Abstract 1691: Clinical characteristics influencing survival in stage-IV non-small cell lung cancer treated with nivolumab: A single-institutional experience

Background: Immune-checkpoint blockade (ICB) using antibodies directed against the programmed cell death-1 (PD-1) axis has revolutionized the management of non-small cell lung cancer (NSCLC). Based on results from the Checkmate 017 and 057, nivolumab, an anti-PD-1 antibody, has emerged as the standard of care in the second line setting for advanced NSCLC. However, the lack of uniform responses as noted in daily practice suggests clinical heterogeneity. Hence, it is essential to identify characteristics that may predict inferior efficacy to ICB. Methods: Retrospectively we identified 61 stage IV NSCLC patients treated with nivolumab from April 2015 to March 2017 after progressing on a platinum doublet. These patients were part of an ongoing institutionally approved prospective biomarker-based study. Follow up cutoff for survival analysis was set on October 1, 2017. Overall survival after immunotherapy (OSI) was defined as the time from ICB initiation to last follow up or death. Cox regression was used to assess the correlation of clinical and biochemical factors influencing OSI. Results: The median age was 63 years with predominant histology being adenocarcinoma in 65.6 %. A majority of patients were of Caucasian ethnicity (68.9%) and male gender (60.7%). Skeletal involvement (54.1 %), liver (27.9 %) and brain (26.2 %) were the most common metastatic compartments. Simultaneous involvement of greater than 1 metastatic compartment at ICB initiation was observed in 54.1% of patients. Approximately 67.3 % patients were either former/never smoker at the time of nivolumab initiation. The median OSI for our NSCLC cohort treated with nivolumab was 6.3 months. On adjusted Cox univariate analysis of the clinically relevant covariates, baseline factors present at anti-PD-1 initiation that were associated with inferior OSI were age greater than 65 [p= 0.036; 2.37 (1.05-5.30)], brain metastasis [p=0.014; 3.30 (1.25-7.37)] and greater than 1 metastatic compartment involvement [P=0.041; 2.78 (1.04-7.44). Using adjusted multivariate Cox regression model with backward elimination, all three factors were noted to be independently associated with inferior OSI.Conclusions: Our study identified subgroups with certain baseline clinical features that tend to behave poorly despite ICB. This suggests that improving outcomes in such subgroups may require exploring strategies involving combination ICB or other novel targeted therapies. Also, better identification of such subgroups via larger datasets may help in the appropriate designation of patients for optimally tailored ICB and thus assist in improving outcomes in NSCLC.

Citation Format: Abdul Rafeh Naqash, Chipman R. Stroud, Li V. Yang, Mahvish Muzaffar, Paul R. Walker. Clinical characteristics influencing survival in stage-IV non-small cell lung cancer treated with nivolumab: A single-institutional experience [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1691.

Abstract P6-10-06: Racial differences in the characteristics and outcomes of young breast cancer patients: A national population-based study

Background:

Disparity in demographic characteristics as it relates to breast cancer outcomes is well-studied. However, studies evaluating racial differences exclusively among young patients are more limited. We sought to examine socioeconomic and clinical factors and their impact on outcomes in young patients, as well as to determine whether variation in outcomes changed over the 22-year study period.

Methods:

Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified female patients aged 20-35 with invasive breast cancer diagnosed from 1990-2012. We performed univariate, multivariate and survival analysis. Variables included patient age, race, stage, receptor status, surgery type and year of diagnosis

Results:

A total of 18,999 women were identified and analyzed. Mean age was 31.7 years. 31.2% were diagnosed between 1990-2000 while 68.7% were diagnosed between 2001-2012. 80.8% (15,364) of patients were white and 19.1% (3,635) were black. A higher percentage of blacks had stage III/IV disease (34% v 27%) and ≥ 4 positive nodes (19% v 16%) compared to whites. 54% of whites were ER receptor positive while 46% of blacks were ER receptor positive (p<0.0001). White patents were more likely to live in counties where ≤15% of households were below the poverty line (64% v 45%) and where ≤15% of the population had less than a high school education (35% v 28%) compared to blacks.

The overall 5-year disease specific survival (DSS) for the entire cohort was 82.5%. 5-year DSS was 84.4% for all white patients and 74.2% for all black patients (p<0.0001). 5-year DSS was 79.1% among all patients diagnosed from 1990-2000 and 84.2% among patients diagnosed from 2001-2012 (p<0.0001). While the 5-year DSS for white patients improved from 80.9% in 1990-2000 to 86.3% in 2001-2012 (p<0.0001), the 5-year DSS improvement for black patients from 1990-2000 to 2001-2012 did not reach statistical significance (71.3% vs 75.7 %, p=0.24).

Discussion:

Racial disparity among breast cancer patients is also an issue in young females, as young white patients have superior disease-specific survival compared to African-Americans collectively and in each time-period studied. Absolute disease-specific survival has improved from 1990-2000 to 2001-2012 for both races. However, the statistically significant difference in improvement of disease-specific survival seen among white patients was not demonstrated in African-American patients. Continued attention to racial disparity in breast cancer outcomes is needed with additional studies examining potential differences in treatment, disease characteristics and biology, and accessibility to health care, with a particular focus on young cancer patients. With continued research, hopefully new treatment approaches will be developed to reduce this disparity.

5-Year Disease Specific SurvivalTime Period5 year DSSp value WhiteBlack 1990-200080.9%71.3%0.00012001-201286.3%75.7%0.0001p value0.00010.24 

Survival by stage 5 yr DSS  WhiteBlackp valueStage I96.2%94.9%<0.001Stage II89.0%83.5%<0.0001Stage III69.4%57.4%<0.0001Stage IV34.6%16.9%<0.0001

Citation Format: McClain JT, Mosquera C, Muzaffar M. Racial differences in the characteristics and outcomes of young breast cancer patients: A national population-based study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-10-06.

Abstract P6-08-21: Early breast cancer-specific mortality in women with early stage breast cancer: Epidemiological and clinical characteristics

Background and Aim:

The five-year survival for women with stage I-II breast cancer is 93-100%. Despite standard of care treatment, a small subset of these women suffer early breast cancer-specific mortality and die within 12 months of diagnosis. This subset of women has not been previously described. The aim of this study is to characterize the incidence, demographics, and clinical characteristics of women with early stage breast cancer who suffer early breast cancer-specific mortality.

Methods:

Retrospective population study of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry of women diagnosed with stage I, IIA, or IIB breast cancer between 2004 and 2010. Data were filtered to histology codes 8500-8543 and 8575. Patient demographics (age, race, ethnicity) and clinical characteristics (stage, T stage, N stage, grade, ER status, PR status) of women in the early mortality subset were compared with those of women who survived > 12 months via the Chi-square test and the student t-test.

Results:

259,380 women formed the basis of our analysis. 4,572 women (0.018%) died within 12 months of diagnosis. Compared with those who survived > 12 months, women who suffered early breast cancer-specific mortality were on average older (mean age 65.7 years versus 60.3 years, p<0.00001) and more likely to be Hispanic (14.3% versus 8.9%, p<0.00001) or black (11.0% versus 9.1%, p<0.00001). Clinical characteristics associated with early mortality included higher stage (stage IIA 34.2% versus 29.4%, stage IIB 21.8% versus 12.9%, p<0.00001), higher T stage (T2 40.5% versus 28.1%, T3 3.1% versus 1.6%, p<0.00001), higher N stage (N1 29.7% versus 23.2%, N2 0.8% versus 0.4%, N3 0.4% versus 0.1%, p<0.00001), higher grade (moderate 39.3% versus 42.5%, high 40.0% versus 31.5%, p<0.00001), higher rates of ER negativity (27.2% versus 19.0%, p<0.00001), and higher rates of PR negativity (38.5% versus 30.2%, p<0.00001).

