A comparative study of the CT effective dose in whole-body 18F-FDG PET/CT for arm-raised position and arm-lowered position

INTRODUCTION

This study aimed to investigate and compare the effective dose (ED) delivered by computed tomography (CT) in whole-body positron emission tomography/CT (WB-PET/CT) scans between patients positioned with their arms-raised and those with their arms-lowered during the scan on a large population.

METHODS

The retrospective study involved 785 oncology patients who underwent WB-PET/CT scans with 18F-FDG between January and June 2019. Exclusion criteria were applied, resulting in a final analysis of data from 732 adult patients. All of the patients were measured height and weight, and the ED from CT in WB-PET/CT was estimated using the dose length product value and a conversion factor. Statistical analyses were conducted to explore relationships between factors and the ED. Linear regression analysis was performed to investigate connections between weight and ED, and height and ED. Multiple linear regression was used to predict ED based on sex, weight, and arm position.

RESULTS

The arm-lowered group had a higher ED than the arm-raised group, and the median dose was 1.1 times higher in the arm-lowered group. The difference in ED between the two groups was found to be greater with higher body weight. Arm-position (β = 0.460), sex (β = -0.190), and weight (β = 0.057) were significant predictors of ED.

CONCLUSION

This study demonstrated that arm position, sex, and weight were significant factors influencing the ED from CT scans in WB-PET/CT.

IMPLICATIONS FOR PRACTICE

The research underscores the importance of considering these factors when evaluating radiation exposure in clinical practice, particularly for patients undergoing WB-CT imaging. These findings contribute to a better understanding of the radiation dosimetry associated with different patient positions during WB-PET/CT scans.

Association of demographics, HCV co-infection, HIV-1 subtypes and genetic clustering with late HIV diagnosis: a retrospective analysis from the Japanese Drug Resistance HIV-1 Surveillance Network

INTRODUCTION

Late diagnosis of the human immunodeficiency virus (HIV) is a major concern epidemiologically, socially and for national healthcare systems. Although the association of certain demographics with late HIV diagnosis has been reported in several studies, the association of other factors, including clinical and phylogenetic factors, remains unclear. In the present study, we conducted a nationwide analysis to explore the association of demographics, clinical factors, HIV-1 subtypes/circulating recombinant form (CRFs) and genetic clustering with late HIV diagnosis in Japan, where new infections mainly occur among young men who have sex with men (MSM) in urban areas.

METHODS

Anonymized data on demographics, clinical factors and HIV genetic sequences from 39.8% of people newly diagnosed with HIV in Japan were collected by the Japanese Drug Resistance HIV-1 Surveillance Network from 2003 to 2019. Factors associated with late HIV diagnosis (defined as HIV diagnosis with a CD4 count <350 cells/μl) were identified using logistic regression. Clusters were identified by HIV-TRACE with a genetic distance threshold of 1.5%.

RESULTS

Of the 9422 people newly diagnosed with HIV enrolled in the surveillance network between 2003 and 2019, 7752 individuals with available CD4 count at diagnosis were included. Late HIV diagnosis was observed in 5522 (71.2%) participants. The overall median CD4 count at diagnosis was 221 (IQR: 62-373) cells/μl. Variables independently associated with late HIV diagnosis included age (adjusted odds ratio [aOR] 2.21, 95% CI 1.88-2.59, ≥45 vs. ≤29 years), heterosexual transmission (aOR 1.34, 95% CI 1.11-1.62, vs. MSM), living outside of Tokyo (aOR 1.18, 95% CI 1.05-1.32), hepatitis C virus (HCV) co-infection (aOR 1.42, 95% CI 1.01-1.98) and not belonging to a cluster (aOR 1.30, 95% CI 1.12-1.51). CRF07_BC (aOR 0.34, 95% CI 0.18-0.65, vs. subtype B) was negatively associated with late HIV diagnosis.

CONCLUSIONS

In addition to demographic factors, HCV co-infection, HIV-1 subtypes/CRFs and not belonging to a cluster were independently associated with late HIV diagnosis in Japan. These results imply the need for public health programmes aimed at the general population, including but not limited to key populations, to encourage HIV testing.

Assessment of the albumin-bilirubin grade as a prognostic factor in patients with non-small-cell lung cancer receiving anti-PD-1-based therapy

Introduction

The albumin-bilirubin (ALBI) grade is a novel indicator of the liver function. Some studies showed that the ALBI grade was a prognostic and predictive biomarker for the efficacy of chemotherapy in cancer patients. The association between the ALBI grade and outcomes in patients with non-small-cell lung cancer (NSCLC) treated with cancer immunotherapy, however, is poorly understood.

Methods

We retrospectively enrolled 452 patients with advanced or recurrent NSCLC who received anti-programmed cell death protein 1 (PD-1)-based therapy between 2016 and 2019 at three medical centers in Japan. The ALBI score was calculated from albumin and bilirubin measured at the time of treatment initiation and was stratified into three categories, ALBI grade 1-3, with reference to previous reports. We examined the clinical impact of the ALBI grade on the outcomes of NSCLC patients receiving anti-PD-1-based therapy using Kaplan–Meier survival curve analysis with log-rank test and Cox proportional hazards regression analysis.

