Association between chronological change of reproductive factors and breast cancer risk defined by hormone receptor status: results from the Seoul Breast Cancer Study

Lifestyle factors have been chronologically changed into western style ones, which could result in the rapid increase of breast cancer incidence in Korea. It is plausible that reproductive factors through hormonal mechanisms are differentially related to the risk of breast cancer subtypes. We investigated the association of reproductive risk factors on breast cancer by birth year groups and also evaluated the differential associations on the hormone receptor-defined subtypes. Using the data from the Seoul Breast Cancer Study (SeBCS), a multicenter case-control study, 3,332 breast cancer patients and 3,620 control subjects were analyzed. The distribution of subtypes among cases was as follows: 61.0 % estrogen receptor (ER)-positive, 51.9 % progesterone receptor (PR)-positive, and 43.4 % both ER/PR-positive status, respectively. Polytomous logistic regression and Wald tests for heterogeneity have been used across the subtypes. The frequencies of reproductive-related risk factors including early age at menarche, nulligravid, age at first full-term pregnancy (FFTP), duration of estrogen exposure before FFTP (EEBF), less number of children, never breastfeeding, and short duration of breastfeeding has increased as women were born later in both cases and controls, respectively (p trend < 0.0001. Among breast cancer patients, either ER- or PR-positive subtypes were increased in women born in 1960s compared to women born in 1940s. Early age at menarche increased the risk of breast cancer regardless of the subtypes while nulligravid, late age at FFTP, and longer duration of EEBP were associated with hormone receptor-positive cancer risk only (p heterogeneity < 0.05), which associations were stronger among women born later. Our results suggest that the associations of age at menarche, parity, age at FFTP, and duration of EEBF with breast cancer risk were different based on the hormone receptor status and birth year groups in Korea.

New breast cancer risk variant discovered at 10q25 in East Asian women

BACKGROUND

Recently, 41 new genetic susceptibility loci for breast cancer risk were identified in a genome-wide association study (GWAS) conducted in European descendants. Most of these risk variants have not been directly replicated in Asian populations.

METHODS

We evaluated nine of those nonreplication loci in East Asians to identify new risk variants for breast cancer in these regions. First, we analyzed single-nucleotide polymorphisms (SNP) in these regions using data from two GWAS conducted among Chinese and Korean women, including 5,083 cases and 4,376 controls (stage 1). In each region, we selected an SNP showing the strongest association with breast cancer risk for replication in an independent set of 7,294 cases and 9,404 controls of East Asian descents (stage 2). Logistic regression models were used to calculate adjusted ORs and 95% confidence intervals (CI) as a measure of the association of breast cancer risk and genetic variants.

RESULTS

Two SNPs were replicated in stage 2 at P < 0.05: rs1419026 at 6q14 [per allele OR, 1.07; 95% confidence interval (CI), 1.03-1.12; P = 3.0 × 10(-4)] and rs941827 at 10q25 (OR, 0.92, 95% CI, 0.89-0.96; P = 5.3 × 10(-5)). The association with rs941827 remained highly statistically significant after adjusting for the risk variant identified initially in women of European ancestry (OR, 0.88; 95% CI, 0.82-0.97; P = 5.3 × 10(-5)).

CONCLUSION

We identified a new breast cancer risk variant at 10q25 in East Asian women.

IMPACT

Results from this study improve the understanding of the genetic basis for breast cancer.

Common genetic determinants of breast-cancer risk in East Asian women: a collaborative study of 23 637 breast cancer cases and 25 579 controls

In a consortium including 23 637 breast cancer patients and 25 579 controls of East Asian ancestry, we investigated 70 single-nucleotide polymorphisms (SNPs) in 67 independent breast cancer susceptibility loci recently identified by genome-wide association studies (GWASs) conducted primarily in European-ancestry populations. SNPs in 31 loci showed an association with breast cancer risk at P < 0.05 in a direction consistent with that reported previously. Twenty-one of them remained statistically significant after adjusting for multiple comparisons with the Bonferroni-corrected significance level of <0.0015. Eight of the 70 SNPs showed a significantly different association with breast cancer risk by estrogen receptor (ER) status at P < 0.05. With the exception of rs2046210 at 6q25.1, the seven other SNPs showed a stronger association with ER-positive than ER-negative cancer. This study replicated all five genetic risk variants initially identified in Asians and provided evidence for associations of breast cancer risk in the East Asian population with nearly half of the genetic risk variants initially reported in GWASs conducted in European descendants. Taken together, these common genetic risk variants explain ~10% of excess familial risk of breast cancer in Asian populations.

The impact of post-transplant hemoglobin level on renal allograft outcome

BACKGROUND

Anemia is a common complication of chronic renal disease and renal transplantation. Early post-transplant anemia is the consequence of blood loss, immunosuppressant therapy, and failure to produce sufficient erythropoietin. Late post-transplant anemia has been attributed to drug therapy, renal dysfunction, and infection. The effect of post-transplant anemia on renal allograft survival and acute rejection rates is not established. The aim of this study was to examine the impact of post-transplant anemia on renal function and allograft outcomes.

