Abstract S2-01: Importance of margin width and re-excision in breast conserving treatment of early breast cancer; a Danish breast cancer cooperative group study of 11,900 women

Background: The majority of women with invasive breast cancer are treated surgically by breast conserving surgery (BCS). A significant proportion subsequently undergo re-excision to obtain clear margins. However what constitutes a sufficient negative margin continues to be subject of controversy. The purpose of the study was to investigate the association between margin width and ipsilateral breast tumour recurrence (IBTR) as well as identifying factors associated with residual disease after repeat surgery, and to determine the effect of re-excision on IBTR in a population-based nationwide cohort.

Method: 11,900 patients treated with breast conserving therapy for unilateral invasive cancer in Denmark between 2000 and 2009 were included. All patients received whole breast irradiation and were offered systemic adjuvant treatment according to the guidelines of the Danish Breast Cancer Cooperative Group.

Results: The median follow-up was 4.9 years. The cumulative incidence of IBTR at 5 and 9 year was 2.4% and 5.9%, respectively. No decrease in IBTR with a wider negative margin compared to a narrow but negative margin was seen in adjusted analysis (>0-1 mm vs. 2-4 mm vs. ≥5 mm (reference): HR 1.54 (CI 95% 0.81-2.93) vs 0.95 (CI 95% 0.56-1.62) vs. 1). A final positive margin did however increase the risk of IBTR (HR 2.51; 95% CI 1.02-6.23). Other factors associated with increased IBTR were young age (HR 3.10; 95% CI 1.89-5.10), more than 4 positive lymph nodes (HR 1.80; 95% CI 1.24-2.62), and re-excision (HR 1.53; 95% CI 1.16-2.02). Receiving chemotherapy (HR 0.45; 95% CI 0.33-0.61) or boost (HR 0.43; 95% CI 0.31-0.60) reduced risk of IBTR as did being oestrogen receptor positive treated with (HR 0.35; 95% CI 0.25-0.49) or without (HR 0.43; 95% CI 0.31-0.60) adjuvant endocrine therapy.

Within two months of initial BCS 1342 women (11%) had a re-excision. Residual disease was found in 20% of re-excisions. In adjusted analysis DCIS outside the invasive tumour (OR 2.69; 95% CI 1.99-3.63), positive initial margin (OR 2.26, 95% CI 1.70-2.99, p<0.001), and age <50 years (OR 1.53; 95% CI 1.00-2.31) was associated with increased risk of residual disease. Patients with residual disease after re-excision had in the adjusted analysis an increased risk of ipsilateral breast tumour recurrence (IBTR), regardless of whether residual findings were invasive carcinoma (HR 2.97, CI 95% 1.57-5.62) or DCIS (HR 2.58, CI 95% 1.50-4.45). However no difference was seen for overall survival comparing one procedure with repeat surgery with or without residual disease (p=0.96).

Conclusion: An overall low rate of IBTR was seen. While a final positive margin was associated with a more than two-fold risk of IBTR, no evidence of improved local control was found with wider negative margins compared to narrow. However the finding of residual disease at re-excision was associated with an increased risk of IBTR.

Citation Format: Bodilsen A, Bjerre K, Offersen BV, Vahl P, Mele M, Dixon MJ, Ejlertsen B, Overgaard J, Christiansen P. Importance of margin width and re-excision in breast conserving treatment of early breast cancer; a Danish breast cancer cooperative group study of 11,900 women. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr S2-01.

Genetic and environmental relationships of detailed milk fatty acids profile determined by gas chromatography in Brown Swiss cows