Results

The classifications of the 452 patients were as follows: grade 1, n = 158 (35.0%); grade 2, n = 271 (60.0%); and grade 3, n = 23 (5.0%). Kaplan–Meier survival curve analysis showed that the ALBI grade was significantly associated with progression-free survival and overall survival. Moreover, Cox regression analysis revealed that the ALBI grade was an independent prognostic factor for progression-free survival and overall survival.

Conclusion

The ALBI grade was an independent prognostic factor for survival in patients with advanced or recurrent NSCLC who receive anti-PD-1-based therapy. These findings should be validated in a prospective study with a larger sample size.

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ALBI grade is calculated from albumin and bilirubin.

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We evaluated the impact of ALBI grade on survival in NSCLC patients receiving immune checkpoint inhibitors.

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ALBI grade was an independent prognostic factor for progression-free survival (PFS) and overall survival (OS).

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ALBI grade effectively stratified PFS and OS in patients with performance status 1-3.

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ALBI grade was significantly associated with PFS and OS, regardless of programmed death ligand-1.

P251 Right ventricular free wall dissection clearly detected and recorded by echocardiography: a fatal complication after inferior myocardial infarction

An 81-year-old man was transferred to our institution by ambulance because of poor feeding, general fatigue and slight disorientation lasting for a week. On arrival, he was awake and able to speak, however, his blood pressure was low at 61/43 mmHg in spite of his medical history of hypertension. His ECG showed abnormal Q waves and ST elevation in II, III, aVF leads. The echo exam detected severe hypokinesis in the left ventricular inferior wall and reduced ejection fraction at 30%. Pericardial effusion was not observed in the first echo exam. The patient was diagnosed as cardiogenic shock due to recent inferior myocardial infarction. Coronary angiography was performed, which detected total occlusion of mid right coronary artery, followed by a successful percutaneous coronary intervention (PCI) with a drug-eluting stent under the support of intra-aortic balloon pumping. Nevertheless, his blood pressure remained low and intravenous adrenaline administration was necessary during and even after PCI. To detect the cause of prolonged low blood pressure, echo was performed again immediately after PCI. The echo exam detected new findings: right ventricular posterior free wall was dissected and abnormal shunt flows were obviously observed from left ventricle to right atrium through the dissection cavity during systole. An urgent surgical repair was considered as the only option for his survival, however, his family did not accept it because the operation itself was too risky. On the next day of his admission, he passed away. Right ventricular free wall dissection is a very rare but fatal complication after inferior myocardial infarction, nevertheless, we could detect it by echocardiography with clearly recorded images.

Abstract P251 Figure.

P1386 A change in left ventricular global longitudinal strain is a prognostic indicator in congestive heart failure patients with preserved ejection fraction

Purposes

We examined how changes in left ventricular (LV) global longitudinal strain (GLS) were associated with prognosis in patients with preserved LV ejection fraction (LVEF) after congestive heart failure (HF) admission.

Methods

We studied 123 consecutive patients (age 70 ± 15 years, 55% male) who had been hospitalized due to congestive HF with preserved LVEF (&gt; 50%). The exclusion criteria were atrial fibrillation and inadequate echo image quality for strain analyses. The patients underwent speckle-tracking echocardiography and measurement of plasma NT-ProBNP levels on the same day at the time of hospital admission as well as in the stable condition after discharge. Differences in GLS, LVEF and NT-ProBNP (delta GLS, LVEF and NT-ProBNP ; 2nd – 1st measurements) were calculated. The study end points were all-cause mortality and cardiac events.

Results

Mean periods of echo performance after hospitalization were 2 ±１days (1st echo) and 240 ± 289 days (2nd echo), respectively. During the follow-up (974 ± 626 days), 12 patients died and 25 patients were hospitalized because of HF worsening. In multivariate analysis, delta GLS and follow-up GLS were prognostic factors, whereas baseline and follow-up LVEF, NT-ProBNP, changes in LVEF and NT-ProBNP could not predict cardiac events. Delta GLS (p = 0.002) turned out to be the best independent prognosticator. Receiver operating characteristics analysis revealed that -0.6% of delta GLS was the optimal cut-off value to predict cardiac events and mortality (sensitivity 76%, specificity 67%, AUC 0.75). Kaplan-Meier analysis showed that patients with delta GLS more than -0.6% experienced significantly less cardiac events during the follow-up period (p &lt; 0.0001, log-rank).

Conclusion

A change in LV GLS after congestive HF admission was a predictor of the prognosis in patients with preserved LVEF. It would be useful to check the changes in GLS in those with preserved LVEF after discharge.

