An oncogenic CTNNB1 mutation is predictive of post-operative recurrence-free survival in an EGFR-mutant lung adenocarcinoma

The Wnt/β-catenin pathway is known to be frequently dysregulated in various human malignancies. Alterations in the genes encoding the components of Wnt/β-catenin pathway have also been described in lung adenocarcinoma. Notably however, the clinical impacts of Wnt/β-catenin pathway alterations in lung adenocarcinoma have not been fully evaluated to date. We here investigated the prognostic implications of single gene variations in 174 cases of surgically resected lung adenocarcinoma tested using targeted next-generation sequencing. Screening of the prognostic impact of single gene alterations identified an association between CTNNB1 mutation and poor recurrence-free survival in EGFR-mutant LUADs. Based on these results, the entire cohort was stratified into three groups in accordance with the mutational status of Wnt/β-catenin pathway genes (i.e. oncogenic CTNNB1 mutation [CTNNB1-ONC], other Wnt/β-catenin pathway gene mutations [Wnt/β-catenin-OTHER], and wild type for Wnt/β-catenin pathway genes [Wnt/β-catenin-WT]). The clinicopathologic characteristics and survival outcomes of these groups were then compared. Oncogenic CTNNB1 and other Wnt/β-catenin pathway gene mutations were identified in 10 (5.7%) and 14 cases (8.0%), respectively. The CTNNB1-ONC group cases displayed histopathologic features of conventional non-mucinous adenocarcinoma with no significant differences from those of the other groups. Using β-catenin immunohistochemistry, we found that the CTNNB1-ONC group displayed aberrant nuclear staining more frequently, but only in 60% of the samples. The LUADs harboring a CTNNB1-ONC exhibited significantly poorer RFS outcomes than the other groups, regardless of the β-catenin IHC status. This was a pronounced finding in the EGFR-mutant LUADs only in subgroup analysis, which was then confirmed by multivariate analysis. Nevertheless, no significant OS differences between these Wnt/β-catenin groups were evident. Hence, oncogenic CTNNB1 mutations may be found in about 6% of lung adenocarcinomas and may predict post-operative recurrence in EGFR-mutant LUADs. Aberrant nuclear β-catenin staining on IHC appears to be insufficient as a surrogate marker of an oncogenic CTNNB1 mutation.

Clinicopathologic and genomic features of high-grade pattern and their subclasses in lung adenocarcinoma

INTRODUCTION

Recent lung adenocarcinoma (LUAD) grading system proposed by the International Association for the Study of Lung Cancer (IASLC) has emphasized the proportion of high-grade patterns (HGPs). We aimed to evaluate the clinicopathologic and genomic characteristics associated with HGP which has not yet been fully investigated.

METHODS

Tissue samples from 174 patients who underwent surgical resection of LUAD from January to December 2015 were histologically evaluated. Proportions of HGPs, including solid, micropapillary, cribriform, and complex glandular patterns, were individually quantified. Prognostic implications of HGP proportion, both as a continuous variable and as subclasses divided by cutoffs of 20%, 50%, and 90% (low-intermediate grade [LIG], HGP <20%; high grade 1 [HG1], 20-<50%, HG2, 50-<90%; HG3, ≥90%) were evaluated. Different clinicopathologic factors and genomic alterations according to the HGP subclasses were assessed.

RESULTS

Relative hazards of the HGP gradually elevated as its proportion increased over 20%, the cut-off value established by the IASLC grading system, and the cancer-specific overall survival (OS) of HG1 subclass was not significantly decreased compared to the LIG subclass on univariate analysis. However, further subgrouping showed significantly increased frequencies of male, advanced stage tumors, lymphovascular invasion, and spread through alveolar space in higher HGP subclasses. Also, common LUAD driver mutations, particularly EGFR mutations, were less frequent, whereas alterations in TP53 and cell cycle pathway-related genes were more frequent. Higher HGP subclasses and TP53 gene alteration were associated with shorter cancer-specific OS and RFS in multivariate survival analysis.

CONCLUSIONS

HGP subclasses of LUAD displayed distinct clinicopathological characteristics and genomic alterations, including TP53 and cell cycle pathway, emphasizing the clinical value of these subclasses in LUAD. Higher HGP subclass and alteration in TP53 may be markers of poor post-operative survival.

Effect of iron deficiency without anaemia on days alive and out of hospital in patients undergoing valvular heart surgery

Comprehensive evidence regarding the treatment of non-anaemic iron deficiency in patients undergoing valvular heart surgery is lacking. This study aimed to investigate the association between non-anaemic iron deficiency and postoperative outcomes in these patients. We retrospectively analysed 321 patients of which 180 (56%) had iron deficiency (defined as serum ferritin < 100 ng.ml^-1 or < 300 ng.ml^-1 with transferrin saturation < 20%). While the iron-deficient group had lower pre-operative haemoglobin levels than the non-iron deficient group (median (IQR [range]) 134 (127-141 [120-172]) g.l^-1 , 143 (133-150 [120-179]) g.l^-1 , p = 0.001), there was no between-group difference in allogeneic red blood cell transfusion. Median (IQR [range]) days alive and out of hospital at postoperative day 90 was 1 day shorter in the iron-deficient group (80 (77-82 [9-85]) days vs. 81 (79-83 [0-85]) days, p = 0.026). In multivariable analysis, only cardiopulmonary bypass duration (p = 0.032) and intra-operative allogeneic red blood cell transfusion (p = 0.011) were significantly associated with reduced days alive and out of hospital at postoperative day 90. Iron deficiency did not exert any adverse influence on secondary outcomes except length of hospital stay. Our findings indicate that non-anaemic iron deficiency alone is not associated with adverse effects in patients undergoing valvular heart surgery when it does not translate into an increased risk of allogeneic transfusion.

Pan-Asian adaptation of the EHNS-ESMO-ESTRO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with squamous cell carcinoma of the head and neck

The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of squamous cell carcinoma (SCC) of the oral cavity, larynx, oropharynx and hypopharynx was published in 2020. It was therefore decided by both the ESMO and the Korean Society of Medical Oncology (KSMO) to convene a special, virtual guidelines meeting in July 2021 to adapt the ESMO 2020 guidelines to consider the potential ethnic differences associated with the treatment of SCCs of the head and neck (SCCHN) in Asian patients. These guidelines represent the consensus opinions reached by experts in the treatment of patients with SCCHN (excluding nasopharyngeal carcinomas) representing the oncological societies of Korea (KSMO), China (CSCO), India (ISMPO), Japan (JSMO), Malaysia (MOS), Singapore (SSO) and Taiwan (TOS). The voting was based on scientific evidence and was independent of the current treatment practices and drug access restrictions in the different Asian countries. The latter was discussed when appropriate. This manuscript provides a series of expert recommendations (Clinical Practice Guidelines) which can be used to provide guidance to health care providers and clinicians for the optimisation of the diagnosis, treatment and management of patients with SCC of the oral cavity, larynx, oropharynx and hypopharynx across Asia.

Nivolumab with carboplatin, paclitaxel, and bevacizumab for first-line treatment of advanced nonsquamous non-small-cell lung cancer

BACKGROUND

This international, randomized, double-blind phase III study (ONO-4538-52/TASUKI-52) evaluated nivolumab with bevacizumab and cytotoxic chemotherapy as first-line treatment for nonsquamous non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

Between June 2017 and July 2019, this study enrolled treatment-naïve patients with stage IIIB/IV or recurrent nonsquamous NSCLC without sensitizing EGFR, ALK, or ROS1 alterations. They were randomly assigned in a 1 : 1 ratio to receive nivolumab or placebo in combination with carboplatin, paclitaxel, and bevacizumab every 3 weeks for up to six cycles, followed by nivolumab/placebo with bevacizumab until progressive disease or unacceptable toxicity. The primary endpoint was progression-free survival (PFS) assessed by an independent radiology review committee (IRRC).

