Adjuvant!, Really Optimal for Korean Early Breast Cancer Patients? Validation in a Single Institution in Korea

Purpose: Adjuvant! (www.adjuvantonline.com) is a widely used web-based program that predicts tailored estimates of 10-year mortality and recurrence risks, and the benefit of adjuvant systemic treatment in early breast cancer. But, in Korea, it had not been used routinely yet to decide to choice for adjuvant therapy. Because Adjuvant! was mainly designed with the Surveillance, Epidemiology, and End-Results (SEER) registry in the United States, it is maybe unreasonable that apply to early breast cancer in Korea without proper validation. This study is planned to validate Adjuvant! program with a data of a single institution in Korea.Methods: Using the Gangnam Severance Hospital database, clinical characteristic, pathologic, and treatment data of 272 patients who diagnosed between 1991 and 1998 with stage I, II breast cancer (total 555 patients) were selected with criteria that less than 10-years of follow-up (n=283) was excluded. And they were calculated for predicted 10-year overall survival (OS), breast cancer-specific survival (BCSS), and event-free survival (EFS) for each patient with Adjuvant! (8.0 version). Also the observed outcomes at 10 years were estimated.Results: Among all 272 patients, the differences of 10-year predicted and observed outcomes were 15.8% (78.8-63.0), 12.4% (78.8-66.4), 12.7% (67.8-55.1) for OS, BCSS, EFS, respectively (all P<.05). Almost subgroups had statistically significant differences between predicted and observed values. Only the subgroup that did not treated by the postoperative radiotherapy had not difference (P>.05). The difference (5.1%) of predictive OS values between the 10-years survival group (184 patients) and dead group (88 patients), the difference (-6.4%) of predictive BCSS values between the 10-years breast specific died group (79 patients) and the others (193 patients), and the difference (4.4%) of predictive EFS values between the 10-years event free survivor group (156 patients) and the others (116 patients) had statistically significant, all. Because of the enormous differences between the predictive outcomes by Adjuvant! and the observed outcomes, we had to verify the differences by comparing outcomes with the Cox's proportional hazards model. The 10-years OS, BCSS, EFS derived by the Cox's model were statistically different with the results by Adjuvant! (all P<.05). More powerful with Adjuvant! to predict the survival rate in who had lived, and more with the Cox's model, to estimate the mortality rate in who had died.Conclusion: The predictive 10-years OS, BCSS, EFS by Adjuvant! for patients who had been diagnosed, treated in Gangnam Severance Hospital as early breast cancer had an enormous differences with the observed outcomes. So it would be inappropriate to apply Adjuvant! with Korean early breast cancer patients. However, there was limitations of this study that used relatively small population for validation of Adjuvant! in a single institution. Therefore, the progress of the further validation study with an adequate population in multi-center will be needed.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6044.

Sentinel Lymph Node Biopsy in Patients Who Have Negative Conversion of Axillary Lymph Node after Neoadjuvant Chemotherapy for Node Positive Breast Cancer

