Free superficial circumflex iliac artery perforator flap with a single-pedicle bilobed design for pediatric multi-digit defect reconstruction

Objectives

This paper describes imaging and anatomical features, in order to assess the feasibility of superficial circumflex iliac artery perforator (SCIP) flap with a single-pedicle bilobed design for multi-digit skin and soft tissue reconstruction in pediatric patients.

Methods

A total of 7 pediatric patients who were being treated with free single-pedicle bilobed SCIP flap reconstruction for multi-digit defects were included in this study. The details of the clinical features were collected, and the following were successively analyzed: the preoperative computed tomographic angiography (CTA) and color Doppler sonography (CDS) examinations for flap design, the intraoperative anatomy for perforator vessel, defect reconstruction and interphalangeal range of motion (ROM) and tactile sense, pain sense, and two-point discrimination recovery results.

Results

CTA and CDS performed preoperatively could accurately and rapidly identify the position, location and course of the superficial circumflex iliac artery perforator. All wounds healed by the first follow-up and no complications occurred at the follow-up visit. All flaps survived, the patients achieved proximal interphalangeal joint (PIP) ranges of motions (ROM) from 80 to 100° and distal interphalangeal joint (DIP) ROM from 65 to 80°. The tactile sense and pain sense recovered, and average of the two-point discrimination scores was 9.3 mm (range 7–12 mm). The donor area was primarily sutured with a tidy scar in the underwear region.

Conclusion

CTA and CDS performed preoperatively are accurate and intuitive methods for assessing the location and course of SCIP. The SCIP flap is suitable for pediatric patients due to its small vessel caliber, specific functional and esthetic benefits. It can be designed in a lobulated fashion in order to repair two or more wounds during one surgery. We suggest that the free single-pedicle bilobed SCIP flap should be considered a good option choice for multi-digit defect reconstruction in pediatric patients in the clinic.

Serum level of CCL2 predicts outcome of patients with pancreatic cancer

BACKGROUND

Pancreatic cancer is one of the most deadly cancers worldwide with a five-year survival rate of less than 5%. Chronic pancreatitis showed increased risk to develop pancreatic cancer, in which chronic inflammation of the pancreas may play a critical role. Cytokines play an indispensable role in inflammatory reaction and tumorigenesis. The purpose of this study was to determine whether cytokines were associated with survival and poor prognosis of pancreatic cancer.

METHODS

In this study, we examined levels of some important cytokines in the serum of 68 patients with pancreatic cancer, including CCL2, CCL17, CXCL-1, CXCL-5, G-CSF, GM-CSF, TGF-β and IFN-γ.

RESULTS

We found that high level of serum CCL2 was strongly associated with poor survival and prognosis, but no significant association with other clinicopathological features, including gender, age, location and TNM staging. For other cytokines, no significant correlation with poor survival and prognosis was found.

CONCLUSION

Our results suggest that serum level of CCL2 may serve as a potential marker for predicting the outcome of patients with pancreatic cancer.

Percutaneous coronary intervention for congenital absence of the right coronary artery with acute myocardial infarction: A case report and literature review

RATIONALE

Congenital absence of the right coronary artery with acute myocardial infarction (AMI) is a rare clinical situation that may lead to death. We report a case of successful percutaneous coronary intervention for congenital absence of the right coronary artery with AMI.

PATIENT CONCERNS

A 53-year-old woman had a 7-day history of chest discomfort that had worsened over 10 hours. She was diagnosed as having myocardial infarction and was admitted to hospital.

DIAGNOSIS

Coronary angiography showed absence of the right coronary artery; the left anterior descending (LAD) branch sent out the right ventricular branch and the posterior descending branch. The LAD branch was occluded and there was diffuse stenosis of the middle right ventricular branch and severe stenosis of the distal circumflex branch.

INTERVENTIONS

Percutaneous coronary intervention was performed. One stent was implanted in the LAD branch and another implanted in the right ventricular branch.