RESULTS

Overall, 550 patients from Japan, Korea, and Taiwan were randomized; of these patients, 273 and 275 received the nivolumab and placebo combinations, respectively. In the present preplanned interim analysis with a median follow up of 13.7 months, the IRRC-assessed median PFS was significantly longer in the nivolumab arm than in the placebo arm (12.1 versus 8.1 months; hazard ratio 0.56; 96.4% confidence interval 0.43-0.71; P < 0.0001). The PFS benefit was observed across all patients with any programmed death-ligand 1 (PD-L1) expression levels including PD-L1-negative patients. The IRRC-assessed objective response rates were 61.5% and 50.5% in the nivolumab and placebo arms, respectively. The incidence of treatment-related adverse events of grade 3 or 4 was comparable between the two arms; treatment-related adverse events leading to death were observed in five and four patients in the nivolumab and placebo arms, respectively.

CONCLUSION

The TASUKI-52 regimen should be considered a viable new treatment strategy for treatment-naïve patients with advanced nonsquamous NSCLC.

Blood Vessel Invasion Predicts Postoperative Survival Outcomes and Systemic Recurrence Regardless of Location or Blood Vessel Type in Patients with Lung Adenocarcinoma

BACKGROUND

Presence of blood vessel invasion (BVI) is one of the prognostic indicators for lung cancer patients with surgical resection. However, prognostic roles of the location and the type of the involved blood vessel have not been fully evaluated yet.

PATIENTS AND METHODS

We retrieved the data of 217 cases of surgically resected lung adenocarcinoma from Asan Medical Center. Clinicopathologic features, including BVI, were reassessed. The location (tumor center and/or periphery) and involved blood vessel types (large and/or small vessels; arteries and/or veins) of BVI were separately examined on standard hematoxylin-eosin slides and confirmed by van Gieson elastic staining.

RESULTS

BVI was identified in 35% of cases (76/217), with the tumor center (intratumoral) as the location in more than half of the cases (42/76, 55.3%). The presence of BVI was significantly associated with higher pathologic stage, increased size of invasive components, frequent pleural invasion, lymphatic permeation, and spread through alveolar spaces. BVI was significantly associated with poor overall survival (OS) and recurrence-free survival (RFS) both in univariate and multivariate survival analyses [for OS, hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.06-3.48, P = 0.031; for RFS, HR 2.65, 95% CI 1.64-4.28; P < 0.001]. BVI subgroups, according to location and type of the involved blood vessels, invariably displayed significantly poor RFS; however, the results for OS varied.

CONCLUSION

Regardless of their location or blood vessel type, presence of BVI is a useful predictor for postoperative survival outcomes, which should be carefully evaluated on pathologic examination.

Convolutional Neural Network to Stratify the Malignancy Risk of Thyroid Nodules: Diagnostic Performance Compared with the American College of Radiology Thyroid Imaging Reporting and Data System Implemented by Experienced Radiologists

BACKGROUND AND PURPOSE

Comparison of the diagnostic performance for thyroid cancer on ultrasound between a convolutional neural network and visual assessment by radiologists has been inconsistent. Thus, we aimed to evaluate the diagnostic performance of the convolutional neural network compared with the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) for the diagnosis of thyroid cancer using ultrasound images.

MATERIALS AND METHODS

From March 2019 to September 2019, seven hundred sixty thyroid nodules (≥10 mm) in 757 patients were diagnosed as benign or malignant through fine-needle aspiration, core needle biopsy, or an operation. Experienced radiologists assessed the sonographic descriptors of the nodules, and 1 of 5 American College of Radiology TI-RADS categories was assigned. The convolutional neural network provided malignancy risk percentages for nodules based on sonographic images. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated with cutoff values using the Youden index and compared between the convolutional neural network and the American College of Radiology TI-RADS. Areas under the receiver operating characteristic curve were also compared.

RESULTS

Of 760 nodules, 176 (23.2%) were malignant. At an optimal threshold derived from the Youden index, sensitivity and negative predictive values were higher with the convolutional neural network than with the American College of Radiology TI-RADS (81.8% versus 73.9%, P = .009; 94.0% versus 92.2%, P = .046). Specificity, accuracy, and positive predictive values were lower with the convolutional neural network than with the American College of Radiology TI-RADS (86.1% versus 93.7%, P < .001; 85.1% versus 89.1%, P = .003; and 64.0% versus 77.8%, P < .001). The area under the curve of the convolutional neural network was higher than that of the American College of Radiology TI-RADS (0.917 versus 0.891, P = .017).

CONCLUSIONS

The convolutional neural network provided diagnostic performance comparable with that of the American College of Radiology TI-RADS categories assigned by experienced radiologists.

Aβ Accumulation in Vmo Contributes to Masticatory Dysfunction in 5XFAD Mice

Alzheimer's disease (AD) shows various symptoms that reflect cognitive impairment and loss of neural circuit integrity. Sensory dysfunctions such as olfactory and ocular pathology are also observed and used as indicators for early detection of AD. Although mastication is suggested to correlate with AD progression, changes in the masticatory system have yet to be established in transgenic animal models of AD. In the present study, we have assessed pathologic hallmarks of AD with the masticatory behavior of 5XFAD mice. We found that masticatory efficiency and maximum biting force were decreased in 5XFAD mice, with no significant change in general motor function. Immunohistochemical analysis revealed significant accumulation of Aβ (amyloid β), increased microglia number, and cell death in Vmo (trigeminal motor nucleus) as compared with other cranial motor nuclei that innervate the orofacial region. Masseter muscle weight and muscle fiber size were also decreased in 5XFAD mice. Taken together, our results demonstrate that Aβ accumulation in Vmo contributes to masticatory dysfunction in 5XFAD mice, suggesting a close association between masticatory dysfunction and dementia.

A new aortoiliac calcification scoring system to predict grade C anastomotic leak following rectal cancer surgery

BACKGROUND

Aortoiliac calcification may be a surrogate marker of decreased visceral perfusion causing anastomotic leak (AL). The aim of this study was to evaluate the predictive role of aortoiliac calcification for AL after rectal cancer surgery.

METHODS

We enrolled patients with primary rectal cancer who had restorative resection at our institution between January 2013 and December 2015. An aortoiliac calcification score was calculated as the sum of calcification scores at the infrarenal aorta (0: no, 1: ≤ 3 cm, 2: > 3 cm) and the common iliac arteries (0: no, 1: unilateral, 2: bilateral). AL was classified into three grades: grade A, requiring no intervention; grade B, requiring therapeutic intervention without re-laparotomy; and grade C, requiring re-laparotomy. Clinicopathological characteristics were analyzed to identify risk factors for AL.

RESULTS

There were 583 patients. Three-hundred forty-five (59.2%) had an aortoiliac calcification score ≥ 3, and 37 (6.3%) patients experienced AL, in 30 cases (5.1%) grade C AL. Patients with an aortoiliac calcification score ≥ 3 had a higher incidence of grade C AL (6.7% vs. 2.9%, p = 0.045). Multivariate logistic regression analysis revealed that an aortoiliac calcification score ≥ 3 was an independent risk factor for grade C AL (odds ratio = 2.669, 95% confidence interval 1.066-6.686, p = 0.036).

CONCLUSIONS

Aortoiliac calcification may be considered a risk factor for grade C AL after rectal cancer surgery.