The Iowa Gambling Task on HIV-infected subjects

HIV-associated neurocognitive disorders (HAND) are characterized by cognitive, behavioral, and motor dysfunctions, which impact daily functioning and are predictive of poor survival among patients. The diagnosis of HAND is marked by clinically significant declines in multiple domains of neurocognitive functioning. Some patients diagnosed with HAND have social problem; however, higher brain dysfunction is not detected in general neuropsychological assessments and the intelligence quotient may remain unchanged. Impaired decision-making may reduce social and occupational qualities of life. The Iowa Gambling Task (IGT) has been developed as a task to evaluate risk predictions at the time of decision-making. In the present study, 38 HIV-infected patients enrolled in our hospital performed IGT and we investigated whether the results obtained are associated with HAND. The median net IGT score of all HIV-infected subjects was significantly lower than that of healthy controls. Patients diagnosed with HAND accounted for 43.8% of the negative net score group. We elucidated the relationship between the net IGT score and HAND for the first time. We think that IGT is a good tool to detect decision-making impairment for ANI and MND. Careful follow-ups of the progression of HAND and increased awareness among HIV-infected patients and medical care workers of the risk of social behavioral disorders, which negatively impact daily life before they are detected, are needed in order to prevent deteriorations in the quality of life of these patients.

Prognostic value of quality-of-life scores in patients with breast cancer undergoing preoperative chemotherapy

Background

Recently, evaluation of quality of life (QOL) has been recognized as a significant outcome measure in the treatment of several cancers. In this study, the Anti-Cancer Drugs-Breast (ACD-B) QOL score was used to assess disease-specific survival in women with breast cancer undergoing preoperative chemotherapy (POC).

Methods

QOL-ACD-B scores were evaluated before and after POC. The cut-off value of QOL-ACD-B contributing to events such as relapse or death was calculated by receiver operating characteristic (ROC) curve analysis.

Results

In 300 women with breast cancer treated with POC, QOL was significantly reduced (P < 0·001). A high QOL-ACD-B score before POC was an independent factor in the multivariable analysis of overall survival (hazard ratio 0·26, 95 per cent c.i. 0·04 to 0·96).

Conclusion

Evaluation by QOL-ACD-B before POC may be useful to predict the prognosis of patients with breast cancer undergoing POC.

An attempt to support by the Japanese society of travel and health for increasing travel clinics

In recent years, both the number of Japanese travelers to foreign countries and foreign travelers who visit Japan have increased remarkably, and the risk of travelers suffering various infectious diseases is also increasing. In many western countries travel clinics commonly perform medical consultations, vaccinations, and issue prescriptions. However, travel clinics are not yet popular in Japan. In 2011, Japanese society of travel and health (JSTH) began a support project for travel clinic with a goal of increasing their number throughout the country. The project included the release of a manual for education, training, equipment, details of medical treatment, sources of information for travel clinic opening on the JSTH website (http://jstah.umin.jp/20TravelClinicSupport/manual_20120726.pdf), and mediation of short-term visitation to experienced travel clinics registered in the JSTH to facilitate learning above information and aftercare services. JSTH accepted requests for visitation to travel clinics from 39 medical institutions between 2011 and 2018. By 2018, 26 (66.7%) of the 39 medical institutions had opened travel clinics within two years and the 25 travel clinics had registered in the JSTH and one was a campus-limited clinic, while most of the remaining institutions are still in preparation stages. The number of travel clinics registered in the JSTH has increased from 45 in 2011 to 108 in 2018. Twenty-five travel clinics registered in the JSTH between 2011 and 2018 were eventually receiving support from JSTH. Our data indicates travel clinics in Japan have gradually increased and establishment areas are expanding after the beginning of support project for travel clinics by JSTH.

Assessment of Canine Pancreas-Specific Lipase and Outcomes in Dogs with Hemodialysis-Dependent Acute Kidney Injury

Background

Renal replacement therapies can be life‐saving for dogs with severe acute kidney injury (AKI), however, comorbidities including pancreatitis might affect outcome.

Hypothesis/Objectives

To investigate the prevalence of pancreas‐specific lipase (Spec cPL) measurements consistent with pancreatitis (≥400 μg/L) in dogs undergoing intermittent hemodialysis (IHD) for treatment of AKI and to determine whether there were associations between 30‐days outcomes and Spec cPL measurements.

Animals

Fifty‐three client‐owned dogs presented to teaching hospitals between November 2008 and September 2016 that underwent IHD.

Methods

Retrospective medical record review from dogs that received IHD for management of AKI and also had a Spec cPL measurement. Association between survival, dialysis‐dependency, and Spec cPL measurements was assessed.

Results

Forty of 53 (76%) dogs were alive at 30‐days and 33/53(62%) had a Spec cPL result ≥400 μg/L. Spec cPL was not significantly different either between surviving (635.5 μg/L, range 29–1,001) and nonsurviving dogs (860 μg/L, range 56–1,001; P = 0.75) or between dialysis‐dependent (1,001 μg/L, range 177–1,001) and nondialysis‐dependent dogs (520 μg/L, range 29–1,001; P = 0.08). Spec cPL ≥400 μg/L was not significantly associated either with survival (P = 0.74) or dialysis‐dependency (P = 0.33).

