Prognostic implication of the neoadjuvant rectal score and other biomarkers of clinical outcome in Hong Kong Chinese patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiotherapy

BACKGROUND

Neoadjuvant chemoradiotherapy is a standard treatment for locally advanced rectal cancer, for which pathological complete response is typically used as a surrogate survival endpoint. Neoadjuvant rectal score is a new biomarker that has been shown to correlate with survival. The main objectives of this study were to investigate factors contributing to pathological complete response, to validate the prognostic significance of neoadjuvant rectal score, and to investigate factors associated with a lower neoadjuvant rectal score in a cohort of Hong Kong Chinese.

METHODS

Data of patients with locally advanced rectal cancer who received neoadjuvant chemoradiotherapy from August 2006 to October 2018 were retrieved from hospital records and retrospectively analysed.

RESULTS

Of 193 patients who had optimal response to neoadjuvant chemoradiotherapy and surgery, tumour down-staging was the only independent prognostic factor that predicted pathological complete response (P<0.0001). Neoadjuvant rectal score was associated with overall survival (hazard ratio [HR]=1.042, 95% confidence interval [CI]=1.021-1.064; P<0.0001), disease-free survival (HR=1.042, 95% CI=1.022-1.062; P<0.0001), locoregional recurrence-free survival (HR=1.070, 95% CI=1.039-1.102; P<0.0001) and distant recurrence-free survival (HR=1.034, 95% CI=1.012-1.056; P=0.002). Patients who had pathological complete response were associated with a lower neoadjuvant rectal score (P<0.0001), but pathological complete response was not associated with survival. For patients with intermediate neoadjuvant rectal scores, late recurrences beyond 72 months from diagnosis were observed.

CONCLUSION

Neoadjuvant rectal score is an independent prognostic marker of survival and disease recurrence in a cohort of Hong Kong Chinese patients who received neoadjuvant chemoradiotherapy for locally advanced rectal cancer.

Theoretical and experimental study of peroxy and alkoxy radicals in the NO3-initiated oxidation of isoprene

Under atmospheric conditions, nitrate-RO₂ radicals are equilibrated and react predominantly with HO₂, RO₂ and NO. The nitrate-RO chemistry is affected strongly by ring closure to epoxy radicals, impeding formation of MVK/MACR.

Experimental and theoretical study on the impact of a nitrate group on the chemistry of alkoxy radicals

The chemistry of nitrated alkoxy radicals, and its impact on RO₂ measurements using the laser induced fluorescence (LIF) technique, is examined by a combined theoretical and experimental study.

Can Male Mice Develop Preference Towards Gentle Stroking by an Experimenter?

Gentle stroking, a type of affective touch that holds hedonic and rewarding value, is critical to our daily inter-individual communication. This positive socio-emotional aspect of touch is conveyed through a subclass of C afferents known as C-Tactile fibers in humans with an analogous system in rodents proposed. Here, we describe a novel tactile conditioned place preference paradigm using mice and demonstrate that gentle stroking by an experimenter is rewarding. In order to investigate the relationship between tactile preference and innate sociability, mice were subjected to the classic three-chambered test of social approach, where mice displayed significant preference towards the experimenter's hand. These findings suggest that gentle stroking evoked by an experimenter can play an important role in reward and preference and establish an affiliative relationship between mice and humans. Future research can potentially use this model to examine fiber type involvement and elucidate the significance of these findings for activation of the reward system.

Systemic therapy in incurable gastroenteropancreatic neuroendocrine tumours: a clinical practice guideline

PURPOSE

The purpose of the present review was to determine which antineoplastic systemic therapy is most effective in improving clinical outcomes for patients with incurable gastroenteropancreatic neuroendocrine tumours (nets).

METHODS

A systematic search (2008-2016) of the literature in the medline and embase databases and the Cochrane Database of Systematic Reviews was conducted; abstracts from the American Society of Clinical Oncology, the American Society of Clinical Oncology Gastrointestinal Cancers Symposium, the European Society for Medical Oncology, the European Cancer Congress, the European Neuroendocrine Tumor Society, and the North American Neuroendocrine Tumor Society were reviewed. Draft recommendations were created, and a comprehensive review process was undertaken. Outcomes-including progression-free survival (pfs), overall survival, objective response rate, adverse events, and quality of life-were extracted from each of the studies.

RESULTS

Eleven randomized controlled trials (rcts), sixteen nonrandomized prospective studies, and thirteen retrospective studies met the inclusion criteria.