Comparative outcomes of robot-assisted minimally invasive versus open esophagectomy in patients with esophageal squamous cell carcinoma: a propensity score-weighted analysis

Robots are increasingly used in minimally invasive surgery. We evaluated the clinical benefits of robot-assisted minimally invasive esophagectomy (RAMIE) in comparison with the conventional open esophageal surgery. From 2012 to 2016, 371 patients with esophageal squamous cell carcinoma underwent an Ivor Lewis or McKeown procedure at our institution. Of these, 130 patients underwent laparoscopic gastric conduit formation followed by RAMIE, whereas 241 patients underwent conventional esophageal surgery, including laparotomy and open esophagectomy (OE). We compared the short- and long-term clinical outcomes of these patients using the propensity score-based inverse probability of treatment weighting technique (IPTW). Among the early outcomes, the OE group showed a higher incidence of pneumonia (P = 0.035) and a higher requirement for vasopressors (P = 0.001). Regarding the long-term outcomes, all-cause mortality was significantly higher (P = 0.001) and disease-free survival was lower (P = 0.006) in the OE group. Wound-related problems also occurred more frequently in the OE group (P = 0.020) during the long-term follow-up. There was no statistical intergroup difference in the recurrence rates (P = 0.191). The Cox proportional-hazard analysis demonstrated that wound problems (HR 0.16, 95% CI 0.02-0.57; P = 0.017), pneumonia (HR 0.23, 95% CI 0.06-0.68; P = 0.019), and use of vasopressors (HR 0.14, 95% CI 0.08-0.25; P = 0.001) were independent predictors of mortality. RAMIE could be a better surgical option for selected patients with esophageal squamous cell carcinoma.

Tumor-derived exosomal miR-619-5p promotes tumor angiogenesis and metastasis through the inhibition of RCAN1.4

Tumor-derived exosomes (TEXs) contain enriched miRNAs that act as novel non-invasive biomarkers for cancer diagnosis and play a role in cancer progression. We investigated the exosomal miRNAs that affect cancer progression in non-small cell lung cancer (NSCLC) and identified the specific molecules involved. We identified that specific miRNAs in NSCLC cell-released exosomes can modulate angiogenesis, among which miR-619-5p was the most potent inducer. RCAN1.4 was identified as a target of miR-619-5p and its suppression promoted angiogenesis. Furthermore, the suppression of RCAN1.4 induced cell proliferation and metastasis in NSCLC cells. In patients with NSCLC, the level of RCAN1.4 expression was significantly lower, and that of miR-619-5p significantly higher, in tumor than normal lung tissues. miR-619-5p expression was higher than normal in exosomes isolated from the plasma of NSCLC patients. Finally, hypoxic conditions induced miR-619-5p upload into NSCLC cell-derived exosomes. Our findings indicate that exosomal miR-619-5p promotes the growth and metastasis of NSCLCs by regulating RCAN1.4 and can serve as a diagnostic indicator for these lung cancers.

P1416 Clinical importance of consecutive transthoracic echocardiography in the patients with hypertrophic cardiomyopathy

Funding Acknowledgements

nothing

OnBehalf

nothing

Background

prediction of outcomes Hypertrophic cardiomyopathy (HCM) have been robustly analyzed with echocardiography. However, there is limited data of serial follow-up (FU) transthoracic echocardiography (TTE) to predict outcomes in patients with HCM.

Objectives

This study aim is to discover clinical predictors associated with consecutive TTE follow-up in patients with HCM.

Methods

From 2010 to 2016, 162 patients with HCM were enrolled retrospectively. Concentric LVH and others systolic disease related to wall thickness were excluded. Index TTE (baseline) was measured when firstly admitted in our hospital. FU TTE was analyzed at the end of follow-up, defined as the last recorded value in patients who did not develop events or the last recorded value before events developed.

Results

The average of FU TTE and clinical FU period was 3.7 ± 2.0 years. Clinical outcomes were defined as stroke, syncope, heart failure, arrhythmia and death. Interestingly, only baseline TR V max was a predictor for clinical outcome whereas the others echo parameters were not associated with events (Table 1). KM curve showed the TR Vmax ≥2.5m/s was also significant (log rank = 0.008, Fig 1.)

Conclusions Our study showed short-term FU TTE did not bring clinician with clinical benefits in the aspect of prediction for events. Only baseline TR V max was good correlation with cardiovascular outcomes and even in the survival analysis.

Serial TTE and changed values Total N = 162 index TTE (baseline) FU TTE Change of FU per year event no event p-value event no event p-value event no event p-value IVDd, mm 14 ± 4 15 ± 5 0.500 15 ± 5 14 ± 5 0.758 0.23 ± 0.51 -0.07 ± 1.27 0.200 LVIDd, mm 47 ± 5 48 ± 6 0.256 47 ± 7 48 ± 6 0.560 -0.22 ± 2.79 0.10 ± 2.27 0.444 LVEF, % 62 ± 5 61 ± 7 0.379 61 ± 6 61 ± 10 0.927 -0.43 ± 3.10 -0.04 ± 4.94 0.620 LAVI 43 ± 9 43 ± 8 0.879 57 ± 27 58 ± 23 0.849 0.53 ± 14.5 3.11 ± 7.2 0.134 EA ratio 0.9 ± 0.6 0.9 ± 0.6 0.782 1.0 ± 0.8 0.9 ± 0.6 0.595 -0.02 ± 0.76 0.003 ± 0.027 0.594 DT,ms 196 ± 58 201 ± 62 0.603 203 ± 91 217 ± 89 0.370 17 ± 57 5 ± 40 0.154 septal e` 4.4 ± 2.1 4.2 ± 1.6 0.585 4.4 ± 1.6 4.6 ± 1.7 0.438 0.24 ± 0.91 0.05 ± 0.65 0.190 E of e` 17 ± 11 17 ± 23 0.993 15 ± 9 15 ± 6 0.726 -0.48 ± 4.42 -1.66 ± 22.78 0.728 TR velocity 2.6 ± 0.5 2.4 ± 0.4 0.012 2.7 ± 0.6 2.6 ± 0.4 0.604 0.05 ± 0.30 0.04 ± 0.18 0.905 Max wall thickness 17 ± 3 18 ± 3 0.137 17 ± 4 17 ± 3 0.888 -0.01 ± 2.19 -0.18 ± 1.14 0.522

Abstract P1416 Figure. TR Vmax and CV outcomes in the KM curve

Hyperprogressive disease during PD-1/PD-L1 blockade in patients with non-small-cell lung cancer

BACKGROUND

Immune checkpoint blockade with Programmed cell death 1 (PD-1)/PD-L1 inhibitors has been effective in various malignancies and is considered as a standard treatment modality for patients with non-small-cell lung cancer (NSCLC). However, emerging evidence show that PD-1/PD-L1 blockade can lead to hyperprogressive disease (HPD), a flair-up of tumor growth linked to dismal prognosis. This study aimed to evaluate the incidence of HPD and identify the determinants associated with HPD in patients with NSCLC treated with PD-1/PD-L1 blockade.

PATIENTS AND METHODS

We enrolled patients with recurrent and/or metastatic NSCLC treated with PD-1/PD-L1 inhibitors between April 2014 and November 2018. Clinicopathologic variables, dynamics of tumor growth, and treatment outcomes were analyzed in patients with NSCLC who received PD-1/PD-L1 blockade. HPD was defined according to tumor growth kinetics (TGK), tumor growth rate (TGR), and time to treatment failure (TTF). Immunophenotyping of peripheral blood CD8+ T lymphocytes was conducted to explore the potential predictive biomarkers of HPD.

RESULTS

A total of 263 patients were analyzed. HPD was observed in 55 (20.9%), 54 (20.5%), and 98 (37.3%) patients according to the TGK, TGR, and TTF. HPD meeting both TGK and TGR criteria was associated with worse progression-free survival [hazard ratio (HR) 4.619; 95% confidence interval (CI) 2.868-7.440] and overall survival (HR, 5.079; 95% CI, 3.136-8.226) than progressive disease without HPD. There were no clinicopathologic variables specific for HPD. In the exploratory biomarker analysis with peripheral blood CD8+ T lymphocytes, a lower frequency of effector/memory subsets (CCR7-CD45RA- T cells among the total CD8+ T cells) and a higher frequency of severely exhausted populations (TIGIT+ T cells among PD-1+CD8+ T cells) were associated with HPD and inferior survival rate.

