Patient-reported outcomes after surgery or radiotherapy for localised prostate cancer: a retrospective study

INTRODUCTION

To compare the intermediate-term outcomes and patient-reported outcomes of robot-assisted laparoscopic prostatectomy (RALP) and radical external beam radiotherapy (RT) in Chinese patients with localised prostate cancer.

METHODS

This was a retrospective study of patients with localised prostate cancer diagnosed between 2010 and 2011 and treated with either RALP or RT. Baseline patient and disease characteristics, post-treatment complications, and latest disease status were retrospectively collected from hospital records. For assessment of patient-reported outcomes, the Chinese version of the Expanded Prostate Cancer Index Composite (EPIC) questionnaire was completed by the patients.

RESULTS

Ninety three patients aged 58 to 84 years were recruited. Thirty patients were treated by RALP (32.3%), whereas 63 received RT (67.7%). The RALP group had significantly lower baseline prostate-specific antigen levels than the RT group (P<0.001). More patients who underwent RALP reported urinary incontinence (70.0% vs 3.2%, P<0.001), whereas more patients who underwent RT reported other voiding symptoms (87.3% vs 50.0%, P<0.001) and perirectal bleeding (36.5% vs 0%, P<0.001) during follow-up. Of the 85 patients who were still alive at the time of the study, 52 (61.2%) returned completed questionnaires. Patients who underwent RALP had poorer median (interquartile range) EPIC urinary summary scores than patients who underwent RT [81.5 (18.3) vs 88.9 (17.9), P=0.016]. Urinary function [75.9 (20.4) vs 93.6 (16.2), P<0.001] and incontinence [60.5 (31.8) vs 91.8 (14.5), P<0.001] were also significantly worse in the RALP group. The bowel and sexual domain scores were similar between the two groups.

CONCLUSIONS

We found that RALP and RT were associated with different patterns of complications and patient-reported outcomes. Urinary incontinence was much more prevalent in the patients treated surgically. This may significantly affect patients' quality of life.

Computer assisted analysis of microtubule dynamics in living cells

Microtubules are dynamic polymers that rapidly transition between states of growth, shortening, and pause. These dynamic events are critical for basic cellular processes, especially cell division. Typically, these events are quantified by imaging microtubule movements over time, which results in large data sets that require rigorous quantitative analysis. In most cases, these analyses are performed manually by the researcher. This process is both tedious and prone to error; thus an efficient and reliable computer-assisted quantification system would provide a rapid approach, suitable for high-throughput data analysis. In this paper, we describe methods to automatically segment and track microtubule movements. Our method is a snake based method [1]. Instead of a closed contour, we use an open contour to track individual microtubule. We redefine some of the internal energy terms specifically for open snake. A new external energy term for locating the end points of a microtubule is also defined. Testing is done using simulated images and untreated MCF-7 breast cancer cell lines as well as cells treated with the microtubule-targeting chemotherapeutic agent, Taxol.

Integrating image analysis algorithms in a web interface for the quantification of microtubule dynamics

We present improvements to a web interface and an integrated computational tracking algorithm for quantitative analysis of microtubule dynamics in live-cell microscopy images. Based on a previously implemented system, more new functionalities have been added to the interface. The system also integrates a computational tracking algorithm to aid the analysis. The analysis workflow of the proposed interface is made similar to the current manual analysis workflow in order to make the interface intuitive to use. We show the workflow of the computer analysis algorithm and how it is used to aid the existing analysis workflow. We also demonstrate how to re-evaluate existing data in a case study using real imaging data. Lastly, we show the added functionalities of the interface including how to share image data and analysis results.