MATERIALS AND METHODS

We included 411 patients who underwent living or deceased donor renal transplantations in our center from April 1990 to March 2010. The patients were divided into 2 groups according to their postoperative hemoglobin level at 1 month: anemic group (<12.0 g/dL in men, <11.0 g/dL in women) and nonanemic group (≥ 12.0 g/dL in men, ≥ 11.0 g/dL in women). The outcome measures included postoperative serum creatinine levels at 12 and 36 months, acute and chronic rejection rates, as well as long-term graft survival.

RESULTS

The acute and chronic rejection rates were significantly higher in the anemic group: 28.1% versus 19.7% (P = .000) and 24.1% versus 19.7% (P = .027), respectively. Postoperative serum creatinine levels at 12 and 36 months were not significantly different in patients with functioning grafts regardless of their anemia status (P = .530 and P = .430, respectively). Graft survival was lower with anemia: 85.4% versus 93.8% at 5 years, and 74.8% versus 83.5% at 10 years (P = .040).

CONCLUSIONS

Post-transplant anemia was associated with poorer renal function at 12 months, higher acute rejection rates, and worse long-term renal allograft outcomes compared with subjects displaying normal hemoglobin levels.

Pharmacogenetic study of deferasirox, an iron chelating agent

Transfusion-associated iron overload induces systemic toxicity. Deferasirox, a convenient long acting oral agent, has recently been introduced in clinical practice with a promising efficacy. But there are some patients who experience drug-related toxicities and cannot tolerate it. To investigate effect of genetic variations on the toxicities and find optimal target population, we analyzed the genetic polymorphisms of UDP-glucuronosyltransferase 1A (UGT1A) subfamily, multi-drug resistance-associated protein 2 (MRP2) and breast cancer resistance protein (BCRP). A total of 20 functional genetic polymorphisms were analyzed in 98 patients who received deferasirox to reduce transfusion-induced iron overload. We retrospectively reviewed the medical records to find out the drug-related toxicities. Fifteen (15.3%) patients developed hepatotoxicity. Patients without wild-type allele carrying two MRP2 haplotypes containing −1774 del and/or −24T were at increased risk of developing hepatotoxicity compared to patients with the wild-type allele on multivariate analysis (OR = 7.17, 95% CI = 1.79–28.67, P = 0.005). Creatinine elevation was observed in 9 patients (9.2%). Body weight ≥40 kg and homozygosity for UGT1A1*6 were risk factors of creatinine elevation (OR = 8.48, 95% CI = 1.7–43.57, P = 0.010 and OR = 14.17, 95% CI = 1.34–150.35, P = 0.028). Our results indicate that functional genetic variants of enzymes to metabolize and transport deferasirox are associated with drug-related toxicities. Further studies are warranted to confirm the results as the pharmacogenetic biomarkers of deferasirox.

The optical properties of quantum transition on ZnS and Ge of electron-piezoelectric interaction system under two circularly oscillating fields

We study optical quantum transition line shapes (QTRSs) and optical quantum transition line widths (QTLWs) in relation to magnetic-field dependence properties of the electron-piezoelec potential phonon interaction system. We consider two systems-one is subject to right circularly oscillating external fields and the other is subject to left circularly oscillatory external fields. The main purpose of this work is to compare QTLSs, which indicate absorption power, in the two oscillating external fields. Our results indicate that the QTLSs of right circularly oscillating external fields is larger than the QTLSs of left circularly oscillating external fields, while the opposite result is obtained for the QTLWs. Through the analysis of this work, we found the increasing properties of QTLW and QTLS of ZnS and Ge with the temperature and the magnetic fields. We also found the dominant scattering processes are the phonon emission transition process.

Korean epithelial ovarian cancer study (Ko-EVE): protocols and interim report

BACKGROUND

There have been few studies of Asian ovarian cancer and benign tumors. The primary aim of this paper was to report the protocol of the Ko-EVE study to examine epidemiological and molecular factors for ovarian cancer and benign neoplasms and to ascertain the major risk factors for ovarian cancer control in Korea.

METHODS

This case-control study covers incident epithelial ovarian cancers and benign neoplasms, four major centers participating in enrolling incident cases and 3 hospitals enrolling healthy controls among health examinees. Standardized questionnaires were administered by trained interviewers, including sections on socio-demographics characteristics, past medical history, medication usage, family history, lifetime consumption of alcohol and tobacco, diet, physical activity, and reproductive factors for women. Various biological specimens were collected in the biorepository according to the standardized protocol. Annual follow-up for cancer cases and follow-up at the 1st year for benign tumor cases are performing to evaluate treatment effect and progression. Passive follow to see long-term survival will be conducting using record linkage with national data.

RESULTS

The total number recruited in 2010-2011 was 246 epithelial ovarian cancer cases, 362 benign epithelial tumors and 345 controls. We are planning to collect subjects for at least 1,500 sets of ovarian cancer, 2,000 benign tumors and 1,500 controls till 2018.