CONCLUSION

HPD is common in NSCLC patients treated with PD-1/PD-L1 inhibitors. Biomarkers derived from rationally designed analysis may successfully predict HPD and worse outcomes, meriting further investigation of HPD.

Co-clinical trials demonstrate predictive biomarkers for dovitinib, an FGFR inhibitor, in lung squamous cell carcinoma

Background

We conducted co-clinical trials in patient-derived xenograft (PDX) models to identify predictive biomarkers for the multikinase inhibitor dovitinib in lung squamous cell carcinoma (LSCC).

Methods

The PDX01-02 were established from LSCC patients enrolled in the phase II trial of dovitinib (NCT01861197) and PDX03-05 were established from LSCC patients receiving surgery. These five PDX tumors were subjected to in vivo test of dovitinib efficacy, whole exome sequencing and gene expression profiling.

Results

The PDX tumors recapitulate histopathological properties and maintain genomic characteristics of originating tumors. Concordant with clinical outcomes of the trial enrolled-LSCC patients, dovitinib produced substantial tumor regression in PDX-01 and PDX-05, whereas it resulted in tumor progression in PDX-02. PDX-03 and -04 also displayed poor antitumor efficacy to dovitinib. Mutational and genome-wide copy number profiles revealed no correlation between genomic alterations of FGFR1-3 and sensitivity to dovitinib. Of note, gene expression profiles revealed differentially expressed genes including FGF3 and FGF19 between PDX-01 and 05 and PDX-02-04. Pathway analysis identified two FGFR signaling-related gene sets, FGFR ligand binding/activation and SHC-mediated cascade pathway were substantially up-regulated in PDX-01 and 05, compared with PDX-02-04. The comparison of gene expression profiles between dovitinib-sensitive versus -resistant lung cancer cell lines in the Cancer Cell Line Encyclopedia database also found that transcriptional activation of 18 key signaling components in FGFR pathways can predict the sensitivity to dovitinib both in cell lines and PDX tumors. These results highlight FGFR pathway activation as a key molecular determinant for sensitivity to dovitinib.

Conclusions

FGFR gene expression signatures are predictors for the response to dovitinib in LSCC.

Prognostic impact of the length of the longitudinal resection margin in colon cancer

AIM

Although several guidelines recommend a longitudinal resection margin (LRM) of at least 5 cm, the impact of the LRM on survival is still unknown. The study assessed the prognostic significance of the LRM in patients with colon cancer.

METHOD

We retrospectively reviewed 1343 primary colon cancer patients without distant metastasis who underwent curative resection between January 2004 and December 2012. Patients were classified into three groups: LRM < 3 cm (n = 186), LRM ≥ 3 and <5 cm (n = 376) and LRM ≥5 cm (n = 781). Clinicopathological characteristics and the oncological outcome in the three groups were compared.

RESULTS

The median LRM length was 5.0 cm (range 0.5-26.0 cm). With increasing LRM, the number of retrieved lymph nodes (LNs) tended to increase (19.5 ± 12.0, 22.1 ± 12.8 and 30.0 ± 16.2; P < 0.001). After a median follow-up period of 45 (1-128) months, 3-year disease-free survival (DFS) (89.2%, 89.0% and 87.0%; P = 0.629) and 5-year overall survival (OS) (89.0%, 92.1% and 91.8%; P = 0.679) were not significantly different between the three groups. When confounders were adjusted, LRM was not significantly associated with either DFS or OS, but the number of retrieved LNs (< 12) was an independent risk factor for both DFS (hazard ratio 1.748, 95% confidence interval 1.048-2.917) and OS (hazard ratio 1.929, 95% confidence interval 1.046-3.559).

CONCLUSION

LRM was not associated with oncological outcome, but care should be taken to obtain an adequate number of LNs for better survival.

Activation of the Met kinase confers acquired drug resistance in FGFR-targeted lung cancer therapy

Aberrant fibroblast growth factor receptor (FGFR) activation/expression is a common feature in lung cancer (LC). In this study, we evaluated the antitumor activity of and the mechanisms underlying acquired resistance to two potent selective FGFR inhibitors, AZD4547 and BAY116387, in LC cell lines. The antitumor activity of AZD4547 and BAY1163877 was screened in 24 LC cell lines, including 5 with FGFR1 amplification. Two cell lines containing FGFR1 amplifications, H1581 and DMS114, were sensitive to FGFR inhibitors (IC50<250 nm). Clones of FGFR1-amplified H1581 cells resistant to AZD4547 or BAY116387 (H1581AR and H1581BR cells, respectively) were established. Receptor tyrosine kinase (RTK) array and immunoblotting analyses showed strong overexpression and activation of Met in H1581AR/BR cells, compared with that in the parental cells. Gene set enrichment analysis against the Kyoto Encyclopedia of Genes and Genomes (KEGG) database showed that cytokine-cytokine receptor interaction pathways were significantly enriched in H1581AR/BR cells, with Met contributing significantly to the core enrichment. Genomic DNA quantitative PCR and fluorescent in situ hybridization analyses showed MET amplification in H1581AR, but not in H1581BR, cells. Met amplification drives acquired resistance to AZD4547 in H1581AR cells by activating ErbB3. Combination treatment with FGFR inhibitors and an anaplastic lymphoma kinase (ALK)/Met inhibitor, crizotinib, or Met-specific short interfering RNA (siRNA) synergistically inhibited cell proliferation in both H1581AR and H1581BR cells. Conversely, ectopic expression of Met in H1581 cells conferred resistance to AZD4547 and BAY1163877. Acquired resistance to FGFR inhibitors not only altered cellular morphology, but also promoted migration and invasion of resistant clones, in part by inducing epithelial-to-mesenchymal transition. Taken together, our data suggest that Met activation is sufficient to bypass dependency on FGFR signaling. Concurrent inhibition of the Met and FGFR pathways may have synergistic clinical benefits when targeting FGFR-dependent LC.

Neutropenia and neutrophil-to-lymphocyte ratio in a healthy Korean population: race and sex should be considered

INTRODUCTION

We evaluated the prevalence and severity of asymptomatic neutropenia in a healthy Korean population according to sex and age. We explored normal neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in an asymptomatic Korean population and the association of these ratios with biomarkers related to inflammation, rheumatoid disease, and glucose metabolism.

METHODS

We analyzed complete blood cell counts in 83 740 subjects who participated in a routine health check-up program. NLR and PLR were compared to age, rheumatoid factor, C-reactive protein (CRP), erythrocyte sedimentation rate, hemoglobin A1c, and fasting glucose levels.

RESULTS

Of the entire study population, 7.48% exhibited neutropenia; 8.61% of females and 6.69% of males. The neutropenia was more severe in females compared to males (P < 0.01). Median NLR and PLR values were 1.53 and 121.07, respectively. An inverse relationship was observed between NLR and age, but no differences were seen between sexes. CRP, erythrocyte sedimentation rate, and fasting glucose level were significantly correlated with NLR.

CONCLUSION

Our data indicate that the normal range of absolute neutrophil counts should be adjusted and cutoff values for neutropenia should be re-established according to sex and race. NLR and PLR cutoff values for disease evaluation should be established separately according to race and age.