Conclusions:

Breast cancer-specific mortality within 12 months of diagnosis of stage I-II breast cancer is a rare phenomenon which has not been previously characterized. There are several demographic and clinical features associated with early mortality, however further research is needed to identify specific prognostic factors that will allow identification of women at risk for early mortality at the time of diagnosis.

Citation Format: Johnson HM, Wong JH, Vohra NA, Muzaffar M. Early breast cancer-specific mortality in women with early stage breast cancer: Epidemiological and clinical characteristics [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-21.

Abstract P1-15-04: Outcome of small (≤1 cm), node-negative breast cancer

Background: Screening mammogram has resulted in increased diagnosis of very small breast cancers, especially less than 1 cm node negative. These small tumors have excellent prognosis with cancer-specific survival rates as high as 90% to 95%. This study evaluates outcome in different subtypes of very early breast cancer in a national population database.

Method: Patients with stage I breast cancer, tumor ≤ 1cm with negative nodes (T1aN0 (<0.5cm), T1bN0 (≥ 0.5cm to ≤ 1cm) diagnosed between 2006 and 2011 were identified in the SEER database. We excluded patients with missing biomarker information. Treatment outcome and prognostic factors for disease-specific survival (DSS) and overall survival (OS) were evaluated.

Results: We identified 70,543 cases and included 54,796 patients with stage T1aN0M0 and T1bN0M0 in the final analysis. The mean age was 62.09 yrs. (CI 95% 62.2-61.99), 84% are white, 7% black and 7% others.89% had ER positive tumor, 11% ER negative and 3% had Her 2 positive tumors.71% of patients had T1b (≤ 1cm). The 5-year disease specific survival (DSS) and overall survival (OS) for patients with stage T1aN0, T1bN0 was 98.7% and 93.7%, respectively. Estrogen receptor (ER) positive tumors were associated with improved 5-yr DSS 99% vs. 96% in ER negative (p<0.0001) and OS in ER positive 94% vs. 92%( p<0.0001). Among white patients 5-yr DSS was 98.8% and OS was 93.7% while 5yr-DSS was 94%, OS 91.5% among black vs. 5-yr DSS 99% and OS 96.3% in others (Asian or Pacific Islanders, AI), (p<0.0001). Tumor subtype was not associated with significant difference in outcome but T1a tumor was associated with OS 94.5% vs. 93.4% with T1b tumors (p<0.0001) On cox model analysis factors which correlated with prolonged DSS and OS are race (p<0.0001), older age (p<0.0001), ER positivity (p<0.0001) and tumor less than 5mm (p=0.0006).

Conclusions: Very early breast cancer is associated with excellent outcome but has some heterogeneity. Nonwhite/Non Black race was associated with better survival compared to white and black patients. ER positive tumors, and older age were also associated with better outcome. This data while reassuring also brings into question the overtreatment of this disease subset. One of the limitations of this dataset is lack of details of systemic therapy administered. Conventional prognostic factors are not sufficient to risk stratify very early breast cancer and molecular profiling may help identify patients who will need adjuvant treatment.

Citation Format: Muzaffar M, Namireddy P, Naqash R, Wong J, Vohra N. Outcome of small (≤1 cm), node-negative breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-15-04.

Survival stratification using a baseline inflammatory physiology based scoring system in advanced non-small cell lung cancer (NSCLC) treated with anti-programmed cell death-1 (anti-PD-1) therapy

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Background: Immune checkpoint blockade (ICB) has shown promise in NSCLC with improved survival and durability in disease control. Despite these advances, the response to ICB remains variable. Thus identifying easily available biomarkers that can assist in the optimal selection of patients for ICB holds paramount importance. Methods: Retrospectively we identified 87 stage III/IV NSCLC patients initiated on anti-PD-1 therapy from April 2015 to March 2017 after progressing on a platinum doublet. These patients were part of an ongoing prospective biomarker-based study at our institution. Follow up cutoff for survival analysis was set at October 1, 2017. Enrolled participants had inflammatory markers (C-reactive protein, absolute neutrophil count, absolute lymphocyte count, serum albumin) measured on the day of first dose of anti-PD-1 administration as well as subsequent doses. Using multivariate Cox analysis, factors demonstrating an association with overall survival after immunotherapy (OSI) were used to develop a composite score to stratify patient survival. Results: The median age was 64 years with predominant histology being adenocarcinoma in 46.0 % followed by squamous cell carcinoma (43.7 %). Stage IV disease was present in 70.1%, with skeletal involvement (54.1 %) and liver (27.9 %) being the most common metastatic sites. In the multivariate Cox regression with backward elimination, factors independently associated with OSI were noted to be: CRP, neutrophil-lymphocyte ratio, and prognostic nutritional index. A composite inflammatory biomarker score was developed using the B-coefficients from the Cox multivariate regression. A score > 1 demonstrated inferior OSI compared to a score of ≤ 1 [1.7 vs. 9.3 months; P < 0.001, HR 4.00, 95% CI (2.21-7.25)]. Conclusions: This study provides preliminary evidence in favor of a composite inflammation based score that can aid in survival stratification of these patients. Validation of this score in prospective NSCLC trials to elucidate its potential utility as a predictive or prognostic tool in facilitating optimal patient selection for ICB is required.

SIDE in metastatic colon cancer: SEER Database analysis

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Background: Recent data suggests side of colon cancer is a prognostic factor and a potential predictive factor for biologic therapy. We sought to analyze SEER database to study impact of colon cancer side. Methods: The SEER database (version 8.3.4) was reviewed for patients with Stage IV colon cancer from 2004-2014. We only included patients with labeled primary site, and excluded appendiceal, rectal or unlabeled cases. Variables included were: age, race, gender, stage, grade and side of the tumor. Primary outcome was overall survival and disease specific survival. Cox proportional hazard regression model was employed to test the association between survival and side of cancer. Results: 48,306 patients met the inclusion criteria, median age was 67 years (range 20-108), 51% were male, and 77% patients were white. 19831 (41%) patients had left colon cancer (LCC). Right colon cancer (RCC) was associated with inferior OS and DSS compared to LCC. The median overall survival was 15 months (mo) for left side and 9 months for right colon cancer (p<0.0001). Estimated 3-year OS for RCC was 14% and 24% for LCC (p <0.0001). RCC was associated with poor outcome across different variables, among patients < 60 years of age median OS was 23 mo for LCC, and 16 mo for RCC (p .0001). In the age group ≥ 60 years, 10 mo for left side and 7 mo for RCC (p < 0.0001). Among male patients RCC had 10 mo median OS vs 16 mo for LCC (p <0.0001), women 15mo for LCC vs 9mo for RCC (<0.0001). Cox regression model suggested age (<0.001), race (<0.0001), year of diagnosis (<0.0001) and grade (<0.0001) correlate with outcome. Conclusions: Right side colon cancer is associated with poor outcome compared to left colon cancer. These findings are consistent with other recent reports.