P5-13-11: PTEN and Tau-Protein Expression: Predictive Value of Poor Response to Trastuzumab Plus Paclitaxel in Patients with HER2−Positive Breast Cancer

Backgrounds: Trastuzumab-based chemotherapy has been an active treatment in patients (pts) with HER2−positive breast cancer; however, primary and secondary resistance has occurred in pts treated with trastuzumab (H) alone or in combination with chemotherapy. Material and Methods: Biomarkers were searched using tissue microarrays (TMA) in the HER2−positive breast cancer pts treated with H and paclitaxel (P) combination chemotherapy between October 2004 and August 2010. Tumor blocks of 101 pts were analyzed for VEGF, IGF-1R, p-Akt, beta-III tubulin, CD44, Tau-protein, p27 and PTEN by immunohistochemical (IHC) analysis. Eight biomarkers were assessed to investigate the correlation with the clinical outcomes, including response rate (RR), progression free survival (PFS), and overall survival (OS).

Results: With a median follow-up duration of 21.7 months (range, 9.1−55.2 months), 101 pts received H+P chemotherapy in neoadjuvant setting (n=36, 35.6%) and recurrent or metastatic setting (n=65, 64.4%). Median age was 48 (range, 19–83 years), and the majority of pts (n=95, 94.1%) had good performance status. Premenopausal pts and hormone receptor-negative pts were 48 (47.5%) and 52 (51.5%), respectively. The median cycle of H+P chemotherapy was six (range, H 1–43; P 1–21). Overall RR was 68.3% (n=69) including complete response with 7 pts, and PFS and OS were significantly longer in pts responsive to H+P chemotherapy compared with non-responsive patients (PFS, p=0.001; OS, p=0.015). Although VEGF, IGF-1R, p-Akt, beta-III tubulin, CD44, p27 and PTEN status by IHC were not significantly associated with response to H+P chemotherapy, Tau-protein showed a trend of association without statistical significance (RR, 46.2% vs. 71.6%, p=0.066). Among 13 pts with high Tau protein expression, 9 pts with both high Tau-protein and low PTEN level showed statistically significant lower RR compared with other 92 pts (22.2% vs. 72.8%; p=0.002). None of the biomarkers was related to PFS and OS in pts with recurrent or metastatic disease, and to pathologic complete response in pts after H+P chemotherapy as neoadjuvant therapy.

Conclusion: Our data showed that both low PTEN level and high Tauprotein expression were significantly associated with poor response to H+P chemotherapy in patients with HER2−positive breast cancer.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-13-11.

A Web Interface for the Quantification of Microtubule Dynamics

We propose a web interface that allows researchers to quantify and analyze microtubule confocal images online. Most analyses of microtubule confocal images are performed manually using very simple software or tools. Analysis results are stored locally within each collaborator with different styles and formats. This has limited the sharing of data and results when collaborating among different research parties. A web interface provides a simple way for users to process data online. It also allows easy sharing of both data and results among different participating groups. Analysis workflow of the interface is made similar to existing manual protocols. We demonstrate the integration of image processing algorithm in the current workflow to aid the analysis. Our design also allows integration of novel automated analysis algorithms and modules to re-evaluate existing data. This interface can provide a validation platform for new automated algorithm and allow collaboration on microtubule image analysis from different locations.

Automatic tip selection for microtubule dynamics quantification

Microtubule (MT) dynamics quantification includes modeling of elongation, rapid shortening, and pauses. It indicates the effect of the cancer treatment drug paclitaxel because the drug causes MTs to bundle, which will in turn inhibit successful mitosis of cancerous cells. Thus, automatic MT dynamics analysis has been researched intensely because it allows for faster evaluation of potential cancer treatments and better understanding of drug effects on a cell. However, most current literatures still use manual initialization. In this work, we propose an automatic initialization algorithm that selects isolated and active tips for tracking. We use a Gaussian match filter to enhance the MT structures, and a novel technique called Pixel Nucleus Analysis (PNA) for isolated MT tip detection. To find dynamic tips, we applied a masked FFT in the temporal domain followed by K-means clustering. To evaluate the selected tips, we used a low level tip linking algorithm, and show the results of applying the algorithm to a model image and five MCF-7 breast cancer cell line images captured using fluorescent confocal microscopy. Finally, we compare tip selection criteria with existing automatic selection algorithms. We conclude that the proposed analysis is an effective technique based on three criteria which include outer region selection, separation, and MT dynamics.