Deficiency in the mRNA export mediator Gle1 impairs Schwann cell development in the zebrafish embryo

GLE1 mutations cause lethal congenital contracture syndrome 1 (LCCS1), a severe autosomal recessive fetal motor neuron disease, and more recently have been associated with amyotrophic lateral sclerosis (ALS). The gene encodes a highly conserved protein with an essential role in mRNA export. The mechanism linking Gle1 function to motor neuron degeneration in humans has not been elucidated, but increasing evidence implicates abnormal RNA processing as a key event in the pathogenesis of several motor neuron diseases. Homozygous gle1(-/-) mutant zebrafish display various aspects of LCCS, showing severe developmental abnormalities including motor neuron arborization defects and embryonic lethality. A previous gene expression study on spinal cord from LCCS fetuses indicated that oligodendrocyte dysfunction may be an important factor in LCCS. We therefore set out to investigate the development of myelinating glia in gle1(-/-) mutant zebrafish embryos. While expression of myelin basic protein (mbp) in hindbrain oligodendrocytes appeared relatively normal, our studies revealed a prominent defect in Schwann cell precursor proliferation and differentiation in the posterior lateral line nerve. Other genes mutated in LCCS have important roles in Schwann cell development, thereby suggesting that Schwann cell deficits may be a common factor in LCCS pathogenesis. These findings illustrate the potential importance of glial cells such as myelinating Schwann cells in motor neuron diseases linked to RNA processing defects.

White matter hyperintensity in ischemic stroke patients: it may regress over time

Background and Purpose

White matter hyperintensities (WMH) are frequently observed on MRI in ischemic stroke patients as well as in normal elderly individuals. Besides the progression of WMH, the regression of WMH has been rarely reported. Thus, we aimed to investigate how WMH change over time in patients with ischemic stroke, particularly focusing on regression.

Methods

We enrolled ischemic stroke patients who underwent brain MRI more than twice with at least a 6 month time-interval. Based on T2-weighted or FLAIR MRI, WMH were visually assessed, followed by semiautomatic volume measurement. Progression or regression of WMH change was defined when 0.25 cc increase or decrease was observed and it was also combined with visible change. A statistical analysis was performed on the pattern of WMH change over time and factors associated with change.

Results

A total of 100 patients were enrolled. Their age (mean±SD) was 67.5±11.8 years and 63 were male. The imaging time-interval (mean) was 28.0 months. WMH progressed in 27, regressed in 9 and progressed in distinctive regions and regressed in others in 5 patients. A multiple logistic regression model showed that age (odds ratio[OR] 2.51, 90% confidence interval[CI] 1.056-5.958), male gender (OR 2.957, 95% CI 1.051-9.037), large vessel disease (OR 1.955, 95% CI 1.171-3.366), and renal dysfunction (OR 2.900, 90% CI 1.045-8.046) were associated with progression. Regarding regression, no significant factor was found in the multivariate analysis.

Conclusions

In 21.5% of ischemic stroke patients, regression of WMH was observed. WMH progression was observed in a third of ischemic stroke patients.

Development and characterization of mouse monoclonal antibodies reactive with chicken IL-1β

Interleukin-1β proteins from chicken, duck, goose, turkey, and pigeon share 77 to 99% amino acid sequence similarity among themselves, and only 31 to 35% sequence similarity is shared between avian and mammalian IL-1β. There have been no antibodies that specifically detect avian IL-1β, and the current study was conducted to develop mouse monoclonal antibodies (mAb) against chicken IL-1β (chIL-1β) to further define its biochemical and immunological properties. In this study, 2 mouse mAb that are specific for chIL-1β were produced and characterized. Both mAb identified a 66.0 kDa recombinant chIL-1β protein expressed in Escherichia coli by Western blot analysis that corresponded to the expected molecular weight of a recombinant fusion protein containing the full-length 23.0 kDa chIL-1β protein and a 43.0 kDa maltose binding protein tag. Immunohistochemical analysis identified cells producing endogenous chIL-1β in the cecal tonsils, bursa of Fabricius, and spleen. Purified recombinant chIL-1β dose-dependently stimulated the proliferation and nitric oxide production by thymocytes, and both activities were inhibited by co-incubation with the 2 chIL-1β mAb described in this paper. These mAb will be important immune reagents for basic and applied poultry research of IL-1β in poultry.

Effects of in ovo injection with selenium on immune and antioxidant responses during experimental necrotic enteritis in broiler chickens

This study was conducted to investigate the effects of in ovo injection of Se on modulating the immune system and antioxidant responses in broiler chickens with experimental necrotic enteritis. Broiler eggs were injected at 18 d of embryo age with either 100 μL of PBS alone or sodium selenite (Na2SeO3) in PBS, providing 0 (SS0), 10 (SS10), or 20 (SS20) μg of Se/egg. At 14 d posthatch, PBS-treated and uninfected chickens were kept as the control group, whereas the remaining chickens were orally infected with 1.0 × 10(4) sporulated oocysts of Eimeria maxima (SS0, SS10, SS20). At 18 d posthatch, E. maxima-infected chickens were orally infected with 1.0 × 10(9) cfu of Clostridium perfringens. Infected control SS0 group showed significantly decreased BW compared with the uninfected control. However, SS20 group showed significantly increased BW compared with the infected control SS0 group, whereas the BW were similar among uninfected control and infected SS10 and SS20 groups. The SS10 group showed significantly lower intestinal lesions compared with the SS0 group, and oocyst production was decreased in both SS10 and SS20 groups. Serum malondialdehyde level and catalase activity were also decreased in both SS10 and SS20 groups, whereas the superoxide dismutase level was significantly lower in the SS10 group compared with the SS0 group. The SS20 group showed significantly higher levels of transcripts for IL-1β and IL-6 in intestine, and SS10 and SS20 groups had higher levels of transcripts for IL-8 and inducible nitric oxide synthase expression and decreased glutathione peroxidase 7 mRNA levels compared with the SS0 group. The SS10 and SS20 groups also showed increased serum antibody levels to C. perfringens α-toxin and NetB toxin compared with the SS0 group. These collective results suggest that the injection of Se into the amniotic cavity of developing eggs may be beneficial for enhancing immune and antioxidant responses in the hatched chickens exposed to the necrotic enteritis-causing pathogens.

Identification of a novel HLA-B allele, B*46:39, by sequence-based typing

The new allele B*46:39 showed a single-nucleotide substitution compared with B*46:01 at codon 185 (CCA/ACA).

Comparison of clinical outcomes after conservative and surgical treatment of isolated anastomotic leaks after esophagectomy for esophageal cancer

The clinical course and outcome of isolated anastomotic leaks (IALs) after esophagectomy are significantly different from those of necrotic leaks. The purpose of this study was to investigate the clinical features, diagnosis, treatment, and long-term outcome in patients with IALs after esophagectomy with reconstruction for esophageal cancer. A total of 663 patients underwent esophagectomy with esophageal reconstruction because of esophageal cancer between 2000 and 2010 at the Seoul Asan Medical Center. IALs occurred in 23 patients (3.5%). All patients with IAL were male, with a median age of 61 years. Patients with IAL were divided into three groups based on their clinical course. group A comprised patients who had definite clinical symptoms and/or signs indicating mediastinal contamination or leak before routine contrast esophagography was performed. Groups B and C comprised patients who had no definite clinical symptoms and/or signs of leaks before the routine contrast examination. Furthermore, group B contained those patients who resumed oral intake because no leak was found in the routine contrast examination and was diagnosed some days after resuming oral intake. Group C contained those patients who kept fasting because the leak was found in the routine contrast examination. The median follow-up period was 30 months. The mean time to closure of the IAL was 70.1 ± 96.0 days (range 4-364). There was a 72.7% overall closure rate within 60 days. By univariate analysis, the mean time to closure of the IAL was found to be significantly longer for group A patients or in cases where the patients had an uncontained leak, leukocytosis, or empyema. However, there was no statistically significant differences in age, neoadjuvant treatment, site of anastomosis (cervical vs. thoracic), fever, or treatment of the leak. By multivariate analysis, group A was found to be an independent predictive factor for the time to closure of the IAL. Repeat contrast studies revealed no anastomotic leaks in 18 patients and the formation of contained fistula in four cases (excluding one patient who died in hospital). The four patients with a contained fistula showed no clinical symptoms or signs, and tolerated resumed oral intake. IALs were resolved in most cases with low leak-related mortality, and resolution of the leaks occurred within 2 months in the majority of patients.

