Abstract P2-13-01: Differential protein expression in primary breast cancer tumors spreading to liver or elsewhere

Breast cancer (BC) outcome is determined mainly by its ability to spread to distant sites, since this is the lethal phase of the disease. Metastasizing cells have to acquire various molecular aberrations in order to go through the metastatic cascade and gain organ tropism. These are probably reflected at the primary tumor. This study was aimed to identify a set of abnormally expressed proteins in primary human BC tumors, which spread preferentially to the liver or elsewhere. Methods: We collected archival paraffin embedded primary BC samples from 48 patients who were divided into 3 groups: 10 who developed liver metastases (A), 20 with metastases to other sites (B) and 18 with no BC recurrence (C). Tissue microarray (TMA) were constructed, sliced and subjected to immuno-histochemical staining. A pre-defined panel of 11 proteins was selected, based on published data that were available at the time of study initiation. Level of expression (coded by IRS scoring) and the intra/extracellular location of each protein was determined by an expert pathologist and compared between the three groups. The panel included: cell-cell interaction proteins (CDH1, BIGH3, MMP14, CD44s, Galectin-3), transcription factors (FRA-1, c-Jun, GATA-3, TP53), an inflammatory chemokine (CCL5), cell signaling protein (Wnt-5a). Results: Metastatic tropism to the liver was studied by comparing results between A and B. When similar, A and B were combined and compared with C group. CDH1 protein expression was significantly reduced in the cytoplasm in groups A and B in comparison to C (p=0.004)and over-expressed in the membrane (p<0.001) in both. Hence, cytoplasmic CDH1was higher in group A than B (p=0.03). In group A only, a trend of BIGH3 over-expression was noted, though it did not reach significance. No further differences were found between A versus B. MMP14 was over-expressed both in the membrane and cytoplasm (p=0.001) of A and B, in comparison with C. CD44s was over-expressed in the membrane in A&B versus C (p<0.001). Galectin-3 was over-expressed in the cytoplasm (p=0.005) and down regulated in the nucleus (p=0.015) in both metastatic groups. CCL5 (RANTES) level was significantly reduced in the cytoplasm in A & B (p<0.001) while significantly over-expressed in the nuclei (p=0.005). c-Jun (part of AP1 complex) was over-expressed in both A and B (p=0.021). On the other hand, levels of FRA-1, localized in both cytoplasm and nucleus in C, were reduced in both compartments in A & B (p=0.029). No difference was noted between the 3 groups in level and localization of TP53, GATA-3 and Wnt-5a. Conclusions: Assessment of the expression of proteins in tumor cells should include protein localization besides its level of expression. Both CDH1 and BIGH3 seem to be over-expressed in tumors that spread preferentially to the liver. No significant changes in pattern of expression of the other proteins studied could be correlated with metastatic propensity to the liver. Compartmental translocation of various proteins is correlated with the acquisition of metastatic potential, such as CDH1 and CCL5 which presented a shift from nucleus to cytoplasm, and Galectin-3 and CCL5, where translocation from cytoplasm to membrane were observed in both metastatic groups.

Citation Format: Goldberg H, Fell R, Apel-Sarid L. Differential protein expression in primary breast cancer tumors spreading to liver or elsewhere [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-13-01.

Low prevalence of latex allergy in children with spinal dysraphism in non-latex-free environment

BACKGROUND

Studies in the past have shown that children with spinal dysraphism have highly prevalent latex allergy. These children have a spectrum of congenital spinal anomalies, caused by defects in neural tube closure, with an incidence of 1 in 1000 births. Proposed risk factors for latex allergy include multiple surgeries since birth, including an insertion of a ventriculoperitoneal shunt, elevated IgE titers, repeat multiple catheterizations, and atopy. In the 1990 s, studies published in the United States and Europe showed a latex allergy prevalence of over 70% in these patients. On the other hand, studies published years later in other countries showed a declining prevalence of no more than 17%.

OBJECTIVE

Our goal was to prospectively assess the prevalence of latex allergy in children with spinal dysraphism in our non-latex free environment center compared with a control group.

