorphism fingerprinting profiles. DNA fragments specific for isolates pathogenic to pear were identified and a quantitative polymerase chain reaction (PCR) was developed on the sequence from one of these specific DNA loci. This TaqMan PCR has a high sensitivity with a dynamic range for reliable quantification between 1 ng and 100 fg of DNA. The method detected pear-pathogenic isolates of S. vesicarium originating from four different European countries and various regions within those countries. No cross-reaction was found with either the nonpathogenic isolates of S. vesicarium tested or isolates belonging to other Stemphylium spp. or related fungi. The pathogen was detected on leaves with brown-spot symptoms originating from six different locations in The Netherlands, Italy, and Spain. Pear-pathogenic S. vesicarium populations were monitored on crop residues in two Dutch orchards between October 2007 and October 2008. Brown spot had been observed at both orchards at the end of the growing season of 2007. In one location, pear-pathogenic S. vesicarium was detected only sporadically on crop residues and no brown-spot symptoms were observed on fruit in 2008. At the other location, a pathogenic population was found on fallen pear leaves and on other crop residues but this population decreased during winter. From the beginning of the growing season in 2008 onward, the pathogen population could not be detected and the disease incidence was only 0.6%. The TaqMan PCR will allow more detailed studies on epidemiology of brown spot and on the effect of disease control measures.

Age dependency of regional impedance indices regardless of clinical stage in patients with cirrhosis of the liver

PURPOSE

To prospectively assess if ageing itself induces modifications of the impedance indices (resistance and pulsatility indexes) of hepatic, splenic, superior mesenteric and renal arteries in patients with liver cirrhosis.

MATERIALS AND METHODS

78 consecutive patients with cirrhosis (41 males, 37 females, Child-Pugh score 7 [range 5 - 12]) were studied by colour-Doppler ultrasound. The resistance index (RI) and pulsatility index (PI) were determined in the main hepatic artery, intraparenchymal branches of hepatic, splenic, and renal arteries, and superior mesenteric artery; clinical data were simultaneously collected. Logistic regression analysis was performed to assess the relative impact of age, severity of liver disease and other relevant variables on the increase of impedance indices. Linear regression analysis was used to identify a coefficient to adjust RIs and PIs to age.

RESULTS

Resistance and pulsatility indices of all the vessels studied except of the superior mesenteric artery showed a direct correlation with age (e. g. splenic artery RI: R = 0.520, p < 0.0001), and correlated most strongly with Child-Pugh score (e. g. right renal artery PI: R = 0.462, p < 0.0001). Age was associated independently with increased PI and RI in hepatic, splenic and renal arterial districts. In these vessels, the RI threshold of normality can be adjusted to the decade of age adding a correction of 0.03.

CONCLUSION

Ageing itself induces an increase of hepatic, splenic and renal impedance indices in cirrhotic patients. The threshold of normality for these indices in cirrhosis should be adjusted according to the patients' age.

Association between iron overload and osteoporosis in patients with hereditary hemochromatosis

SUMMARY

In 87 patients with hereditary hemochromatosis, osteoporosis was detected in 25%, and osteopenia in 41%. Bone mineral density was independently associated with BMI, ALP levels, hypogonadism/menopause, and the amount of iron removed to reach depletion, but not with cirrhosis. Osteoporosis is influenced by iron overload in hemochromatosis.

INTRODUCTION

To analyze prevalence, clinical characteristics and genetic background associated with osteoporosis in a retrospective study in Italian patients with hereditary hemochromatosis (HHC).

METHODS

In 87 consecutive patients with HHC, bone mineral density was systematically evaluated by dual energy x-ray absorptiometry of the lumbar spine (n = 87) and femoral neck (n = 66).

RESULTS

Osteoporosis was detected in 22 (25.3%), and osteopenia in 36 (41.4%) patients. Mean Z scores were -0.92 +/- 1.42 at lumbar spine and -0.35 +/- 1.41 at femoral neck. Lumbar spine T-score was independently associated with total ALP (p = 0.002), hypogonadism/menopause (p = 0.026), and iron overload (p = 0.033 for ferritin and p = 0.017 for iron removed). We observed a borderline significance for BMI (p = 0.069) and smoking status (p = 0.086). Lumbar spine osteoporosis was independently associated with lower BMI (OR 0.73, 95% CI 0.54-0.94), total ALP (OR 1.17, 95% CI 1-1.39 per 10 unit increase) and the amount of iron removed (OR 1.53, 95% CI 1-2.5 per 5 g increase). HFE genotypes did not differ between patients with and without osteoporosis.

CONCLUSIONS

Osteoporosis is observed in a quarter of unselected patients with HHC, independently of the genetic background, and is associated with ALP, hypogonadism, body weight, and severity of iron overload.