CONCLUSION

The Ko-EVE will provide unique and important data to probe the etiology and natural history of Korean epithelial ovarian cancer. It will be continued by genomic and proteomic epidemiological analyses and future intervention studies for the prevention of ovarian cancer among Koreans.

Abstract 1181: Association between DNA methylation profile and neo-adjuvant treatment response in breast cancer patients

Epigenetic alterations are common in breast cancer, yet how these modifications contribute to chemotherapy response is poorly understood. This study aimed to define a DNA methylation profile associated with response to neo-adjuvant treatment in breast cancer and to identify possible candidate genes associated with resistance as predictors.

Eleven pre-treatment and 12 post-treatment serum samples with 6 pairs of FFPE tissues were collected in neo-adjuvant chemotherapy with operable and locally advanced breast cancer. Illumina HumanMethylation450K BeadChip technology for serum DNA and Roche Nimblegen Human DNA Methylation 3x720K CpG Island Plus RefSeq Promoter Arrays, MeDIP-chip technology for FFPE DNA were used for simultaneous analysis of 450,000 CpG sites for serum DNA and 27,728 for FFPE DNA, respectively.

Genes generated from pre-treatment samples were compared with those genes obtained from post-treatment samples, which showed differential modulation following neo-adjuvant chemotherapy. Association on 11 pre-treatment serum DNA highlighted 102 genes significantly related to Ki67 level change as the treatment response (p =0.2) after excluding genes changed by neo-adjuvant chemotherapy. Among them, 16 genes showed consistent methylation levels between serum and tissue (hypermethylation including ITIH3, p-value=0.0015, 8.9 fold-change; hypomethylation including ARID3A, p-value=0.0037, 1.4 fold-change). Hypomethylation of DBH, PRDM16, SLC12A7 and VSX2 in pre-treatment serum and tissue DNA were also predicted to another response surrogate measured by the changes of tumor size (p =0.2).

Our study suggests that testing for methylation levels of genes identified in this study may be beneficial in predicting individual patient response to neo-adjuvant therapies.

Citation Format: Ji-Yeob Choi, Taehyun Kim. Association between DNA methylation profile and neo-adjuvant treatment response in breast cancer patients. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1181. doi:10.1158/1538-7445.AM2013-1181

Abstract 2550: A genome-wide association study of breast cancer survival according to molecular subtype in Korean women

Background: Breast cancer is heterogeneous disease according to ethnicity and molecular subtype. In this study, we conducted a genome-wide association study (GWAS) to evaluate the association between susceptibility loci and breast cancer survival by the molecular subtypes which were classified into four subtypes based on estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) in Korean women.

Methods: Analyses included 2,023 invasive breast cancer patients, comprised of ER/PR+ and HER2- (N=1,006), ER/PR+ and HER2+ (N=245), ER/PR- and HER2+ (N=226), ER/PR- and HER2- (N=279), and unknown subtype (N=267), from Seoul Breast Cancer Study (SeBCS). For analyses, 555,117 SNPs were genotyped using Affymetrix SNP Array 6.0 and 2,416,663 SNPs were imputated based on HapMap Phase II (release 22). Cox proportional hazard models adjusted for age, recruited centers, and TNM stage were used to test the association of these SNPs with disease-free survival (DFS) and overall survival (OS) by molecular subtype.

Results: With median follow-up periods of 3.8 years in DFS and 4.0 years in OS, there was significant difference in survival between molecular subtypes tested by log-rank (P&lt;0.0001, Log-rank test). Compared to ‘ER/PR+ and HER2-‘, ‘ER/PR- and HER2+’ and ‘ER/PR- and HER2-’ were associated with a poorer prognosis (HRER/PR- and HER2+ (95% CI)=2.00 (1.35-2.97), HRER/PR- and HER2-=2.37 (1.70-3.29) in DFS and HRER/PR- and HER2+=2.54 (1.50-4.30), HRER/PR- and HER2-=2.59 (1.65-4.08) in OS). By molecular subtypes, we identified 5 SNPs associated with DFS (HRrs161041(PPP2R2B)=2.35 (1.68-3.30) in ER/PR+ and HER2-, HRrs1896346(TBX3)=8.19 (3.52-19.08) in ER/PR+ and HER2+, HRrs1278329(ADAM12)=3.96 (2.23-7.02) in ER/PR- and HER2+, HRrs10894375(NTM)=3.10 (2.02-4.74), HRrs10825036(PCDH15)=2.87 (1.90-4.34) in ER/PR- and HER2-) and 3 SNPs associated with OS (HRrs7659008(LYPLA1P2)=0.20 (0.09-0.39) in ER/PR+ and HER2-, HRrs4750561(CDNF)=0.12 (0.05-0.29), and HRrs4807216(SF3A2)=11.51 (4.30-30.81) in ER/PR- and HER2+) in breast cancer with the level of P-value&lt;1×10−5.

Conclusion: This study suggests that associations between SNPs and survival were heterogeneous according to the molecular subtype of breast cancer. Furthermore, Additional larger studies are needed to replicate these findings.