Long-term results of thoracoscopic thymectomy for thymoma without myasthenia gravis

OBJECTIVE

To compare the feasibility and safety of thoracoscopic thymectomy with conventional sternotomy thymectomy for thymoma without myasthenia gravis.

METHODS

Data from 70 patients diagnosed with thymoma, who underwent thoracoscopic thymectomy (n = 25, Group T) or sternotomy thymectomy (n = 45, Group S) between March 2002 and March 2008, were retrospectively evaluated.

RESULTS

Mean follow-up durations were 78.0 ± 21.9 months and 70.0 ± 23.6 months in Groups T and S, respectively. No deaths occurred in Group T; seven deaths occurred in Group S, all > 1 month post follow-up. Durations of chest intubation and hospitalization were significantly shorter in Group T than in Group S. No significant between-group difference in the incidence of operative complications was observed. Tumour recurrence-free rates at 5 and 7 years postsurgery were 96% (both years) in Group T and 95% (both years) in Group S.

CONCLUSIONS

Long-term follow-up indicates that thoracoscopic thymectomy for thymoma without myasthenia gravis is effective and is well tolerated, and associated with low rates of operative complications and recurrence.

The frequency and impact of ROS1 rearrangement on clinical outcomes in never smokers with lung adenocarcinoma

BACKGROUND

To determine the frequency and predictive impact of ROS1 rearrangements on treatment outcomes in never-smoking patients with lung adenocarcinoma.

PATIENTS AND METHODS

We concurrently analyzed ROS1 and ALK rearrangements and mutations in the epidermal growth factor receptor (EGFR), and KRAS in 208 never smokers with lung adenocarcinoma. ROS1 and ALK rearrangements were identified by fluorescent in situ hybridization.

RESULTS

Of 208 tumors screened, 7 (3.4%) were ROS1 rearranged, and 15 (7.2%) were ALK-rearranged. CD74-ROS1 fusions were identified in two patients using reverse transcriptase-polymerase chain reaction. The frequency of ROS1 rearrangement was 5.7% (6 of 105) among EGFR/KRAS/ALK-negative patients. Patients with ROS1 rearrangement had a higher objective response rate (ORR; 60.0% versus 8.5%; P = 0.01) and a longer median progression-free survival (PFS; not reached versus 3.3 months; P = 0.008) to pemetrexed than those without ROS1/ALK rearrangement. The PFS to EGFR-tyrosine kinase inhibitors in patients harboring ROS1 rearrangement was shorter than those without ROS1/ALK rearrangement (2.5 versus 7.8 months; P = 0.01).

CONCLUSIONS

The frequency of ROS1 rearrangements in clinically selected patients is higher than that reported for unselected patients, suggesting that ROS1 rearrangement is a druggable target in East-Asian never smokers with lung adenocarcinoma. Given the different treatment outcomes to conventional therapies and availability of ROS1 inhibitors, identification of ROS1 rearrangement can lead to successful treatment in ROS1-rearranged lung adenocarcinomas.

Clinicopathological characteristics of T1 colorectal cancer without background adenoma

AIM

Background adenoma (BGA) is defined as benign adenomatous tissue contiguous to resected carcinomas, and the absence of BGA in a tumour is considered a histological criterion of de novo cancers. The present study aimed to identify the clinicopathological characteristics of T1 colorectal cancer (CRC) without BGA.

METHOD

A retrospective review was carried out of prospectively collected data from two centres: the National Cancer Center, Korea; and Chonnam National University Hwasun Hospital, Korea. A total of 590 patients with T1 CRC, treated by endoscopic or surgical resection between January 2001 and August 2011, were enrolled. Details regarding gender, age, tumour location, endoscopic gross type, tumour size, depth of submucosal (SM) invasion, angiolymphatic invasion, tumour grade, budding and lymph node (LN) metastasis were evaluated with regard to the presence or absence of BGA.

RESULTS

BGA was absent in 197 (33.4%) patients. Tumour size <20 mm, flat or depressed type, deep SM depth and tumour budding were associated with the absence of BGA in univariate and multivariate analyses (P < 0.05). In surgically resected patients, LN metastases were significantly associated with the absence of BGA (P = 0.022).

CONCLUSION

T1 CRC without BGA presented several characteristics of small size (<20 mm), flat or depressed type, deep SM depth (SM 2/3), LN metastasis and tumour budding. These results indicate that de novo cancers may have a more invasive potential.

Immature Rubus coreanus Shows a Free Radical-Scavenging Effect and Inhibits Cholesterol Synthesis and Secretion in Liver Cells

Rubus coreanus fruits have been employed as a traditional medicine for centuries in the Asia-Pacific region. Its pharmacological action differs according to the different extraction methods utilized and the degree of fruit ripening. In this study, we determined the cellular effect of different ethanol extracts of mature and immature Rubus coreanus fruits in human hepatic cell line, HepG2 cells. The antioxidant activity, effect on superoxide dismutase activity and cholesterol biosynthesis efficiency was also evaluated. Immature Rubus coreanus extract showed higher antioxidant capability, compared with that of its mature fractions. Cellular antioxidant proteins including HO-1, Cu/Zn-superoxide dismutase and catalase were highly expressed in the presence of Rubus coreanus. Cholesterol levels in HepG2 cells treated with the water fraction of immature Rubus coreanus were significantly reduced. This antihyperlipidaemic action of Rubus coreanus is a consequence of cholesterol biosynthesis and extracellular secretion in HepG2 cells. These results indicate that among different ethanol fraction of mature and immature Rubus coreanus fruit extracts, water extract of immature fruit extract shows higher antioxidant as well as higher antihyperlipidaemic action.

An extended medial to lateral approach to mobilize the splenic flexure during laparoscopic low anterior resection

AIM

The aim of this retrospective study of laparoscopic low anterior resection was to compare splenic flexure mobilization (SFM) carried out by an extended medial to lateral approach with that by a lateral approach.

METHOD

Records of patients with rectal cancer on a prospectively maintained database undergoing laparoscopic low anterior resection performed between January 2009 and November 2011 by a single surgeon were analysed. The extended medial to lateral approach involved continuing the medial to lateral approach upwards to enter the lesser sac over the pancreas, thus permitting detachment of the splenic flexure.

RESULTS

Two hundred and thirty-seven patients, including 164 undergoing a lateral SFM and 73 an extended medial to lateral SFM, were evaluated. Both patient groups had similar characteristics except for operative time (152.7 ± 32.7 min extended medial to lateral; 171.5 ± 40.8 min lateral; P < 0.001), postoperatively the interval to oral intake (3.1 ± 0.8 days extended medial to lateral; 3.7 ± 0.9 lateral; P < 0.001) and duration of hospital stay (8.2 ± 2.8 days extended medial to lateral; 10.3 ± 7.5 days lateral; P = 0.002) favoured the extended medial to lateral group.

CONCLUSION

An extended medial to lateral approach for SFM during laparoscopic low anterior resection of rectal cancer appears to be an improvement over the previously used lateral approach, because it may provide a shorter operation time and shorter hospital stay.

Application of transanal irrigation for patients with spinal cord injury in South Korea: a 6-month follow-up study

STUDY DESIGN

A 6-month follow-up study.

OBJECTIVES

To investigate the outcome of transanal irrigation (TAI) in patients with spinal cord injury (SCI) and to identify factors significantly related to clinical success.