Background: Sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) has been currently debatable. It is possible that the tumor response to chemotherapy may alter the lymphatic drainage thus causing lower SLN identification rate and higher false negative rate. Further, the response of NAC can be different in each lymph nodes. It is doubtful whether SLNB can accurately predict axillary lymph node (ALN) status after NAC. The aim of this study to determine the identification rate, the false-negative rate, and the accuracy of SLNB after NAC for node positive breast cancer.Patients and Methods: A prospective study was initiated to evaluate the results of SLNB after NAC. From January 2007 to April 2009, 81 patients with positive axillary lymph nodes enrolled from two institutions after IRB-approved. They received NAC and then evaluated negative conversion of metastatic lymph node with both PET and breast US. All of them underwent ALN dissection after SLNB with subareolar intradermal injection technique using radioisotope. We evaluated the identification rate, false negative rate, accuracy of SLNB according to the response of chemotherapy in axillary lymph nodes (negative conversion group or remaining positive group).Results: Before the NAC, 31 patients had multiple axillary lymph node metastasis and 50 patients had single metastasis. After NAC 44 cases (54.3%) turned into negative node and 37 cases (45.7%) remained positive nodes. Total identification rate was 80.2% (65 of 81), false negative rate was 19.0% (8 of 42) and accuracy was 87.7% (57 of 65). In negative conversion group showed 84.1% (37 of 44) of identification rate, 21.1% (4 of 19) of false negative rate, 89.2% (33 of 37) of accuracy. In remaining positive group revealed 75.7% (28 of 37) of identification rate, 17.4% (4 of 23) of false negative rate, 85.7% (24/28) of accuracy. There was no statistical significant difference of identification rate, false negative rate, accuracy of SLNB among the two group after NAC (p=0.343, p=0.534, p=0.478, respectively).Conclusion: This study showed relatively low detection rate and accuracy, high false-negative rate of SLNB, even if the positive nodes changed to negative node after NAC. Thus sentinel lymph node biopsy after NAC for node positive breast cancer should be cautious. Since this study had small number of negative conversion patients, further larger prospective studies are required for more proper conclusion.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1022.

Identification and characterization of a novel mouse and human MOPT gene containing MORN-motif protein in testis

A novel testis-derived membrane occupation and recognition nexus (MORN)-motif protein was identified in mouse testis (MOPT) by subtraction screening methods and found to be localized on chromosome 17E3, spanning approximately 7kb. Sequence analysis showed that MOPT contains 669 base pair nucleotides of open reading frame and the corresponding 79 amino acids. The protein is predicted to have theoretical molecular mass of 9000 Da and an expected isoelectric point of 5.8 and seems to have unique sequences except for MORN-motif domain. The transcript of MOPT is highly and specifically expressed in adult testis as well as skeletal muscle. Moreover, MOPT transcript and protein are confined mainly to round and elongated spermatids, except for a few individual dispersed spermatocytes, and increase in abundance at subsequent stages. MOPT first appeared in the proacrosomic vesicles of the early Golgi phase spermatids and was translocated from the head cap of elongated spermatid to the nucleus of mature spermatozoa at the final stage of spermiogenesis. Our study suggests that MOPT may play an important role in dynamic regulation of acrosome biogenesis during late spermiogenesis.

Influence of pretransplantation bacterial and fungal culture positivity on outcome after living donor liver transplantation

BACKGROUND

Bacterial and fungal infections are serious complications in patients with cirrhosis and are among the main causes of morbidity and mortality. The effects of pretransplantation infection on the outcome after orthotopic liver transplantation (OLT), however, have not been fully described.

OBJECTIVE

To assess the influence of pretransplantation infection on OLT by analyzing the clinical profiles of liver recipients with preexisting bacterial or fungal infection.

PATIENTS AND METHODS

We retrospectively reviewed the medical records of 223 adult patients who underwent living donor OLT between October 1, 2005, and September 30, 2006. In all patients, routine blood culture, was performed, and in patients with suspected bacterial or fungal infection; sputum, urine, and ascitic fluid cultures were performed.

RESULTS

Of 223 patients, 37 (16.6%) had a positive culture in one or more samples. Culture-positive and culture-negative groups differed significantly in end-stage liver disease score but showed no differences in Child-Turcotte-Pugh score, existence of spontaneous bacterial peritonitis, hemodialysis, or duration of stay in the intensive care unit or hospital. Six of 37 patients with positive cultures (16.2%) and 4 (2.2%) of 186 patients with negative cultures (2.2%) died during the first 90 days after OLT (P = .007). The causes of death among culture-positive patients were brain edema (n = 2), brain hemorrhage (n = 1), hepatic dysfunction (n = 1), and sepsis (n = 2), whereas all 4 culture-negative patients died of infectious complications.

CONCLUSION

Prompt OLT accompanied by adequate antibiotic or antifungal therapy may be acceptable in patients with preexisting bacterial or fungal infection unless there are overt manifestations of active infection.