Citation Format: Nan Song, Ji-Yeob Choi, Hyuna Sung, Keun-Young Yoo, Wonshik Han, Dong-Young Noh, Sei-Hyun Ahn, Daehee Kang. A genome-wide association study of breast cancer survival according to molecular subtype in Korean women. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2550. doi:10.1158/1538-7445.AM2013-2550

Abstract 128: Chronological changes of hormone receptor status in breast cancer by reproductive factors: results from Seoul Breast Cancer Study (SeBCS)

Lifestyle factors have been chronologically changed into western-style in Korea, which may result in the rapid increase of breast cancer incidence. It is plausible reproductive factors through hormonal mechanisms are differentially related to risk of breast cancer subtypes defined estrogen receptor (ER) and progesterone receptor (PR) status. We investigated the differential association of reproductive risk factors on such subtypes and also evaluated the temporal trends between those factors and the subtypes.

Using data of Seoul Breast Cancer Study (SeBCS), a multicenter based case-control study, 3,689 breast cancer patients and 3,870 control subjects were analyzed in this study. The distribution of subtypes among cases was 62.7% of ER+, 37.3% ER-, 53.2% of PR+ and 46.8% PR-, respectively. Reproductive factors including age at menarche, pregnancy history, age at first full term pregnancy, number of children, duration of estrogen exposure before first full term pregnancy (EEBF), duration of lifetime estrogen exposure (LEED), breast feeding history and duration of breast feeding were evaluated on breast cancer risk by hormone receptor status. Multinomial logistic regression and Wald tests for heterogeneity across the subtypes were conducted.

The frequency of PR-positive breast cancer significantly was higher among the women born in 1960s (56.4%) compared to women born in 1940s (41.9%) (p for trend &lt;0.0001). However, there was no significant trend of the distribution in ER-defined breast cancer subtype. Breast cancer risks associated with number of children, EEBF, LEED, duration of breast feeding were different between ER or PR status (all p for heterogeneity &lt;0.05). Those reproductive factors showed a chronological trend according to the birth year groups. EEBF was longer among the women born in 1960s group than women born in 1940s. As the EEBF increased, the risk of breast cancer increased significantly; this association was stronger among PR-positive (OR= 1.96, 95% CI= 1.65 - 2.33 for Q4 vs Q1) than among PR-negative cancer (OR= 1.48, 95% CI= 1.24 - 1.77 for Q4 vs Q1) (p for heterogeneity= 0.0100). LEED was shorter among the women born in 1960s group than women born in 1940s. As the LEED increased, the risk of breast cancer decreased significantly, which is stronger among PR-negative (OR= 0.67, 95% CI= 0.57 - 0.79 for Q4 vs Q1) than among PR-positive cancer (OR= 0.89, 95% CI= 0.76 - 1.05 for Q4 vs Q1) (p for heterogeneity= 0.0014).

Our results suggest that association between the reproductive risk factors and breast cancer risk differs appreciably for breast cancer defined by hormone receptor status. Increasing distribution of PR-positive breast cancer might be attributed to changes of EEBF and LEED.

Citation Format: Seokang Chung, Nan Song, Hyuna Sung, Sue K. Park, Wonshik Han, Dong-Young Noh, Sei-Hyun Ahn, Keun-Young Yoo, Daehee Kang, Ji-Yeob Choi. Chronological changes of hormone receptor status in breast cancer by reproductive factors: results from Seoul Breast Cancer Study (SeBCS). [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 128. doi:10.1158/1538-7445.AM2013-128

Abstract 2557: Genetic variants in microRNA genes and breast cancer risk

microRNA (miRNA) are small noncoding molecules that function as regulators of the genome. Genetic variants in miRNA binding sites and miRNA genes have begun to be evaluated in relation to disease risk; however, no studies have yet comprehensively evaluated miRNA variants in relation to breast cancer risk. Using a two stage study design, and genome-wide association study (GWAS) data, we evaluated genetic variants within 1,425 miRNA genes (±5kb). In Stage 1, a total of 2,213 common genetic variants were evaluated among 2,876 breast cancer cases and 2,285 controls using data from the Shanghai Breast Cancer Genetics Study. Nominally significant associations (P value ≤0.05) were found for 108 variants in 96 genetic loci (r²≥0.6). In Stage 2, 94 variants in 84 loci were evaluated among 2,225 cases and 2,052 controls from the Seoul Breast Cancer Study; nine variants in eight loci had nominally significant associations. In analyses of the two study stages combined, 14 loci had highly significant associations (P value ≤0.01) and 19 additional loci had significant associations (P value ≤0.05) with breast cancer risk, all with consistent directions of association between the two study stages. These 36 variants in 33 loci have been mapped to 16 miRNA genes, many in the promoter regions. Based on our findings, genetic variants in miRNA genes are likely to contribute to breast cancer susceptibility.

