CA125 Kinetics as a Potential Biomarker for Peritoneal Metastasis Progression following Taxane-Plus-Ramucirumab Administration in Patients with Advanced Gastric Cancer

Currently, no established marker exists for predicting peritoneal metastasis progression during chemotherapy, although they are major interruptive factors in sequential chemotherapy in patients with advanced gastric cancer (AGC). This multicenter retrospective study was conducted from June 2015 to July 2019, analyzing 73 patients with AGC who underwent taxane-plus-ramucirumab (TAX/RAM) therapy and had their serum carbohydrate antigen 125 (CA125) concentrations measured. Of 31 patients with elevated CA125 levels above a cutoff of 35 U/mL, 25 (80.6%) had peritoneal metastasis. The CA125 concentrations before TAX/RAM treatment were associated with ascites burden. The overall survival was significantly shorter in the CA125-elevated group. CA125 kinetics, measured at a median of 28 days after chemotherapy, were associated with the ascites response (complete or partial response: -1.86%/day; stable disease: 0.28%/day; progressive disease: 2.33%/day). Progression-free survival in the CA125-increased group, defined by an increase of 0.0067%/day using receiver operating characteristic curve analysis, was significantly poorer among patients with peritoneal metastases. In conclusion, this study highlights that CA125 kinetics can serve as an early predictor for the progression of peritoneal metastasis during TAX/RAM treatment.

The Efficacy and Safety of Nivolumab Plus mFOLFOX6 in Gastric Cancer with Severe Peritoneal Metastasis

(1) Background: Nivolumab plus chemotherapy is established as a first-line treatment for advanced gastric cancer (AGC). While mFOLFOX6 is commonly used for AGC with severe peritoneal metastasis, the efficacy of nivolumab combined with it remains uncertain. We evaluated the outcomes of nivolumab plus mFOLFOX6 for AGC with severe peritoneal metastasis in clinical practice. (2) Methods: This multicenter retrospective study was conducted between December 2021 and June 2023. We investigated AGC patients with massive ascites or inadequate oral intake due to severe peritoneal metastasis and who received nivolumab plus mFOLFOX6. (3) Results: Among 106 patients treated with nivolumab plus chemotherapy, 21 (19.8%) had severe peritoneal metastasis, with 14 receiving nivolumab plus mFOLFOX6. The median progression-free survival was 7.4 months (95%CI 1.9-10.1), and the median overall survival was 10.7 months (95%CI 5.3-NA), with four patients (28.5%) surviving more than 12 months. Improved ascites and oral intake were observed in 6/14 patients (42.8%) and 10/11 patients (90.9%), respectively. The major grade 3 or more adverse events included leukopenia (28.5%) and neutropenia (21.4%), with no severe immune-related adverse events reported. (4) Conclusions: The safety and moderate efficacy of nivolumab plus mFOLFOX6 were suggested even in AGC patients with severe peritoneal metastasis.

Assessment of maxillary sinus fluid volume for postmortem diagnosis of drowning

INTRODUCTION

Drowning is a comprehensive and exclusive diagnosis at autopsy. Autopsy findings such as pleural effusion and waterlogged lungs contribute to the diagnosis. Herein, we aim to reveal the practical usefulness and postmortem changes of the maxillary sinus fluid volume to diagnose drowning.

METHODS

We evaluated 52 drowning and 59 nondrowning cases. The maxillary sinus fluid volume was measured using a computed tomography (CT) scan, and pleural effusion volume and lung weight were manually measured at autopsy. The utility of these three indices for diagnosing drowning and its postmortem changes was evaluated.

RESULTS

The maxillary sinus fluid volume was significantly higher in drowning cases than in other external causes and cardiovascular death cases. Receiver operating characteristic curve analysis revealed that a total maxillary sinus fluid volume >1.04 mL more usefully indicated drowning (odds ratio, 8.19) than a total pleural effusion volume >175 mL (odds ratio, 7.23) and a total lung weight >829 g (odds ratio, 2.29). The combination of maxillary sinus fluid volume and pleural effusion volume more effectively predicted drowning than one index alone. Moreover, the maxillary sinus fluid volume was less influenced by the postmortem interval than the other two indices up to a week after death.

CONCLUSION

Maxillary sinus fluid volume can be more useful than pleural effusion volume and lung weight with higher sensitivity and odds ratio for diagnosing drowning.

IMPLICATIONS FOR PRACTICE

Fluid accumulation in both the maxillary sinuses strongly predicts drowning in the postmortem imaging.

Comparison of an image cytometry somatic cell count analyzer to a flow cytometry analyzer

The objective of this study was to evaluate the performance of a small footprint benchtop somatic cell counter based on image cytometry (LactiCyte HD; Page and Pedersen International Ltd., Hopkinton, MA) against a flow cytometer employed at a regional dairy herd improvement (DHI) laboratory. Milk samples collected during monthly DHI testing were split into 2 samples. One sample was evaluated using flow cytometry (Bentley SomaCount FCM; Bentley Instruments, Chaska, MN) at the regional DHI laboratory, whereas the other was evaluated using image cytometry at 2 different image levels (full number of images, 16 pictures per slide; half number of images, 8 pictures per slide). Mean bias of the image cytometer at 16 images was -15,500 cells/mL, whereas at 8 images the bias was 21,800 cells/mL. When considering only cell counts ≤400,000 cells per mL, the bias for both imaging resolutions was positive, meaning the image cytometer read higher than the flow cytometer. Both imaging resolutions (16 and 8) had a concordance correlation coefficient greater than 0.95. Considering ≥200,000 cells/mL to be indicative of subclinical mammary gland infection, the sensitivity and specificity of the image cytometer at 16 images were 92.0% and 91.7%, whereas the sensitivity and specificity of the analyzer at 8 images were 92.0% and 85.7%, respectively. Method precision (repeatability; coefficients of variation) were calculated at 3 different somatic cell counts (100,000, 200,000, and 400,000 cells/mL) where each sample was run repeatedly 12 times. When analyzed at the full number of images the coefficients of variation were 16.9%, 11.7%, and 10.9% for 100,000, 200,000, and 400,000 cells/mL, respectively. Analysis at half the number of images resulted in coefficients of variation of 18.9%, 24.8%, and 8.7% for 100,000, 200,000, and 400,000 cells/mL. We conclude that the image cytometer is an acceptable somatic cell count analyzer for on-farm use for applications such as screening cows for microbiological testing, and that precision is superior when the analysis is performed at the full number of images allowed by the instrument.