Detecting and quantifying biomarkers of risk for colorectal cancer using quantum dots and novel image analysis algorithms

Colorectal cancer, the second leading cause of cancer deaths in the United States, is a molecular disease that is largely lifestyle determined and preventable. While heart disease has been sharply declining, in large part from widespread use of biological measurements that indicate risk ("biomarkers of risk"), such as blood cholesterol, to motivate and guide preventive treatment, colorectal cancer is a disease for which mortality rates have changed little and for which there have been no biomarkers of risk. Based on new knowledge about the molecular basis of colorectal cancer we developed and validated a panel of treatable biomarkers of risk that can be measured in rectal biopsies using automated immunohistochemistry and semi-automated image analysis. The methodology is now being made practical for clinical application through the use of 1) quantum dots, so that all of the biomarkers can be detected simultaneously on the same histologic sections (i.e., multiplexed), and 2) novel, automated image analysis algorithms to measure the quantities and tissue distributions of the biomarkers. Herein we summarize our methods, results, current directions, and progress.

Bioconjugated quantum dots for multiplexed and quantitative immunohistochemistry

Bioconjugated quantum dots (QDs) provide a new class of biological labels for evaluating biomolecular signatures (biomarkers) on intact cells and tissue specimens. In particular, the use of multicolor QD probes in immunohistochemistry is considered one of the most important and clinically relevant applications. At present, however, clinical applications of QD-based immunohistochemistry have achieved only limited success. A major bottleneck is the lack of robust protocols to define the key parameters and steps. Here, we describe our recent experience, preliminary results and detailed protocols for QD-antibody conjugation, tissue specimen preparation, multicolor QD staining, image processing and biomarker quantification. The results demonstrate that bioconjugated QDs can be used for multiplexed profiling of molecular biomarkers, and ultimately for correlation with disease progression and response to therapy. In general, QD bioconjugation is completed within 1 day, and multiplexed molecular profiling takes 1-3 days depending on the number of biomarkers and QD probes used.

Automatic microtubule tracking for QD-based in vivo cell imaging and drug efficacy study

Microtubules (MT) are dynamic polymers that rapidly transition between states of growth, shortening, and pause. These dynamic events are critical for many microtubule functions such as intracellular trafficking and signaling. In addition, cancer chemotherapy drugs that target microtubules, such as the taxanes and the vinca alkaloids, are known to suppress microtubule dynamics at low doses, leading to mitotic arrest and cell death. Quantification of microtubule dynamics can be used as a read-out of anticancer-drug activity and can be a surrogate marker of drug sensitivity/resistance. The emerging nanotechnology such as quantum dots has provided properties such as less photo bleaching, higher probe imaging intensity, better specificity and sensitivity, which finally makes visualizing subcellular events over long enough time a possibility. But it also results in big increase in data acquisition. The traditional way of annotating MT manually is becoming a daunting task. Thus, the goal is to research and develop an efficient, reliable, and rapid MT tracking. In this paper, we describe active contour-based tracking methods to automatically track MT. We redefine the internal energy terms specifically for open snake, and examine different external energy terms for locating the end tips of a microtubule. This algorithm has been validated using simulated images, images of untreated MCF-7 breast cancer cells, and image of cells treated with the microtubule-targeting chemotherapeutic agent, Taxol.

Residual levels of DDTs and PAHs in freshwater and marine fish from Hong Kong markets and their health risk assessment