Citation Format: Alicia C. Beeghly-Fadiel, Hyuna Sung, Ben Zhang, Ji-Yeob Choi, Ryan J. Delahanty, Jirong Long, Yu-Tang Gao, Wei Lu, Qiuyin Cai, Xiao Ou Shu, Daehee King, Wei Zheng. Genetic variants in microRNA genes and breast cancer risk. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2557. doi:10.1158/1538-7445.AM2013-2557

Seasonal nutrient uptake of plant biomass in a constructed wetland treating piggery wastewater effluent

The surface-flow constructed wetland (CW) located in Nonsan City, South Korea, and constructed as the final stage of a piggery wastewater treatment plant that aims to treat high nutrient content effluent during dry days and stormwater runoff during wet days was monitored from October 2008 to November 2011. This research investigated the seasonal nutrient uptake of plant biomass in the CW and nutrient concentration changes in each treatment region under monsoon and temperate climate conditions. Results showed that the mean total nitrogen removal during summer (June to August) was higher by 13% than in spring (March to May), while total phosphorus removal was higher by 22% in fall (September to November) than in winter (December to February). All plants in the CW reached their maximum biomass coverage and weight in summer and minimum growth in winter. The highest N and P content in plants occurred in September with 583.2 g/m(2) and August with 62.0 g/m(2), respectively. Based on the results, it is recommended that the harvesting of plants should be conducted during the time of the peak nutrient uptake and before the plants release the nutrient content back to the CW. The dependence of nutrient removal efficiency on plants is not so significant. In order to increase the nutrient removal rate by plant uptake, it is suggested that the treatment regions in the CW be covered by plants.

Natural course of noncurative endoscopic resection of differentiated early gastric cancer

BACKGROUND AND STUDY AIMS

Following noncurative endoscopic resection of early gastric cancer (EGC), the patient should be observed when the underlying disease is severe, the patient is elderly, or the patient refuses further treatment. The aim of this study was to analyze the clinical outcomes of patients with differentiated EGC who underwent noncurative endoscopic resection without additional treatment.

PATIENTS AND METHODS

Included patients underwent noncurative endoscopic resection for differentiated EGC without additional treatment at the Asan Medical Center between July 1994 and January 2009. Clinical and oncological outcomes were analyzed.

RESULTS

A total of 159 patients were included in the analysis. The median follow-up period was 33 months (interquartile range [IQR] 22 - 52 months). In total, 40 patients died (25.2 %) - 3 due to stomach cancer, 34 due to other causes, and 3 from unknown causes; the median survival time after endoscopic treatment for these patients was 27.5 months (IQR 13.8 - 48.3 months). Multivariate analysis showed that the rates of underlying disease (P < 0.001) and lymphovascular invasion (P = 0.005) were higher among the 40 patients who died than among the 119 survivors. The overall 3-  and 5-year survival rates were 82.9 % and 77.1 %, respectively; the rates of the patients with lymphovascular invasion were 61.9 % and 42.4 %, respectively, and the rates of patients without lymphovascular invasion were 86.1 % and 81.8 %, respectively (P < 0.001).

CONCLUSIONS

Additional treatment provides fewer benefits to patients who do not have long life expectancies. Additional surgery can be considered for patients with lymphovascular invasion because of its high mortality rate; however, the benefits and risks of surgery should be considered carefully.

Four cases of possible human infections with Delftia lacustris

We report four cases of possible human infections with Delftia lacustris. D. lacustris isolates, which were isolated from blood cultures and bile fluid of patients with underlying diseases such as empyema, renal injury, hepatocellular carcinoma, and renal infarction, were identified using 16S rRNA gene sequencing and biochemical tests. Four D. lacustris isolates did not show the same antimicrobial susceptibility profiles and enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) patterns, indicating their non-clonality.

Pharmacogenetic analysis of pediatric patients with acute lymphoblastic leukemia: a possible association between survival rate and ITPA polymorphism

Genetic polymorphisms are important factors in the effects and toxicity of chemotherapeutics. To analyze the pharmacogenetic and ethnic differences in chemotherapeutics, major genes implicated in the treatment of acute lymphoblastic leukemia (ALL) were analyzed. Eighteen loci of 16 genes in 100 patients with ALL were analyzed. The distribution of variant alleles were CYP3A4*1B (0%), CYP3A5*3 (0%), GSTM1 (21%), GSTP1 (21%), GSTT1 (16%), MDR1 exon 21 (77%), MDR1 exon 26 (61%), MTHFR 677 (63%), MTHFR 1298 (29%), NR3C1 1088 (0%), RFC1 80 (68%), TPMT combined genotype (7%), VDR intron 8 (11%), VDR FokI (83%), TYMS enhancer repeat (22%) and ITPA 94 (30%). The frequencies of single nucleotide polymorphisms (SNPs) of 10 loci were statistically different from those in Western Caucasians. Dose percents (actual/planned dose) or toxicity of mercaptopurine and methotrexate were not related to any SNPs. Event free survival (EFS) rate was lower in ITPA variants, and ITPA 94 AC/AA variant genotypes were the only independent risk factor for lower EFS in multivariate analysis, which was a different pharmacogenetic implication from Western studies. This study is the first pharmacogenetic study in Korean pediatric ALL. Our result suggests that there are other possible pharmacogenetic factors besides TPMT or ITPA polymorphisms which influence the metabolism of mercaptopurine in Asian populations.