STUDY DESIGN

The study group included 58 children with spinal dysraphism attending our center between 2010 and 2013. Findings were compared to 65 children referred for evaluation of allergic diseases. The parents completed questionnaires assessing personal and familial history of allergic diseases. All children were tested for blood latex IgE-specific antibodies (IMMULITE 2000).

RESULTS

The mean age was 120.9 (67.6) months in the study group and 129.5 (68.5) months in the control group (p = 0.27). The corresponding median number of surgical procedures was 2 (range 0-10) and 0 (range 0-4), and mean duration of clean intermittent catheterization was 52 (72.2) months in the study group. Positive IgE antibodies and clinical allergic reactions were low with very similar prevalence in both groups (Figure).

DISCUSSION

Our results show considerable lower latex allergy and sensitization than studies published in the United States and Europe in the past, despite the fact that our center utilizes minimal avoidance measures for latex allergy. Study limitations include the relatively small number of patients in our single-center study. Moreover, our control group could not include normal volunteering healthy children due to institutional review board refusal.

CONCLUSIONS

Children with spinal dysraphism in our center have a low prevalence of latex allergy. Possible explanations include low latex protein content gloves and catheters used worldwide, including our center, lower number of surgeries, or a disease associated propensity for latex sensitization with a geographically variable genetic association. More studies are needed to validate our conclusion that using minimal avoidance measures, without maintaining a strict latex free environment, seems sufficient to prevent clinical latex allergy, at least in the Mediterranean region.

Orthotopic neobladder vs. ileal conduit urinary diversion: A long-term quality-of-life comparison

PURPOSE

The optimal form of urinary diversion following radical cystectomy remains controversial. We sought to compare the long-term health-related quality-of-life outcomes between patients with orthotopic neobladder and ileal conduit diversion (ICD).

PATIENTS AND METHODS

We enrolled 95 patients following radical cystectomy and ICD (n = 49) or orthotopic neobladder reconstruction (ONR) (n = 46), with a minimum interval of 1 year from surgery. All patients completed the Bladder Cancer Index questionnaire, assessing their urinary, bowel, and sexual function, and bother scores.

RESULTS

Patients treated with ONR were generally younger and healthier compared with those who underwent ICD (P<0.01). Sex, marital status, disease status at the time of enrollment, and mean duration elapsing from surgery to interview were similar between the subgroups. Better functional scores in favor of ICD were recorded in the urinary domain (P<0.01), whereas the corresponding bother scores were roughly identical in both groups. Conversely, although higher functional scores were recorded in the sexual domain of patients with ONR (P<0.01), the corresponding bother scores in this group were lower compared with their counterparts with ICD (53.2 vs. 65.3; P<0.05). As patients grew older they were more likely to report on better urinary function and worse sexual function, but were less likely to be bothered by the decline in sexual function.

CONCLUSIONS

Our study suggests that the bother resulting from urinary incontinence and the risk of sexual dysfunction be highlighted to those electing for neobladder reconstruction, whereas patients preferring conduit diversion should be reassured that their expected quality of life is not compromised.

Laparoscopic partial nephrectomy (LPN) for totally intrarenal tumours

OBJECTIVE

To evaluate the feasibility and outcomes of laparoscopic partial nephrectomy (LPN) for totally intrarenal tumours (TIT).

PATIENTS AND METHODS

TIT were defined as completely intraparenchymatic masses, without any exophytic element. Identification of such a tumour necessitates guidance of intraoperative laparoscopic ultrasonography. Data of patients with TIT who underwent LPN was collected from our Ethical Committee-approved database. Their data was compared with that of patients who underwent LPN for tumours with any degree of exophytic element. The two groups were compared for preoperative data (age, gender, tumour size and location), intraoperative variables (warm ischemia time [WIT], open conversions rate, radical nephrectomy [RN] rate, blood loss and other complications), and postoperative data (renal function, reoperation rates, pathological results, and incidence of positive surgical margins).