OUTCOMES

The patient was discharged 3 weeks after surgery. The follow-up showed that the patient was asymptomatic without recurrence.

LESSONS

Although absence of the right coronary artery with AMI is a fatal condition, percutaneous coronary intervention remains an effective treatment.

Maternally Inherited Diabetes Mellitus Associated with a Novel m.15897G>A Mutation in Mitochondrial tRNAThr Gene

We report here the clinical, genetic, and molecular characteristics of type 2 diabetes in a Chinese family. There are differences in the severity and age of onset in diabetes among these families. By molecular analysis of the complete mitochondrial genome in this family, we identified the homoplasmic m.15897G>A mutation underwent sequence analysis of whole mitochondrial DNA genome, which localized at conventional position ten of tRNA^Thr, and distinct sets of mtDNA polymorphisms belonging to haplogroup D4b1. This mutation has been implicated to be important for tRNA identity and stability. Using cybrid cell models, the decreased efficiency of mitochondrial tRNA^Thr levels caused by the m.15897G>A mutation results in respiratory deficiency, protein synthesis and assembly, mitochondrial ATP synthesis, and mitochondrial membrane potential. These mitochondrial dysfunctions caused an increase in the production of reactive oxygen species in the mutant cell lines. These data provide a direct evidence that a novel tRNA mutation was associated with T2DM. Thus, our findings provide a new insight into the understanding of pathophysiology of maternally inherited diabetes.

[Research progress of odontoid fracture in children]

The majority of cervical spine injuries in children occur in the upper cervical spine, of which odontoid fracture is the most common. Odontoid fracture in children is a very insidious injury. Due to the unclear language and incompatible physical examination, the disease is often missed diagnosis. Because the child axis is still in the developmental segment, including 4 synchondrosis and 6 ossification centers, there are obvious anatomical and biological differences between the child odontoid fracture and the adult. Therefore, the choice of treatment is different from that of adults. This article will introduce the development of odontoid in children, and summarize the injury characteristics, clinical classification and treatment of odontoid fracture in children.

Rapid, simplified microscale quantitative analysis of lignin H/G/S composition with GC-MS in glass ampules and glass capillaries

The characterization of monolignols H-, G- and S- units composition Vanholme et al. (2010) of lignin is important in agriculture, forestry, herb medicine, livestock, and health care research Vanholme et al. (2008) and Sticklen (2008). The conventional methods often require a great deal of samples and reagents and are time-consuming. Here, we present a newly developed method with fewer operations. The optimized method is suitable for detecting and characterizing lignin composition of cell wall in different plant species and has the advantages of:

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Avoiding the influence of plasticizer by plasticware and enhancing the accuracy of monolignols analysis.

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Lowering the required samples from grams to milligrams, and organic reagents from milliliters to microliters.

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Reducing the time required from a few days to 6 h.

[Research progress on meralgia paresthetica after posterior spine surgery]

Meralgia paresthetica (MP) after posterior spine surgery is caused by mechanical compression injury of lateral femoral cutaneous nerve, which presents as numbness or paresthesia in the confined area of the anterolateral thigh. MP after posterior spine surgery is a common postoperative complication, and the incidence is 12.7%-25.5%. Because its clinical manifestations are mild and easy to be ignored, often leading to treatment delays. This article mainly reviews the incidence, risk factors, prevention and treatment of MP after posterior spine surgery.