Genetic variants in interleukin-2 and risk of lymphoma among children in Korea

To estimate the genetic susceptibility for childhood lymphoma, we conducted an association study for 23 cases and 148 controls. Total 1536 tag single nucleotide polymorphisms (SNPs) were selected in 138 candidate gene regions related to immune responses, apoptosis, the cell cycle, and DNA repair. Twelve SNPs were significantly associated with the risk of lymphoma (P(trend)<0.05) in six genes (IL1RN, IL2, IL12RB1, JAK3, TNFRSF13B, and XRCC3). The most significant association was seen for IL2 variant rs2069762 (OR(TG+GG) vs. TT=3.43 (1.29-9.11), P(trend)=0.002, minP=0.005). These findings suggest that common genetic variants in IL2 might play a role in the pathogenesis of childhood lymphoma.

Prognosis of breast cancer is associated with one-carbon metabolism related nutrients among Korean women

Background

The 5-year survival rate for breast cancer among Korean women has increased steadily; however, breast cancer remains the leading cause of cancer mortality among women. One-carbon metabolism, which requires an adequate supply of methyl group donors and B vitamins, may affect the prognosis of breast cancer. This aim of this study was to investigate the associations of dietary intake of vitamin B₂, vitamin B₆ and folate before diagnosis on the prognosis of breast cancer.

Methods

We assessed the dietary intake using a food frequency questionnaire with 980 women who were newly diagnosed and histopathologically confirmed to have primary breast cancer from hospitals in Korea, and 141 disease progression events occurred. Cox’s proportional hazard regression models were used to estimate the hazard ratio (HR) and 95% confidence interval (95% CI) adjusting for age, education, recruitment sites, TNM stage, hormone status, nuclear grade and total calorie.

Results

There was no significant association between any one-carbon metabolism related nutrients (vitamin B₂, B₆ and folate) and the progression of breast cancer overall. However, one-carbon metabolism related nutrients were associated with disease progression in breast cancer patients stratified by subtypes. In ER + and/or PR + breast cancers, no association was observed; however, in ER–/PR– breast cancers, a high intake of vitamin B₂ and folate statistically elevated the HR of breast cancer progression (HR = 2.28; 95% CI, 1.20-4.35, HR = 1.84; 95% CI, 1.02-3.32, respectively) compared to a low intake. This positive association between the ER/PR status and progression of the disease was profound when the nutrient intakes were categorized in a combined score (P_interaction = 0.018). In ER–/PR– breast cancers, high combined scores were associated with a significantly poor DFS compared to those belonging to the low score group (HR = 3.84; 95% CI, 1.70-8.71).

Conclusions

In conclusion, our results suggest that one-carbon related nutrients have a role in the prognosis of breast cancer depending on the ER/PR status.

DNA methylation in peripheral blood: a potential biomarker for cancer molecular epidemiology

Aberrant DNA methylation is associated with cancer development and progression. There are several types of specimens from which DNA methylation pattern can be measured and evaluated as an indicator of disease status (from normal biological process to pathologic condition) and even of pharmacologic response to therapy. Blood-based specimens such as cell-free circulating nucleic acid and DNA extracted from leukocytes in peripheral blood may be a potential source of noninvasive cancer biomarkers. In this article, we describe the characteristics of blood-based DNA methylation from different biological sources, detection methods, and the factors affecting DNA methylation. We provide a comprehensive literature review of blood-based DNA methylation as a cancer biomarker and focus on the study of DNA methylation using peripheral blood leukocytes. Although DNA methylation patterns measured in peripheral blood have great potential to be useful and informative biomarkers of cancer risk and prognosis, large systematic and unbiased prospective studies that consider biological plausibility and data analysis issues will be needed in order to develop a clinically feasible blood-based assay.

Common genetic variants in the microRNA biogenesis pathway are not associated with breast cancer risk in Asian women

BACKGROUND

Although the role of miRNA in cancer development and progression has been well established, the association between genetic variants in miRNA biogenesis pathway genes and breast cancer risk has been yet unclear.

METHODS

We analyzed data from two genome-wide association studies conducted in East Asian women including 5,066 cases and 4,337 controls. Among the single-nucleotide polymorphisms (SNP), which were directly genotyped or imputed, we selected 237 SNPs in 32 genes involved in miRNA biogenesis pathway and its regulation.

RESULTS

Although eight SNPs were nominally associated with breast cancer risk in combined samples (P < 0.05), none of them were significant after adjustment for multiple comparisons.

CONCLUSIONS

The common genetic variants in miRNA biogenesis pathway genes may not be associated with breast cancer risk.

IMPACT

This study suggests no association between the polymorphisms in miRNA biogenesis pathway genes and breast cancer risk. Studies with large sample size and more genetic variants should be warranted to adequately evaluate the potential association.