Equality during end-of-life cancer care: Trends in aggressiveness of cancer care at the end of life

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Background: Aggressive cancer care at the end of life (EOL) can impact quality of life and have major economic burden. The purpose of this study was to portray the aggressiveness of EOL cancer care, and its relation to race, gender and social factors in Eastern North Carolina with high rural and minority population. Methods: This is a retrospective analysis of 401 stage 4 solid tumor patients who died between 2011 and 2014. Aggressiveness of care was calculated by a composite score adopted from Earle et al. Scores range from 0 to 7 with higher scores indicating more aggressive EOL care. 1 point was given to each indicator of aggressiveness in the last 30 days of life: ED visits ≥2,hospital admissions ≥2,any ICU admission,hospitalized days ≥14,new chemotherapy, hospice care ≤ 3 days, and any chemotherapy in the last 14 days. Results: Among the 401 patients, 217 (54%) were white and 178 (44%) were black. The mean composite score of aggressiveness (CSA) for whites was 1.18 and for blacks it was 1.87. (p<0.001).In the last 30 days of death, a higher proportion of blacks had ≥ 2 ED visits 28% vs 13%(p<.0001), ≥ 2 hospital admission 23% vs 13%(p=0.001), any ICU admission 29% vs 16%(p=0.0002), chemotherapy in the last 14 days 30% vs 20%(p=0.001), ≥ 14 hospitalized days 35% vs 21%(p<0.001), and hospital deaths 46% vs 32%(p=0.001) compared to whites. More whites enrolled in hospice compared to blacks 53% vs 45% (p<0.001). Correlation analysis using Fit Y by X model between CSA (score ≤ 3 and >3) and other variables showed statistically significant difference between whites vs blacks p <0.001, females vs males p=0.0006, not married vs married p<0.0001, and no family support vs family support p<0.0001. Conclusions: Male, unmarried and black patients were associated with higher CSA. Patients who were white, married and with family support had high likelihood of enrolling in hospice. [Table: see text]

Veristrat based stratification of responses to immune checkpoint blockade (ICB)

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Background: Veristrat (Biodesix, Boulder, CO) is a blood based proteomic assay that is dominated by inflammatory proteins and is prognostic and predictive in metastatic NSCLC after treatment with platinum based chemotherapy (Gregorc et al, Lancet 2014). Smoldering inflammation in the tumor microenvironment regulates and escalates cancer invasion, angiogenesis and immune surveillance escape (Balkwill and Mantovani, Lancet 2001). There is preclinical evidence to suggest that the tumor microenvironment can be altered with immunomodulatory interventions (Martino et al, 2016). While immune checkpoint blockade has shown durable benefit in metastatic NSCLC, the response rates still hover around 20%. As a result, identification of predictive biomarkers are of critical importance. The predictive value of the Veristrat assay with respect to ICB is poorly defined. Methods: At our institution, 83 pts with metastatic lung cancer pts were treated with nivolumab between 6/2015 to 12/2016. The following clinicopathologic characteristics were abstracted from medical records: tumor histology, Veristrat status, no. of doses of nivolumab, irAEs and overall survival. Results: Of the 83 pts, 65 pts were found to have NSCLC. Veristrat status was available for 17/65 of these pts. Nine pts were identified to have “Veristrat good” and seven pts were “Veristrat poor”. Median number of nivolumab doses was 4. Median survival for all patients was 30 weeks. Median survival was 20 weeks for “Veristrat poor” and 26 weeks for “Veristrat good”(p = 0.68). Grade 3-4 irAEs were noted in 5/9 patients with “Veristrat good” and 5/7 patients with “Veristrat poor”. Conclusions: “Veristrat poor” pts treated with ICB have a lower median survival as compared to “Veristrat good” pts. Our study did not meet statistically significant end point due to limited sample size. Further studies are needed to identify poorly immunogenic tumors and develop novel treatment approaches to optimize outcomes. [Table: see text]

Racial and social disparities on aggressiveness of end-of-life cancer care in a rural academic center

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Background: Aggressive cancer care at the end of life (EOL) can impact quality of life and have major economic burden. The purpose of this study was to determine the aggressiveness of EOL cancer care, and its relation to race, gender and social factors in Eastern North Carolina with a high rural and minority population. Methods: This is a retrospective analysis of 401 stage 4 solid tumor patients who died between 2011 and 2014 at Vidant Medical Center. Aggressiveness of care was calculated by a composite score adopted from Earle et al. Scores range from 0 to 7 with higher scores indicating more aggressive EOL care. 1 point was given to each indicator of aggressiveness in the last 30 days of life: ED visits ≥2, hospital admissions ≥2, any ICU admission, hospitalized days ≥14, new chemotherapy, hospice care ≤ 3 days, and any chemotherapy in the last 14 days. Results: Among 401 patients, 217 (54%) were white and 178 (44%) were black. The mean composite score for aggressiveness (CSA) for whites was 1.18 and for blacks it was 1.87 (p<0.001). In the last 30 days of life, a higher proportion of blacks had ≥ 2 ED visits 28% vs 13%(p<.0001), ≥ 2 hospital admission 23% vs 13%(p=0.001), any ICU admission 29% vs 16%(p=0.0002), chemotherapy in the last 14 days 30% vs 20%(p=0.001), and ≥ 14 hospitalized days 35% vs 21%(p<0.001) compared to whites. More whites were enrolled in hospice compared to blacks 53% vs 45% (p<0.001). Correlation analysis using Fit Y by X model showed statistically significant differences between CSA (score ≤ 3 and >3) and other variables such as whites vs blacks p <0.001, females vs males p=0.0006, not married vs married p<0.0001, and no family support vs family support p<0.0001. Conclusions: Male, unmarried and black patients were associated with higher CSA. Patients who were white, married and with family support had higher likelihood of enrolling in hospice. [Table: see text]

Clinical outcomes in very early breast cancer (≤ 1cm): A national population based analysis

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Background: The utilization of screening mammogram has resulted in increased diagnosis of very small breast cancers including T1a (≤5 mm), T1b ( > 0.5 but ≤1 cm). These small tumors have excellent prognosis with cancer-specific survival rates as high as 90% to 95%.This study evaluates outcomes in very early breast cancer in a national database. Methods: Patients with stage I breast cancer, tumor ≤ 1cm (T1aN0, T1bN0) diagnosed between 2006 and 2011 were selected from the SEER database. We excluded patients with missing biomarker information. Treatment outcome and prognostic factors for disease-specific survival (DSS) and overall survival (OS) were evaluated. Results: We identified 70,543 cases and included 54,796 patients with stageT1aN0M0 and T1bN0M0 in the final analysis.The mean age was 62.09 yrs(CI 95% 62.2-61.99),84% are white,7% black and 7% Other.89% were ER positive,11% ER negative and 3% had Her 2 positive tumors.71% of patients had T1b. ≤ 1cm breast cancer cases increased from 15% in 2006 to 18% in 2011.The 5-year disease specific survival (DSS) and overall survival (OS) for patients with stage T1aN0T1b N0 was 98.7% and 93.7%, respectively. Estrogen receptor(ER) positive tumors were associated with improved 5-yr DSS 99% vs 96% in ER negative (p < 0.0001) and OS in ER positive 94% vs 92%( p < 0.0001).Among white patients 5-yr DSS was 98.8% and OS was 93.7% while 5yr-DSS was 94%,OS 91.5% among black vs 5-yr DSS 99% and OS 96.3% in others( Asian or Pacific Islanders,AI), (p < 0.0001).Tumor subtype was not associated with significant difference in outcome but T1a tumor was associated with OS 94.5% vs 93.4% with T1b tumors(p < 0.0001) On cox model analysis factors which correlated with prolonged DSS and OS are race (p < 0.0001),older age (p < 0.0001), ER positivity (p < 0.0001) and tumor less than 5mm (p = 0.0006). Conclusions: Very early breast cancer is associated with excellent outcome but has some heterogeneity. Nonwhite/Non Black race was associated with better survival compared to white and black patients.ER positive tumors, older age were also associated with better outcome. This data while reassuring also brings into question of overtreatment of this disease subset.