Liver metastasis affects progression pattern during immune checkpoint inhibitors monotherapy in gastric cancer

Introduction

The efficacy of immune checkpoint inhibitors (ICIs) is heterogeneous at each metastatic site, and tumor progression pattern is associated with survival; however, it remains unclear in gastric cancer (GC). Therefore, we aimed to clarify the progression pattern in response to ICIs in patients with GC, and we analyzed its mechanism focusing on the intratumoral immune cells.

Methods

Patients who received ICIs were retrospectively classified into non-systemic and systemic progression groups based on their radiological assessments. Moreover, the best percentage change in target lesions from each organ was compared.

Results

Among 148 patients, the non-systemic progression group showed a significant improvement in overall survival (OS) compared with the systemic progression group (median, 5.6 months vs. 3.3 months; HR, 0.53; 95%CI, 0.32-0.89; p = 0.012). Poor performance status (HR, 1.73, 95%CI, 1.00-2.87) and systemic progression (HR, 3.09, 95%CI, 1.95-4.82) were associated with OS. Of all metastatic sites, the liver showed the poorest percentage change, and liver metastasis (OR, 2.99, 95%CI, 1.04-8.58) was associated with systemic progression. Hence, intratumoral CD8+ T-cell density was lower in patients with liver metastasis than in those without liver metastasis after ICIs, although the density of CD4+ T-cells (Th1, Th17, and Treg) and CD163+ cells (TAM) were not significantly different.

Conclusion

The new progression pattern was associated with OS in GC. Liver metastasis may be a predictive factor of systemic progression during ICIs by regulating intratumoral CD8+ T-cells.

Clinical significance of CA125 in unresectable pancreatic cancer treated with first-line chemotherapy

745

Background: Serum CA125 is a potential biomarker for diagnosis of peritoneal metastasis in gastric cancer. However, its significance of pancreatic cancer (PC) has not been investigated. Therefore, we aimed to clarify association between serum CA125 and ascites burden, and its kinetics during first-line chemotherapy for PC. Methods: This multicenter retrospective study comprised PC patients who received FOLFIRINOX or gemcitabine plus nab-paclitaxel in first-line setting between Jan 2014 and Dec 2021. Patient background and treatment outcome was assessed in CA125 elevated and non-elevated group before chemotherapy. The CA125 kinetics after chemotherapy was calculated based on baseline and first measure of CA125. Further, the association between early CA125 change and clinical response during chemotherapy were evaluated based on optimal cut off value calculated receiver operating characteristic (ROC) curve analysis. Results: A total 109 patients from 3 hospitals were assessable. The overall survival (OS) was significantly shorter in elevated group than that in non-elevated group (median, 10.7 vs. 21.3 months, p = 0.0002). The median value of CA125 before chemotherapy was elevated according to ascites burden (Non, 36U/ml; mild, 173U/ml; moderate/severe, 575U/ml; p < 0.0001). CA125 elevation, CA19-9 elevation, poor performance status and poor glasgow prognostic score were independent prognostic factors in multivariate analysis. After chemotherapy, the median first-time measure of CA125 was performed in day 41. Among patients with peritoneal dissemination, the median change of CA125 was correlated with clinical response (CR/PR, -0.55%/day; SD, -0.24%/day; PD, 3.35%/day, p = 0.004). After chemotherapy, first-time measure of CA125 was performed in a median of day 41. According to the ROC curve analysis, the optimal cut-off value of increase in CA125 for progressive disease was 1.56 %/day (specificity 94.1%, sensitivity 80%). The median PFS and OS were 1.4 and 6.6 months in increased group and 3.3 months and 14.0 months in non-increased group, respectively (p = 0.016 and p = 0.028). Conclusions: CA125 is considered a clinically useful marker in unresectable PC treated with first-line chemotherapy because CA125 above the ULN is a poor prognostic factor for OS and an increased CA125 can be an early predictor of progression in patients with peritoneal dissemination.