Axial and ventral muscle from 10 each species of freshwater and marine fish purchased from markets in Hong Kong were analyzed for dichlorodiphenyltrichloroethane (total DDTs including DDE, DDD and DDT) and polycyclic aromatic hydrocarbons (PAHs). Among the 10 freshwater fish species, rice field eel (Monopterus albus) showed significantly higher levels of DDTs in both ventral (125 ng/g wet wt) and axial muscle (127 ng/g wet wt) than the other species. The highest concentration of PAHs was detected in catfish (Clarias fuscus), with 24.8 ng/g in ventral muscle and 9.1 ng/g in axial muscle. As to marine fish, snubnose pompano (Trachinotus blochii) showed significantly higher levels of DDT and its metabolites (1018 ng/g in ventral and 409 ng/g wet wt in axial tissues) than all other marine fish species. The overall concentrations of PAHs in marine fish species were 15.5-57.0 ng/g (axial muscle) and 18.1-118 ng/g wet wt (ventral muscle) where yellow seafin (Acanthopeyrus latus) and golden threadfin bream (Nemipterus virgatus) exhibited the highest concentrations of PAHs in the axial and ventral muscles, respectively. In general, results showed that levels of PAHs in Hong Kong market fish was low and do not expect to cause any concern for human consumption. However, the levels of DDTs in fish samples ranged from 1.10 to 1018 ng/g wet wt, and based on a fish consumption rate of 142.2g/day to calculate the screening value of 14.4 ng/g wet wt for human consumption (USEPA, 2000. Guidance for assessing chemical contaminant, data for use in fish advisories, vol. 1: fish sampling and analysis, third ed. EPA 823-R-95-007. Office of Water, Washington, DC), there were 9 out of 20 (45%) muscle samples of freshwater fish species and 14 out of 20 (70%) muscle samples of marine fish species had elevated levels of DDTs exceeded the screening value. It was also suggested to use ventral muscle for detecting concentrations of persistent organic pollutants in fish.

The residual dynamic of polycyclic aromatic hydrocarbons and organochlorine pesticides in fishponds of the Pearl River delta, South China

Hong Kong and South China are the most developed regions within China. The industrialization in these areas has resulted in severe environmental problems. Sediment and biotic samples including tilapia (Oreochromis mossambicus), bighead carp (Aristichthys nobilis), grass carp (Ctenopharyngodon idellus), crucian carp (Carassius auratus) and mandarin fish/fresh water grouper (Siniperca chuatsi) were collected from different fishponds in the Pearl River Delta (Tanzhou, Sanjiao, Guangzhou, Shipai, Changan and Mai Po) for the analysis of polycyclic aromatic hydrocarbons (PAHs) and organochlorine (OC) pesticides. Mandarin fish, which belongs to the highest trophic level, accumulated the highest concentrations of PAHs and DDTs among all fish species. The levels of DDTs in fish samples ranged from 1.5 to 62ng g-1 (wet wt.), with more than 30% of the fish samples exceeding the limit of 14.4ng g-1 (wet wt.) for human consumption recommended by US EPA (2000). Levels of PAHs in fish samples ranged from 1.91 to 224.03ng g-1 (wet wt.), but the potency-weighted total concentrations of PAHs in all muscle tissues were below the guideline value of 0.67ng g-1 (wet wt.) for human consumption set by US EPA (2000). The guideline value calculated was based on a tissue consumption rate of 142.2g day-1 (4-5 meals per week), which is a more protective rate for populations with a high consumption of fish, like Chinese and Asians. The effect of lipid content in PAHs and DDTs accumulation in fish tissue was not significant in general.

Juxtacortical chondromyxoid fibroma arising in an apophysis

We present a rare case of juxtacortical chondromyxoid fibroma arising in the lesser trochanter of the right femur which corresponds to an apophysis. Radiography showed a well-defined expansive lesion with a sclerotic margin measuring 5x3.5 cm in diameter in the lesser trochanter. On spin echo T1-weighted images, the lesion revealed low signal intensity similar to muscle. On spin echo T2-weighted images, the lesion revealed high heterogeneous signal intensity, which after gadolinium injection showed heterogeneous enhancement. The inner margin of the cortex was intact and adjacent bone marrow was of normal signal intensity. The outer margin of the lesion was also clearly defined and extension into adjacent soft tissue beyond the exophytic cortical outgrowth was not evident.

MR findings of desmoplastic fibroma of the spine. A case report

We report on the MR imaging findings in a case of spinal desmoplastic fibroma (DF). DF of the bone is a rare, locally aggressive tumor. It is commonly located in long bones, pelvis or mandible. DF involving the spine is extremely rare and difficult to distinguish from other bony lesions such as giant cell tumor, chordoma and fibrous dysplasia of the spine. This case of DF of the spine showed MR findings similar to those of DF arising in the metaphysis of a long bone.