Peripheral Asymmetry of Cell-Mediated Immunity

Exploring the prognostic impact of tumor sidedness in ovarian cancer: A population-based survival analysis of over 10,000 patients

Very recently, emerging evidence demonstrated that laterality might be an independent prognostic factor in patients with advanced ovarian cancer (OC). Based on preliminary provocative observations, our study aimed to investigate the prognostic impact of sidedness in a large cohort of women with OC. Survival was estimated based on Kaplan-Meier method and survival curves were compared using Log-rank test. Cox proportional-hazards model was used to study the association between survival and covariates. A total of 10,177 women with OC were included. Mean age at diagnosis was 59.58 years (±13.5); 36.7% OC right-sided, 36.9% were left- sided, and 26.4% had bilateral OC. The median overall survival (OS) for the entire population was 77 months, with the lowest median OS observed in bilateral OC (median OS: 34 months). The prognostic value of OC sidedness was not confirmed at the univariable analysis (HR = 0.958; 95% CI: 0.888-1.033, p = 0.268). However, women with bilateral OC has a 45% higher risk of death as compared with unilateral diagnosis (HR = 1.453; 95% CI: 1.410-1.497; p< 0.001). The independent prognostic value was further confirmed on multivarible analysis after adjusting for covariates including age, marital status, histological type, CA-125 at diagnosis, grade, stage, chemotherapy and surgery (HR = 1.087; 95% CI: 1.043-1.136, p = 0.02). However, the ultimate prognostic significance appeared less prominent, with bilateral OC conferring a relative increase of 8.7% of mortality. Our real-world study demonstrated that impact of tumor sidedness has no prognostic implication (right vs left OC) but bilateral OCs might be marginally more prognostically unfavorable. Prospective validation might be warranted, to confirm the prognostic significance of OC sidedness, including for the presence of key genetic alterations and lymph nodes asymmetry, to better stratify patients with OC and predict outcomes according to tumor sidedness at diagnosis.

Variation in risk and outcomes of Epstein-Barr virus-associated breast cancer by epidemiologic characteristics and virus detection strategies: an exploratory study

PURPOSE

A relationship of Epstein-Barr virus (EBV) and breast cancer etiology and outcome may have clinical utility and potential to enhance understanding of tumor biology. Research to date has yielded variable results, likely reflecting differing virus detection assays and unaddressed epidemiologic heterogeneity across studies.

METHODS

Applying our novel, five-target assay detection strategy in an exploratory study, we examined demographic, clinical, and tumor characteristics, and overall survival, associated with EBV positivity in breast adenocarcinomas from 59 non-Hispanic white and 68 Hispanic women sampled by age (<50, 50+) and stage (localized, regional/remote) and examined associations based on single assay targets.

RESULTS

EBV was localized only to lymphocytes. Nevertheless, viral prevalence, although low, varied across patient subgroups. Adjusted odds ratios (OR) for EBV positivity were lower for younger Hispanic than white women (p _interaction = 0.05), and marginally higher for larger [OR (95% confidence intervals) 1.03 (1.00-1.05) per mm increase] and right-sided [2.8 (0.97-7.8)] tumors. In whites, ORs were marginally higher for larger tumors [1.04 (1.00-1.07)] and marginally lower for age 50+ [0.24 (0.06-1.03)]; in Hispanics, ORs were higher for ER negative [5.6 (1.1-30.5)], and marginally higher for right-sided, tumors [5.8 (0.94-36.2)]. Survival was suggestively poorer for EBV-positive than EBV-negative tumors in older women with localized disease. EBV associations differed across single assay targets, indicating variation in prior findings likely due to assay performance.

CONCLUSIONS

The differing EBV associations by age and race/ethnicity suggest a non-random role of EBV in breast cancer and support further study using multi-target assays, relevant epidemiologic design, and a larger study sample.

Predator exposure-induced cerebral interleukins are modulated heterogeneously by behavioral asymmetry

Predator exposure is a naturalistic stressor that is likely to elicit a stressful response pattern similar to those experienced in the real world. As a consequence of stress, HPA hormonal activity and the alteration of mediators such as cytokines may result. Behavioral asymmetry, as assessed by paw preference, exerted effects on immune responses and peripheral cytokine production, observed after exposure to the physical stimuli. Thus, we hypothesized that behavioral asymmetry can modulate mouse brain interleukins and HPA activity after exposure to an internally generated psychological stress source. To determine the impact of behavioral asymmetry, mice were divided into left- and right-pawed groups by paw preference. Then, the mice received either a single 60-min or a daily 60-min predator exposure (cat exposure) for 14 consecutive days. After receiving predator exposure, trunk blood was collected and brain tissues, including the cerebral cortex, hippocampus and hypothalamus, were separated. Plasma corticosterone (CS) was detected by EIA, and IL-1β and IL-6 levels in the cortex, hippocampus and hypothalamus, were quantified by ELISA. The results revealed that predator stress, in particular chronic stress, could enhance plasma CS concentration and could alter IL-1β and IL-6 concentrations in the cortex, hippocampus and hypothalamus. Simultaneously, predator stress-induced CS and brain interleukin levels were modulated by behavioral asymmetry. The left-pawed mice showed a decreased variation in CS, less than right-pawed mice, and both left-pawed and right-pawed mice displayed heterogeneous direction and intensity of changes for IL-1β and IL-6 in the cortex, hippocampus and hypothalamus after predator exposure. From these results, it can be concluded that the alteration of cytokines depends on the characteristics of the stressor. Furthermore, the asymmetric cytokine responses within the brain to a natural, psychological stressor may be involved in the immunomodulation of behavioral asymmetry. These findings likely reflect the flexibility in reactivity patterns of a population in response to various insults.