Radiological response predicts survival following transarterial chemoembolisation in patients with unresectable hepatocellular carcinoma

BACKGROUND

It remains unclear whether initial compact lipiodol uptake after transarterial chemoembolisation (TACE) is associated with improved survival in patients with hepatocellular carcinoma (HCC).

AIM

To reveal the clinical relevance of compact lipiodolisation after TACE.

METHODS

We studied 490 patients with unresectable HCC who had first been treated with TACE. Compact lipiodolisation was defined as the absence of an arterial enhancing lesion, reflecting complete lipiodol uptake, as assessed by dynamic computed tomography (CT) 1 month after treatment. The rate of initial compact lipiodolisation was analysed according to multiplicity and size of tumour, and survival of patients who achieved compact lipiodolisation was compared to that of patients who did not.

RESULTS

Of the 490 patients, 409 (83.5%) were in Child-Pugh class A and 81 (16.5%) in class B. The rate of initial compact lipiodolisation in single HCCs was higher than that in multinodular HCCs (33.7% vs. 14.6%, P < 0.001). Among single HCCs, the rate of compact lipiodolisation in tumours ≤5, 5-10 and >10 cm was 46.6%, 13.6%, and 0% respectively. The 1-, 3- and 5-year survival rates of patients with compact uptake were 92.7%, 70.7% and 52.4% compared to 60.8%, 28.0% and 16.9% in patients with noncompact lipiodolisation. Multivariate analysis revealed that Child-Pugh class, alpha-fetoprotein level, tumour node metastasis stage, portal vein thrombosis and initial compact lipiodolisation were independent predictors of survival.

CONCLUSIONS

Initial compact lipiodol uptake after transarterial chemoembolisation is associated with improved survival in patients with unresectable hepatocellular carcinoma. Accordingly, initial complete lipiodolisation should be considered a relevant therapeutic target.

The association between the preoperative serum levels of lipocalin-2 and matrix metalloproteinase-9 (MMP-9) and prognosis of breast cancer

Background

Although a number of experimental studies have suggested the role of lipocalin-2 (LCN2) and matrix metalloproteinase-9 (MMP-9) in breast cancer progression, limited numbers of epidemiological studies have examined the relationship between the levels of lipocalin-2 and MMP-9 and breast cancer survival.

Methods

Preoperative serum levels of lipocalin-2 and MMP-9 were measured in 303 breast cancer patients and 74 healthy controls recruited between 2004 and 2007. We examined the association between lipocalin-2 and MMP-9 levels and disease-free survival (DFS) using Cox proportional hazard regression model.

Results

The serum levels of lipocalin-2 and MMP-9 were not significantly different between patients and controls (P > 0.05). Elevated lipocalin-2 and MMP-9 levels were associated with reduced DFS of breast cancer ( P_trend = 0.029 and P_trend = 0.063, respectively). When lipocalin-2 and MMP-9 levels were categorized based on the combined risk score, patients with higher levels of both lipocalin-2 and MMP-9 exhibited poor DFS compared to patients with lower levels (P_trend = 0.004). Furthermore, these effects were profound in patients with BMI less than 25 kg/m² (adjusted hazard ratio (aHR), 3.17; 95% confidence intervals (CI), 1.66-6.06, P_trend < 0.001) or lymph-node negative breast cancer (aHR, 5.36; 95% CI, 2.18-13.2, P_trend < 0.001).

Conclusions

Our study suggests that the elevated levels of lipocalin-2 and MMP-9 are associated with reduced breast cancer survival, particularly in patients with lower BMI and lymph-node negative breast cancers.

Common genetic polymorphisms of microRNA biogenesis pathway genes and breast cancer survival

Background

Although the role of microRNA’s (miRNA’s) biogenesis pathway genes in cancer development and progression has been well established, the association between genetic variants of this pathway genes and breast cancer survival is still unknown.

Methods

We used genotype data available from a previously conducted case–control study to investigate association between common genetic variations in miRNA biogenesis pathway genes and breast cancer survival. We investigated the possible associations between 41 germ-line single-nucleotide polymorphisms (SNPs) and both disease free survival (DFS) and overall survival (OS) among 488 breast cancer patients. During the median follow-up of 6.24 years, 90 cases developed disease progression and 48 cases died.

Results

Seven SNPs were significantly associated with breast cancer survival. Two SNPs in AGO2 (rs11786030 and rs2292779) and DICER1 rs1057035 were associated with both DFS and OS. Two SNPs in HIWI (rs4759659 and rs11060845) and DGCR8 rs9606250 were associated with DFS, while DROSHA rs874332 and GEMIN4 rs4968104 were associated with only OS. The most significant association was observed in variant allele of AGO2 rs11786030 with 2.62-fold increased risk of disease progression (95% confidence interval (CI), 1.41-4.88) and in minor allele homozygote of AGO2 rs2292779 with 2.94-fold increased risk of death (95% CI, 1.52-5.69). We also found cumulative effects of SNPs on DFS and OS. Compared to the subjects carrying 0 to 2 high-risk genotypes, those carrying 3 or 4–6 high-risk genotypes had an increased risk of disease progression with a hazard ratio of 2.16 (95% CI, 1.18- 3.93) and 4.47 (95% CI, 2.45- 8.14), respectively (P for trend, 6.11E-07).