Conclusions and Clinical Importance

Results revealed a high prevalence of Spec cPL ≥400 μg/L in dogs with AKI treated with IHD. No significant associations between Spec cPL and survival or dialysis‐dependency in dogs with AKI at 30 days were identified in the current study, however, the latter could be due to lack of power in this study.

Association of age and time of disease with HIV-associated neurocognitive disorders: a Japanese nationwide multicenter study

There is no detailed information on the association between age, time of disease, and HIV-associated neurocognitive disorders (HAND). In this prospective study involving 17 medical facilities across Japan, we recruited HIV-infected patients to complete a 14-test neuropsychological battery that assess eight neurocognitive domains. HAND were diagnosed by the Frascati criteria. Of 1399 recruited patients, 728 were enrolled. The prevalence of HAND was 25.3% [13.5% asymptomatic neurocognitive impairment, 10.6% mild neurocognitive disorder (MND), and 1.2% HIV-associated dementia (HAD)]. Tests that assess executive and visuospatial functions showed better diagnostic accuracy than other tests for HAND. Multivariate analysis identified age (≥ 50 years) and incomplete virological suppression as risk factors for MND and HAD and current ART as a protective factor. The prevalence of MND and HAD was low in the early stage of infection (6.3% in ≥ 2 to < 6 years), then increased in the later stage [17.3% in ≥ 11 years, p = 0.001 (vs. ≥ 2 to < 6 years)], independent of age or treatment. Older patients were more likely to show MND or HAD in the early stage of HIV infection (26.7 vs. 8.7% for < 2 years and 17.4 vs. 3.1% for ≥ 2 to < 6 years, p = 0.040 and 0.004, respectively) compared to younger ones. In conclusion, MND and HAD were more commonly found in later years since diagnosis of HIV infection and older patients are at risk of neurocognitive impairment at the early stage of HIV infection. Tests for executive and visuospatial functions seem more sensitive than other tests for diagnosing HAND.

Abstract P6-09-25: Circulating tumor cell clusters-associated gene plakoglobin is a novel prognostic predictor in patients with breast cancer

Background: Accumulating evidence shows that circulating tumor cells (CTC) are linked to metastatic relapse and are regarded as a prognostic marker for human cancer. It was reported that CTC clusters (CTCc) have more metastatic potential than single CTC. Lately, studies also show that the high expression of plakoglobin, a cell adhesion protein, within the primary tumor are positively associated with CTCc in breast cancer patients. In addition, it is thought that insufficient expression of plakoglobin could promote epithelial-mesenchymal transition (EMT). In this study, we investigated the correlation between plakoglobin expression and survival of breast cancer.

Materials and Methods:A total of 126 patients with resectable early-stage breast cancer were treated with neoadjuvant chemotherapy (NAC). All patients received a standardized protocol of NAC consisting of four courses of FEC100 (500 mg/m2 fluorouracil, 100 mg/m2 epirubicin, and 500 mg/m2 cyclophosphamide) every 3 weeks, followed by 12 courses of 80 mg/m2 paclitaxel administered weekly. The expression of plakoglobin were identified by immunohistochemical staining properties in cell membrane. Staining with plakoglobin (clone 4C12) was scored according to the percentage of cells that stained positively: low, 0-25%; medium, 26-75%; high, &gt;75%. We investigated the correlation between the plakoglobin expression in primary tumor specimen and clinical outcomes including overall-survival (OS), disease-free-survival (DFS), distant-metastasis-free-survival (DMFS), the efficacy of NAC. And we examined the relation between the expression of plakoglobin and E-cadherin, EMT marker.

Results: The patient with high plakoglobin expression had significantly worse OS (p=0.021, log-rank) and DFS (p=0.015, log-rank), DMFS (p=0.040, log-rank). And the plakoglobin expression had no correlation with pathological complete response (pCR) rate (p=0.596). Also, there was not a statistically significant relationship between the plakoglobin expression and other clinicopathological parameters including tumor size (p=0.708), lymph node status (p=0.479), subtype (p=0.413), nuclear grade (p=0.642), Ki67 (p=0.202), tumor infiltrating lymphocytes (p=0.828). On univariate analysis with respect to distal metastasis, high plakoglobin expression showed worse prognosis than low plakoglobin expression (p=0.013, hazard ratio=4.221). And multivariate analysis found the same result (p=0.015, hazard ratio=4.070). In addition, there was a significant relationship between the expression of plakoglobin and E-cadherin (p=0.023).

Conclusions: Plakoglobin expression is an independent prognostic factor in the patients with breast cancer; particularly for DMFS, and this mechanism related to EMT.Background: Accumulating evidence shows that circulating tumor cells (CTC) are linked to metastatic relapse and are regarded as a prognostic marker for human cancer. It was reported that CTC clusters (CTCc) have more metastatic potential than single CTC. Lately, studies also show that the high expression of plakoglobin, a cell adhesion protein, within the primary tumor are positively associated with CTCc in breast cancer patients. In addition, it is thought that insufficient expression of plakoglobin could promote epithelial-mesenchymal transition (EMT). In this study, we investigated the correlation between plakoglobin expression and survival of breast cancer.

