Influence of nutritional counseling on treatment results in patients with head and neck cancers

OBJECTIVES

Nutritional intervention, including nutritional counseling (NC), plays a significant role in the comprehensive management of patients with head and neck cancer (HNC). The aim of this study was to investigate the effects of NC combined with oral nutritional supplements during radical treatment on weight loss and survival outcomes in patients with HNC.

METHODS

The study included 310 patients who received radical treatment for HNC. Among these patients, 119 underwent NC along with oral nutritional supplements (NCONS); 191 were supported with oral nutritional supplements only (ONS). The study aimed to investigate the effects of sex, disease stage, treatment modality, and tumor site on weight loss. Additionally, the Kaplan-Meier method assessed the influence of NC on overall survival and disease-free survival.

RESULTS

The present study suggested that the NC independently prevented weight loss, regardless of sex and disease stage (female: -1.6%, P = 0.001; male: -2.3 %, P = 0.003; T stage (0-2): -1.7%, P = 0.008; T stage (3-4): -2.7%, P = 0.003; N stage (0-1): 2.5%, P = 0,027; N stage (3-4): 2.9%, P < 0.001). The protective effect was most significant in patients with oral cancer and oropharyngeal cancer and in patients treated with chemotherapy (oral: -1.7%, P = 0.03; oropharynx: -3.3%, P < 0.001; radiochemotherapy: -3%, P = 0.028; induction chemotherapy preceded radiochemotherapy: -6%, P < 0.001). Furthermore, the 3-year overall survival rates were 93.4% and 85.4% in the NC along with oral nutritional supplements (NCONS) and oral nutritional supplement (ONS) groups, respectively (P = 0.031).

CONCLUSIONS

Patients with HNC who received NC during radical treatment experienced reduced weight loss. This effect was particularly pronounced in patients with oral cavity or oropharyngeal cancer and those undergoing chemotherapy. Additionally, NC was associated with improved overall survival in this patient cohort. Nevertheless, further studies are required to validate and support these findings.

Communities of Uropodina (Acari: Mesostigmata) in Nest Boxes Inhabited by Dormice (Glis glis and Muscardinus avellanarius) and Differences in Percentages of Nidicoles in Nests of Various Hosts

Bird and mammal nests and nest boxes constitute microenvironments in which various groups of invertebrates can live, including mites from the suborder Uropodina (Acari: Mesostigmata). The main aim of the current study was to ascertain the characteristics of mite communities from the suborder Uropodina, which inhabit the nests of dormice (Gliridae) built in nest boxes. The second aim of the study was to compare the habitat preferences of Leiodinychus orbicularis (C. L. Koch) and Apionoseius infirmus (Berlese), i.e., two typically nest-dwelling species of Uropodina. The material for the study was collected from nest boxes in six forest complexes in southwestern Poland. The conducted research revealed the presence of five species of Uropodina, with a total number of 559 specimens, in the examined boxes. Leiodinychus orbicularis was found in almost half of all of the examined boxes and was a superdominant species in the communities. The analysis of the habitat preferences of the two nest species of Uropodina showed that A. infirmus preferred old natural nests, in which the communities were formed from a larger number of species, without a significant statistical prevalence of one species. On the other hand, L. orbicularis occurred sporadically in open bird nests, but was very numerous and frequent in nest boxes. The significant dominance of L. orbicularis in nest boxes can probably be explained by the specific conditions prevailing in this type of microhabitat, including the very low humidity and food resources that this mite species prefers compared to other species of Uropodina.

DNA Double-Strand Break Response and Repair Gene Polymorphisms May Influence Therapy Results and Prognosis in Head and Neck Cancer Patients

Radiotherapy and cisplatin-based chemotherapy belong to the main treatment modalities for head and neck squamous cell carcinoma (HNSCC) and induce cancer cell death by generating DNA damage, including the most severe double-strand breaks (DSBs). Alterations in DSB response and repair genes may affect individual DNA repair capacity and treatment sensitivity, contributing to the therapy resistance and poor prognosis often observed in HNSCC. In this study, we investigated the association of a panel of single-nucleotide polymorphisms (SNPs) in 20 DSB signaling and repair genes with therapy results and prognosis in 505 HNSCC patients treated non-surgically with DNA damage-inducing therapies. In the multivariate analysis, there were a total of 14 variants associated with overall, locoregional recurrence-free or metastasis-free survival. Moreover, we identified 10 of these SNPs as independent predictors of therapy failure and unfavorable prognosis in the whole group or in two treatment subgroups. These were MRE11 rs2155209, XRCC5 rs828907, RAD51 rs1801321, rs12593359, LIG4 rs1805388, CHEK1 rs558351, TP53 rs1042522, ATM rs1801516, XRCC6 rs2267437 and NBN rs2735383. Only CHEK1 rs558351 remained statistically significant after correcting for multiple testing. These results suggest that specific germline variants related to DSB response and repair may be potential genetic modifiers of therapy effects and disease progression in HNSCC treated with radiotherapy and cisplatin-based chemoradiation.

Sacubitril/valsartan for cardioprotection in breast cancer (MAINSTREAM): design and rationale of the randomized trial

AIMS

In recent years, survival in patients with breast cancer has increased. Despite the improvement in outcomes of those patients, the risk of treatment-related cardiotoxicity remains high, and its presence has been associated with a higher risk of treatment termination and thus lower therapeutic efficacy. Prior trials demonstrated that a preventive initiation of heart failure drugs, including the renin-angiotensin-aldosterone inhibitors, might reduce the risk of treatment-related cardiotoxicity. However, to date, no study investigated the efficacy of sacubitril/valsartan, a novel antineurohormonal drug shown to be superior to the previous therapies, in the prevention of cardiotoxicity in patients with early-stage breast cancer, which is the aim of the trial.