Effect of a kappa-opioid agonist, i.v. JNJ-38488502, on sensation of colonic distensions in healthy male volunteers

Kappa-opioid receptors are located on visceral pain fibres. JNJ-38488502 is a highly selective tetrapeptide kappa-opioid agonist with little access to the central nervous system and low risk of central nervous system side effects. The aim of the study was to evaluate the effects of i.v. JNJ-38488502 on sensations, including pain, during colonic distension. In a single-centre study, 23 healthy adult males underwent a single-dose, randomized, double-blind crossover study of JNJ-38488502 (0.42 mg kg(-1) i.v. infusion) vs placebo on left colon compliance, sensory thresholds and ratings during standard distensions. One participant could not undergo sensation studies. In the other 22, JNJ-38488502 increased colonic compliance (pressure at half-maximum volume 17.9 +/- 0.8 mmHg) compared to placebo (21.6 +/- 0.9 mmHg, P = 0.007). There was no significant effect on sensory thresholds which, however, were not reached by 44 mmHg in >50% of participants in both treatment phases. There were no significant treatment effects on sensory ratings to distensions at 8, 16, 24, 32 and 36 mmHg above baseline operating pressure. JNJ-38488502 was associated with increased urine output and plasma prolactin, consistent with kappa-opioid receptor activation. This study concluded that i.v. JNJ-38488502 induced kappa-opioid effects, but did not attenuate colonic sensations following random order colonic distension. Further studies of effects on pain sensations in health and disease are required.

Lobular neoplasia on core biopsy and risk factors to predict upstaging at surgical excision

Abstract #5009

Introduction: Lobular neoplasia (including atypical lobular hyperplasia and lobular carcinoma in-situ) identified on core biopsy (CB) is often recommended for surgical excision because the risk of upstaging to invasive carcinoma is documented to be 0-50%. We sought to identify risk factors to predict upstaging at surgical excisional biopsy.
 Methods: Retrospective chart review was used to identify women with CB revealing lobular neoplasia (LN) as highest risk pathological diagnosis. LN was defined as atypical lobular hyperplasia (ALH) and/or lobular carcinoma in situ (LCIS). Radiologic findings were correlated with pathology and excision results were recorded when available. Follow-up radiologic data was also recorded when available.
 Results: From 1997-2008, 45 women (age ranging from 33 to 81) underwent CB revealing LN. Ten had LCIS only, 34 had ALH only and 1 had both. Twenty five (56%) underwent surgical excision and 20 (44%) were followed clinically and mammographically. Core biopsy was recommended for mammographic microcalcifications (three with associated mass or focal asymmetry) in 29 pts (64%), while 14 CB (31%) were recommended for either mammographic mass or focal asymmetry only. Two CB (4%) were recommended for MRI abnormalities. For patients who underwent surgical excision, 8 (32%) were upstaged to invasive carcinoma or DCIS. Two of these 8 (25%) had LCIS on core biopsy and 6 (75%) had ALH only. Of the 6 pts with ALH only, the original core biopsy was done for focal asymmetry or mass in 3, abnormal MRI in 1 and microcalcifications in the remaining 2 (one with synchronous contralateral carcinoma). Patients not upstaged at surgical excision had original CB done for LCIS only in 5 (31%) and ALH only in 11 (69%). Of these 11 pts with ALH who were not upstaged, 8 underwent original CB for mass, focal asymmetry or MRI finding. Patients with LN on core biopsy done exclusively for mammographic microcalcifications underwent excision only 46% (13/28) of the time. Of those excised 4 were upstaged at surgical excision ( 3 with DCIS and 1 tubular carcinoma). Follow-up mammographic data was available for 65% (13/20) of patients who did not have surgical excision. At median follow-up of 16 months no new biopsies have been recommended and no new lesions have been identified for these patients.
 Conclusion :Of all patients who underwent surgical excision for LN found on core biopsy, 32% had a final diagnosis of either DCIS or invasive cancer. Of the 25 patients who underwent surgical excision, 24 were associated with one of the following risk factors: mass or focal asymmetry on mammogram, LCIS, synchronous contralateral carcinoma and non-concordant core biopsy. We did not identify any significant risk factors to predict upstaging at surgical excision, however, this may be due to selection bias. Further studies with larger number of patients are needed to identify risk factors to predict upstaging at surgical excision.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5009.