SETTING

Survey for community-dwelling patients with SCI in South Korea.

METHODS

Between December 2010 and March 2012, TAI was initiated with 52 patients (41 men; age: 44.5±11.0 years) with neurogenic bowel dysfunction (NBD). At 1, 3 and 6 months after initiation, a telephone interview was conducted. Data were collected on patient-specific bowel management and TAI performance as a new procedure.

RESULTS

Only 18 patients (34%) used TAI for at least 6 months, which was a lower compliance rate than similar studies in some European countries. Relative to the compliant group, the noncompliant group contained a higher proportion of tetraplegia than paraplegia (P=0.031), and a higher proportion dependent on physical help (P=0.034). In all, 33 of the 52 patients (63.5%) complained of practical problems with the TAI procedure such as expulsion of the rectal catheter. Fifteen patients (28.8%) presented with adverse effects. The incidence of practical problems or adverse effects did not alter the frequency of patient-reported successful outcome.

CONCLUSION

Korean participants showed a relatively lower compliance rate with TAI. We conclude that TAI, combined with adequate patient instruction and physical assistance, has potential as a management tool for NBD in Korea.

Upregulation of stromal cell-derived factor by IL-17 and IL-18 via a phosphatidylinositol 3-kinase-dependent pathway

Th17 cells that produce interleukin (IL)-17 play a key role in the pathogenesis of autoimmune inflammation. Among the various cytokines that are involved in the IL-17 pathway, members of the IL-1β family, including IL-18, have recently gained attention. In this study, we stimulated synovial fibroblasts with a combination of IL-17 and IL-18 and quantified their stromal cell-derived factor-1 (SDF-1) production by enzyme-linked immunosorbent assay and their transcript levels by reverse transcription-polymerase chain reaction. Both IL-17 and IL-18 significantly increased the level of SDF-1, not only individually but also synergistically (P< 0.05). The synergism was effectively suppressed by anti-IL-17 and -IL-18 antibodies, and a PI3K inhibitor. To the best of our knowledge, this is the first report of PI3K-dependent synergism between IL-18 and IL-17, and this work adds a novel perspective of the role of IL-18 in immune regulation. The individual effects of these two cytokines, and their interactions, suggest an interrelationship between the IL-1 family and IL-17.

Prognostic value of preoperative radiological staging assessed by computed tomography in patients with nonmetastatic colon cancer

PURPOSE

This study evaluated the prognostic value of preoperative locoregional staging in patients with colon cancer and who underwent curative resection.

METHODS

A total of 536 consecutive patients who underwent curative resection for colon cancer from February 1999 to November 2007 were prospectively enrolled. The clinicopathological variables, including the radiological staging using computed tomography, were analyzed for the prognostic significance.

RESULTS

The 5-year overall survival rates of the patients with radiological T1, T2, T3, and T4 were 96%, 89%, 75%, and 79%, respectively (P = 0.028). The 5-year overall survival rates were 83%, 76%, and 54%, respectively, for patients with radiological N0, N1, and N2 disease (P < 0.001). The 5-year overall survival rates of the patients with radiological TNM (tumor-node-metastasis) stages I, II, and III were 90%, 81%, and 70%, respectively (P < 0.001) and the 5-year overall survival rates of the patients with pathological TNM stages I, II, and III were 93%, 80%, and 70%, respectively (P = 0.001). On multivariate analysis, the radiological T and N categories remained independent prognostic factors for both overall survival and disease-free survival.

CONCLUSION

Radiological staging is an independent predictor of long-term survival in the preoperative setting.

Chronic obstructive lung disease-related health care utilisation in Korean adults with obstructive lung disease

OBJECTIVES

The numbers of nationwide epidemiological surveys about chronic obstructive pulmonary disease (COPD) prevalence and prospective cohort studies for health care utilisation are limited. We investigated COPD-related health care utilisation in adults with obstructive lung disease in the second Korean National Health and Nutritional Survey (KNHANES II) in 2001 using Korean national medical insurance claim data.

METHODS

Among people aged >40 years, obstructive lung disease (OLD) is defined according to Global Initiative for Chronic Obstructive Lung Disease criteria. Data from a total of 1942 subjects were linked with Korean national medical insurance claims data, and we investigated their COPD-related out-patient visits from 2002 to 2005.

RESULTS

Among the 1942 subjects, 256 (13.2%) had airflow obstruction. COPD-related out-patient visits were reported for 8.2% of patients without airway obstruction, 18.1% of those with mild airway obstruction, and 33.9% of those with moderate to very severe airway obstruction. Multivariate analysis revealed that previous COPD diagnosis by a physician (OR 2.54; P = 0.02) and lower socio-economic status (OR 0.45; P = 0.02) were independent predictors of COPD-related out-patient visits in subjects with OLD.

CONCLUSIONS

Of the subjects with airway obstruction, those with poor financial status utilised COPD-related health care services less frequently, and those previously diagnosed as having COPD by a physician utilised the services more frequently.

Identification of a novel HLA-B allele, B*35:01:25, by sequence-based typing in a Korean individual

The new allele B*35:01:25 showed a single nucleotide substitution compared with B*35:01:01 at codon 238 (GAT/GAC).

Transglutaminase 2 as an independent prognostic marker for survival of patients with non-adenocarcinoma subtype of non-small cell lung cancer

Background

Expression of transglutaminase 2 (TGase 2) is related to invasion and resistance to chemotherapeutic agents in several cancer cells. However, there has been only limited clinical validation of TGase 2 as an independent prognostic marker in cancer.

Methods

The significance of TGase 2 expression as an invasive/migratory factor was addressed by in vitro assays employing down-regulation of TGase 2. TGase 2 expression as a prognostic indicator was assessed in 429 Korean patients with early-stage non-small cell lung cancer (NSCLC) by immunohistochemical staining.

Results

TGase 2 expression increased the invasive and migratory properties of NSCLC cells in vitro, which might be related to the induction of MMP-9. In the analysis of the immunohistochemical staining, TGase 2 expression in tumors was significantly correlated with recurrence in NSCLC (p = 0.005) or in the non-adenocarcinoma subtype (p = 0.031). Additionally, a multivariate analysis also showed a significant correlation between strong TGase 2 expression and shorter disease-free survival (DFS) in NSCLC (p = 0.029 and HR = 1.554) and in the non-adenocarcinoma subtype (p = 0.030 and HR = 2.184). However, the correlation in the adenocarcinoma subtype was not significant.

Conclusions

TGase 2 expression was significantly correlated with recurrence and shorter DFS in NSCLC, especially in the non-adenocarcinoma subtype including squamous cell carcinoma.

Laparoscopy-assisted resection of tailgut cysts: report of a case

Tailgut cysts, or retrorectal cystic hamartomas, are rare congenital developmental lesions, most commonly located in the retrorectal space, and are more common in women. We present a case of retrorectal tailgut cyst managed using a laparoscopic approach. A 36-year-old woman presented with incidentally detected retrorectal tumors during evaluation for a gallbladder polyp. Her past medical history revealed that she had undergone cesarean section twice. The tumor marker CA 19-9 level was 42.52 U/ml. CT of the pelvis with contrast and pelvic MRI revealed a 3.9 × 3.3 cm well-defined, homogeneous cystic mass in the right presacral area, and a 2.5 × 1.5 cm cystic mass in the precoccygeal space. The patient underwent laparoscopic exploration with a preoperative diagnosis of tailgut cysts based on radiological findings. The operative time was 90 min including 30 min of subsequent laparoscopic cholecystectomy without placement of additional trocars. The surgical specimens consisted of two fragments of fibrofatty tissues, unilocular cystic masses. The final pathologic diagnosis was tailgut cysts with no evidence of malignancy. Postoperative recovery was uneventful, and the patient was discharged after 3 days. In conclusion, surgical resection is recommended in the management of retrorectal tailgut cyst to establish a definite diagnosis and to rule out malignancy. The laparoscopic approach is a feasible and safe option.