RESULTS

Among 458 patients who underwent LPN, 41 had TIT. The mean (sd) tumour size was 2.6 (0.8) cm, mean WIT was 22.6 (13.8) min and blood loss was 279 (210) mL. The RN rate was significantly higher in the TIT group compared with the remaining cohort of LPNs (9.7% vs 5.3%). The intra- and postoperative complications, open conversion and positive margin rates were similar between the two groups. Malignant tumours were found in 84.2% and 78.2%, respectively.

CONCLUSIONS

LPN for a TIT is technically feasible. TIT carry a significantly higher RN rate due to tumour involvement of vital kidney structures. This aspect should be discussed with the patient preoperatively but TIT should not be considered a definitive indication for RN.

The impact of retrograde intrarenal surgery for asymptomatic renal stones in patients undergoing ureteroscopy for a symptomatic ureteral stone

BACKGROUND AND PURPOSE

In the era of rigid ureteroscopy (URS) for ureteral stones, asymptomatic renal stones were often left in place. With the advent of flexible URS, however, the treatment of such renal stones became an attractive option. Data are scarce regarding the impact of retrograde intrarenal surgery (RIRS) performed at the time of URS for a symptomatic ureteral stone in comparison with ureteral stone removal alone. The purpose of the study was to compare the outcomes of URS combined with RIRS with URS alone.

PATIENTS AND METHODS

A comparison between patients who underwent URS and RIRS (group A, n=47) and a matched control group of patients undergoing URS alone (group B, n=47) was performed. Matching was based on ureteral stone size and location, and preprocedural Double-J stent placement.

RESULTS

The median size of the largest ureteral stone in both groups was 8 mm with a mean total stone burden of 52.9 mm(2) (28.9) and 47 mm(2) (21.1) in groups A and B, respectively. Median renal stone size was 9 mm with a mean total stone burden of 84.1 mm(2) (40.3). Mean surgery time in groups A and B was 68 minutes (19.61) and 39 minutes (15.96), respectively (P<0.001). Median hospital stay was 1 day for both groups. The success rate for ureteral stone removal was 98% and 100% in groups A and B, respectively. Success rate for RIRS was 85% (40/47 cases). Hospitalization length and complications, mainly postoperative fever, did not differ significantly between the groups.

CONCLUSIONS

Managing asymptomatic renal stones at the time of URS for symptomatic ureteral stones significantly prolongs surgery duration but does not lengthen hospital stay, increase complications, or lower success rates. This combined approach reduces the need for future procedures and is probably more cost effective.

Abstract P2-14-04: Co-Administration of GnRH-Agonists with Adjuvant Chemotherapy in Young Breast Cancer Patients: The Effect on Ovarian Function and on Clinical Outcome

Background: Loss of fertility is a major concern for young breast cancer (BC) patients who require adjuvant chemotherapy. The risk of ovarian failure depends on patient's age and chemotherapy regimen. Use of GnRH agonists (GnRHa) has been proposed as a mean for ovarian function preservation but has been investigated mainly in small single arm studies. Objectives: To evaluate ovarian function preservation and disease free survival (DFS) in young breast cancer patients following GnRHa and adjuvant chemotherapy co-administration. Methods: In this multicenter retrospective study, we reviewed medical records of 560 breast cancer patients diagnosed before the age of 40, from 1990 through 2006. All patients were treated in one of 5 Israeli cancer centers with standard adjuvant or neoadjuvant chemotherapy regimens with curative intent. GnRHa were prescribed at the discretion of the treating physician. Ovarian function preservation was determined by resumption of menses, premenopausal hormonal profile or pregnancy during follow up. Multivariate analysis was applied in order to determine whether coadministration of GnRHa with chemotherapy affects DFS. Results: Data was available for 71 patients who received GnRHa during chemotherapy (group A), 60 of those were evaluable for fertility and 68 were evaluated for DFS. The group not receiving GnRHa included 460 patients (group B). Of those 207 were evaluable for fertility and 370 for DFS. Data concerning patients’ characteristics and outcome in each group are presented in the table 1. In a Cox regression model including age, stage, ER/PR status and GnRHa administration, the latter variable predicted a better DFS rate (RR 0.31; 95% CI 0.16-0.70; p=0.003), excluding the subgroup with ER/PR positive tumors (p=0.128). This probably reflects selection bias of prognostic factors not included in the analysis and not a real anti neoplastic hormonal effect. Conclusions: Patients who received GnRHa were younger and had less advanced disease. Fertility was preserved independent of GnRHa administration and regardless of cumulative doses of cyclophosphamide or taxans. This observation suggests that GnRHa are unnecessary for fertility preservation in patients younger than 40yrs. No detrimental effect of GnRHa during chemotherapy was observed on disease outcome.