The aim of this study was to characterize the profile of 47 fatty acids, including conjugated linoleic acid (CLA), 13 fatty acid groups, and 5 Δ(9)-desaturation indices in milk samples from Brown Swiss cows. The genetic variation was assessed and the statistical relevance of the genetic background for each trait was evaluated using the Bayes factor test. The additive genetic, herd-date, and residual relationships were also estimated among all single fatty acids and groups of fatty acids. Individual milk samples were collected from 1,158 Italian Brown Swiss cows and a detailed analysis of fat percentages and milk fatty acid compositions was performed by gas chromatography. Bayesian animal models were used for (co)variance components estimation. Exploitable genetic variation was observed for most of the de novo synthesized fatty acids and saturated fatty acids, except for C4:0 and C6:0, whereas long-chain fatty acids and unsaturated fatty acids (including CLA) were mainly influenced by herd-date effects. Herd-date effect explained large portions of the total phenotypic variance for C18:2 cis-9,cis-12 (0.668), C18:3 cis-9,cis-12,cis-15 (0.631), and the biohydrogenation and elongation products of these fatty acids. The desaturation ratios showed higher heritability estimates than the individual fatty acids, except for CLA desaturation index (0.098). Among the medium-chain fatty acids, C12:0 had greater heritability than C14:0 (0.243 vs. 0.097, respectively). Both C14:0 and C16:0 showed negative additive genetic correlations with the main monounsaturated and polyunsaturated fatty acids of milk fat, suggesting that their synthesis in the mammary gland may be influenced by the presence of unsaturated fatty acids. No correlation was observed between C4:0 and the other short-chain fatty acids (except for C6:0), confirming the independence of C4:0 from de novo mammary fatty acid synthesis. Among the genetic correlations dealing with potentially beneficial fatty acids, C18:0 was positively correlated with vaccenic and rumenic acids and negatively with linoleic acid. Finally, fatty acids C6:0 through C14:0 showed relevant correlations due to unknown environmental effects, suggesting the potential existence of genetic variances in micro-environmental sensitivity. This study allowed us to acquire new knowledge about the genetic and the environmental relationships among fatty acids. Likewise, the existence of genetic variation for most of de novo synthetized fatty acids and saturated fatty acids was also observed. Overall, these results provide useful information to combine feeding with genetic selection strategies for obtaining a desirable milk fatty acids profile, depending on the origin of fatty acids in milk.

Conjugated linoleic acid isomers strongly improve the redox status of bovine mammary epithelial cells (BME-UV1)

Some studies have shown the protective effects of conjugated linoleic acid (CLA) isomers against oxidative stress and lipid peroxidation in animal models, but no information is available about CLA and changes in oxidative status of the bovine mammary gland. The objectives of the study were to assess in vitro the effect of CLA on the cellular antioxidant response of bovine mammary cells, to examine whether CLA isomers could play a role in cell protection against the oxidative stress, and to study the molecular mechanism involved. For the study, BME-UV1 cells, a bovine mammary epithelial cell line, were used as the experimental model. The BME-UV1 cells were treated with complete medium containing 50 µM cis-9,trans-11 CLA (c9,t11 CLA), trans-10,cis-12 CLA (t10,c12 CLA), and CLA mixture (1:1, cis-9,trans-11: trans-10,cis-12 CLA). To monitor cellular uptake of CLA isomers, cells and culture medium were collected at 0, 3, and 48 h from CLA addition for lipid extraction and fatty acid analyses. To assess the cellular antioxidant response, glutathione (GSH/GSSH), NADPH, and γ-glutamyl-cysteine ligase activity was measured after 48 h from addition of CLA. Cytoplasmic superoxide dismutase, glutathione peroxidase, glutathione S-transferase, and glutathione reductase activities and mRNA were also determined. Intracellular reactive oxygen species and thiobarbituric acid reactive substance production were assessed in cells supplemented with CLA isomers. Cell viability after 3h to H2O2 exposure was assessed to evaluate and to compare the potential protection of different CLA isomers against H2O2-induced oxidative stress. Mammary cells readily picked up all CLA isomers, their accumulation was time dependent, and main metabolites at 48 h are two 18:3 isomers. The CLA treatment induced an intracellular GSH increase, matched by high concentration of NADPH, and an increase of γ-glutamyl-cysteine ligase activity mainly in cells treated with the t10,c12 CLA isomer. The CLA isomer treatment of bovine mammary cells increased superoxide dismutase, glutathione peroxidase, and glutathione S-transferase activity and decreased glutathione reductase activity, but no changes in gene expression of these antioxidant enzymes were observed. Cells supplemented with CLA isomers showed a reduction in intracellular reactive oxygen species and thiobarbituric acid reactive substance levels. All CLA isomers were able to enhance cell resistance against H2O2-induced oxidative stress. These suggest an antioxidant role of CLA, in particular of t10,c12 CLA, by developing a significantly high redox status in cells.