Efficacy of PD-1 inhibitors in patients with metastatic non-small cell lung cancer (NSCLC) with KRAS or EGFR T790M mutations

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Background: Immune checkpoint blockade(ICB) has revolutionized the treatment of progressive NSCLC with its durable benefit when compared to cytotoxic agents. In the era of personalized medicine, there is a need to identify effective predictive biomarkers to detect exceptional responders to ICB. Immune modulating interventions with cytotoxic or biologic agents can maximize clinical responses from ICB in poorly immunogenic tumors. KRAS mutations are a negative prognostic factor for survival and generally lack targeted therapies. The T790M mutation in EGFR is the most common cause of acquired resistance to first line TKIs. As a group, patients with EGFR mutations generally do not derive clinical benefit from ICB versus cytotoxic chemotherapy. Preclinical data suggests that mutations like T790 m are associated with higher immunogenicity leading to avid stimulation of antigen specific T-cells (Ofuzi et al, 2014) and better response to ICB (Yamada, 2013). However, the efficacy of ICB by specific molecular mutations remains poorly defined. Methods: We reviewed data for 83 pts with recurrent or progressive metastatic lung cancer treated with nivolumab from June 2015-Dec 2016. All pts were treated with ICB as a second or subsequent line of treatment. The patients were assessed for pathology, mutational status and overall survival. Mutational status was checked on either tissue biopsy or serum samples submitted for proteomic veristrat/genestrat (Biodesix Inc., Boulder, CO, USA) assay. Results: Of the 83 patients treated with nivolumab, 65 patients were found to have NSCLC. Eleven pts were found to have KRAS mutation which was further subdivided as: 6 pts with KRAS G12C, 4 with KRAS G12V, 1 with KRAS G12D. Two pts were found to have T790M mutation. 81%(9/11) pts with KRAS mutation died. Median survival in pts with KRAS G12C mutation was 10 weeks and KRAS G12V was 12 weeks (p = 0.17). Median survival was not reached for patients with T790M mutation. Conclusions: KRAS mutations tend to have a shorter overall survival with ICB as compared to patients with EGFR T790M mutations. Further studies are necessary to isolate poorly immunogenic subtypes of NSCLC and develop novel treatment approaches to optimize outcomes.

National population-based study of racial variation in characteristics and outcomes of young breast cancer patients: Analysis of temporal trends

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Background: Breast cancer outcomes correlate with racial and socioeconomic status. Efforts to reduce disparities in breast cancer among vulnerable populations has had limited success. We sought to examine trends of racial and socioeconomic factors and its impact on outcome in young breast cancer patients. Methods: Using the Surveillance, Epidemiology, and End Results database, we identified female patients aged 20-35 with invasive breast cancer diagnosed from 1990-2012. We performed univariate, multivariate and survival analysis. Variables included patient age, race, stage, receptor status, surgery type and year of diagnosis. Results: A total of 18,999 women were identified. Mean age was 31.7. 80.8% were white and 19.1% were black. A higher percentage of blacks had stage III/IV disease (34% v 27%) and ≥ 4 positive nodes (19% v 16%) compared to whites. 54% of whites were ER receptor positive while 46% of blacks were ER receptor positive (p<0.0001). Analysis of American Community Survey attributes indicated white patents were more likely to live in counties where ≤15% of households were below the poverty line (64% v 45%) and where ≤15% of the population had less than a high school education (35% v 28%) compared to blacks. 31.2% were diagnosed in 1990-2000 while 68.7% were diagnosed in 2001-2012. 5 year disease specific survival (DSS) was 79.1% among all patients diagnosed from 1990-2000 and 84.2% among patients diagnosed from 2001-2012 (p<0.0001). In each time period, white patients had significant difference in 5 year DSS compared to black patients. While the 5 year DSS for white patients improved from 80.9% to 86.3% (p<0.0001), the 5 year DSS improvement for black patients from 1990-2000 to 2001-2012 did not reach statistical significance (71.3% vs 75.7%, p=0.24). Conclusions: Demographic and economic factors are associated with outcomes in young breast cancer patients. Absolute DSS has improved over consecutive time periods, but the improvement was not significant among blacks. More effort is needed to evaluate and address disparity in these patients. [Table: see text]

Abstract P3-13-21: Primary surgery in inflammatory breast cancer

Background: Inflammatory Breast Cancer (IBC) is a rare but very aggressive variant of breast cancer accounting for around 1-5% of all breast cancer cases. Current standard of care is multimodality therapy with preoperative chemotherapy followed by modified radical mastectomy and adjuvant radiotherapy.

Method and Material: We searched the Surveillance Epidemiology and End results Registry to identify female patients diagnosed with Stage III IBC between 1988-2013.We performed descriptive and univariate analyses of the patients with IBC. Variables assessed included patient age, race/ethnicity, histologic subtype, tumor grade, hormone receptor status, surgery type.

Results: We identified 11604 women with IBC from SEER database diagnosed between 1988-2013.The median age was 57 yrs., 80 % ( 9273) of patients were white,14.4 % ( 1667) blacks, and around 73% had nodal involvement. 32.4 % (3756) patients were diagnosed with IBC between 1988-2000, while 67.6 % ( 7848) between 2001-2013.We excluded patients with missing primary surgery information with 7586 patients remaining for analysis. The median age in this final cohort was 56yrs, 80.4 % ( 6097) patients were white, and 13.7 % (1044) were black. The predominant tumor type was invasive ductal carcinoma, majority of the patients had grade 3 tumor 59.4 % ( 4504), grade2 in 23.2 % ( 1757),47.1% were estrogen receptor (ER)positive,43% were ER negative,53% were progesterone receptor negative, and 7% had HER 2 positive tumor. In this cohort 6.4 % (487) patients underwent partial mastectomy and 93.6 % (7099) underwent mastectomy. In the cohort undergoing breast conservation, 15% were during 1988-2000 and 84.4% during years 2001-2013 (p value=0.06).

Surgery in non-metastatic inflammatory Breast CancerType of Surgery1988-20002001-2013p-valuePartial Mastectomy76 (6.7%)1140(93.3%)0.06Mastectomy411 (6.9%)5959(93.1%)

The median survival was 46 months among patients diagnosed between 1988-2000 and 61 months for 2001-2013 time period(p&lt;0.0001).The median survival in patients undergoing partial mastectomy was 42 months versus 48 months among patients undergoing mastectomy (p=0.0001).

Discussion: IBC continues to be an aggressive breast cancer subtype, but survival has improved over last decade. The utility of partial mastectomy has increased in the last decade compared to 1988-2000. Mastectomy still remains the standard surgical option, but with more effective systemic therapeutic agents, better tumor responses are noted especially in Her 2 positive and triple negative IBC. Partial Mastectomy may be a viable option for patients achieving complete clinical response.

Citation Format: Muzaffar M, Vohra N, Wong J. Primary surgery in inflammatory 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 P3-13-21.

Effect of Ca(2+) on Aß40 fibrillation is characteristically different

Alzheimer's disease (AD) is the only one among top ten diseases in USA that cannot be cured, prevented or slowed down. At molecular level the mechanism of onset has been closely associated with mis-folding of Aβ40 and Aβ42 and is well supported by the genetic data for AD. Extensive research efforts have led to identification of factors and metal ions that could manipulate Aβ equilibrium, especially Ca(2+). Previously, we reported selectively acceleration of Aβ42 fibril formation by Ca(2+)in vitro within physiological concentrations (BBA (2009) 1794:1536). Aβ40 on the other hand did not appear to be significantly affected by Ca(2+) addition. In an effort to understand the distinctive behavior of Aβ40, we monitored changes of Aβ40 aggregation by intrinsic tyrosine fluorescence and CD and took different approaches for data processing. Our analysis of CD data indicates a complex effect induced by the addition of 2mM Ca(2+) resulting in an increase in the rate of transformation from monomer to β-sheet rich fibrilar or intermediate species formation in Aβ40. Surprisingly, the kinetics observed by intrinsic fluorescence studies in this article and ThT, SEC or EM studies in our previous report were not able to unravel the existence of this effect in Aβ40.