CA125 kinetics as a potential biomarker of prognosis in nivolumab monotherapy for patients with advanced gastric cancer and peritoneal metastasis

445

Background: The ascites develop in large proportion of patients during salvage-line chemotherapy for advanced gastric cancer (AGC). Serum CA125 is reported to be potential biomarker in peritoneal metastasis and associate with prognosis in first-line treatment for AGC. Therefore we aimed to clarify the association between serum CA125 and therapeutic efficacy for AGC treated with third of later-line nivolumab monotherapy (Nivo). Methods: This multicenter retrospective study comprised AGC patients who received Nivo in third line or later setting between Jun. 2015 to May 2019. Patient background and treatment outcome was assessed in CA125 elevated and non-elevated group before Nivo (cut-off, 37 U/ml). The CA125 kinetics after chemotherapy was calculated based on baseline and first measure of CA125. Further, the association between CA125 kinetics and ascites burden during chemotherapy were evaluated based on optimal cut off value calculated receiver operating characteristic (ROC) curve analysis. Results: A total 50 patients from 5 hospitals were assessable. The proportion of poor PS, moderate/severe peritoneal effusion, low albumin was significantly larger in CA125 elevated group (n=29) than those in non-elevated group. The median value of CA125 before Nivo was elevated according to ascites burden (none, 31.0 U/ml; mild, 49.4 U/ml; moderate/severe, 187.0 U/ml; p<0.001). The overall survival was significantly shorter in elevated group than that in non-elevated group (median, 3.2 vs. 9.4 months, p=0.035). After Nivo, first-time measure of CA125 was performed in a median of day 27. The median change of CA125 was correlated with ascites response (CR/PR, 0.04%/day; SD, 2.06%/day; PD, 4.17 %/day, p=0.013). ROC curve analysis showed that the optimal cut-off value of CA125 kinetics for ascites progression was 2.4%/day (specificity 75%, sensitivity 70%). The progression free survival in increased group was significantly shorter than that of non-increased group in patients with peritoneal dissemination (median, 1.4 vs 3.3 months, p=0.016). Conclusions: The serum CA125 before Nivo was associated with ascites burden. Further, CA125 kinetics after Nivo was associated with prognosis in AGC patients with peritoneal dissemination.

CA125 kinetics as a potential biomarker for ascites progression during taxane plus ramucirumab therapy in patients with advanced gastric cancer

437

Background: Ascites and peritoneal metastases are major interruptive factors in sequential chemotherapy for advanced gastric cancer (AGC), although there are no established markers that predict ascites burden during treatment. Therefore, we aimed to clarify the association between serum CA125 and therapeutic efficacy for AGC treated with taxane plus ramucirumab (TAX/RAM). Methods: This multicenter retrospective study comprised AGC patients who received TAX/RAM in second or third line setting between Jun. 2015 to May 2019. Patient background and treatment outcome was assessed in CA125 elevated and non-elevated group before TAX/RAM (cut-off, 37 U/ml). The CA125 kinetics after chemotherapy was calculated based on baseline and first measure of CA125. Further, the association between early CA125 change and ascites burden during chemotherapy were evaluated based on optimal cut off value calculated receiver operating characteristic (ROC) curve analysis. Results: A total 73 patients from 5 hospitals were assessable. The proportion of poor PS, moderate/severe peritoneal effusion, low albumin was significantly larger in CA125 elevated group (n=31) than those in non-elevated group. The median value of CA125 before TAX/RAM was elevated according to ascites burden (none, 37.5 U/ml; mild, 57.9 U/ml; moderate/severe, 134.8 U/ml; p<0.001). The overall survival was significantly shorter in elevated group than that in non-elevated group (median, 8.2 vs. 14.6 months, p=0.0004). Baseline CA125 elevation and peritoneal metastasis were independent prognostic factors in multivariate analysis. After TAX/RAM, first-time measure of CA125 was performed in a median of day 28. The median change of CA125 was correlated with ascites response (CR/PR, -1.86%/day; SD, 0.28%/day; PD, 2.33 %/day, p<0.001). ROC curve analysis showed that the optimal cut-off value of CA125 kinetics for ascites progression was 0.0067%/day (specificity 74%, sensitivity 100%). The progression free survival in increased group was significantly shorter than that of non-increased group in patients with peritoneal dissemination (median, 2.5 vs 6.1 months, p=0.0008). Conclusions: The serum CA125 before TAX/RAM was associated with ascites burden. Further, early change of CA125 after TAX/RAM was associated with prognosis in AGC patients with peritoneal dissemination. CA125 monitoring may be biomarker in determining timing of treatment change.

A multicenter retrospective cohort study evaluating the clinical significance of CA125 in later line of patients with metastatic colorectal cancer

253

Background: The peritoneal dissemination is one of the metastatic forms of gastrointestinal cancer and has a poor prognosis. It has been reported that the presence of CA125 in mesothelial cells lining the peritoneum is involved in the elevation of CA125 due to peritoneal dissemination and inflammation of cancerous ascites, and CA125 may be a useful predictor of peritoneal dissemination in gastrointestinal cancer. It has also been reported that CA125 correlates with ascites volume and prognosis. However, there are no reports evaluating the clinical significance of CA125 in the later line of metastatic colorectal cancer (mCRC). Therefore, we conducted a multicenter retrospective study. Methods: We retrospectively analyzed the clinical data of 121 patients who received trifluridine/tipiracil (FTD/TPI) or Regorafenib from January 2012 to May 2018 in 10 centers and had the result of serum CA125 just before the treatment. Patients who had received either FTD/TPI or Regorafenib were excluded. In this study, the levels of ascites were classified as follows: "none" as undetectable by computed tomography scanning, "mild" as confined to the pelvic cavity or upper abdomen, "severe" as continuous from the pelvic cavity to the upper abdomen, and "moderate" as between "mild" and "severe". RECIST ver.1.1 was used for analysis of tumor response. Survival analyses were performed with Kaplan-Meier method, log-rank test and Cox proportional hazards model. Results: There were 75 patients in the baseline CA125 normal group (group N) and 46 patients in the high group (group H). ECOG PS tended to be worse in group H than in group N (ECOG PS (0/1/2) 26/43/6 and 9/28/9 in N and H groups, p=0.076). There were significantly more patients with ascites in group H than in group N (Yes/No 7/68 and 26/20 in N and H groups, p<0.001). Furthermore, ALP, CRP, CA19-9 and NLR were significantly higher, and Alb was significantly lower in group H than in group N. Baseline CA125 correlated with baseline ascites volume (p<0.001). PFS and OS were significantly shorter in group H compared to group N (PFS; 1.9 vs. 3.0 months; HR 1.576 [95%CI 1.081-2.299]; p=0.016, OS; 4.1 vs. 11.0 months; HR 2.418 [95%CI 1.634-3.576]; p<0.001). The rate of change for CA125 was significantly higher in patients with progressive disease on first evaluation CT compared to patients with disease control (p=0.002), and PFS and OS were significantly shorter in the increased CA125 group measured first after treatment than in the non-increased CA125 group (PFS; 1.9 vs. 4.6 months; HR 3.104 [95%CI, 2.004-4.809]; p<0.001, OS; 5.9 vs. 13.0 months; HR 2.199 [95%CI, 1.474-3.282]; p<0.001). Conclusions: In this retrospective analysis, baseline CA125 correlated with ascites volume in later line treatment of patients with mCRC, suggesting that increased CA125 may be a predictive and prognostic factor. Clinical trial information: UMIN000040059 .