A case of tuberculosis in a pregnant woman and review of current literature

Tuberculosis (TB) in pregnancy can present with non-pulmonary symptoms, making diagnosis and treatment challenging. We present a case of TB in a pregnant woman and review current management recommendations.

Self-reported HIV testing practice among physicians treating tuberculosis in Australia and New Zealand

Not all people with tuberculosis have their HIV status ascertained despite the interaction between these infections. We investigated the self-reported HIV testing practice among physicians treating tuberculosis in Australia and New Zealand and used logistic regression to assess factors associated with a routine offer of HIV testing in cases of tuberculosis. Of 290 subjects, 61% always recommended an HIV test for a 38-year-old married man with smear-positive pulmonary tuberculosis. A lower proportion (40%) always tested a 78-year-old man or a female patient (58%), and more always HIV tested a South African case (85%), a patient with oral candidiasis (87%) or an unmarried male patient (66%). No scenario was associated with a universal offer of HIV testing. Clinician factors such as specialty (odds ratio [OR] 3.09), jurisdiction of practice (OR 4.09) and number of HIV tests requested in the past five years (OR 0.29) predicted the self-reported frequency of always HIV testing tuberculosis patients. At least 48% of respondents reported that epidemiological or clinical factors influenced their decision to offer testing. Strategies to increase HIV testing in cases of tuberculosis need to consider clinician factors.

Association between standard clinical and pathological breast cancer characteristics and the 21-gene recurrence score: A population-based study

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Background: The 21-gene recurrence score (RS) aims to quantify chemotherapy benefit in lymph node-negative, estrogen receptor (ER)-positive breast cancer (BC) patients. We aimed to elucidate the association between the RS and clinical-pathological features in a population-based Israeli cohort. Methods: Study population included all Israeli BC female patients referred to the RS assay from October 2004 until October 2006. Clinical and pathology data were collected upon referral, RS risk was categorized as previously defined (low < 18, intermediate 18–30, high = 31) and chemotherapy benefit was also assessed for each patient using NCCN guidelines, St. Gallen recommendations and Adjuvant! Online. Results: 300 patients were referred to the assay by 70 physicians from 16 institutions. Low, intermediate and high RS were noted in 109 (36 %), 134 (45 %) and 57 (19%) of the patients respectively, compared to 54%, 21% and 25% respectively, in the validation study (JCO;24:3726). Median age was 54 and median tumor size was 1.6 cm. Similar age distribution, tumor size and ER staining intensity were noted in all risk categories. Interestingly, no association has been identified between the RS and the presence of lymph nodes micrometastases. High tumor grade was noted in 15%, 20% and 56%; progesterone expression in 88% 72% 43%; non-infiltrative ductal carcinoma (IDC) 24%, 12% and 6%; and Her2 expression in 2%, 3% and 19% of the low, intermediate and high risk categories respectively (p<0.0001 for all variables). Risk assessment according to clinical guidelines or Adjuvant! Online correlated poorly with the RS. Conclusions: Risk stratification of referred Israeli patients differs from that of the validation study population. Moreover, the RS did not correlate with age, tumor size and ER intensity. The RS correlated with histology, grade, PR and Her2 expression and may be predicted, in specific subsets of patients, using these features. However, RS categorization cannot be predicted by commonly-used clinical predicting tools.

No significant financial relationships to disclose.