Abstract P6-15-01: A comparative analysis of primary tumor resection in men and women with stage IV breast cancer

Background: Primary tumor resection (PTR) for metastatic female breast cancer continues to be debated. Given the rarity of male breast cancer, treatment paradigms for female breast cancer are extended to the management of male breast cancer. Whether the role of PTR in men with metastatic breast cancer is similar to that in women remains unclear. We sought to compare these two populations using a large, national database.

Methods:

All patients with Stage IV breast cancer between the years 1988-2011 in the SEER database were identified. Uni and multivariate descriptive and survival analyses were performed.

Results: A total of 41,601 patients with stage IV breast cancer were identified; 98.9% (n=41,162) females, 1.1% (n=439) males. On average, female patients were younger (63 vs. 66y) and more often White (78 vs. 74%), p≤0.02. Tumors in male patients were more likely to be hormonally positive, with varying breakdown of T and N-stages and histologic subtypes as compared to tumors in females, p≤0.05. Males were more likely to undergo PTR (51 vs.40%, p&lt;0.05), however both males and females had similar rates of radiotherapy (35 vs. 32%, p=0.35). Among male patients, those who received PTR were of similar age to those who did not receive PTR (p=0.64), but had a greater representation of White patients (p=0.04). There were differences in T-stage, N-stage and hormonal status between men who did and did not receive PTR, p≤0.05. Men receiving surgery were also more likely to receive radiation therapy (38 vs. 32%, p=0.003). In women, all demographic and tumor-related factors were significantly different between those who did and did not undergo PTR. On univariate analysis, surgery was associated with improved disease-specific median survival in both men (36 vs. 21 mths) and women (34 vs. 18 mths), p&lt;0.05. Younger age, White race, lower T and N-stage, lower grade, hormonal positivity, mucinous histology, and radiation therapy were associated with improved disease specific survival (DSS) in females, while only lower T-stage, hormone positivity and mucinous histology were associated with improved DSS in men. On multivariate analysis, a lack of resection of the primary tumor remained independently associated with increased mortality in men (HR 1.91, p&lt;0.05) and women (HR 1.6, p&lt;0.05). Over the study period there was a decrease in the rate of surgery in both men and women, p≤0.0006, but only women were found to have a statistically significant improvement in DSS with surgery over time.

Conclusion: Regardless of gender, patients with metastatic breast cancer who underwent primary tumor resection had a significant improvement in DSS. Factors associated with DSS varied between male and female patients, but the reasons for this difference are unclear. A well designed randomized trial including both genders will help determine the utility of PTR in stage IV breast cancer patients.

Characteristics of Stage IV Breast Cancer in Males: Surgery vs. No surgery (S = ≤ p.05) Surgery (%)No surgery (%)P-valueWhite race78.468.7ST1 stage15.87.4SN1 stage27.538.6SER +72.557.6SPR +57.245.2SHer2 +1.43.70.25Grade II34.726.3SInfiltrating ductal carcinoma76.656.2SRadiation therapy37.832.3SYear of diagnosis   1988-19928.17.4S2008-201125.236.9S

Citation Format: Nasreen A Vohra, Swapnil D Kachare, Timothy L Fitzgerald, Jan H Wong, Mahvish Muzaffar. A comparative analysis of primary tumor resection in men and women with stage IV breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-15-01.

Abstract P2-13-26: Trend in primary tumor resection and disease specific survival in patients with metastatic breast cancer: A SEER database analysis (1988-2011)

INTRODUCTION: The value of primary tumor resection in patients with metastatic breast cancer is a topic of ongoing debate. We aimed to analyze the trend and impact of primary tumor resection on survival over the last two decades using a national database. We hypothesized that there would be a decreasing utilization of primary tumor resection over time with an increase in disease specific survival.

METHODS: All patients with stage IV breast cancer at diagnosis between the years 1988 and 2011 were identified in the SEER database. Univariate and multivariate descriptive and survival analyses were performed.

RESULTS: A total of 41,601 patients with stage IV breast cancer were included in the study, 98.9 % (41,162) were females and 1.1% were males. Forty percent underwent surgery. Table 1 summarizes the other significant differences in demographic and tumor-related characteristics of patients who did and did not receive PTR. Over the 23- year study period there was a statistically significant temporal trend of decreased primary tumor resection (62% of patients underwent PTR in 1988, 42.4% in 2000 and 27.7% in 2011). On univariate analysis, patients who underwent PTR had a greater median disease-specific survival (DSS), (34 vs. 18 months, p&lt;0.0001). Younger age (p&lt;0.0001), non-African American race (p&lt;0.0001), lower T and N-stage (p&lt;0.0001), positive hormone receptor status (p&lt;0.0001), lower grade (p&lt;0.0001), mucinous histology (p&lt;0.0001), radiation therapy (p&lt;0.0001), and surgery performed in the latter years (p&lt;0.0001) were also associated with improved DSS. On multivariate analysis increasing age (p&lt;0.0001), AA race (p=0.0001), higher T and N stage (p&lt;0.0001), negative hormone receptor status (p&lt;0.0001), higher grade (p&lt;0.0001), no history of radiation therapy (p=0.002), and surgery in earlier years were associated with increased mortality (p&lt;0.0001). Not undergoing PTR was independently associated with increased mortality, (p&lt;0.0001).

Table 1: Comparison of patient and tumor characteristics in the surgery vs no surgery group (all p&lt;0.0001)VariableSurgeryNo surgeryFemale (%)16,328 (98.7)24,750 (99.1)White Race (%)13,198 (79.7)19,328 (77.4)T1 stage (%)3,067 (18.5)2,096 (8.4)N1 stage (%)4,173 (25.2)5,834 (23.4)ER Positive (%)9,642 (58.3)12,300 (49.3)PR Positive (%)7,532 (45.5)9,346 (37.4)Her2 Positive (%)414 (4.5)745 (3.0)Grade II (%)4,844 (29.3)5,400 (21.6)Infiltrating ductal cancer (%)11,539 (69.7)12,461 (50.0)Radiation Therapy (%)6,338 (38.3)6,937 (27.8)

CONCLUSIONS: Results from this retrospective study suggest a survival advantage in patients with stage IV breast cancer who undergo primary tumor resection. However, there has been a marked reduction in the number of patients undergoing surgery, most likely reflecting more focused patient selection. Ongoing randomized controlled trials will help address the impact of primary tumor surgery on survival of patients diagnosed with metastatic disease.

Citation Format: Mahvish Muzaffar, Swapnil D Kachare, Timothy L Fitzgerald, Jan H Wong, Kathryn Verbanac, Nasreen A Vohra. Trend in primary tumor resection and disease specific survival in patients with metastatic breast cancer: A SEER database analysis (1988-2011) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-13-26.