Estimation of brain natriuretic peptide values from N-terminal pro brain natriuretic peptide levels and other factors

Funding Acknowledgements

Type of funding sources: None.

Backgrounds

Both brain natriuretic peptide (BNP) and N-terminal proBNP (NT-pro BNP) are established biomarkers that are necessary in the diagnosis and management of heart failure (HF). Recently with the introduction of angiotensin receptor-neprilysin inhibitor in the treatment of HF, the course of HF is now assessed using NT-ProBNP levels1). However, it is difficult to infer BNP concentration from NT-proBNP levels for a physician who is familiar with BNP. Generally, simultaneous measurement of BNP and NT-proBNP is not permitted in medical insurance.

Purpose

To estimate BNP concentration from NT-proBNP levels and other factors as an equivalent prognostic strength compared to the actual BNP concentration.

Methods

From August 2021 to October 2021, we measured BNP and NT-proBNP levels of patients who were known or suspected to have HF (n=200). We created a formula for estimating BNP concentration from the data of NT-proBNP, age, body mass index (BMI), white cell counts, hemoglobin (Hb), estimated glemerular filtration rate) (eGFR) and C-reactive protein (CRP) using multivariate analysis.

Results

Patients’ background were as follows: age 66.4±23.6 years, male /female : 112/88 , BMI: 23.1±5.2 kg/m2, Hb level: 12.3±2.2 g/dL, albmine level: 3.7±0.7 g/dL, eGFR level: 63.3±27.0 mL/min/1.73m², CRP level; 1.80±4.67 mg/dL, BNP level: 103.3±207.9 pg/mL, NT-proBNP level: 1,505.1±3,479.6 pg/mL (mean ± SD). There was a strong correlation between BNP concentration and NT-proBNP level when using actual measured values (r= 0.84) and when using log-transformed values (r=0.92) in these patients.Using multiple regression analysis, we created an equation that estimated

LogBNP=-0.864+0.734×LogNT-proBNP+0.005×age-0.003×eGFR-0.009×BMI+0.016×CRP (R²=0.89).

Conclusion

This equation will be useful, especially for a physician who is not familiar with NT-proBNP. Testing BNP concentrations were reliably estimated from an equation featuring NT-proBNP, eGFR, age, BMI and CRP2),3),4).

U-shaped plastic optical fiber sensor for scale deposition in hot spring water

Fiber optic sensors for monitoring scale deposition in geothermal brine and hot spring water should be safe, easily fabricated, and readily disposable. These desired features already have been enhanced in plastic optical fibers (POFs) and U-shaped sensors for other applications. The present work reports a U-shaped POF sensor for CaCO₃ scale deposition. The sensors were easily fabricated by thermally bending the bulk POF without removing the cladding. At the bend, the percentage of total internal reflection between the water and the POF surface is affected by the high refractive index of the CaCO₃ deposit. The optical responses of the U-shaped sensor to CaCO₃ formation were investigated in a mixture of calcium chloride dehydrate and sodium hydrogen carbonate using a white-light source and a spectroscopic detector. The sensor was responsive to CaCO₃ formation on the sensor surface and was especially sensitive at small bending radii. The sensitivity was further enhanced by increasing the number of bends. Finally, the U-shaped POF sensor was applied to the monitoring of CaCO₃ scale deposition in hot spring water sampled at Matsushiro, Japan.

Factors, Including Clinical Trial Eligibility, Associated with Induction of Third-Line Treatment for Advanced Gastric Cancer

INTRODUCTION

Third-line chemotherapy has been suggested to improve survival in patients with gastric cancer. This study aimed to identify factors associated with the induction of third-line chemotherapy for advanced gastric cancer, focusing on patient eligibility for clinical trial.

METHODS

We retrospectively analyzed 335 patients treated for unresectable or recurrent gastric cancer between April 2009 and May 2020. The patients were grouped into those that met the key eligibility criteria for clinical trial (136 patients, 40.6%) and those that did not (199 patients, 59.4%) before receiving first-line chemotherapy.