Materials and Methods:A total of 126 patients with resectable early-stage breast cancer were treated with neoadjuvant chemotherapy (NAC). All patients received a standardized protocol of NAC consisting of four courses of FEC100 (500 mg/m2 fluorouracil, 100 mg/m2 epirubicin, and 500 mg/m2 cyclophosphamide) every 3 weeks, followed by 12 courses of 80 mg/m2 paclitaxel administered weekly. The expression of plakoglobin were identified by immunohistochemical staining properties in cell membrane. Staining with plakoglobin (clone 4C12) was scored according to the percentage of cells that stained positively: low, 0-25%; medium, 26-75%; high, &gt;75%. We investigated the correlation between the plakoglobin expression in primary tumor specimen and clinical outcomes including overall-survival (OS), disease-free-survival (DFS), distant-metastasis-free-survival (DMFS), the efficacy of NAC. And we examined the relation between the expression of plakoglobin and E-cadherin, EMT marker.

Results: The patient with high plakoglobin expression had significantly worse OS (p=0.021, log-rank) and DFS (p=0.015, log-rank), DMFS (p=0.040, log-rank). And the plakoglobin expression had no correlation with pathological complete response (pCR) rate (p=0.596). Also, there was not a statistically significant relationship between the plakoglobin expression and other clinicopathological parameters including tumor size (p=0.708), lymph node status (p=0.479), subtype (p=0.413), nuclear grade (p=0.642), Ki67 (p=0.202), tumor infiltrating lymphocytes (p=0.828). On univariate analysis with respect to distal metastasis, high plakoglobin expression showed worse prognosis than low plakoglobin expression (p=0.013, hazard ratio=4.221). And multivariate analysis found the same result (p=0.015, hazard ratio=4.070). In addition, there was a significant relationship between the expression of plakoglobin and E-cadherin (p=0.023).

Conclusions: Plakoglobin expression is an independent prognostic factor in the patients with breast cancer; particularly for DMFS, and this mechanism related to EMT.

Citation Format: Goto W, Kashiwagi S, Asano Y, Takada K, Takashima T, Morisaki T, Noda S, Onoda N, Ohsawa M, Hirakawa K, Ohira M. Circulating tumor cell clusters-associated gene plakoglobin is a novel prognostic predictor in patients with breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-25.

Abstract P3-04-20: Predicting therapeutic effect by on tumor invasion lymphocytes (TILs) in endocrine therapy for stage IV breast cancer

Background: Breast cancer with distant metastasis at first presentation (stage IV disease) is often encountered in the outpatient department. With recent advances in multimodal therapies for breast cancer, long-term survival can now be expected even in stage IV breast cancer with distant metastasis. However, a goal in treating metastatic disease is prolongation of survival while maintaining good quality of life (QOL). Endocrine therapy is suitable for this purpose.The tumor immune environment not only modulates the effects of immunotherapy, but also the effects of other anticancer drugs and treatment outcomes. These immune responses can be evaluated with tumor-infiltrating lymphocytes (TILs), which has frequently been verified clinically. In the present study, we hypothesized that TILs would be useful as predictive marker of the therapeutic effect in endocrine therapy as well. In this study, the prediction of the therapeutic effect by TILs in endocrine therapy for stage IV breast cancer was clinically verified.

Materials and Methods:Data from 40 patients who underwent endocrine therapy as the initial drug therapy for stage IV breast cancer were used. The correlation between TILs evaluated according to the standard method, and prognosis, including the efficacy of endocrine therapy, was investigated retrospectively. Patients with 350% lymphocytic infiltration were considered to have lymphocyte-predominant breast cancer (LPBC).

Results:Among all 40 patients, TIL levels were high in 13 (32.5%) and low in 27 (67.5%) patients. Nine patients (22.5%) had LPBC, and 31 patients (77.5%) had non-LPBC. Investigation of the clinical pathological features of patients showed no significant differences between the high TIL and low TIL groups. There were also no significant differences between LPBC and non-LPBC patients. An analysis of outcomes comparing the high TIL and low TIL groups showed no prolongation in progression-free survival (PFS) (p=0.171, log-rank), time to treatment failure (TTF)(p=0.054), or overall survival (OS) (p=0.641). LPBC patients had significant prolongations of PFS (p=0.005), TTF (p=0.001), and OS (p=0.027) compared to non-LPBC patients. On receiver operating characteristic (ROC) curve analyses, results were better with LPBC (AUC: 0.700) than with TILs (AUC: 0.606).

Conclusion: The present findings suggest that a high level of lymphocytic infiltration in the tumor stroma may serve as a predictor of the therapeutic effect of endocrine therapy for patients with stage IV ER-positive breast cancer.