Conditional survival for intrahepatic cholangiocarcinoma: SEER database analysis

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Background: Conditional survival can be useful for estimating survival probability for patients who have survived one or more years after the initial diagnosis. It reflects the possible change in risk profile over time especially for malignancies with poor outcome. Methods: The Surveillance, Epidemiology and End Results database was reviewed for intrahepatic cholangiocarcinoma. We reviewed data for all intrahepatic cholangiocarcinoma from year 2000-2010. Data of 8278 patients was extracted from SEER database. We sub stratified using factors like age <50 versus ≥50, gender, grade, stage, primary site surgery. SEER*Stat: Version *8.1.2 software was used to calculate conditional survival. Conditional survival is defined as the calculated probability of survival after having already survived a specified number of years from diagnosis. Results: The analysis showed that Conditional survival (CS) probability for intrahepatic cholangiocarcinoma increased from 33.25 to 85% at 5 years for all age groups conditional to surviving one year after diagnoses. For age group <50 years CS increased from 50.4% to 86.9%, while for age group >50yrs from 31.4% to 84.5%.The conditional survival for well differentiated histology increased from 60.7% to 81.0%, moderately differentiated from 53.8% to 87.7%, poorly differentiated from 37.1% to 83.6% .The conditional survival for localized stage increased from 50.7% to 88.8%, regional 40.6% to 77.7% and distant 19.0% to 65.6%.Majority of cases had missing data with regard to primary site surgery. 1707 cases had documented primary site surgery. Conditional survival for this group increased from 30.7% to 82.8% subject to surviving one year after diagnosis. Conclusions: There are several limitations associated with these results due to missing data in SEER. Nonetheless these results emphasize the trend of patient’s surviving more than 1 year after diagnosis have higher conditional survival probability. CS may provide more relevant prognostic information as compared to traditional survival estimates.

Prevalence of the polar vessel sign in parathyroid adenomas on the arterial phase of 4D CT

BACKGROUND AND PURPOSE

The "polar vessel" sign has been previously described on sonography of parathyroid adenomas. We estimated the 4D CT prevalence of the polar vessel sign and determined features of parathyroid adenomas that are associated with this sign.

MATERIALS AND METHODS

Twenty-eight consecutive patients with parathyroid adenomas underwent 4D CT between 2008 and 2012 at 2 institutions. 4D CT images were reviewed for the presence of the polar vessel sign and a second vascular finding of an enlarged ipsilateral inferior thyroid artery. The polar vessel sign was correlated with adenoma weight and size and arterial phase CT attenuation.

RESULTS

Thirty-two parathyroid adenomas in 28 patients were studied, with a mean adenoma weight of 0.66 ± 0.65 g, a mean maximal CT diameter of 11.1 ± 4.9 mm, and a mean arterial attenuation of 148 ± 47 HU. The polar vessel sign was seen in 20/32 (63%) adenomas. Adenomas with a polar vessel had higher arterial phase attenuation than adenomas without a polar vessel (163 and 122 HU, respectively, P < .01). Size and weight were not significantly different for adenomas with and without polar vessels. An enlarged inferior thyroid artery was seen in only 2/28 (7%) patients with unilateral disease.

CONCLUSIONS

The polar vessel sign was present in nearly two-thirds of parathyroid adenomas on 4D CT and was more likely to be present in adenomas that had greater arterial phase enhancement. This sign can be used along with enhancement characteristics to increase the radiologist's confidence that a visualized lesion is a parathyroid adenoma rather than a thyroid nodule or lymph node.

Primary CNS lymphoplasmacytic lymphoma: a case report and review of literature

Lymphoplasmacytic lymphoma is a chronic lymphoproliferative disorder characterized by a proliferation of plasma cells, small lymphocytes, plasmacytoid lymphocytes and the production of monoclonal IgM. Primary central nervous system lymphomas (PCNSL) are rare non-Hodgkin lymphomas (NHL) that can be found in the brain, leptomeninges, eyes or spinal cord, and are mostly intracerebral. PCNSLs constitute 3-4% of primary brain tumors, and in most cases are diffuse large B-cell lymphomas (DLBCL).(1) Low grade lymphomas as primary central nervous system (CNS) lymphoma are very rare. We present here a case report of a woman who presented with headache and was found to have primary intracranial lymphoplasmacytic lymphoma (LPL).

Type of surgery for early breast cancer and predictive factors an institutional review: A regression model

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Background: Breast conserving surgery (BCS) is the preferred surgical management for most early-stage breast cancer, given the equivalent survival after BCS plus radiation and mastectomy (M). Clinical reports of an increasing trend in mastectomy from some institutional reviews have been published. The aim of this study was to assess correlation of type of surgery with different factors in our cancer registry database. Methods: We retrospectively reviewed the cancer registry data at UTMC for early breast cancer stage I/II from 2006-2010. Patient demographics, tumor characteristics, institution of surgery, academic versus private surgeon were identified and compared. We used univariate analysis to select factors for entry into a multivariate analysis. Multinomial logistic regression analysis was performed to predict the type of surgery (cancer side mastectomy (CSM) versus BCS, bilateral mastectomy (BM) versus BCS based on the above variables. A p-value of < 0.05 was significant and comparisons were two tailed. Results: We identified 506 eligible patients with stage I/II breast cancer. 306(60.5%) had undergone breast conservative surgery (BCS), 91 (18%) patients had cancer side mastectomy (CSM) and 109 (21.5%) patients had bilateral mastectomy (BM). 298 (59%) patients were stage I and 208 (41%) had stage II, 218 (42%) had undergone surgery at academic center versus 298 (58%) at nonacademic institution. Predictors o CSM were stage II (p =0.0193), high-grade tumor (p=0.015), surgeon from academic institution (p=0.64), age (p=0.61). Predictors of BM were surgeon from academic institution (p=0.060), age (p=0.07). Conclusions: This study confirms some known factors like stage, surgeon expertise, as influencing factors in type of local surgery, while at the same time did not show impact of race and other tumor characteristics. Further research of these factors need to confirm the influence on decision making prospectively.

Conditional survival probability of patients with pancreatic cancer

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Background: Conditional survival gives more accurate estimate of survival probability for patients who have survived one or more years since initial diagnosis. The aim of this study was to analyze conditional survival probability for pancreatic cancer patients and impact of gender, age and extent of disease on conditional survival. Methods: Using the Surveillance, Epidemiology, and End Results database we analyzed 57,409 patients with pancreatic cancer diagnosed between 1990 and 2008. SEER*Stat: Version7.0.5 software was used to calculate conditional survival, defined as the calculated probability of survival having already survived a specified number of years from diagnosis, with sub-stratification by age(less than 65 yrs and above/equal 65yrs ), gender and stage summary (localized, regional and distant). Results: Conditional survival probability for patients with pancreatic cancer increased from 8.3% to 47.1% having survived one year after diagnosis. Conditional survival per gender increased from 8.5% to 49.8% in women and for men from 8.1% to 44.3%. Conditional survival probability per summary stage increased most for patients with localized disease (from 25.5% to 70.2%) as opposed to distant disease (3.2% to 37.0%). Age may have a slight impact on conditional survival probability, with increase from 12.5% to 50.7% in patient younger than 65 years, as opposed to from 5.7% to 42.3% in age group more than or equal to 65yrs. Conclusions: The expected 5-year conditional survival increases for pancreatic cancer patients who survive a number of years post diagnosis. The increase in conditional survival probability may be to a lesser extent than other cancers, but provides more useful longer term prognostic information.

Association of hyperplastic polyposis syndrome, colorectal cancer and meningioma

Recent research has provided compelling evidence that a subset of hyperplastic polyps may be associated with a risk of colorectal cancer. Colorectal cancer with extracolonic manifestation is usually seen in a hereditary syndrome setting, but some association with meningioma has been reported. The association of colorectal cancer with hyperplastic polyposis and meningioma is extremely rare. This report in a 57-year-old female with no family history of colon cancer or polyps, could be the first case of hyperplastic polyposis syndrome, colorectal cancer and meningioma. Hyperplastic polyposis syndrome was diagnosed as per WHO criteria at the time of colon cancer diagnosis. Within 4 months of colon cancer diagnosis she developed seizures. Imaging of the brain revealed meningioma of the left cerebellopontine angle. The patient underwent surgery followed by chemotherapy.