RESULTS

The overall survival (OS) was 16.8 months (95% CI: 14.0-19.6) and 9.3 months (95% CI: 7.8-11.0) in the eligible and ineligible group, respectively. Multivariate analyses to identify the risk factors associated with the induction of third-line chemotherapy revealed ineligibility of clinical trial (OR 1.95; 95% CI: 1.15-3.31), number of metastatic sites (OR 1.99; 95% CI: 1.23-3.22), low albumin concentration (OR 2.24; 95% CI: 1.14-4.38), and a lack of complete or partial response to first-line treatment (OR 1.85; 95% CI: 1.05-3.26). Indeed, in responders to first-line treatment for ineligible patients, the median OS was 17.7 months (95% CI: 10.6-27.9), respectively.

CONCLUSIONS

Treatment outcomes were different for those eligible for clinical trials and those who were not. However, this study suggested that patients who responded to first-line treatment have more favorable prognosis when treated with salvage chemotherapy, even if they were deemed ineligible for clinical trials.

Proton-electron-coupled functionalities of conductivity, magnetism, and optical properties in molecular crystals

Proton-electron-coupled reactions, specifically proton-coupled electron transfer (PCET), in biological and chemical processes have been extensively investigated for use in a wide variety of applications, including energy conversion and storage. However, the exploration of the functionalities of the conductivity, magnetism, and dielectrics by proton-electron coupling in molecular materials is challenging. Dynamic and static proton-electron-coupled functionalities are to be expected. This feature article highlights the recent progress in the development of functionalities of dynamic proton-electron coupling in molecular materials. Herein, single-unit conductivity by self-doping, quantum spin liquid state coupled with quantum fluctuation of protons, switching of conductivity and magnetism triggered by the disorder-order transition of deuterons, and their external responses under pressure and in the presence of an electric field are introduced. In addition, as for the functionalities of proton-d/π-electron coupling in metal dithiolene complexes, magnetic switching with multiple PCET and vapochromism induced by electron transfer through hydrogen-bond (H-bond) formation is introduced experimentally and theoretically. We also outlined the basic and applied issues and potential challenges for development of proton-electron-coupled molecular materials, functionalities, and devices.

Lesion-level response to immune checkpoint inhibitor in patients with advanced gastric cancer

311

Background: The efficacy of anti-PD-1 monotherapy has been reported to be heterogeneous in each metastatic location in non-small cell lung cancer. Therefore, we analyzed the response of target lesions in each organ and the association between pattern of progression and survival in patients with gastric cancer (GC). Methods: We performed retrospective analysis, which include 148 patients with GC who received nivolumab or pembrolizumab treatment between 2017 and 2021 at eight institutions in Japan. Response rate (RR), progression free survival (PFS), and overall survival (OS) were evaluated in total patients. The percent change of target lesions of each organs was measured by CT using RECIST, and their best percent changes were compared. In the GC patients with best response of progression disease (PD), the association between pattern of progression and survival was analyzed. Systemic progression was defined as PD in two or more lesions including target or non-target lesions, and non-systemic progression was defined as PD in only one lesion. Results: Among 148 patients, the RR, median PFS, and median OS were 11.6%, 1.6 months (95%CI, 1.4-1.9), and 4.4 months (95%CI, 3.6-6.6), respectively. A total of 293 lesions from 112 patients with target lesions were examined. The median best percent change of lymph node (n = 76), liver (n = 62), peritoneum (n = 19) and lung (n = 8) was +2.3%, +27%, +12%, +8.5%, respectively. Liver had significantly the lowest responses compared with lymph node and peritoneum (p < 0.0001 and p = 0.016). The median OS in non-systemic and systemic progression group was 5.6 months (95%CI, 3.6-8.8) and 3.3 months (95%CI, 1.9-3.6) and survival of patients with non-systemic progression showed significantly longer than that of systemic progression (p = 0.012). According to univariate and multivariate analysis, poor performance status (PS) (HR 1.73, 95%CI, 1.00-2.87) and systemic progression (HR 3.09, 95%CI, 1.95-4.82) were associated with OS in total patients. Additionally, liver metastasis (OR 2.99, 95%CI, 1.04-8.58) was identified as a baseline factor associated with systemic progression in the univariate and multivariate analysis. Conclusions: The efficacy of immune checkpoint inhibitor (ICI) is dependent on the metastatic location. Moreover, pattern of progression has been associated with overall survival. Liver metastasis might be a predictive factor of systemic progression in ICI treatment for GC.

Design and Synthesis of a C3 Symmetrical Phenalenyl Derivative with Three Oxo Groups by Regioselective Deoxygenation/Oxygenation

Tri-tert-butylated 4,7-dihydroxyphenalenone was designed and synthesized from a corresponding 4,9-dimethoxyphenalenone derivative by regioselective deoxygenation/oxygenation. The 4,7-dihydroxyphenalenone derivative showed a chromic behavior accompanied by protonation and deprotonation, giving monocation and dianion species, respectively, and their C₃ symmetric electronic structures were elucidated by experimental and theoretical methods.

Construction and commissioning of mid-infrared self-amplified spontaneous emission free-electron laser at compact energy recovery linac

The mid-infrared range is an important spectrum range where materials exhibit a characteristic response corresponding to their molecular structure. A free-electron laser (FEL) is a promising candidate for a high-power light source with wavelength tunability to investigate the nonlinear response of materials. Although the self-amplification spontaneous emission (SASE) scheme is not usually adopted in the mid-infrared wavelength range, it may have advantages such as layout simplicity, the possibility of producing a single pulse, and scalability to a short-wavelength facility. To demonstrate the operation of a mid-infrared SASE FEL system in an energy recovery linac (ERL) layout, we constructed an SASE FEL setup in cERL, a test facility of the superconducting linac with the ERL configuration. Despite the adverse circumstance of space charge effects due to the given boundary condition of the facility, we successfully established the beam condition at the undulators and observed FEL emission at a wavelength of 20 μm. The results show that the layout of cERL has the potential for serving as a mid-infrared light source.