Milk fatty acid composition, rumen microbial population, and animal performances in response to diets rich in linoleic acid supplemented with chestnut or quebracho tannins in dairy ewes

The aim of the study was to evaluate milk fatty acid (FA) profile, animal performance, and rumen microbial population in response to diets containing soybean oil supplemented or not with chestnut and quebracho tannins in dairy ewes. Eighteen Comisana ewes at 122±6 d in milking were allotted into 3 experimental groups. Diets were characterized by chopped grass hay administered ad libitum and by 800 g/head and day of 3 experimental concentrates containing 84.5 g of soybean oil/kg of dry matter (DM) and 52.8 g/kg of DM of bentonite (control diet), chestnut tannin extract (CHT diet), or quebracho tannin extract (QUE diet). The trial lasted 4 wk. Milk yield was recorded daily, and milk composition and blood parameters were analyzed weekly. At the end of the experiment, samples of rumen fluid were collected to analyze pH, volatile fatty acid profile, and the relative proportions of Butyrivibrio fibrisolvens and Butyrivibrio proteoclasticus in the rumen microbial population. Hepatic functionality, milk yield, and gross composition were not affected by tannin extracts, whereas milk FA composition was characterized by significant changes in the concentration of linoleic acid (CHT +2.77% and QUE +9.23%), vaccenic acid (CHT +7.07% and QUE +13.88%), rumenic acid (CHT -1.88% and QUE +24.24%), stearic acid (CHT + 8.71% and QUE -11.45%), and saturated fatty acids (CHT -0.47% and QUE -3.38%). These differences were probably due to the ability of condensed versus hydrolyzable tannins to interfere with rumen microbial metabolism, as indirectly confirmed by changes in the relative proportions of B. fibrisolvens and B. proteoclasticus populations and by changes in the molar proportions of volatile fatty acids. The effect of the CHT diet on the milk FA profile and microbial species considered in this trial was intermediate between that of QUE and the control diet, suggesting a differential effect of condensed and hydrolyzable tannins on rumen microbes. Compared with control animals, the presence of B. fibrisolvens increased about 3 times in ewes fed CHT and about 5 times in animals fed QUE. In contrast, the abundance of B. proteoclasticus decreased about 5- and 15-fold in rumen liquor of ewes fed CHT and QUE diets, respectively. The use of soybean oil and a practical dose of QUE or CHT extract in the diet of dairy ewes can be an efficient strategy to improve the nutritional quality of milk.

Antihypertensive and neuroprotective effects of catestatin in spontaneously hypertensive rats: interaction with GABAergic transmission in amygdala and brainstem

The chromogranin A-derived peptide catestatin (CST) exerts sympathoexcitatory and hypertensive effects when microinjected into the rostral ventrolateral medulla (RVLM: excitatory output); it exhibits sympathoinhibitory and antihypertensive effects when microinjected into the caudal ventrolateral medulla (CVLM: inhibitory output) of vagotomized normotensive rats. Here, continuous infusion of CST into the central amygdalar nucleus (CeA) of spontaneously hypertensive rats (SHRs) for 15 days resulted in a marked decrease of blood pressure (BP) in 6-month- (by 37 mm Hg) and 9-month- (by 65 mm Hg)old rats. Whole-cell patch-clamp recordings on pyramidal CeA neurons revealed that CST increased both spontaneous inhibitory postsynaptic current (sIPSC) amplitude plus frequency, along with reductions of sIPSC rise time and decay time. Inhibition of GABAA receptors (GABAARs) by bicuculline completely abolished CST-induced sIPSC, corroborating that CST signals occur through this major neuroreceptor complex. Hypertension is a major risk factor for cerebrovascular diseases, leading to vascular dementia and neurodegeneration. We found a marked neurodegeneration in the amygdala and brainstem of 9-month-old SHRs, while CST and the GABAAR agonist Muscimol provided significant neuroprotection. Enhanced phosphorylation of Akt and ERK accounted for these neuroprotective effects through anti-inflammatory and anti-apoptotic activities. Overall our results point to CST exerting potent antihypertensive and neuroprotective effects plausibly via a GABAergic output, which constitute a novel therapeutic measure to correct defects in blood flow control in disorders such as stroke and Alzheimer's disease.