The mechanism of enhanced insulin amyloid fibril formation by NaCl is better explained by a conformational change model

The high propensity of insulin to fibrillate causes severe biomedical and biotechnological complications. Insulin fibrillation studies attain significant importance considering the prevalence of diabetes and the requirement of functional insulin in each dose. Although studied since the early years of the 20(th) century, elucidation of the mechanism of insulin fibrillation has not been understood completely. We have previously, through several studies, shown that insulin hexamer dissociates into monomer that undergoes partial unfolding before converting into mature fibrils. In this study we have established that NaCl enhances insulin fibrillation mainly due to subtle structural changes and is not a mere salt effect. We have carried out studies both in the presence and absence of urea and Gdn.HCl and compared the relationship between conformation of insulin induced by urea and Gdn.HCl with respect to NaCl at both pH 7.4 (hexamer) and pH 2 (monomer). Fibril formation was followed with a Thioflavin T assay and structural changes were monitored by circular dichroism and size-exclusion chromatography. The results show salt-insulin interactions are difficult to classify as commonly accepted Debye-Hückel or Hofmeister series interactions but instead a strong correlation between the association states and conformational states of insulin and their propensity to fibrillate is evident.

Successful preemptive renal retransplantation in a patient with previous acute graft loss secondary to HIT type II: a case report and review of literature

Type II heparin-induced thrombocytopenia (HIT II) is an immune-mediated reaction to heparin administration associated with thrombocytopenia and thrombotic complication with potentially serious outcome. We report a case of a 50-year-old man with history of autosomal dominant polycystic kidney disease (ADPKD), homocystinemia, and history of deep vein thrombosis (DVT), who was switched to intravenous heparin from oral coumadin preoperatively in preparation for preemptive living related renal transplant. Following the operation heparin-induced thrombocytopenia type II lead to graft renal artery thrombosis and subsequent graft loss. One year after first transplant patient underwent successful second living unrelated kidney transplantation with no complications with continued anticoagulation with coumadin and with no reexposure to heparin. Two years after the second transplant and 1 year after stopping anticoagulation, patient was readmitted with bilateral lower extremity DVT and high probability of pulmonary embolism. He was given argatroban on admission as a bridge to anticoagulation with lifelong coumadin therapy and is doing well with excellent graft function. To our knowledge, this is the third reported case of HIT in renal transplantation, second reported case associated with graft loss secondary to HIT and the first reported case of successful retransplantation after initial HIT with graft loss. Heparin-induced thrombocytopenia in transplantation can lead to catastrophic consequences in organ recipients. Successful management of this condition emphasizes promptness of diagnosis and treatment and complete cessation of heparin exposure.

135 EXPRESSION OF APOPTOSIS-RELATED GENES IN BUFFALO (BUBALUS BUBALIS) EMBRYOS PRODUCED THROUGH IN VITRO FERTILIZATION AND PARTHENOGENETIC ACTIVATION

Apoptosis, a highly conserved evolutionary mechanism that allows an organism to tightly control cell numbers, tissue size, and protect itself from dangerous cells and unfavourable environments that threaten homeostasis, is generally directed by specific genes involved in the regulation of a series of pro-apoptotic (BAX) and anti-apoptotic (BCL-XL) proteins that are expressed during early development. All mammalian species show the highest level of spontaneous apoptotic processes at the blastocyst stage. These proteins prevent apoptosis by maintaining the cell survival by interfering with the release of cytochrome-C from mitochondria. In this study, immature oocytes were obtained from buffalo slaughterhouse ovaries and were subjected to in vitro maturation (IVM) in TCM-199 + 10% FBS + 5 μg mL–1 porcine FSH for 24 h in a CO2 incubator (5% CO2, 90 to 95% relative humidity) at 38.5°C. The mature oocytes were used for IVF, and the cleaved embryos were cultured for 8 days in culture medium (CR2 medium containing 0.6% BSA and 10% FBS) for production of embryos at different stages. The parthenotes were produced with exposure of 7% ethanol, 6-dimethyl aminopurine and cultured for 8 days in culture medium. The total RNA was isolated from oocytes and embryos and transcribed using Cell-to-cDNA-II (Ambion, Austin, TX, USA), according to manufacturer protocol. The PCR cycle included heating to 94°C for 5 min, followed by 35 cycles of 94°C for 30 s, 60 (BAX) and 62°C (BCL) for 30 s, and 72°C for 45 s with a final extension at 72°C for 10 min. The amplified product of both genes were separated on agarose gel and densitometry data for band intensities were generated using AlphaDigiDocTM AD-1201 software under a WindowsTM environment and data analysed with the help of SYSTAT software. Relative abundance of BCL-XL transcripts in immature, mature oocytes and embryos produced through IVF (i.e. 2-cell, 4-cell, 8- to 16-cell, morula, and blastocyst stage) were 25.33 ± 0.90, 12.67 ± 1.20, 37.67 ± 0.90, 30.67 ± 0.30, 23.67 ± 0.90, 18.33 ± 0.90, and 27.00 ± 1.20, respectively, whereas in parthenogenesis these values were 23.67 ± 0.88, 13.67 ± 1.20, 23.67 ± 1.20, 22.34 ± 0.88, 24.34 ± 0.88, 33.67 ± 0.88, and 45.34 ± 1.20, respectively. Relative abundance of BAX transcripts by IVF were 23.0 ± 0.60, 0.33 ± 0.10, 4.00 ± 0.60, 5.00 ± 0.60, 0.37 ± 0.06, 13.0 ± 0.66, and 56.7 ± 0.90; and by parthenonenesis were 22.3 ± 0.90, 0.13 ± 0.03, 13.67 ± 0.90, 14.0 ± 0.60, 15.33 ± 0.90, 64.67 ± 2.20, and 55.0 ± 2.10, respectively. In conclusion, the expression pattern of the apoptosis-related genes revealed that the incidence of apoptosis was significantly higher in IVF and parthenogenetically produced buffalo embryos at stages such as immature oocytes, morula, and blastocyst than the early cleavage stage embryos.

59 SYNCHRONIZATION OF CELL CYCLE STAGE OF BUFFALO (BUBALUS BUBALIS) FETAL FIBROBLAST CELLS BY DIFFERENT TREATMENTS

Cell cycle stage of donor cells significantly influences the cloning efficiency during SCNT. Donor cells in G1/G0 stage have better capability to undergo nuclear reprogramming following transfer to an unfertilized oocyte. The lack of availability of cells synchronized at G1/G0 stage is one of the major factors limiting cloning efficiency in buffalo. The aim of this study was to compare the efficacy of various methods for cell cycle synchronization of buffalo fetal fibroblast cells for SCNT. Cells isolated from fetus, 2 to 3 months old, were cultured in DMEM + 10% FBS. The primary culture was sub-cultured 8 to 10 times. For cell cycle synchronization, the cells were cultured to 1) 60 to 70% confluence (controls), 2) 60 to 70% confluence followed by serum starvation (DMEM + 0.5% FBS) for 24 h (serum starved), 3), full confluence followed by culture for additional 3 to 5 days (full confluent), 4) full confluence followed by serum starvation (DMEM + 0.5% FBS) for 24 h (full confluent+serum starved) and 5) 60 to 70% confluence followed by treatment with roscovitine (10, 20, or 30 μM) for 24 h. The synchronization efficiency was examined by propidium iodide staining followed by analysis of DNA content using flow cytometry and the data were analysed by 1-way ANOVA followed by Fisher’s l.s.d. test after arcsine transformation. The percentage of cells in G0/G1 phase of cell cycle was significantly higher (P < 0.05) in the full confluent+serum starved and roscovitine treated (20 or 30 μM) groups than that in the full confluent group and that treated with 10 μM roscovitine which, in turn, was higher (P < 0.05) than that in the serum starved and control groups. These results suggest that buffalo fetal fibroblast cells can be synchronized by roscovitine treatment or by serum starvation of fully confluent cell cultures to obtain a high proportion of cells in G0/G1 stage for SCNT. Table 1.Buffalo skin fibroblast cells at various stages following different treatments for cell cycle synchronization Supported by grant No. 1(5)/2007-NAIP from ICAR, India.