METHODS AND RESULTS

MAINSTREAM is a randomized, placebo-controlled, double-blind, multicentre, clinical trial. After the run-in period, a total of 480 patients with early breast cancer undergoing treatment with anthracyclines and/or anti-human epidermal growth factor receptor 2 drugs will be randomized to the highest tolerated dose of sacubitril/valsartan, being preferably 97/103 mg twice daily or placebo in 1:1 ratio. The patients will be monitored, including routine transthoracic echocardiography (TTE) and laboratory biomarker monitoring, for 24 months. The primary endpoint of the trial will be the occurrence of a decrease in left ventricular ejection fraction by ≥5% in TTE within 24 months. The key secondary endpoints will be the composite endpoint of death from any cause or hospitalization for heart failure, as well as other imaging, laboratory, and clinical outcomes, including the occurrence of the cancer therapy-related cardiac dysfunction resulting in the necessity to initiate treatment. The first patients are expected to be recruited in the coming months, and the estimated completion of the study and publication of the results are expected in December 2027, pending recruitment.

CONCLUSIONS

The MAINSTREAM trial will determine the efficacy and safety of treatment with sacubitril/valsartan as a prevention of cardiotoxicity in patients with early breast cancer (ClinicalTrials.gov number: NCT05465031).

Dermoscopy of acute radiation-induced dermatitis in patients with head and neck cancers treated with radiotherapy

Head and neck cancer (HNC) was the seventh most common cancer in the world in 2018. Treatment of a patient may include surgery, radiotherapy (RT), chemotherapy, targeted therapy, immunotherapy, or a combination of these methods. Ionizing radiation used during RT covers relatively large volumes of healthy tissue surrounding the tumor. The acute form of radiation-induced dermatitis (ARD) are skin lesions that appear usually within 90 days of the start of RT. This is a prospective study which compares 2244 dermoscopy images and 374 clinical photographs of irradiated skin and healthy skin of 26 patients at on average 15 time points. Dermoscopy pictures were evaluated independently by 2 blinded physicians. Vessels in reticular distribution, white, yellow or brown scale in a patchy distribution, perifollicular pigmentation and follicular plugs arranged in rosettes were most often observed. For these dermoscopic features, agreement with macroscopic features was observed. Two independent predictors of severe acute toxicity were identified: gender and concurrent chemotherapy. Knowledge of dermoscopic features could help in the early assessment of acute toxicity and the immediate implementation of appropriate therapeutic strategies. This may increase the tolerance of RT in these groups of patients.

Seeking a Sufficient Data Volume for Railway Infrastructure Component Detection with Computer Vision Models

Railway infrastructure monitoring is crucial for transportation reliability and travelers' safety. However, it requires plenty of human resources that generate high costs and is limited to the efficiency of the human eye. Integrating machine learning into the railway monitoring process can overcome these problems. Since advanced algorithms perform equally to humans in many tasks, they can provide a faster, cost-effective, and reproducible evaluation of the infrastructure. The main issue with this approach is that training machine learning models involves acquiring a large amount of labeled data, which is unavailable for rail infrastructure. We trained YOLOv5 and MobileNet architectures to meet this challenge in low-data-volume scenarios. We established that 120 observations are enough to train an accurate model for the object-detection task for railway infrastructure. Moreover, we proposed a novel method for extracting background images from railway images. To test our method, we compared the performance of YOLOv5 and MobileNet on small datasets with and without background extraction. The results of the experiments show that background extraction reduces the sufficient data volume to 90 observations.

Songbird nests on the ground as islands of diversity of ptyctimous mites (Acari: Oribatida) in the primeval Białowieża Forest (Poland)

Due to specific microclimatic conditions and accumulation of organic matter, bird nests are microhabitats that are often inhabited by various invertebrates, including mites (Acari). We tested whether nests of the ground-nesting passerine Phylloscopus sibilatrix (Bechstein) (Passeriformes: Phylloscopidae) [wood warbler] were associated with an increased local diversity of ptyctimous mites (Acari: Oribatida) on the forest floor in the Białowieża National Park, East Poland. In 2019-2020, we analysed 150 warbler nests shortly after they had been vacated by the birds, and additionally we sampled mites in leaf litter at 1 and 6 m distances from 21 of the collected nests. We found on average more mite species in nests sampled in 2020 than in nests sampled in 2019. Although the species composition largely overlapped between bird nests and the litter, bird nests contained a greater average number of mite species than litter samples, including species found only - Microtritia minima (Berlese) and Phthiracarus crenophilus Willmann - or mostly - Euphthiracarus cribrarius (Berlese) and Phthiracarus globosus (C.L. Koch) - in bird nests. The results suggest that the presence of bird nests may increase the local diversity of the invertebrate species assemblage.

An analytical four-layer horizontal electric current dipole model for analysing underwater electric potential in shallow seawater

The paper presents a new analytical four-layer (air-water-bottom-non-conductive layer) horizontal electric dipole model which allows an accurate approximation of ship's Underwater Electric Potential (UEP) from a sufficient depth in shallow coastal marine waters. The numerical methods, usually Finite Element Method (FEM) or Boundary Elements Method (BEM), are typically used to estimate the electric field and the distribution of static electric components of UEP around the ship. These methods enable analyses with high accuracy but, compared to other point-electrode methods and the proposed analytical model, they are relatively complex and need high computational time. The developed analytical model proposed in this paper allows real-time calculations without significant loss of accuracy of the UEP estimations. In the model, the problem of boundary values at the borders of individual layers is solved using the reflection/image method and applying the idea of continuity of electric potential at a given boundary between two adjacent layers. Its accuracy is verified based on the synthetic data provided by specialised software packages making use of FEM and BEM numerical methods. A dimensionless quantitative analysis of the relationships between basic parameters of the proposed four-layer analytical model and their impact on the accuracy of representation of individual electric field strength components is also delivered. The relationships between water and bottom conductivity and between water depth and bottom thickness are investigated and described. The obtained results show that the developed model allows detailed and reliable analysis of the electric field, especially in shallow coastal waters.