Synthesis and Physical Properties of Trioxotriangulene Having Methoxy and Hydroxy Groups at α-Positions: Electronic and Steric Effects of Substituent Groups and Intramolecular Hydrogen Bonds

New 4,8,12-trioxotriangulene (TOT) neutral radical derivatives having three methoxy and hydroxy groups at the α-positions were synthesized, and the substituent effects on the electronic spin and redox properties were elucidated in the theoretical and experimental methods. Due to the small SOMO coefficients at the α-positions of TOT, the methoxy groups in the TOT neutral radical had negligible effects on the electronic spin structure and redox ability. On the other hand, methoxy groups greatly increased the LUMO energy having large coefficients at α-positions and, thus, caused a remarkable negative-potential shift of the redox wave of anion species involving the dianion and trianion species. Converting the methoxy groups to hydroxy groups caused a dramatic change in the electronic structure of TOT, where the intramolecular hydrogen bonds between hydroxy groups and oxo groups strongly attracted a minus charge on the TOT skeleton. The HOMO energy of the monoanion species was significantly reduced, causing a blue shift of the HOMO-LUMO transition and an anodic shift of the redox potential. In addition, due to the steric repulsion smaller than that of the methoxy group, the hydroxy derivative showed a more planar molecular structure and a strong π-stacking ability.

Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run

We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.

Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run

We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.

Prognosis of Immune-related Adverse Events in Patients With Advanced Gastric Cancer Treated With Nivolumab or Pembrolizumab: A Multicenter Retrospective Analysis

BACKGROUND

Immune-checkpoint inhibitors (ICI), including nivolumab and pembrolizumab, are among the standard treatments for previously treated advanced gastric cancer (AGC). This study aimed to evaluate the frequency of immune-related adverse events (irAEs) and the correlation between irAEs and their efficacy in AGC cases.

PATIENTS AND METHODS

Patients were divided into two groups according to irAE occurrence. The frequency of irAEs and the treatment outcome (response rate [RR], progression-free survival [PFS], and overall survival [OS]) were evaluated. The survival rates were evaluated by landmark analysis considering lead-time bias.

RESULTS

Among 108 patients who received nivolumab or pembrolizumab, 17 (15.7%) had irAEs. In a 4-week landmark analysis, the RR, median PFS, and median OS were 28.5%, 3.9 months (95% CI=2.8-9.3), and 12.2 months (95% CI=3.8-NA) in patients with irAEs, while 3.0% (2/65), 1.8 months (95% CI=1.4-2.1), and 3.5 months (95% CI, 2.9-5.1) in patients without irAEs, respectively. In multivariate analysis, irAEs were associated with better PFS (HR=2.08, 95% CI=1.34-3.21).

CONCLUSION

The occurrence of irAEs was associated with a better clinical outcome of ICIs in patients with AGC.

Phase II trial of docetaxel and ramucirumab combination therapy as second-line treatment in patients with metastatic or advanced gastric cancer (HGCSG1903)

TPS4152

Background: Paclitaxel and ramucirumab combination therapy had become a standard regimen in the second-line treatment of advanced gastric cancer, since RAINBOW trial showed paclitaxel and ramucirumab combination therapy increased overall survival compared with paclitaxel monotherapy. However, the incidence of neuropathy in paclitaxel and ramucirumab combination therapy has been reported 70.6% and 38.3% in Japanese and western patients, and the toxicity sometimes disturbs treatment continuation. Whereas docetaxel monotherapy used to be one of standard second-line treatment of advanced gastric cancer as well as paclitaxel monotherapy because the phase III trial, COUGAR-2 showed clinical benefit of docetaxel monotherapy. In addition, the combination therapy of docetaxel and ramucirumab was reported to cause neuropathy at an incidence of 21.3% in patients with lung cancer. Based on these results, we hypothesized that the combination therapy of docetaxel and ramucirumab for patients with gastric cancer could be as effective as the paclitaxel and ramucirumab combination therapy and could reduce the incidence of neuropathy. Therefore, we planned to develop new combination chemotherapy with docetaxel and ramucirumab for advanced gastric cancer. Methods: To evaluate efficacy and safety of docetaxel and ramucirumab combination therapy, HGCSG1903 study started as a multicenter, non-randomized, single arm, prospective, phase II study in November 2020. The patients with metastatic gastric adenocarcinoma that were refractory or intolerant to initial chemotherapy are eligible. Docetaxel and ramucirumab combination therapy is administered as follows; an intravenous infusion of docetaxel at 60 mg/m2 on day 1, an intravenous infusion of ramucirumab at 8 mg/kg on day 1 and day 15 of each 4-week cycle is performed. The therapy is repeated until disease progression, unacceptable toxicity, or patient refusal. The primary endpoint is response rate, and the secondary endpoints are overall survival, progression-free survival, safety, and dose intensity for each drug. The response rate is calculated based on the RECIST version 1.1 criteria. Adverse events are evaluated using the CTCAE v5.0 criteria. A hypothesis test of binary probability was performed, with condition that threshold of response rate was set to 10.7% of docetaxel monotherapy in phase III trial and the expected response rate was set to 27.9% of paclitaxel and ramucirumab combination therapy in RAINBOW trial. A minimum number of cases that achieved a detection power of 80% at a one-sided significance level of 5% was calculated to be 32 cases. In anticipation of dropouts, the total number of registration cases was set to 35. Sixteen institutions are participated, and the registration period is 2 years. This study is registered with Japan Registry of Clinical Trials (jRCTs011200010). Clinical trial information: jRCTs011200010.