Ca(2+), within the physiological concentrations, selectively accelerates Abeta42 fibril formation and not Abeta40 in vitro

Alzheimer's disease (AD) in humans is a common progressive neurodegenerative disease, associated with cognitive dysfunction, memory loss and neuronal loss. Alzheimer peptides Abeta40 and Abeta42 are precursors of the amyloid fibers that accumulate in the brain of patients. These peptides misfold and the monomers aggregate to neurotoxic oligomers and fibrils. Thus, the aggregation kinetics of these peptides is central to understanding the etiology of AD. Using size exclusion chromatography as well as filtration methods, we report here that Ca(2+) ions at physiological concentrations greatly accelerate the rate of aggregation of Abeta42 to form intermediate soluble associated species and fibrils. In the presence of 1 or 2 mM Ca(2+), CD spectra indicated that the secondary structure of Abeta42 changed from an unfolded to a predominantly beta-sheet conformation. These concentrations of Ca(2+) greatly decreased the lag time for Abeta42 fibril formation, measured with thioflavin T. However, the elongation rate was apparently unaffected. Ca(2+) appears to predominantly accelerate the nucleation stage of Abeta42 on pathway to the Alzheimer's fibril formation. Unlike Abeta42, Ca(2+) was not observed to trigger similar effect at any stage during the study of fibrillation kinetics of Abeta40 by any techniques. Abeta40 and Abeta42 seem to have distinct aggregation pathways.

Eye position information on CT increases the identification of acute ischemic hypoattenuation

BACKGROUND AND PURPOSE

It is possible that identification of eye deviation may sensitize a scan reader to early brain hypodensity associated with an arterial occlusive process. Our aim was to investigate the value of observing eye deviation on blinded CT identification of early hypoattenuation following ischemic infarct.

MATERIALS AND METHODS

Two staff and 2 fellow neuroradiologists reviewed 75 brain CT scans obtained within 3 hours of acute ischemia from subjects in the Interventional Management of Stroke Study. Films were reviewed 3 months apart, the first time with tape over the eyes on the images, the second with the eyes visible. Readers were asked if early hypoattenuation in the middle cerebral artery (MCA) distribution or if a hyperattenuated MCA was present. kappa statistics were calculated to determine agreement among the 4 readers and between each of the 2 readings by the same reader, not only for the original interpretation of the blinded study neuroradiologist but also for the Alberta Stroke Program Early CT Score (ASPECTS) for each subject assigned by an unblinded expert panel. A generalized estimating equations modeling approach was used to look at the overall effect of including eye information for agreement between interpretations.

RESULTS

Eye information availability was associated with improved agreement for detection of early ischemic hypoattenuation not only among the 4 readers but also between the 4 readers and both the blinded study neuroradiologist (P = .02) and the unblinded expert ASPECTS panel. When comparing first and second readings for hypoattenuation, we also noted increased mean values for sensitivity (46.8% first, 56.5% second), specificity (78.2%, 80.2%), positive predictive value (72.0%, 80.7%), negative predictive value (55.5%, 61.0%), and percentage agreement (61.0%, 67.5%).

CONCLUSION

Observation of CT eye deviation significantly improves reader identification of acute ischemic hypoattenuation.

Time-resolved spinal MR angiography: initial clinical experience in the evaluation of spinal arteriovenous shunts

BACKGROUND AND PURPOSE

Spinal arteriovenous shunts usually require digital subtraction angiography (DSA) for evaluation. We report a unique time-resolved spinal MR angiographic (TRSMRA) technique with a temporal resolution of 3-6 seconds and spatial resolution of approximately 1 mm(3) that has the potential to noninvasively detect, localize, and follow-up these cases.

MATERIALS AND METHODS

Eleven patients with clinical presentation and/or MR findings suspicious for a spinal arteriovenous shunt were referred for TRSMRA. Patients subsequently underwent spinal DSA to confirm the presence or absence of a shunt or were followed clinically until an alternative diagnosis was found. TRSMRA was also used to predict the level of the shunt in the positive cases. In addition, 2 of these patients as well as a 12th patient referred to us posttreatment received a follow-up TRSMRA to assess treatment outcome.

RESULTS

Early venous shunting was identified by using TRSMRA in 6 cases. All 6 were confirmed to have an AV shunt on subsequent spinal DSA. The shunt level predicted by TRSMRA consistently correlated with DSA to within 1 vertebral level. In the 5 patients with a negative screening TRSMRA, DSA or clinical outcome confirmed the absence of an arteriovenous shunt in all of the cases. Posttreatment TRSMRA in 3 patients accurately assessed the success or failure of treatment.

CONCLUSION

Combining acceleration techniques to achieve high frame rate TRSMRA provides sufficient temporal and spatial resolution to identify, localize, and follow patients suspected of having a spinal arteriovenous shunt. Further study in a larger population is warranted to assess the accuracy of this technique.

Profile of lung cancer in Kashmir, India: a five-year study

AIM

To study the clinico-pathological aspects of lung cancer, and the outcome of various treatment modalities.

METHODS

A retrospective review of histopathologically confirmed lung cancer patients who were registered and treated at our institution over a period of five years was carried out.

RESULTS

A total of 321 patients were studied. There was a preponderance of males (91.9%) as compared to females (8.1%). Smoking history was present in 88% of the male patients. Cough was the main presenting feature in 71.6% of patients. Diagnosis was established by bronchoscopy in 94% of cases. Squamous cell carcinoma was observed in 77.3%, while 17.1% had small cell carcinoma. Radiotherapy formed the main treatment modality alone (22.4%) and in combination (27%). Out of the 321 patients, 206 were evaluable on follow-up. Local failure and distant metastasis were seen in 9.2% and 19.9% of cases, respectively. The overall survival rate of 2, 3 and 5 years was 19.9%, 13.59% and 6.79%, respectively.

CONCLUSIONS

. The outcome of lung cancer is poor. Increased survival is possible if the disease is detected early, treated adequately with multi modality approach.

Morphological study of liver in patients of chronic hepatitis C treated with interferon

The effect of interferon therapy on liver morphology was assessed in ten patients with serologically proven chronic hepatitis C. All these patients received 3 million units of alpha interferon three times a week. Six patients received therapy for 6 months, two patients for 12 months, one patient each for 3 and 9 months. All patients underwent a second liver biopsy 1 to 6 months after cessation of therapy. Alanine aminotransferase levels were determined before, during and after therapy. Each biopsy was assessed histologically by revised classification of chronic hepatitis proposed by Desmet et al and Kondell histological activity index was determined. Four patients showed significant reduction in the necroinflammatory activity with decrease in the HAI and normalisation of ALT level. Three patients showed partial reduction in the necroinflammatory activity with partial reduction of ALT levels. Two patients did not show any change in the grade of disease while one patient showed worsening of necroinflammatory activity with rising ALT levels. One patient showed a significant reduction in fibrosis with conversion of early developing cirrhosis into bridging fibrosis. A second liver biopsy is extremely useful for assessing the response of interferon treatment, however, it must be done at a suitable time after cessation of therapy.