Conclusions

Our results suggest that genetic variants in miRNA biogenesis pathway genes may be associated with breast cancer survival. Further studies in larger sample size and functional characterizations are warranted to validate these results.

Preoperative serum levels of matrix metalloproteinase-2 (MMP-2) and survival of breast cancer among Korean women

BACKGROUND

Matrix metalloproteinase-2 (MMP-2) has been thought of as a predictor of recurrence or metastasis risk or prognostic markers in cancer. We evaluated whether preoperative serum levels of MMP-2 work as a prognostic biomarker in breast cancer prognosis.

METHODS

Preoperative serum levels of MMP-2 were measured with ELISA in 303 patients with histologically confirmed breast cancer. The median follow-up time for all patients was 4.24 years. The relationship of MMP-2 to survival was investigated using Cox proportional hazard regression model adjusted for the tumor-node-metastasis (TNM) stage and estrogen receptor (ER) status.

RESULTS

In the multivariate analysis, disease-free survival (DFS) was worse among patients with the third tertile of MMP-2 level than with the first tertile of MMP-2 level [hazard ratio, 1.80; 95% confidence interval (CI), 1.04-3.11; P = 0.04]. However, when the patients were stratified by age, ER status, histologic grade, and nuclear grade, inverse correlation was shown between serum MMP-2 levels and prognostic factors, and the associations between MMP-2 and DFS were only significant among patients with poor prognostic factors (HR, 2.75; 95% CI, 1.32-5.73 in ER-negative; HR, 2.90; 95% CI, 1.42-5.92 in histologic grade III; and HR, 2.61; 95% CI, 1.26-5.39 in nuclear grade III).

CONCLUSIONS

Our results suggest that the preoperative serum levels of MMP-2 were associated with the survival in patients with breast cancer in ER-negative, higher histologic grade, or higher nuclear grade breast cancers.

IMPACT

Our results indicate that serum levels of MMP-2 may play a role as prognostic biomarker in breast cancer survival.

The effect of donor-recipient relationship on long-term outcomes of living related donor renal transplantation

BACKGROUND

Presensitization to human leukocyte antigen (HLA) tends to decrease renal graft survival. During the pregnancy, fetal blood is frequently exposed to the maternal circulation possibly inducing maternal immunization to paternal HLA inherited by the fetus. In this way, pregnancy may occasionally present a hazard to renal graft survival. In this study, we compared retrospectively graft survivals according to living related donor-recipient pairs.

MATERIALS AND METHODS

From July 1979 to January 2011, 374 patients underwent living related renal transplantation sharing at least one HLA haplotype with their donor. We compared acute rejection and complication rates as well as long-term graft survival according to the donor-recipient paring: child-to-mother, child-to-father, mother-to-child, father-to-child, and one haplotype-matched siblings. All patients received immunosuppressive therapy, consisting of a calcineurin inhibitor, mycophenolate mofetil, or azathioprine and prednisolone.

RESULTS

Twenty-one cases (5.6%) were child-to-father paring; 28 (7.5%), child-to-mother; 179 (47.9%), one-haplotype-matched siblings; 46 (12.3%), father-to-child; and 100 (26.7%), mother-to-child paring. Child-to-father pairing displayed the best graft survival; child-to-mother (hazard ratio [HR] = 1.709, P = .662) and one-haplotype-matched siblings (HR = 6.589, P = .062) showed no significant difference. Father-to-child pares experienced poorer outcomes than child-to-father pairs (HR = 11.579, P = .017) and mother-to-child, the poorest graft survival (HR 17.188, P = .005).

CONCLUSION

Pregnancy continues to be a significant source of presensitization in the course of gestation and after parturition. Graft failure can result from an anamnestic reaction subsequent to intrauterine exposure of the mother to HLA of a fetus due to sensitization.

Abstract 2635: association between CASP7 and CASP14 genetic polymorphisms and the risk of childhood leukemia

Current evidence suggests that apoptosis and the cell cycle system play an important role in cancer development. To identify susceptible genetic markers in these mechanisms, we did an association study in 63 patients and 148 controls. A total of 304 SNPs in 31 gene regions were selected. We evaluated an association at a gene region level by computing the minimum p-value (minP) and doing the false discovery rate (FDR) test. Both SNP and gene-based analyses presented associations with the risk of childhood leukemia for 5 genes: CASP7, CASP14, CASP8AP2, MYC, and RIPK1 (Ptrend &lt; 0.05). There were statistically significant associations for CASP7 (rs12416109 and rs3814231, Ptrend = 0.002 and 0.009, respectively, minP = 0.013, FDR = 0.042) and CASP14 (rs8110862, Ptrend &lt; 0.001, minP = 0.002, FDR = 0.027). This study suggests that genetic polymorphisms in apoptosis and cell cycle related genes might play a role in childhood leukemia development.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2635. doi:1538-7445.AM2012-2635