Use of whey permeate for cultivating Ganoderma lucidum mycelia

A novel approach to utilizing whey permeate, the cultivation of mycelia of the edible mushroom Ganoderma lucidum, is introduced. The major objective of this research was to use whey permeate as an alternative growth medium for the cultivation of mycelia of edible mushroom G. lucidum and to find an optimum condition for solid-state cultivation. Response surface analysis was applied to determine the combination of substrate concentration (25 to 45 g of lactose/L), pH (3.5 to 5.5), and temperature (25 to 35 degrees C) resulting in a maximal mycelial growth. The radial extension rates, estimated by measuring the diameters of growing colonies on the Petri dishes, were used as the growth of the mycelia at different conditions. In the model, pH and temperature significantly affected mycelial growth, but lactose concentration did not. The condition predicted to maximize the radial extension rate of 17.6 +/- 0.4 mm/d was determined to be pH 4.4 and temperature 29.4 degrees C. Therefore, the results suggest that whey permeate could be utilized as a growth substrate for the cultivation of mycelia from the edible mushroom G. lucidum, enhancing the use of this by-product by the cheese manufacturing industry.

Increased cochlear fluid-attenuated inversion recovery signal in patients with vestibular schwannoma

BACKGROUND AND PURPOSE

Elevated protein levels have been reported in perilymph of patients with vestibular schwannoma. Fluid-attenuated inversion recovery (FLAIR) imaging is sensitive to high protein contents in fluids. The purpose of this study was to investigate if in patients with unilateral vestibular schwannoma, cochlear FLAIR signal intensity on the affected side is increased compared with the unaffected side and control subjects.

MATERIALS AND METHODS

Fifteen patients with unilateral vestibular schwannoma and 25 age-matched control subjects (without a history of hearing loss) were retrospectively evaluated. All patients and controls had routine 5-mm FLAIR and T1- and T2-weighted imaging of the brain. The signal intensity of both cochleae was evaluated by placing a small region of interest on FLAIR images. The signal intensity of the brain stem was also determined by placing a second region of interest. A ratio of cochlear signal intensity to brain stem signal intensity (CIBI ratio) was determined. A t test was used to compare the CIBI ratios.

RESULTS

In patients, the mean CIBI ratio of the affected side was 0.89 +/- 0.18, and that of the unaffected side was 0.57 +/- 0.12. In control subjects, it was 0.51 +/- 0.07. The CIBI ratio of the affected side was significantly higher compared with the unaffected side (P < .001) and compared with control subjects (P < .001).

CONCLUSION

Patients with vestibular schwannoma have increased cochlear FLAIR signal intensity on the affected side compared with the unaffected side and healthy subjects.

Small-sized liver graft does not increase the risk of hepatocellular carcinoma recurrence after living donor liver transplantation

PURPOSE

Following implantation into adult recipients, living donor liver grafts usually undergo liver regeneration. This regeneration process may provoke the growth of occult hepatocellular carcinoma (HCC) cells in the recipient body. To assess the risk of HCC recurrence, we analyzed the influence of graft-recipient weight ratio (GRWR).

METHODS

The 181 recipients with HCC within the University of California at San Francisco (UCSF) criteria were divided into four groups according to GRWR: low GRWR (<0.8; n = 30), mid GRWR (0.8-1.0; n = 65), high GRWR (>1.0; n = 64), and whole liver graft group (>1.5; n = 22).

RESULTS

There were no differences in overall patient survival (P = .105) and recurrence-free survival (P = .406) among these four groups. GRWR <0.8 was not a significant risk factor for HCC recurrence. Similar outcomes were obtained in HCC patients who met the Milan criteria (n = 170).

CONCLUSIONS

We think that small living donor liver graft and subsequent liver regeneration do not increase the risk of posttransplant HCC recurrence when HCC is within the Milan or UCSF criteria.