Effect of Alkyl Chain Length on Charge Transport Property of Anthracene-Based Organic Semiconductors

Anthracene, a simple planar building block for organic semiconductors, shows strong intermolecular interactions and exhibits strong blue fluorescence. Thus, its derivatives have a great potential to integrate considerable charge carrier mobility and strong emission within a molecule. Here, we systematically studied the influence of alkyl chain length on the crystal structures, thermal properties, photophysical characteristics, electrochemical behaviors, and mobilities for a series of 2,6-di(4-alkyl-phenyl)anthracenes (C_n-Ph-Ants, where n represents the alkyl chain length). Among them, C_n-Ph-Ants (n = 0, 1, 2, and 3) display similar layered herringbone (LHB) packing motifs, which facilitate two-dimensional charge transport and thereby enables high-performance organic field-effect transistors (OFETs). All C_n-Ph-Ants exhibit similar work functions and show strong blue fluorescence with photoluminescence quantum yields (PLQY) of approximately 40% in toluene. In addition, the absolute powder PLQYs of C₀-, C₂-, C₃-, C₄-, and C₆-Ph-Ants are 24.6, 8.2, 5.7, 10.9, and 8.6%, respectively. Note that the alkyl chain length shows a significant effect on the charge mobilities of C_n-Ph-Ants. Our newly synthesized C₁-, C₃-, and C₄-Ph-Ants show hole mobilities of up to 2.40, 1.34, and 1.00 cm² V^-1 s^-1, respectively, with mobilities of 3.40, 1.57, and 0.82 cm² V^-1 s^-1 for C₀-, C₂-, and C₆-Ph-Ants, indicating an increasing tendency of mobility with shorter alkyl chain length. This feature is related to the microstructures of the thin films, which reveal the enhanced film order, crystallinity, and grain size with a decrease in the alkyl chain length. Moreover, we theoretically analyze the intermolecular transfer integrals of HOMOs, which increase at T-shaped contacts as the alkyl chain length decreases, which improves the intermolecular charge transport properties, leading to the increases in mobility. Interestingly, the anisotropy of the transfer integral tends to decrease upon substitution with longer alkyl chains, suggesting that alkyl chain adjustments may facilitate isotropic charge transport property in 2,6-alkylated anthracenes.

[A case of Lemmel syndrome caused by food residue in giant juxtapapillary diverticulum]

A woman in her 70s was admitted to our hospital because of epigastric pain and anorexia. Laboratory evaluations revealed elevated levels of liver transaminases, biliary enzymes, and amylase. CT and MRCP showed dilatation of the bile and pancreatic ducts and a large juxtapapillary diverticulum filled with contents. There were no gallstones or tumors present. Our differential diagnosis included obstruction of the papilla of Vater, so we performed an urgent ERCP. Endoscopic examination showed the juxtapapillary diverticulum filled with food residue;however, we were unable to locate the papilla of Vater. We rinsed out and removed food residue from the diverticulum using a retrieval balloon catheter used for gallstones. After the endoscopic removal of the food residue, the patient's epigastric pain immediately subsided and her cholangitis and pancreatitis improved gradually.

Prognostic impact of immune-related adverse events with nivolumab in patients with advanced gastric cancer: A multicenter retrospective analysis

347

Background: Nivolumab was established as one of the standard treatments for previously treated advanced gastric cancer (AGC). The aim of this study is to evaluate the frequency of immune-related adverse events (irAEs) with Nivolumab and its impact on treatment efficacy in clinical practice. Methods: We performed multicenter retrospective analysis, which included 90 patients with advanced gastric cancer who received Nivolumab treatment between October 2017 and September 2019. The frequency of irAEs and its treatment outcome were evaluated, and survival was compared during Nivolumab treatment. Results: The characteristics of 90 patients in this analysis were as follows: median age (range), 68 (36-85); male/female, 56/34; ECOG PS 0-1/≥2, 62/28; number of metastatic sites 1/≥2, 36/56; treatment line 3/≥4, 63/27. Median treatment cycle of nivolumab treatment was 3 (range 1-26). The overall response in 68 patients with target lesions was 6.3% (4/68), and the median PFS and OS was 1.5 and 4.3 months, respectively. IrAEs were observed in 8 patients (8.8%), including grade 4 pneumonitis, grade 2 or 3 adrenal insufficiency, and grade 2 hypothyroidism, encephalitis, and immune thrombocytopenia. Median time to onset of irAEs was 1.3 (range 0.6-10.5) months. Six were treated with systemic corticosteroid therapy, and all irAEs were relieved. The median PFS and OS were 4.7 months (95%CI, 1.2-9.3) and 12.2 months (95% CI, 3.2-not reached) in patient with irAEs, and 1.4 months (95%CI, 1.1-1.9) and 4.1 months (95%CI, 2.6-6.6) in those without, respectively. There was significant difference in the PFS (p=0.005) and OS (p=0.03). Conclusions: Nivolumab was effective and well tolerated even in clinical practice. Development of irAEs may be associated with better outcome of Nivolumab in patients with AGC.