Citation Format: Kashiwagi S, Asano Y, Goto W, Takada K, Takashima T, Morisaki T, Noda S, Onoda N, Ohsawa M, Hirakawa K, Ohira M. Predicting therapeutic effect by on tumor invasion lymphocytes (TILs) in endocrine therapy for stage IV breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-04-20.

Abstract P2-05-05: Prediction of survival after neoadjuvant chemotherapy for breast cancer by evaluation of tumor-infiltrating lymphocytes (TILs) and residual cancer burden (RCB)

Background: The tumor immune environment not only modulates the effects of immunotherapy, but also the effects of other anticancer drugs and treatment outcomes. Thus, the importance of inhibiting and improving the tumor immune microenvironment is now recognized. These immune responses can be evaluated with tumor-infiltrating lymphocytes (TILs), which has frequently been verified clinically. On the other hand, residual cancer burden (RCB) evaluation has been shown to be a useful predictor of survival after neoadjuvant chemotherapy (NAC). In this study, RCB and TILs evaluations were combined to produce an indicator that we have termed “RCB-TILs”, and its clinical application to NAC for breast cancer was verified by subtype-stratified analysis.

Materials and Methods:A total of 177 patients with resectable early-stage breast cancer were treated with NAC.The correlation between TILs evaluated according to the standard method, and prognosis, including the efficacy of NAC, was investigated retrospectively. The RCB was calculated using the Residual Cancer Burden Calculator on the website of the MD Anderson Cancer Center. The RCB and TILs evaluations were combined to create the “RCB-TILs”. Patients who were RCB-positive and had high TILs were considered RCB-TILs-positive, and all other combinations were RCB-TILs-negative.

Results: Univariable analysis of patients with high TILs found that this contributed significantly to prolonging DFS in all patients (p = 0.022, hazard ratio = 0.420), TNBC patients (p = 0.004, hazard ratio = 0.177), and HER2BC patients (p = 0.026, hazard ratio = 0.123). For HRBC patients, however, high TILs did not contribute to survival (p = 0.990, hazard ratio = 0.992). Being RCB-TILs-positive, however, contributed significantly to prolonging DFS in all patients (p &lt; 0.001, hazard ratio = 0.181), TNBC patients (p &lt; 0.001, hazard ratio = 0.099), HER2BC patients (p = 0.026, hazard ratio = 0.123), and HRBC patients (p = 0.039, hazard ratio = 0.258). On multivariable analysis, being RCB-TILs-positive was an independent factor for recurrence after NAC in all patients (p &lt; 0.001, hazard ratio = 0.048), TNBC patients (p = 0.018, hazard ratio = 0.041), HER2BC patients (p = 0.036, hazard ratio = 0.134), and HRBC patients (p = 0.002, hazard ratio = 0.081).

Conclusion: The results of the present study suggest that RCB-TILs is a significant predictor for breast cancer recurrence after NAC and may be a more sensitive indicator than TILs alone.

Citation Format: Asano Y, Kashiwagi S, Goto W, Takada K, Takashima T, Morisaki T, Noda S, Onoda N, Ohsawa M, Hirakawa K, Ohira M. Prediction of survival after neoadjuvant chemotherapy for breast cancer by evaluation of tumor-infiltrating lymphocytes (TILs) and residual cancer burden (RCB) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-05-05.

Asymmetry in the Condylar Long Axis and First Molar Rotation

Asymmetric growth occurs frequently in the mandibulofacial region, but little attention has been given to asymmetry in the temporomandibular joint. The purpose of this study was to clarify the feature of asymmetry in the condylar long axis and its relation to upper first molar rotation. Records of 148 pre-orthodontic patients were used. The angle of the condylar long axis and that of the molar rotation were both larger on the left side than on the right side. Positive correlations were found between the corresponding bilateral measurements of condylar long axes and also between those of molar rotations, whereas no correlation was found between the condylar long axis and molar rotation. These findings were found in most subgroups classified by dental age, skeletal pattern, bite force balance, or gender. These results suggest that consistent left-right differences in the condylar long axis and first molar rotation are common.

Mental Stress-induced Physiological Changes in the Human Masseter Muscle

The effect of a long mental stress on the hemodynamics of masticatory muscles has not been investigated to date. We hypothesized some hemodynamic and electromyographic changes in jaw-closure muscles related to sympathetic nervous system activity. While healthy adult female volunteers performed a two-hour mental stress task, electromyographic activity of the temporal and masseteric muscles was recorded, and hemodynamic changes of the masseter muscle were measured non-invasively. Autonomic function was assessed by heart rate spectral analysis. Integrated electromyographic activity of the temporalis muscle, but not the masseter muscle, showed an increase that coincided with the increase in sympathetic nervous activity. In the masseter muscle, despite little change in integrated electromyographic activity, notable changes were found in hemodynamic parameters. These results suggest that hemodynamics of jaw muscles is susceptible to mental stress, implying a potential role in the etiology of jaw muscle dysfunction associated with mental stress.