CONCLUSIONS

Patients with well-or moderately-differentiated pancreatic nets (pnets) should receive targeted therapy (that is, everolimus or sunitinib), and patients with non-pnets should be offered either targeted therapy (that is, everolimus) or somatostatin analogues (ssas-that is, octreotide long-acting release or lanreotide). Evidence from two phase iii trials demonstrated a significant pfs benefit for patients with pnets. For patients with non-pnets, the evidence comes from subgroup analyses of rcts, as well as from a planned interim analysis. Although the evidence has limitations, the rarity of the disease, coupled with the difficulty of conducting methodologically sound trials in the affected population, means that treatment decisions have to make use of the best available evidence. Because of insufficient evidence for both pnets and non-pnets, no evidence-based recommendation can be made for or against other types of targeted therapy, other ssas, chemotherapy, or combination therapy.

Prevalence and risk factors of chronic rhinosinusitis in South Korea according to diagnostic criteria

BACKGROUND

We aimed to compare the prevalence and risk factors of chronic rhinosinusitis (CRS) using two different diagnostic criteria with the same statistical data from the Korean National Health and Nutrition Examination Survey in 2009.

METHODS

Symptom-based CRS was defined as CRS diagnosed by questionnaires related to nasal symptoms. Endoscopy-based CRS was defined based on endoscopic findings and nasal symptoms of symptom-based CRS.

RESULTS

The overall prevalence of CRS based on the different diagnostic criteria was as follows: symptom-based CRS was 10.78% (797 of 7,394) and endoscopy-based CRS was 1.20% (88 of 7,343). Comparing symptom-based CRS to endoscopy-based CRS showed slight agreement (kappa = 0.183 (0.150-0.216, 95% confidence interval)). Allergic rhinitis was identified as a common risk factor for CRS based on the two diagnostic criteria.

CONCLUSIONS

The prevalence and risk factors of CRS were quite different from each other according to the different criteria, even in the same population. Therefore, it would be important to consider what specific diagnostic criteria have been adopted in the studies comparing the prevalence of CRS.

Sophorae radix reduces autoimmune response in NZB/w F1 systemic lupus erythematosus mouse model

The immunosuppressive effects of Sophorae radix (SR) make this plant an attractive agent for the treatment of autoimmune diseases. The effect of SR on systemic lupus erythematosus (SLE) in the New Zealand Black/White F1 (NZB/w F1) mouse model system was investigated. Three-month-old NZB/w F1 mice were separated into two groups: one treated with SR (1% SR solution by oral administration, daily for 15 weeks) and one with water as a control. Experimental parameters include proteinuria, anti-dsDNA antibody titers, T-cell response and renal histopathological analysis. Results in the SR-treated group showed a significant reduction in proteinuria and anti-dsDNA antibodies either in serum or in glomerular capillaries, along with significant recovery from renal glomerular damage. The lymphocyte population was significantly increased in the SR-treated mice compared with the control group. In the T helper (Th)1/Th2 cytokine secretion profile, interferon-γ in splenocyte culture was significantly reduced in the SR-treated mice, while interleukin-4 secretion was not altered. These results strongly suggest SR therapy corrects the deviated Th1/Th2 balance, thereby alleviating SLE-like symptoms in the NZB/w F1 mice. Therefore, SR may be useful in the clinical treatment of SLE. Lupus (2007) 16, 335—341.

Signaling pathways controlling pluripotency and early cell fate decisions of human induced pluripotent stem cells

Human pluripotent stem cells from embryonic origins and those generated from reprogrammed somatic cells share many characteristics, including indefinite proliferation and a sustained capacity to differentiate into a wide variety of cell types. However, it remains to be demonstrated whether both cell types rely on similar mechanisms to maintain their pluripotent status and to control their differentiation. Any differences in such mechanisms would suggest that reprogramming of fibroblasts to generate induced pluripotent stem cells (iPSCs) results in novel states of pluripotency. In that event, current methods for expanding and differentiating human embryonic stem cells (ESCs) might not be directly applicable to human iPSCs. However, we show here that human iPSCs rely on activin/nodal signaling to control Nanog expression and thereby maintain pluripotency, thus revealing their mechanistic similarity to human ESCs. We also show that growth factors necessary and sufficient for achieving specification of human ESCs into extraembryonic tissues, neuroectoderm, and mesendoderm also drive differentiation of human iPSCs into the same tissues. Importantly, these experiments were performed in fully chemically defined medium devoid of factors that could obscure analysis of developmental mechanisms or render the resulting tissues incompatible with future clinical applications. Together these data reveal that human iPSCs rely on mechanisms similar to human ESCs to maintain their pluripotency and to control their differentiation, showing that these pluripotent cell types are functionally equivalent.