Intramolecular Magnetic Interaction of Spin-Delocalized Neutral Radicals through m-Phenylene Spacers

A new diradical having two 4,8,10-trioxotriangulene (TOT) neutral radical units linked through an m-phenylene moiety was synthesized and characterized by ESR measurements. An electrochemical study showed that the diradical undergoes two one-electron reductions to generate corresponding dianion species, suggesting the electronic interaction between two TOT units through the π-conjugated spacer. A strong intramolecular interaction between the two TOT units gives rise to the spin-projected small hyperfine couplings in comparison with those of the monomer. Furthermore, the temperature dependent ESR measurement revealed that the dimer behaves as an S=1 species in the ground state with a ferromagnetic interaction of 2 J/k_B =+7±3 K.

Prospects for observing and localizing gravitational-wave transients with Advanced LIGO, Advanced Virgo and KAGRA

We present our current best estimate of the plausible observing scenarios for the Advanced LIGO, Advanced Virgo and KAGRA gravitational-wave detectors over the next several years, with the intention of providing information to facilitate planning for multi-messenger astronomy with gravitational waves. We estimate the sensitivity of the network to transient gravitational-wave signals for the third (O3), fourth (O4) and fifth observing (O5) runs, including the planned upgrades of the Advanced LIGO and Advanced Virgo detectors. We study the capability of the network to determine the sky location of the source for gravitational-wave signals from the inspiral of binary systems of compact objects, that is binary neutron star, neutron star-black hole, and binary black hole systems. The ability to localize the sources is given as a sky-area probability, luminosity distance, and comoving volume. The median sky localization area (90% credible region) is expected to be a few hundreds of square degrees for all types of binary systems during O3 with the Advanced LIGO and Virgo (HLV) network. The median sky localization area will improve to a few tens of square degrees during O4 with the Advanced LIGO, Virgo, and KAGRA (HLVK) network. During O3, the median localization volume (90% credible region) is expected to be on the order of 10 5 , 10 6 , 10 7 Mpc 3 for binary neutron star, neutron star-black hole, and binary black hole systems, respectively. The localization volume in O4 is expected to be about a factor two smaller than in O3. We predict a detection count of 1 - 1 + 12 ( 10 - 10 + 52 ) for binary neutron star mergers, of 0 - 0 + 19 ( 1 - 1 + 91 ) for neutron star-black hole mergers, and 17 - 11 + 22 ( 79 - 44 + 89 ) for binary black hole mergers in a one-calendar-year observing run of the HLV network during O3 (HLVK network during O4). We evaluate sensitivity and localization expectations for unmodeled signal searches, including the search for intermediate mass black hole binary mergers.

P1547 Left ventricular papillary muscle strain as an indicator of hypertrophic cardiomyopathy

Results

Among the 42 patients, 22 (52%) and 17 (40%) had hypertension and HCM, respectively. We measured the strength of linear associations among paired variables (LV-PMS, age, EF, e’, s’, E/e’, E/A, LAV-I and GLS) using Pearson product-moment correlation coefficients.

Age (r = 0.64), e’ (r = -0.76), s’ (r = -0.61), LAV-I (r = 0.61) and GLS (r = 0.57; all p &lt; 0.001), as well as E/e’ (r = 0.44, p &lt; 0.05) significantly correlated in patients without HCM, whereas only GLS correlated in patients with HCM (r = 0.723, p &lt; 0.001).

One-way analyses of variance showed that LV-PMS values significantly differed only among patients without HCM when categorized according to age &lt; 50, ≥ 50 &lt; 75 and &gt; 75 years (p &lt; 0.001), whereas these values significantly differed in all patients (p &lt; 0.05) when categorized according to GLS &lt; -20%, ≥ -20 to &lt; -15% and &gt; -15%.

Conclusions

We found that LV-PMS correlated with five factors including age in patients without HCM, but only with GLS in those with HCM. Despite the small study cohort, we considered that LV-PMS and GLS would be useful for evaluating left ventricular function in patients with HCM.

Stromal-type Nephroblastoma with or without Anaplasia in Two Hedgehogs (Atelerix albiventris)

We describe the clinical and histological characteristics of stromal-type nephroblastomas that developed in two hedgehogs (Atelerix albiventris). In case 1, the tumour was composed of a proliferation of anaplastic stromal cells with ductal structures resembling the epithelium of nephroblastoma. In case 2, spindle-shaped cells that were somewhat larger than nephroblasts were frequently seen surrounding the cell cluster, and there was proliferation of stromal cells with collagen fibres at the periphery. Immunohistochemically, the tumour cells labelled weakly to strongly for the nephroblast marker Wilms' tumour-1 and were positive for Ki67 with rates of 5% and 10% for cases 1 and 2, respectively. Based on the above, the diagnosis was of stromal-type nephroblastoma with anaplasia in case 1 and without anaplasia in case 2. Our findings suggest that stromal-type nephroblastomas arise in adult hedgehogs and are clinically benign, and that histological anaplasia does not affect the prognosis.

Investigation of the effects of electromagnetic field treatment of hot spring water for scale inhibition using a fibre optic sensor

Treatment with an electromagnetic field, one of the potential techniques to inhibit scale deposition from water, has the advantage of not requiring the addition of any chemicals. Field tests using a fibre optic sensor were conducted to evaluate the effect that the treatment of hot spring water in Matsushiro, Japan with an electromagnetic field had on calcium carbonate scale formation. The optical response to scale deposition recorded by the fibre optic sensor decreased as a consequence of the application of an electromagnetic field, and the effectiveness of scale formation inhibition depended on the frequency of the electromagnetic field. This evidence was compared with results from changes in scale mass measured using the quartz crystal microbalance (QCM) method. Mass increases of the scale formed on the quartz crystal surface in hot spring water were inhibited by electromagnetic field treatment. These results were verified performing a column flow test, whereby the flow rate of hot spring water through a column was measured.