-93G>A polymorphism of hMLH1 associated with prognosis for patients with colorectal cancer

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Background: Polymorphisms in the DNA repair genes may contribute to variation in DNA repair capacity, thereby affecting the risk of carcinogenesis and prognosis of colorectal cancer. Accordingly, the present study analyzed polymorphisms of DNA repair genes and their impact on the prognosis for patients with colorectal cancer. Methods: Three hundred and ninety- seven consecutive patients with curatively resected colorectal adenocarcinoma were enrolled in the present study. The genomic DNA was extracted from fresh colorectal tissue and 14 polymorphisms of DNA repair genes (XRCC1, hMLH1, ERCC2, ERCC4, VARS2[rs2074511, rs2249459], XPA, XPC, POLR2A, POLR2B, RFC1, RFC4, XAB2, DNMT3B) determined using a PCR-RFLP assay. Results: The median age of the patients was 63 years (range, 21–85), and 218 (54.9%) patients had colon cancer and 179 (45.1%) patients rectal cancer. Pathologic stages after surgery were as follows: stage 0/I (n=86, 21.7%), stage II (n=146, 36.8%), stage III (n=145, 36.5%), and stage IV (n=20, 5.0%). Multivariate survival analysis including stage, differentiation, age, and CEA level showed that the survival for the patients with the -93AA genotype of hMLH1 was worse than for the patients with the combined -93GG and GA genotype (overall survival: hazard ratio [HR]=2.953, 95% Confidential Interval [CI], 1.273–6.850, P=0.012; disease-free survival: HR=2.299, 95% CI, 1.417–3.730, P=0.001), whereas the other polymorphisms were not associated with survival. Conclusions: The -93G>A polymorphism of hMLH1 was found to be an independent prognostic marker for patients with colorectal cancer. Accordingly, in addition to the pathologic stage, the analysis of -93G>A polymorphism of hMLH1 can help identify patient subgroups at high risk of a poor disease outcome.

No significant financial relationships to disclose.

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 <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).
 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.
 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.
 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%).
 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.

Auditory oddball deficits in schizophrenia: an independent component analysis of the fMRI multisite function BIRN study

Deficits in the connectivity between brain regions have been suggested to play a major role in the pathophysiology of schizophrenia. A functional magnetic resonance imaging (fMRI) analysis of schizophrenia was implemented using independent component analysis (ICA) to identify multiple temporally cohesive, spatially distributed regions of brain activity that represent functionally connected networks. We hypothesized that functional connectivity differences would be seen in auditory networks comprised of regions such as superior temporal gyrus as well as executive networks that consisted of frontal-parietal areas. Eight networks were found to be implicated in schizophrenia during the auditory oddball paradigm. These included a bilateral temporal network containing the superior and middle temporal gyrus; a default-mode network comprised of the posterior cingulate, precuneus, and middle frontal gyrus; and multiple dorsal lateral prefrontal cortex networks that constituted various levels of between-group differences. Highly task-related sensory networks were also found. These results indicate that patients with schizophrenia show functional connectivity differences in networks related to auditory processing, executive control, and baseline functional activity. Overall, these findings support the idea that the cognitive deficits associated with schizophrenia are widespread and that a functional connectivity approach can help elucidate the neural correlates of this disorder.

Striving for a better operative outcome: 101 pancreaticoduodenectomies

Pancreaticoduodenectomy (PD), once carried high morbidity and mortality, is now a routine operation performed for lesions arising from the pancreatico-duodenal complex. This study reviews the outcome of 101 pancreaticoduodenectomies performed after formalization of HepatoPancreatoBiliary (HPB) unit in the Department of Surgery. A prospective database comprising of patients who underwent PD was set up in 1999. Retrospective data for patients operated between 1996 and 1999 was included. One hundred and one cases accrued over 10 years from 1996 to 2006 were analysed using SPSS (Version 12.0). The mean age of our cohort of patients was 61+/-12 years with male to female ratio of 2:1. The commonest clinical presentations were obstructive jaundice (64%) and abdominal pain (47%). Majority had malignant lesions (86%) with invasive adenocarcinoma of the head of pancreas being the predominant histopathology (41%). Median operative time was 315 (180-945) minutes. Two-third of our patients had pancreaticojejunostomy (PJ) while the rest had pancreaticogastrostomy (PG). There were five patients with pancreatico-enteric anastomotic leak (5%), three of whom (3%) were from PJ anastomosis. Overall, in-hospital and 30-day mortality were both 3%. The median post-operative length of stay (LOS) was 15 days. Using logistic regressions, the post-operative morbidity predicts LOS following operation (p<0.005). The strategy in improving the morbidity and mortality rates of pancreaticoduodenectomies lies in the subspecialization of surgical services with regionalization of such complex surgeries to high volume centers. The key success lies in the dedication of staffs who continues to refine the clinical care pathway and standardize management protocol.