Prediction of Radiation-Induced Hypothyroidism Using Radiomic Data Analysis Does Not Show Superiority over Standard Normal Tissue Complication Models

Simple Summary

Radiation-induced hypothyroidism (RIHT) commonly develops in cancer survivors that receive radiation therapy for cancers in the head and neck region. The state-of-art normal tissue complication probability (NTCP) models perform satisfactorily; however, they do not use the whole spectrum of information that can be obtained from imaging techniques. The radiomic approach offers the ability to efficiently mine features, which are imperceptible to the human eye, but may provide crucial data about the patient’s condition. We gathered CT images and clinical data from 98 patients undergoing radiotherapy for head and neck cancers, 27 of whom later developed RIHT. For them, we created machine-learning models to predict RIHT using automatically extracted radiomic features and appropriate clinical and dosimetric parameters. We also validated the well-established external state-of-art NTCP models on our datasets and observed that our radiomic-based models performed very similarly to them. This shows that automated tools may perform as well as the current standard but can be theoretically applied faster and be implemented into existing imaging software used when planning radiotherapy.

Abstract

State-of-art normal tissue complication probability (NTCP) models do not take into account more complex individual anatomical variations, which can be objectively quantitated and compared in radiomic analysis. The goal of this project was development of radiomic NTCP model for radiation-induced hypothyroidism (RIHT) using imaging biomarkers (radiomics). We gathered CT images and clinical data from 98 patients, who underwent intensity-modulated radiation therapy (IMRT) for head and neck cancers with a planned total dose of 70.0 Gy (33–35 fractions). During the 28-month (median) follow-up 27 patients (28%) developed RIHT. For each patient, we extracted 1316 radiomic features from original and transformed images using manually contoured thyroid masks. Creating models based on clinical, radiomic features or a combination thereof, we considered 3 variants of data preprocessing. Based on their performance metrics (sensitivity, specificity), we picked best models for each variant ((0.8, 0.96), (0.9, 0.93), (0.9, 0.89) variant-wise) and compared them with external NTCP models ((0.82, 0.88), (0.82, 0.88), (0.76, 0.91)). We showed that radiomic-based models did not outperform state-of-art NTCP models (p > 0.05). The potential benefit of radiomic-based approach is that it is dose-independent, and models can be used prior to treatment planning allowing faster selection of susceptible population.

Serum MicroRNAs as Xerostomia Biomarkers in Patients With Oropharyngeal Cancer Undergoing Radiation Therapy

PURPOSE

Severe xerostomia is noted in the majority of patients irradiated for oropharyngeal cancer. Extracellular microRNAs (miRNAs) may serve as effective tools allowing prediction of radiation-related toxicity. The aim of this study was to create an efficient prognostic miRNA-based test for severe, patient-rated xerostomia 3 months after primary treatment.

METHODS AND MATERIALS

This prospective study enrolled patients with oropharyngeal cancer treated between 2016 and 2018 in 3 centers in Poland. The primary endpoint was severe (grade ≥3) xerostomia as assessed by the European Organisation for Research and Treatment of Cancer H&N-35 questionnaires. Initially, a group of 10 patients with severe xerostomia was randomly selected and matched with a comparative group of 10 patients without severe xerostomia. Samples were collected before radiation therapy, after receiving 20 Gy, and within 24 hours after treatment completion. Quantitative real-time polymerase chain reaction arrays (QIAGEN, Hilden, Germany) were used to quantify expression levels of 752 miRNAs in the serum at all timepoints. The resulting logistic-regression based model was validated in additional 60 patients: 30 with grade >3 xerostomia and 30 without.

RESULTS

Of 152 eligible patients, we successfully recruited 111 patients. Severe xerostomia 3 months after treatment was reported by 63 patients (56.8%). Mean dose delivered to parotid glands was higher in both the exploratory and validation cohort. The model based on miR-185-5p and miR-425-5p expression levels measured before the start of radiation therapy had an area under the curve of 0.96 (95% confidence interval, 0.88-1.00). The model based on the same miRNAs remained robust when parameters were measured after 20 Gy (area under the curve 0.90; 95% confidence interval, 0.75-1.00). These results were confirmed in the validation group. In the validation group, preradiation therapy model application yielded 73.3% sensitivity and 80.0% specificity. In the samples taken after 20 Gy, the same 2 miRNAs yielded 67.7% sensitivity and 72.4% specificity. The model including pretreatment miR-185-5p and miR-425-5p levels together with mean parotid dose yielded 90.0% sensitivity and 80.0% specificity. In the validation cohort, this model yielded 80.6% sensitivity and 55.2% specificity. The model based on miRNA levels measured after 20 Gy and mean parotid dose had 80.0% sensitivity and 100% specificity in the exploratory group. In the validation cohort its performance fell to 71.0% sensitivity and 58.6% specificity.

CONCLUSIONS

Serum expression levels of miR-425-5p and miR-185-5p measured before the start of radiation therapy or during therapy (after 20 Gy) had significant prognostic value for the occurrence of severe xerostomia 3 months after treatment completion. The variability explained by miRNAs appears to be, at least partially, independent from that related to the dosimetric data.

Comparison of Selected Immune and Hematological Parameters and Their Impact on Survival in Patients with HPV-Related and HPV-Unrelated Oropharyngeal Cancer

Simple Summary

This is a research article on oropharyngeal cancer (OPC). The aim of the study was to assess and compare basic immune parameters and ratios in patients with Human Papilloma Virus (HPV)+ and HPV− OPC, before and after radiotherapy (RT) or chemoradiotherapy (CRT), and to investigate their impact on overall survival (OS) and disease-free survival (DFS). The higher neutrophil-lymphocyte ratio (NLR) and systemic immune inflammation (SII) are significant adverse prognostic factors for HPV+ OPC patients, because they are significantly associated with both inferior OS and DFS in this group, whereas the higher platelet cells (PLT) count is significant adverse prognostic factor for HPV− OPC patients, because it is significantly associated with inferior OS and DFS in this group. This study confirmed that determination of HPV etiology as well as analysis of various hematological and immune parameters should be a standard management in OPC patients in order to properly treat them for improved prognosis.