Study of anxiety and depression in cervical cancer survivors

e20644

Background: Cervical cancer is the second leading cause of cancer related deaths among women in Korea. However, few studies have been conducted to elucidate the psychological distress of this population. This study aimed to examine the prevalence of anxiety and depression among cervical cancer survivors, and to identify factors associated with such caseness. Methods: A total of 832 cervical cancer survivors recruited from six large hospitals in Korea completed a mailed survey, which included the Hospital Anxiety and Depression Scale (HADS), European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, and QLQ-CX24. Anxiety and depression were defined by a score of ≥ 8 on the HADS subscales. With a framework that included socio-demographic, clinical, and symptom characteristics, multivariate logistic regression models were used to identify factors associated with anxiety and depression. Results: Among cervical cancer survivors, 34.3% reported HADS-defined anxiety and 39.7% reported HADS-defined depression. Anxiety was associated with having a lower income (OR=1.95, p=.021), smoking (OR=2.42, p=.002), poor body image (OR=3.26, p<.001), peripheral neuropathy (OR=2.21, p=.002), menopausal symptoms (OR=2.02, p=.004), and sexual inactivity (OR=2.35, p=.001). Depression was associated with younger age (OR=1.75, p=.006), having a lower income (OR=2.14 p<.001), drinking (OR=1.56, p=.050), poor body image (OR=4.59, p<.001), peripheral neuropathy (OR=2.34, p<.001), and sexual inactivity (OR=2.68, p=.002). Both anxiety and depression were influenced by socio-demographic factors, health behaviors, and cervical cancer-specific symptom characteristics rather than cancer- or treatment-related factors. Conclusions: Anxiety and depression were highly prevalent among cervical cancer survivors in Korea. This examination of risk factors for anxiety and depression will be helpful for the development of clinical management strategies in cervical cancer survivors.

No significant financial relationships to disclose.

Prospective evaluation of neurotoxicity in breast cancer patients treated with adjuvant paclitaxel

Abstract #1115

Background: Taxanes are increasingly used in the treatment of early stage breast cancer (BC). Up to 30% of patients develop moderate-severe neurotoxicity during treatment. We recently reported that about 60% of BC patients complain of some neuropathy up to 2 years after completing adjuvant paclitaxel (T) treatment. The prevalence, severity, and natural history of this syndrome have not been well described.&#x2028; Methods: Using a prospective cohort study design, women with stage I-III breast cancer undergoing adjuvant paclitaxel were enrolled. At baseline, 4 weeks, 8 weeks, 3 months, and 6 months, all patients completed the Functional Assessment of Cancer Therapy-Taxane (FACT-Tax) and quantitative sensory testing (touch perception and vibration threshold) was conducted. The FACT-Tax includes a 16-item subscale which measures the severity of neurotoxicity, where lower scores represent worsening symptoms. Blood was obtained at baseline and 2 weeks post-treatment to measure serum nerve growth factor (NGF) levels.&#x2028; Results: A total of 34 out of a target of 50 patients have been enrolled to date; median age: 48 (32-77); White/Hispanic/Black/Other: 10/17/4/1; median body mass index (kg/m2): 28 (21-44); stage I/II/III: 4/19/8; paclitaxel regimen T q2wks x4/T q2wks x6/T qwk x12: 19/8/5. Compared to baseline, there was a significant decrease in vibration sense at 8 weeks during active treatment. Mean scores on the Neurotoxicity subscale of the FACT-Tax decreased from 37.3 at baseline to 30.7 at week 4 (p=0.009) and 29.7 at week 8 (p=0.006). These scores remained lower than baseline at 3 months and 6 months after completing paclitaxel treatment (33.7 and 33.2, respectively). At 6 months, up to 50% of patients reported persistent numbness or discomfort in the hands and feet. Serum NGF analyses are underway to determine whether this biomarker correlates with neuropathy symptoms.&#x2028; Discussion: To our knowledge, this is one of the first studies to prospectively evaluate persistent neuropathy in women prior to, during and following adjuvant paclitaxel therapy. Over 50% of patients developed moderate to severe neuropathy during active treatment, which persisted 6 months post-treatment. Taxane-based chemotherapy has been shown to improve survival, however, neurotoxicity is the main long-term side effect. Understanding the natural history of this toxicity and validating appropriate measures to be used in interventions to prevent and treat taxane-induced neuropathy are critical.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1115.