Abstract P4-02-12: Genomic Evolution of Endocrine-Resistant Breast Cancer Cell Lines Reveals Molecular Aberrations Consistent with Biological Phenotype

Suppression of estrogen synthesis using aromatase inhibitors (AIs) is highly effective in the treatment of postmenopausal women with estrogen receptor alpha-positive (ER+) breast cancer. Third generation AIs are superior to adjuvant tamoxifen resulting in improved disease-free survival and a lower incidence of side effects. Unfortunately, one of the consequences of long-term estrogen deprivation or exhaustive endocrine therapy is the development of drug resistance. We and others have shown that acquisition of resistance to long term estrogen deprivation or to selective estrogen receptor modulators (SERMs) in breast cancer cells is accompanied by an increase in malignant cell behavior. The Jordan Laboratory has developed in vitro and in vivo models of endocrine-resistant breast cancer that mimic pathobiology observed in anti-hormone refractory breast tumors. MCF-7:5C and MCF-7:2A are two ER+ human breast cancer cell lines derived from long term estrogen deprivation of hormone-dependent MCF-7 cells. MCF-7:TAM2 and MCF-7:RAL2 are also ER+ derivatives of MCF-7 that are resistant to tamoxifen and raloxifene, respectively. These models of resistance share several phenotypic and molecular characteristics, which differ dramatically from the isogenic parental line. Differences include robust growth in estrogen-deprived medium, mesenchymal morphology, and increased invasiveness and motility in vitro. They also exhibit elevated AKT activity, loss of E-cadherin, and additional molecular markers consistent with malignant progression. We have conducted an array-based genomic study to elucidate molecular mechanisms associated with development of endocrine resistance in each model. We observed a high degree of genomic evolution in all endocrine-resistant models. Several regions of common genomic aberration were observed in the MCF-7:5C and MCF-7:2A cells that indicate significant deregulation of glycolysis and glucose metabolism, a metabolic process known to be driven by activated AKT. Gene ontology analysis of genes differentially expressed by both MCF-7:5C and MCF-7:2A also highlighted deregulated AKT signaling and cell cycle control in these cells. Interestingly, amplification of the estrogen receptor 1 (ESR1) gene, which encodes estrogen receptor alpha, was observed in MCF-7:5C and MCF-7:2A models but not in the SERM-resistant models supporting diversity underlying mechanisms of endocrine resistance depending on therapies used. This study indicates that biological drivers of endocrine resistance can be identified using integrated genomic and bioinformatic approaches. We are currently prioritizing the likely molecular drivers of endocrine-resistant disease using high throughput RNAi technology.

Grant support: Department of Defense Breast Program under award number BC050277 Center of Excellence (V.C. Jordan). Views and opinions of and endorsements by the author(s) do not reflect those of the U.S. Army or the Department of Defense.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-02-12.

Smooth muscle signalling pathways in health and disease

Smooth muscle contractile activity is a major regulator of function of the vascular system, respiratory system, gastrointestinal system and the genitourinary systems. Malfunction of contractility in these systems leads to a host of clinical disorders, and yet, we still have major gaps in our understanding of the molecular mechanisms by which contractility of the differentiated smooth muscle cell is regulated. This review will summarize recent advances in the molecular understanding of the regulation of smooth muscle myosin activity via phosphorylation/dephosphorylation of myosin, the regulation of the accessibility of actin to myosin via the actin-binding proteins calponin and caldesmon, and the remodelling of the actin cytoskeleton. Understanding of the molecular 'players' should identify target molecules that could point the way to novel drug discovery programs for the treatment of smooth muscle disorders such as cardiovascular disease, asthma, functional bowel disease and pre-term labour.

Clinical features and treatment outcomes of advanced stage primary hepatic angiosarcoma

BACKGROUND

Primary hepatic angiosarcoma is a very rare malignancy with a poor prognosis. While surgical resection has been validated as curative choice, most cases are diagnosed too late for resection. Nonetheless, treatment protocols have not been established and also there are very few reports on the clinical features and treatment outcomes.

PATIENTS AND METHODS

Among 11,939 patients diagnosed with primary hepatic tumors from January 1985 to December 2007 at two centers, five patients were diagnosed with primary hepatic angiosarcoma. We analyzed patients' demographics, tumor characteristics, treatment modality, and outcomes using imaging, serology, and pathology.

RESULTS

All five patients were diagnosed at advanced stage with distant metastases. The most common symptom was abdominal pain. The levels of the tumor markers were within the normal range and serological tests were negative for hepatitis B and C viruses. Two of four patients who received chemotherapy died <3 months after diagnosis, but the other two patients survived >6 months.

CONCLUSIONS

A combination of chemotherapy resulted in an improved outcome for two of four patients, suggesting the potential usefulness of palliative chemotherapy to improve survival. This case study may aid in planning chemotherapy for patients with advanced hepatic angiosarcoma.

Smooth muscle signalling pathways in health and disease

Smooth muscle contractile activity is a major regulator of function of the vascular system, respiratory system, gastrointestinal system and the genitourinary systems. Malfunction of contractility in these systems leads to a host of clinical disorders, and yet, we still have major gaps in our understanding of the molecular mechanisms by which contractility of the differentiated smooth muscle cell is regulated. This review will summarize recent advances in the molecular understanding of the regulation of smooth muscle myosin activity via phosphorylation/dephosphorylation of myosin, the regulation of the accessibility of actin to myosin via the actin-binding proteins calponin and caldesmon, and the remodelling of the actin cytoskeleton. Understanding of the molecular 'players' should identify target molecules that could point the way to novel drug discovery programs for the treatment of smooth muscle disorders such as cardiovascular disease, asthma, functional bowel disease and pre-term labour.

Synthesis of pure white color and its equal power, equal chromatic splitting through a novel 3x3 fiber optic visible multiplexer

We report generation of pure-white color by mixing red, green, blue (RGB) lights from LEDs through a novel 3??3 fiber optics color synthesizer (FOCS), which is made of hard plastic cladding fiber (HPCF). The three output ports provided an equal power for the synthesized white color with almost identical CIE color coordinates. The FOCS rendered tunable white color temperature and optical properties of the outputs were experimentally investigated in terms of uniformity in power, photometric luminance, and color coordinate. We further packaged the device and applied to small form factor back light unit (BLU) to show feasibility in illumination uniformity enhancement.

p38 MAPK and NF-κB on IL-6 Release in Human Gingival Fibroblasts

The induction of interleukin-6 (IL-6) using a proinflammatory cytokine (IL-1beta) was studied in human gingival fibroblasts (HGFs) in relation to p38 MAPK and NF-kappaB transcription factor. When added to HGFs, IL-1beta had a stimulatory effect on the production of IL-6, and this effect was significantly reduced by SB203580, a specific p38 MAPK inhibitor. In addition, the stimulation of IL-6 release also was reduced by the addition of pyrrolidine dithiocarbamate or NF-kappaB SN50, which has been reported as potent NF-kappaB inhibitor. Both the NF-kappaB inhibitors in the presence of SB203580 had more inhibitory effect on IL-6 release. IL-13 stimulated NF-kappaB binding affinity as well as p38 MAP kinase activation, leading to the release of IL-6. However, a specific inhibitor of p38 MAPK, SB203580, had no effect on the NF-kappaB activation, and both the NF-kappaB inhibitors failed to reduce the p38 MAPK activation in the IL-1beta-stimulated HGFs. These results strongly suggest that both p38 MAPK and NF-kappaB are required in IL-1beta-induced IL-6 synthesis and that these two IL-1beta-activated pathways can be primarily dissociated.