Physicochemical and biological characterizations of complex formation between lipopolysaccharide and lysozyme

Endotoxin (lipopolysaccharide, LPS) from Gram-negative bacteria induces a variety of biological effects in mammals. We have earlier demonstrated that lysozyme (LZM) will bind to both smooth and rough forms of LPS and lipid A with high affinity, and inhibits several of the immunomodulatory activities of LPS. The production of LZM/LPS complexes was suggested to be significantly influenced by both reaction temperature and ionic strength. In this manuscript, we describe experiments designed to examine the formation of LZM/LPS complexes prepared under various conditions as assessed by fluorescence measurements of dansylated LZM and also by separation of complexes via nitration methodologies. The results of these studies provide additional experimental evidence that complex formation requires both ionic and hydrophobic interactions. The most stable complexes were formed at conditions of low ionic strength and higher temperature. Under these conditions, hydrophobic interactions were predominant in complex formation. At lower temperatures, the extent of complex formation was less, and ionic interactions were predominant. TNF production by RAW264.7 cells in vitro was decreased by LZM/LPS complexes prepared in both high and low ionic strength, but was most significantly decreased at conditions of low ionic strength and higher temperatures. These facts suggest that both ionic and hydrophobic interactions of LZM with LPS are important for neutralizing the biological activity of LPS.

Validation of a Clinical Scoring System for Outcome Prediction in Dogs with Acute Kidney Injury Managed by Hemodialysis

Background

A scoring system for outcome prediction in dogs with acute kidney injury (AKI) recently has been developed but has not been validated.

Hypothesis

The scoring system previously developed for outcome prediction will accurately predict outcome in a validation cohort of dogs with AKI managed with hemodialysis.

Animals

One hundred fifteen client‐owned dogs with AKI.

Methods

Medical records of dogs with AKI treated by hemodialysis between 2011 and 2015 were reviewed. Dogs were included only if all variables required to calculate the final predictive score were available, and the 30‐day outcome was known. A predictive score for 3 models was calculated for each dog. Logistic regression was used to evaluate the association of the final predictive score with each model's outcome. Receiver operating curve (ROC) analyses were performed to determine sensitivity and specificity for each model based on previously established cut‐off values.

Results

Higher scores for each model were associated with decreased survival probability (P < .001). Based on previously established cut‐off values, 3 models (models A, B, C) were associated with sensitivities/specificities of 73/75%, 71/80%, and 75/86%, respectively, and correctly classified 74–80% of the dogs.

Conclusions and Clinical Relevance

All models were simple to apply and allowed outcome prediction that closely corresponded with actual outcome in an independent cohort. As expected, accuracies were slightly lower compared with those from the previously reported cohort used initially to develop the models.

Successful treatment of severe refractory lupus hepatitis with mycophenolate mofetil

Systemic lupus erythematosus-related hepatitis, known as lupus hepatitis, is a rare manifestation of systemic lupus erythematosus, and is usually subclinical with mild abnormalities of serum liver enzymes. While cases with clinically significant and refractory lupus hepatitis are uncommon, treatment options for lupus hepatitis are to be established. Here, we report the case of a 45-year-old man with progressive lupus hepatitis accompanied by autoimmune haemolytic anaemia. Lupus hepatitis of this patient was refractory to tacrolimus, azathioprine and cyclophosphamide, but was successfully treated by mycophenolate mofetil. Mycophenolate mofetil might be an effective therapeutic option for refractory lupus hepatitis.

Sexual dimorphism in the facial morphology of adult humans: A three-dimensional analysis

The objective of this study was to demonstrate sexual dimorphism in the entire three-dimensional facial surface form of adult humans. The sample consisted of female and male groups (n=200; age range, 18-35 years). Three-dimensional images of each participant's face at rest were recorded. A total of 185 variables that described facial surface configuration features were extracted from each image. The variables were compared between the groups using t-tests, and those exhibiting P-values <0.0001 were entered into a stepwise discriminant function analysis for sex determination. Wire mesh fitting was also performed on each image to examine the facial surface morphology. The mean node coordinates of the fitted mesh were compared between the groups using t-tests. Sixty-seven of the 185 variables differed significantly between the groups, and 11 qualified for inclusion in the stepwise analysis. The female group exhibited a greater vertical height of the eye fissure, shorter postero-anterior height of the nasal tip, vertically greater supraorbital ridge, shorter lower face height relative to the total upper anterior face height, more prominent cheeks in the infraorbital region, less prominent cheeks in the buccal region, shorter vertical height of the subnasal region, a smaller nasal hump, and a smaller alar. The discriminant function analysis was 96.5% accurate overall. The wire mesh fitting results showed that the eyes, forehead, and chin were in vertically higher positions in the female group than in the male group. The cheeks and nose were more protuberant in the female group and male group, respectively.