Abstract

Several immune and hematological parameters are associated with survival in patients with oropharyngeal cancer (OPC). The aim of the study was to analyze selected immune and hematological parameters of patients with HPV-related (HPV+) and HPV-unrelated (HPV−) OPC, before and after radiotherapy/chemoradiotherapy (RT/CRT) and to assess the impact of these parameters on survival. One hundred twenty seven patients with HPV+ and HPV− OPC, treated with RT alone or concurrent chemoradiotherapy (CRT), were included. Patients were divided according to HPV status. Confirmation of HPV etiology was obtained from FFPE (Formalin-Fixed, Paraffin-Embedded) tissue samples and/or extracellular circulating HPV DNA was determined. The pre-treatment and post-treatment laboratory blood parameters were compared in both groups. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), and systemic immune inflammation (SII) index were calculated. The impact of these parameters on overall (OS) and disease-free (DFS) survival was analyzed. In HPV+ patients, a high pre-treatment white blood cells (WBC) count (>8.33 /mm³), NLR (>2.13), SII (>448.60) significantly correlated with reduced OS, whereas high NLR (>2.29), SII (>462.58) significantly correlated with reduced DFS. A higher pre-treatment NLR and SII were significant poor prognostic factors for both OS and DFS in the HPV+ group. These associations were not apparent in HPV− patients. There are different pre-treatment and post-treatment immune and hematological prognostic factors for OS and DFS in HPV+ and HPV− patients. The immune ratios could be considered valuable biomarkers for risk stratification and differentiation for HPV− and HPV+ OPC patients.

The role of bracket fungi in creating alpha diversity of invertebrates in the Białowieża National Park, Poland

Bracket fungi are seen mainly as the cause of economic losses in forestry, and their role as creators of biodiversity is relatively poorly understood. The aim of the study was defining the manner in which the degree of decay (DD) of the fruiting bodies determines the character of the invertebrate assemblages colonising them. The effect of this group of fungi on the modification of biodiversity of invertebrates (Aranae, Opiliones, Pseudoscorpionida, two groups of mites-Mesostigmata and Oribatida, and Collembola and Insecta) was investigated by analyzing 100 fruiting bodies of 10 species of bracket fungi divided into four DD classes. The material was collected at Białowieża National Park, which is considered to be the largest area of natural forests in the North European Plain. 16 068 invertebrate individuals classified into 224 species were obtained. Oribatid mites (12 543 individuals) constituted the largest group of individuals, which were classified into 115 species with the most numerous Carabodes femoralis (8,811 individuals). Representatives of this group of mites have been reported previously in the publications on bracket fungi; however, the contributions of Oribatida and other groups of invertebrates were not broadly compared. Moreover, the species such as Hoploseius mariae and H. oblongus, which were predominantly found in fruiting bodies of bracket fungi, have also been discerned. The invertebrate fauna differs depending on DD of the samples: In the more decayed samples, a higher number of both individuals and species were recorded compared to the samples with lower DDs; however, this trend proved to be nonlinear. The DCA and cluster analysis revealed a similarity of the invertebrate assemblages from the 2 DD and 4 DD samples. They also indicated that the group 3 DD differed the most from all the other samples. The indicator species analysis identified species characteristic to individual DDs: For group 1 DD, it was, for example, Hoploseius oblongus; for 2 DD-Orchesella bifasciata; and for 3 DD-Chernes cimicoides, while for 4 DD-Dinychus perforatus.

Lack of specialist nidicoles as a characteristic of mite assemblages inhabiting nests of the ground-nesting wood warbler, Phylloscopus sibilatrix (Aves: Passeriformes)

Bird and mammal nests provide microhabitats that support a range of other species, including invertebrates. However, the variation between communities of nest-dwelling invertebrates in different nests is poorly understood. The major aim of this study was to analyze the assemblage structure of mites from the suborder Uropodina (Acari: Mesostigmata) and from superfamily Crotonioidea (Acari: Oribatida) inhabiting nests of the wood warbler, Phylloscopus sibilatrix (Aves: Passeriformes), located on a forest floor in Białowieża Forest, in eastern Poland. We also assessed the correlation between the nest material used by the birds with the assemblage structure of Uropodina mites, and compared the results with published studies of the nests of other birds and a mammal (common mole, Talpa europaea), and also with communities of mites inhabiting the soil. The field research was conducted in the strict nature reserve of the Białowieża National Park, a near-primeval European temperate forest. In 2019, immediately after the breeding period, 69 wood warbler nests and 439 soil samples were collected. Analyses revealed assemblages of Uropodina mites inhabiting the nests that consisted of 14 species, mostly common soil species. Only five species of oribatid mites from superfamily Crotonioidea were present in the nest material. Analyzed nests had a high percentage of tree leaves and grass blades, whereas moss was the least frequent component of the nest material. The Uropodina mites were more abundant in the nests that had greater amounts of grass blades, but similar relationships were insignificant for the nests with varying amounts of tree leaves or moss. The assemblages of Uropodina mites inhabiting wood warbler nests were very similar to those found in soil and nests of the common mole, but they lacked typical nest-dwelling species of Uropodina (i.e., specialized nidicoles).