Abstract P3-03-02: Na+,HCO3--cotransport is the major mechanism of cellular acid extrusion in human and murine breast cancer

High metabolism and insufficient blood supply are characteristics of cancer tissue, which in combination with biochemical changes favor glycolytic metabolism and result in prominent intracellular acid production. Although extracellular pH at the core of malignant tumors is as low as one unit below normal, intracellular pH (pHi) in tumor cells is typically normal or even slightly alkaline. Thus, cancer cells must possess efficient mechanisms of acid extrusion to eliminate the excess acid load.

We investigated the role of the Na+,HCO3–cotransporter NBCn1 (SLC4A7), which in recent genome-wide association studies has been linked to human breast cancer. Based on immunohistochemistry of tumor slices and immunoblotting of enzymatically isolated epithelial organoids, we found that NBCn1 expression is upregulated in human and murine primary breast carcinomas and metastases compared to normal breast tissue. The upregulation of NBCn1 was of similar or greater magnitude than that observed for the Na+/H+-exchanger NHE1, which has previously been implicated in cell migration, proliferation and malignancy. Measurements of pHi from slices of human and murine breast cancers and from malignant and normal breast epithelial organoids showed that Na+,HCO3–cotransport is the major mechanism of acid extrusion in the near-physiological pHi range. Na+/H+-exchange was important for acid extrusion only at very low pHi values. We furthermore found that Na+,HCO3–cotransport activity was substantially greater in malignant compared to normal breast epithelial organoids of both human and murine origin, while no apparent difference in Na+/H+-exchange activity was detected between cancer and normal breast tissue. Steady-state pHi was higher in the breast cancer tissue compared to normal breast epithelium in the presence of CO2/HCO3- but not in its nominal absence.

We propose that NBCn1 plays a major role for cellular acid extrusion and pHi regulation in human and murine breast cancer. The upregulated expression of NBCn1 and the functional importance of Na+,HCO3–cotransport for pHi regulation support a causative role for NBCn1 in breast cancer development or progression.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-03-02.

The effect of the change from a herbage- to a concentrate-based diet on the oxidative stability of raw and cooked lamb meat

Over 89 days, 10 lambs (S) were fed concentrates and hay in stall, while 9 lambs (P) grazed at pasture. Two groups of 9 animals grazed at pasture until switching to a concentrate-based diet for 14 or 37 days before slaughter (P-S14 and P-S37). The fat content of longissimus dorsi muscle (LM) increased with increasing duration of concentrate feeding (P=0.05). As a consequence, the concentration of polyunsaturated fatty acids (PUFA) and of the highly peroxidisable (HP) PUFA in the polar lipids was similar between treatments. Lipid oxidation in fresh LM over 8 days of storage was affected by the diet (P<0.0005) with the P-S37 and P treatments producing, respectively, the highest and the lowest TBARS values. The P treatment reduced TBARS in cooked minced LM over 2 days of storage and no difference was found between the P-S14, P-S37 and S treatments. Colour stability of fresh LM was not noticeably affected by the dietary treatment.

Dietary olive cake reduces the oxidation of lipids, including cholesterol, in lamb meat enriched in polyunsaturated fatty acids

Over 40 days, lambs were fed: concentrate (C), concentrate containing 20% linseed (L), concentrate containing 35% olive cake (OC), or concentrate containing 10% linseed and 17% olive cake (OCL). The polyunsaturated fatty acids (PUFA) and peroxidation index (PI) in phospholipids were increased by the L and OCL treatments (P=0.007 and P=0.003, respectively). The OC and OCL diets increased the concentration of tocopherol in muscle (P<0.001). Compared to the OC and OCL diet, the L diet increased fatty acid oxidation, measured as conjugated dienes (CD; P=0.003), peroxides (PV; P<0.001) and TBARS (P=0.002) in minced muscle over 11 days of storage in high-oxygen atmosphere. Also, the L diet increased (P<0.001) the levels cholesterol oxidation products (COPs). In conclusion, feeding olive cake improved the oxidative stability of lamb meat and the combination of olive cake and linseed improved the fatty acid composition of meat without compromising its oxidative stability.