Temporomandibular joint articulations on working side during chewing in adult females with cross-bite and mandibular asymmetry

Influence of mandibular asymmetry and cross-bite on temporomandibular joint (TMJ) articulation remained unknown. This study aimed to investigate whether/how the working-side condylar movement irregularity and articular spaces during chewing differ between patients with mandibular asymmetry/cross-bite and control subjects. The cross-bite group and the control group consisted of 10 adult female patients and 10 adult female subjects, respectively. They performed unilateral gum-chewing. The mandibular movements were recorded using a video-based opto-electronic system. The 3D articular surface of the TMJ for each individual was reconstructed using CT/MRI data. For local condylar points, the normalised jerk cost (NJC) towards normal direction to the condylar surface, the angle between tangential velocity vector and condylar long axis and intra-articular space were measured. Three rotatory angles at centre of the condyle were also measured. During closing and intercuspation, (i) movements of posterior portion of the deviated side condyle showed significantly less smoothness as compared with those for the non-deviated side and control subjects, (ii) the rotations of the condyle on the deviated side induced greater intra-articular space at posterior and lateral portions. These findings suggest that chewing on the side of mandibular deviation/cross-bite may cause irregular movement and enlarged intra-articular space at posterior portion of the deviated side condyle.

Influence of balancing-side occlusal interference on smoothness of working-side condylar movement and intra-articular space in chewing efforts

Response of temporomandibular joint (TMJ) articulation adapting to occlusal alteration has been sparsely known. For 10 healthy adults with acceptably good occlusion, an artificial occlusal interference (OI) was introduced to the lower molar on the balancing side of unilateral chewing. Subjects were asked to chew a gum on their preferred side. The chewing jaw movements with/without the OI were recorded using a video-based optoelectronic system. The mandibular movements were generated in each individual's TMJ model reconstructed by magnetic resonance images. The smoothness of local condylar point movements towards the normal direction of the condylar surface and interarticular space on the working side was measured. Overall, the smoothness of condylar point movements in the closing phase was impaired immediately after introduction of the OI. In the intercuspal phase, the OI increased the joint space. After about 60 chewing cycles, the movement smoothness and joint space began to recover. These findings suggest that OI on the balancing side induced irregular stress field translation on the working-side condylar surface followed by acute recovery process.

Objective classification of nose-lip-chin profiles and their relation to dentoskeletal traits

OBJECTIVES

To objectively classify the nose-lip-chin profiles of adult women and identify any associations between the nose-lip-chin profile patterns and dentoskeletal patterns.

SETTING AND SAMPLE POPULATION

Lateral facial photographs and lateral cephalograms were obtained for 229 Japanese women who were being assessed for orthodontic treatment.

METHODS

A feature vector that was effective in distinguishing differences in nose-lip-chin profiles was extracted for each photograph. To categorize the records into an optimum number of subclasses according to nose-lip-chin profile configurations, a vector quantization method was applied to the feature vectors of all samples. Dentoskeletal patterns that corresponded to the nose-lip-chin profile subclasses were compared.

RESULTS

Eight profile patterns were identified, and the differences among patterns were notably maximized by the nasolabial angle, configuration and vertical length of the subnasal region, vertical thickness of the lip vermilion borders, sagittal position of the upper- and lower-lip vermilion borders and their relation to each other, labiomental angle, depth of the labiomental sulcus, degree of prominence of the chin, and degree of protrusion of the mandible. The dentoskeletal patterns showed significant differences between the classified profile patterns (p < 0.01).

CONCLUSIONS

A method to objectively classify the nose-lip-chin profiles of adult women was established, and the nose-lip-chin profile patterns were found to be associated with the dentoskeletal patterns.

An HBV-HIV co-infected patient treated with tenofovir-based therapy who achieved HBs antigen/antibody seroconversion

The present report describes a case of a patient with hepatitis B virus (HBV)-human immunodeficiency virus (HIV) co-infection who was treated with tenofovir disoproxil (TDF)-based highly active antiretroviral therapy (HAART) and who achieved HBs antigen (Ag)/antibody (Ab) seroconversion. An 18-year-old Japanese man with HIV and HBV co-infection presented to our hospital. His CD4 count was decreased, and TDF-based HARRT was started. At 30 months after initiation of therapy, HBsAg was not detected. At 36 months after initiation of therapy, HBsAb was detected. We conclude that TDF-based therapy is useful for the management of patients with HBV and HIV co-infection.

Development of Interferon Suppositories. I. Enhanced Rectal Absorption of Human Fibroblast Interferon by Fusogenic Lipid via Lymphotropic Delivery in Rats

We attempted to enhance the rectal absorption of human fibroblast interferon (HuIFN-β) in rats by the administration of suppositories containing fusogenic lipid and a nontoxic surfactant. Suppositories containing either the lipid (linoleic acid) or the surfactant [HCO60; polyoxyethylated (60 mol) hydrogenated castor oil] alone failed to enhance the absorption of HuIFN-β. However, suppositories containing both linoleic acid and HCO60 facilitated the rectal absorption of HuIFN-β. The absorbed HuIFN-β was selectively delivered via the lymph.