Xerophilic Alopecosa sulzeri (Pavesi, 1873) (Araneae: Lycosidae)-a new wolf spider species in Poland

There are 44 species and subspecies of the genus Alopecosa known in Europe, and 13 of them have so far been listed as occurring in Poland. Alopecosa sulzeri (Pavesi, 1873) is a xero- and thermophilic species distributed in the western Palearctic. In Europe, it occurs primarily in the south-east, while it is rare in Central Europe. Between 2007 and 2013, we recorded the species in the central-eastern, north-western and south-western parts of Poland. The sites of A. sulzeri in Poland are located at the northern limit of the geographic range of the species in Europe. Alopecosa sulzeri was caught at four sites in three regions, exclusively in xerothermic grasslands: in the Podlasie Bug Gorge, the Lower Oder Valley and the Trzebnickie Hills. The sites may be relict, or they may provide evidence of the spread of the species from sites located in neighbouring countries. Further spread of stenotopic, xerophilous A. sulzeri in Poland, if continued, is likely to be a slow process, due to the limited number of suitable habitats.

Underground diversity: Uropodina mites (Acari: Mesostigmata) from European badger (Meles meles) nests

Badgers can gather huge quantities of organic material to build their nests for winter time and to rear their cubs. Moreover, badger burrows (setts) are characterized by specific microclimate with quite stable temperature and humidity. Their fauna is poorly studied, especially in respect of saprobiontic Uropodina mites. In 2018-2019, we monitored 94 badger setts to search for nest material that had been thrown away during cleaning of the chambers after mating and winter sleep. In the collected material from 32 badger nests, we found 413 Uropodina mites of 16 species, in various stages of development (adults, protonymphs, and deutonymphs). The community was dominated by three mite species: Trematura patavina (22.5%, n = 93), Oodinychus ovalis (17.2%, n = 71), and Olodiscus minima (15.5%, n = 64). Other nidicolous-i.e., nest-dwelling-species included: Nenteria oudemansi (14.8%, n = 61), Phaulodiaspis borealis (7.0%, n = 29), Phaulodiaspis rackei (4.6%, n = 19), Uroseius hunzikeri (1.7%, n = 7), Uropoda orbicularis (1.5%, n = 6), and Apionoseius infirmus (1.0%, n = 4). The most frequent species were: Oodinychus ovalis (62.5%, 20 nests), N. oudemansi (46.9%, 15 nests), and Olodiscus minima (40.6%, 13 nests). Detrended correspondence analysis indicated that the Uropodina community from badger nests differed from that of mole nests, studied earlier. In setts, the Uropodina community included T. patavina and N. oudemansi, which were for the first time recorded from underground badger nests. This is the first record of N. oudemansi from Poland.

Metabolic Profiles of Whole Serum and Serum-Derived Exosomes Are Different in Head and Neck Cancer Patients Treated by Radiotherapy

BACKGROUND

In general, the serum metabolome reflects the patient's body response to both disease state and implemented treatment. Though serum-derived exosomes are an emerging type of liquid biopsy, the metabolite content of these vesicles remains under researched. The aim of this pilot study was to compare the metabolite profiles of the whole serum and serum-derived exosomes in the context of differences between cancer patients and healthy controls as well as patients' response to radiotherapy (RT).

METHODS

Serum samples were collected from 10 healthy volunteers and 10 patients with head and neck cancer before and after RT. Metabolites extracted from serum and exosomes were analyzed by the gas chromatography-mass spectrometry (GC-MS).

RESULTS

An untargeted GC-MS-based approach identified 182 and 46 metabolites in serum and exosomes, respectively. Metabolites that differentiated cancer and control samples, either serum or exosomes, were associated with energy metabolism. Serum metabolites affected by RT were associated with the metabolism of amino acids, sugars, lipids, and nucleotides.

CONCLUSIONS

cancer-related features of energy metabolism could be detected in both types of specimens. On the other hand, in contrast to RT-induced changes observed in serum metabolome, this pilot study did not reveal a specific radiation-related pattern of exosome metabolites.

Association of Genetic Variants in ANGPT/TEK and VEGF/VEGFR with Progression and Survival in Head and Neck Squamous Cell Carcinoma Treated with Radiotherapy or Radiochemotherapy

Angiogenesis is essential for growth, progression, and metastasis of solid tumors. Vascular endothelial growth factor (VEGF)/VEGF receptor (VEGFR) and angiopoietin (ANGPT)/ tyrosine kinase endothelial (TEK) signaling plays an important role in regulating angiogenesis. Very little is known about the effects of single-nucleotide polymorphisms (SNPs) in angiogenesis-related genes on treatment outcome in head and neck squamous cell carcinoma (HNSCC). Therefore, we evaluated the association between SNPs in ANGPT1, ANGPT2, TEK, VEGF, VEGFR1, and VEGFR2 genes and five clinical endpoints in 422 HNSCC patients receiving radiotherapy alone or combined with chemotherapy. Multivariate analysis showed an association of ANGPT2 rs3739391, rs3020221 and TEK rs639225 with overall survival, and VEGF rs2010963 with overall and metastasis-free survival. VEGFR2 rs1870377 and VEGF rs699947 affected local recurrence-free survival in all patients. In the combination treatment subgroup, rs699947 predicted local, nodal, and loco-regional recurrence-free survival, whereas VEGFR2 rs2071559 showed an association with nodal recurrence-free survival. However, these associations were not statistically significant after multiple testing correction. Moreover, a strong cumulative effect of SNPs was observed that survived this adjustment. These SNPs and their combinations were independent risk factors for specific endpoints. Our data suggest that certain germline variants in ANGPT2/TEK and VEGF/VEGFR2 axes may have predictive and prognostic potential in HNSCC treated with radiation or chemoradiation.

Significance of HPV16 Viral Load Testing in Anal Cancer

Human papilloma virus (HPV) is highly frequent among patients with anal squamous cell carcinoma, but the viral load (VL) differs between patients. This study aimed to compare the rate of HPV positivity, HPV16VL, p16^INK4A and p53 expression between treatment naive and recurrent anal cancer patients. HPV was genotyped via AmpliSens® HPV HCR-genotype-titre-FRT kit. HPV16 VL was determined via quantitative polymerase chain reaction-based in-house test. p16^INK4A and p53 expression was tested via immunohistochemistry. The cohort comprised 13 treatment-naive and 17 recurrent anal SCC patients. High-risk HPV was detected in 87% of cases, and HPV16 (73%) was the predominant genotype. The rate of HPV positivity was higher among women and nonsmokers, and majority of HPV-positive cases were also p16^INK4A-positive. All p53-negative tumors were HPV16-positive. The most predominant p53 staining pattern in the HPV-positive group was scattered type, whereas it was diffuse type in the HPV-negative group. The HPV16 VL was higher in the treatment-naive group. Further, in the treatment-naive group, cases with scattered staining pattern of p53 had higher HPV16 VL than cases with diffuse staining pattern. The opposite result was noted in the recurrent cancer group. Moreover, p16-positive cases with scattered p53 staining pattern in the treatment naive group had higher HPV16 VL than their counterparts in the recurrent cancer group. In conclusion, the HPV VL, as is the association between VL and p16^INK4A /p53, is in an inversed trend in treatment naive and recurrent cancer patients, highlighting the importance of HPV VL measurement in anal SCC.

[Infiltrates of M2-Like Tumour-Associated Macrophages Are Adverse Prognostic Factor in Patients with Human Papillomavirus-Negative but Not in Human Papillomavirus-Positive Oropharyngeal Squamous Cell Carcinoma]

INTRODUCTION

Human papillomavirus with a high oncogenic potential (HR-HPV) is responsible for more than a half of squamous cell carcinomas of the oropharynx. The HR-HPV-dependent cases of this tumour have a better prognosis compared to the HR-HPV-negative cases, despite the usually more advanced disease at the time of diagnosis. In addition to genetic and epigenetic factors, the causes of this more favourable course of the disease are also seen in the participation of the tumour microenvironment, including the patient's immune system. Macrophages are one of the most important elements of the immunocompetent cells landscape that make up the tumour microenvironment. Traditionally, they are divided into 2 groups: inflammatory macrophages with the M1 phenotype and tumour-associated macrophages known as M2 phenotype macrophages.

OBJECTIVE

The aim of this study was to investigate the impact of the macrophage infiltrates intensity of the M1/M2 and M2 phenotype separately on the clinical outcome of patients with squamous cell carcinoma of the oropharynx (OPSCC), taking into account the HR-HPV status of tumours.

METHODS

The study involved 85 patients with OPSCC in which HR-HPV status in tumour tissue was determined using a double-check algorithm including the detection of viral DNA by RT-PCR method with subsequent confirmation of its biological activity by immunohistochemical demonstrating the P16INK4A protein overexpression. In each of the groups formed on the basis of HR-HPV status, macrophages were discriminated using CD68 and CD163 proteins as markers of pan-macrophage and M2 phenotype. The intensity of infiltrates was quantified by means of computer-assisted analysis in digital images of whole slides (virtual slides) separately in tumour tissue and stroma.

RESULTS

In HPV-positive patients, significantly more intense infiltration of both M1/M2 and M2 macrophages was found in the tumour stroma compared to HPV-negative patients. The infiltrates from both types of macrophages in the tumour tissue were less intense and did not differ between these groups. Intensive infiltration of CD68+ macrophages in the tumour front was associated with higher rate of nodal failures and a shorter nodal control in both HR-HPV groups. In the group of HR-HPV-negative patients, heavy infiltration of CD163+ macrophages was associated with significantly shorter: loco-regional control (LRC), metastasis-free survival and overall survival (OS). These parameters and prognosis in patients with scanty CD163+ infiltration were similar to favourable outcomes in HR-HPV-positive patients. The relative risk of local-regional recurrence, distant metastases and disease-related death in HR-HPV-negative patients with intense CD163+ infiltrates was, respectively, 4.7, 5.4 and 5.7 compared to patients with scanty infiltrates.

CONCLUSIONS

Tumours with a positive HR-HPV status demonstrate intense infiltrations of total pool M1/M2 and M2 macrophages. In the group of HPV-negative patients, intensive M1/M2 macrophage infiltrates correlate with higher risk of nodal failures, and intensive M2 infiltrates are an adverse prognostic factor for LRC, metastasis-free survival and OS.

Prognostic significance of Epstein-Barr virus viral load in patients with T1-T2 nasopharyngeal cancer

Nasopharyngeal cancer (NPC) is highly prevalent in southern Chinese populations but it is rare in most parts of the world. A few studies were performed in nonendemic regions of the world, and suggested the prognostic value of Epstein-Barr virus (EBV) DNA load in blood. In this study, EBV DNA presence and viral load (VL) level in the blood of patients with NPC in Polish population were presented. In addition, its prognostic value for locoregional control among other clinicopathological features was evaluated. Patients with carcinoma of the nasopharynx treated definitively with radiotherapy or radiochemotherapy were included in the study. Real-time polymerase chain reaction was performed for quantitating of EBV DNA in plasma. Among patients with NPC, 51% (22 of 43) were classified as EBV-positive with the mean of the VL of 4934 ± 8693 copies/mL. Multiple regression analysis between log EBV DNA VL and clinical parameters revealed that the most important factors increasing the VLs were advanced N disease together with no-smoking status and advanced T tumors. Multivariate Cox regression analysis revealed that T3-T4 tumors were an independent prognostic factor for poor locoregional control. Analysis for the subgroup of patients with T1-T2 tumors showed that T1-T2 EBV-negative patients had better locoregional control compared with T1-T2 EBV-positive, though without statistical significance. In conclusion, it seems that EBV DNA determination may have an important role in diagnostics of patients with NPC with T1-T2 tumors indicating a subgroup with poorer prognosis, though it needs to be proven on a larger cohort.

The impact of the patient's condition, diagnostic procedures and treatment on the survival of carcinoma of unknown primary site patients

Introduction

Carcinoma of unknown primary site (CUP) refers to 1–5% of all head and neck neoplasms. Very often, the primary site remains difficult to determine. Squamous cell carcinoma is the most frequent histopathological type diagnosed in the head and neck region. According to statistics, a primary site is usually located in the oropharynx.

Study objective

The study presents diagnostic difficulties and the methods of diagnosing and the therapy of CUP and primary sites in patients treated in the region of Lower Silesia and Silesia. The aim of the study was to show a retrospective analysis of 233 CUP patients to assess how clinical features, diagnosis and treatment affect the survival of patients.

Material and methods

The diagnostics of patients included panendoscopy with specimen collection (nasoendoscopy, laryngoscopy, esophagoscopy, brochoscopy), computed tomography examination of the neck, chest, abdomen and pelvis minor, as well as positron emission tomography examination. Tonsilletomy was performed in 37 patients. Neck dissection was carried out in 109 subjects and 165 patients were treated bt radiotherapy, and 135 by chemotherapy.

Conclusions

Tonsillectomy is required in CUP patients with the negative results of biopsy and imaging tests. It gives a possibility of detecting the primary site and improves the results of treatment and survival of CUP patients.Combination therapy, including surgical treatment and chemoradiotherapy, gives the best therapeutic results in CUP patients. The general condition of patient and younger age have an impact on prognosis and survival.

Hafnium oxide nanoparticles NBTXR3 activated by radiotherapy as a new therapeutic option for elderly/frail HNSCC patients

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Background: New therapeutic approaches are needed for elderly or frail head and neck squamous cell carcinoma (HNSCC) patients (pts) ineligible for standard of care treatment. NBTXR3, a crystalline solution of hafnium oxide nanoparticles may represent such an option. Injected intratumorally, NBTXR3 enters tumor cells and yields an increased cell-localized energy deposit upon exposure to radiotherapy (RT), leading to increased tumor cell death compared to the same dose of RT alone. Methods: Phase I study of NBTXR3 activated by RT in pts ≥70 years old or ≥65 years old and unable to receive cisplatin, eligible for exclusive RT with stage III or IV HNSCC of the oral cavity or oropharynx [NCT01946867]. A 3+3 dose escalation design was implemented with dose levels corresponding to 5%, 10%, 15% and 22% of baseline tumor volume, followed by an expansion phase. Pts received an intratumoral (IT) injection of NBTXR3 and intensity modulated RT (IMRT; 70 Gy/35 fractions/7 weeks). Determination of Recommended Phase 2 Dose (RP2D) and Dose Limiting Toxicities (DLT) were primary endpoints of phase I. Absence of NBTXR3 leakage and preliminary efficacy using RECIST 1.1 principles were also evaluated. Results: The dose-escalation is complete. Nineteen pts were enrolled: 3 at 5%, 3 at 10%; 5 at 15% and 8 at 22% with no observed DLT or SAE related to NBTXR3 or IT injection. One grade 1 NBTXR3-related AE (asthenia at 22%) and four IT injection-related AE (grade 2 oral pain; grade 1 tumor hemorrhage; grade 1 asthenia, and grade 1 injection site hemorrhage) were reported. RT-related toxicity was as expected with IMRT. RP2D has been determined to be 22%. CT-scan assessment between 24h and 7 weeks post-IT injection demonstrated absence of NBTXR3 leakage in the surrounding tissues. Among 13 evaluable pts treated at doses ≥10%, 9 achieved a complete response of the injected lesion. Conclusions: These results show that NBTXR3 activated by RT is safe and well tolerated at all doses with preliminary encouraging efficacy results. It thus represents a promising future treatment for frail and elderly pts with locally advanced HNSCC with limited therapeutic options. Expansion phase has started at the RP2D. Clinical trial information: NCT01946867.

The Role of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio, and Platelets in the Prognosis of Metastatic Renal Cell Carcinoma

OBJECTIVE(S)

The aim of this analysis was to evaluate the platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), platelets (PLT), and neutrophil level for their prognostic value in patients with metastatic renal cell carcinoma (mRCC).

MATERIALS

We retrospectively reviewed medical records of 141 patients with mRCC (2006-2016). Univariate and multivariate analyses were performed with the Cox proportional hazards regression model. The cutoff value of NLR was "elevated" as >3.68 and the PLR cutoff value was "elevated" as >144.4.

RESULTS

The median PFS and OS were shorter in elevated NLR and PLR. A higher value of PLT was associated with worse median OS and higher neutrophil level with worse OS and PFS. In multivariate analysis, higher NLR (p = 0.007) and PLR (p = 0.006) were independent prognostic factors for shorter OS together with BMI ≤30 (p = 0.004), higher Fuhrman grade (p = 0.0002), lower level of hemoglobin (p= 0.010), and ZUBROD 2 (p = 0.0002). Higher PLR (p = 0.0002) was an independent negative prognostic factor for PFS together with higher Fuhrman grade (p = 0.001), higher neutrophil level (p = 0.001), and lower lymphocyte level (p = 0.013).

CONCLUSION

Elevated pretreatment NLR, PLR, PLT, and neutrophil count are associated with shorter OS and PFS in patients with mRCC. NLR and PLR are independent prognostic factors for OS. However, PLR and neutrophil count are independent prognostic factors for PFS.

Abstract P2-08-49: The role of neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) andmonocyte – lymphocyte ratio (MLR) in prognosis of breast cancer patients

Introduction: Breast cancer (BC) is common malignancies in women.Biomarkers such as neutrophils, lymphocyte, neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), monocyte – lymphocyte ratio (MLR) and PLT have been demonstrated to be closely related to poor prognosis in several solid tumors. The objective of this study was to evaluate the blood PLR, NLR andMLR for its prognostic value in patients with breast cancer.Material and Methods: We retrospectively reviewed 436 breast cancer patients (all woman) diagnosed and treated in MSC Memorial Cancer and Institute of Oncology, Gliwice Branch in years 2005 - 2018. The median age of patients was 52.5 years (range from 25 to 78). We assessed the prognostic value (overall survival) of pretreatment PLR, NLR and MLRbased on univariate and multivariate analysis. The cut-off value of NLR was 'elevated' as &gt;2.65, MLR value was 'elevated'as &gt;0.28 and PLR cut-off value was 'elevated' as &gt;190.9.Results: Median follow-up was 71 months (range, from 3 to 165 months). The 5-year and 10-year OS rates were 88.1% and 80.2%, respectively. The 5-year OS was lower in NLR &gt; 2.65 in comparison to NLR&lt;=2.65 (82.5% vs.89.6%, p=0.053), especially in subgroup of triple negative breast cancer (TNBC) (70.3% vs. 89.3%, p=0.034) and in patients with estrogen receptor negative status tumors (66.6% vs. 83.6%, p=0.018).Similarly, the 5-year OS was lower in patients with PLR &gt; 190.9 in comparison to PLR&lt;=190.9 (78.7% vs. 89.4%; p=0.020). The worse OS rate was also observed in subgroup with TNBC and PLR &gt; 190.9 (68.2% vs. 88.5%, p=0.032) or in subgroup with ER negative steroid receptor status tumors with 'elevated' PLR (57.7% vs. 83.6%, p=0.002).The 'elevated' value of MLR (&gt;0.28) was not associated with overall survival time in our group of patients (p=0.830), also in TNBC (p=0.219) and ER (-) (p=0.453) subgroups of patients. Multivariate analysis has showed that NLR and PLR were insignificantly negative prognostic factors in all analyzed group. However the analysis in subgroup of patients with ER (-) negative tumors has showed that higher NLR (p=0.013; HR=2.40; 95%CI 1.20-4.80) and higher PLR (p=0.012; HR=2.51; 95%CI 1.23-5.14) were an independent factors for lower OS together with metastatic lymph nodes (p=0.0001). Conclusion: Elevated pre-treatment NLR (&gt;2.65) and PLR (&gt;190.9) are associated with lower OS in breast cancer patients. In ER (-) subgroups of patients elevated NLR and PLR were significant independent prognostic factors. MLR did not affect overall survival.

Citation Format: Huszno J, Kołosza Z, Mrochem Kwarciak J, Rutkowski T, Składowski K. The role of neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) andmonocyte – lymphocyte ratio (MLR) in prognosis of breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-49.

Detection of circulating HPV16 DNA as a biomarker in the blood of patients with human papillomavirus-positive oropharyngeal squamous cell carcinoma

BACKGROUND

Development of biomarker analysis using the circulating cell-free DNA (cfDNA) methodology is a challenge for noninvasive cancer diagnosis. In this study, a comparison between the plasma and tumor tissue HPV16 DNA viral loads (VLs) has been presented.

METHODS

Real-time polymerase chain reaction was performed for quantitating of HPV16 DNA in the plasma and tumor samples of patients with oropharyngeal cancer.

RESULTS

Among the tissues, HPV16-positive patients with oropharyngeal squamous cell carcinoma, nonsmoking patients, displayed significantly higher HPV16 DNA VLs in their tissue. No smoking and advanced N disease were the most important predictors for cHPV16 DNA (circulating HPV16 DNA) detection. The cHPV16-positive women displayed significantly higher VLs in their tumor tissues compared to the men, although without notable impact on the blood detection.

CONCLUSIONS

Many factors were responsible for human papillomavirus DNA circulation in blood. As a result of the small size of the analyzed group, some observed discrepancies need to be proven on a larger cohort.

Advanced adenoid cystic carcinoma (ACC) is featured by SWI/SNF chromatin remodeling complex aberrations

Purpose

Adenoid cystic carcinoma (ACC) is a rare neurotropic cancer with slow progression occurring in salivary glands and less frequently in other body parts. ACC is featured by hyperchromatic nuclei and various mutations in genes encoding chromatin-related machineries. The ACC treatment is mainly limited to the radical surgery and radiotherapy while the chemotherapy remains ineffective. As the knowledge about molecular basis of ACC development is limited, we investigated here the molecular features of this disease.

Patients and methods

This study included 50 patients with ACC. Transcript profiling of available ACC samples vs normal salivary gland tissue, quantitative real-time PCR (qRT-PCR) transcript level measurements and the immunohistochemistry (IHC) for SWI/SNF chromatin remodeling complex (CRC) subunits and androgen receptor on surgery-derived paraffin-embedded samples were performed.

Results

Transcriptomic study followed by Gene Ontology classification indicated alteration of chromatin-related processes, including downregulated transcript levels of main SWI/SNF CRC subunits and elevated expression of BRM ATPase-coding SMARCA2 gene in ACC. Subsequent IHC indicated broad accumulation of BRM ATPase and several SWI/SNF subunits, suggesting affected control of their protein level in ACC. The IHC revealed ectopic, heterogeneous expression of androgen receptor (AR) in some ACC cells.

Conclusions

Our study indicated that ACC features aberrant expression of genes controlling chromatin status and structure. We found that the balance between SWI/SNF classes is moved towards the BRM ATPase-containing complex in ACC. As BRM is known to be involved in chemoresistance in cancer cells, this observation may be the likely explanation for ACC chemoresistance.

Electronic supplementary material

The online version of this article (10.1007/s00432-018-2783-5) contains supplementary material, which is available to authorized users.

Myrmicinosporidium durum in Poland: a new location for this fungal ant endoparasite and updated world distribution

Myrmicinosporidium durum is an enigmatic fungal parasite of ants with an unclear phylogeny and life cycle. Despite the fact that new records of this fungus have been revealed in the last few years; several countries from Eastern Europe still lack such information. With this study, we reveal the most northerly location of this fungus to date and its first record in Poland a contribution to filling the gaps in data about its European distribution. Additionally, we present an updated compilation of the world distribution of M. durum and its host ant species.