Development and validation of a nomogram to predict the risk of occult cervical lymph node metastases in cN0 squamous cell carcinoma of the tongue

We have explored the relations between clinicopathological features and cervical lymph node metastases (LNM) in patients with cN0 squamous cell carcinoma (SCC) of the tongue, and developed and validated a nomogram for predicting the risk of their development. Clinical data on 230 patients with cN0 SCC of the tongue who had had primary extended excision and lymph node dissection of the neck were collected retrospectively. They were divided into a development cohort and a validation cohort in a 4:1 ratio. Logistic regression analysis was used to assess the risk factors of cervical LNM in patients in the development cohort, and a nomogram was established to predict the risk of such nodes. In the validation cohort, the predictive performance and compliance of the model were evaluated using the consistency index (C-index) and calibration curve, and the clinical value was evaluated by decision curve analysis. Of the 230 patients, 60 had cervical LNM, of which 60 were invaded (26%). Analysis of the development cohort showed that the site of the primary lesion, depth of invasion, size of the tumour, and histopathological grade were included in the prediction model, which was validated in the validation cohort. Consistency was high (C-index=0.846), calibration good, and it was clinically valuable. The nomogram could be used to predict the probability of occult cervical LNM before operation in patients with stage cN0 SCC of the tongue. It could also be used as a reference tool for dissection of cervical nodes and a communication tool between the doctor and the patient.

[Correlation between chest CT features and clinical characteristics of patients with bronchiectasis]

Objective: To analyze the features of chest CT imaging in adult patients with bronchiectasis and explore its correlation with clinical characteristics. Methods: From January 2010 to December 2017, patients with bronchiectasis diagnosed by chest high-resolution CT (HRCT) and aged at or above 18 years old in 5 general hospitals of Shandong province were included in the study. The correlations between the HRCT imaging features and etiology, clinical manifestations, lung function, sputum culture, prognosis and other characteristics were analyzed. Results: There were 410 bronchiectasis patients included in the study. The chest HRCT imaging of bronchiectasis were divided into three types, including columnar 46.8%, cystic 45.9% and varicose 7.3%, respectively. The HRCT imaging score was [6.0 (4.0, 7.0)]. In addition, the most common etiology of bronchiectasis was idiopathic (262, 69.3%). The proportion of idiopathic bronchiectasis in cystic bronchiectasis patients was significantly higher than that in columnar and varicose bronchiectasis (71.8% vs 58.3%, 50.0%; both P<0.017). Compared with columnar bronchiectasis, patients with cystic bronchiectasis were more likely to suffer from clinical manifestations such as cough, dyspnea, fever and wet rales (P<0.017). Compared with patients with HRCT scores of 1 to 4, patients with scores ≥8 were more likely to suffer from cough, dyspnea, fever, wet rales and clubbing (P<0.017). The proportions of pulmonary ventilatory dysfunction were significantly greater in patients with cystic bronchiectasis and varicose bronchiectasis than columnar bronchiectasis (86.7%, 86.7% vs 51.0%; both P<0.017). The HRCT scores were significantly negatively correlated with pulmonary function (P<0.001). The number of acute exacerbations, hospitalizations, and bronchiectasis severe index scores in patients with cystic bronchiectasis were significantly higher than those with columnar bronchiectasis (P<0.017). There was a significantly positive correlation between HRCT scores and the number of acute exacerbations, hospitalizations and the bronchiectasis severity index scores (P<0.001). The mortality of patients with cystic and varicose bronchiectasis was significantly higher than that of patients with columnar bronchiectasis (9.0%, 10.0% vs 2.1%; both P<0.017). Compared with patients with HRCT scores of 1 to 4, patients with scores ≥8 had a higher mortality rate (15.9% vs 0.9%; P<0.017). Conclusions: There is a correlation between HRCT findings and clinical manifestations in patients with bronchiectasis. The clinical manifestations, lung function and prognosis of patients with cystic bronchiectasis are worse than those of the columnar bronchiectasis; the higher the HRCT scores are, the worse the clinical manifestations, lung function and prognosis of the patients are.

[An age-stratified follow-up of complications and clinical benefit of posterior lumbar intervertebral fusion procedure in middle-aged and older patients]

Objective

To compare the complications and clinical scores of posterior lumbar intervertebral fusion (PLIF) in middle-aged and older patients of different ages, and to assess the risk of complications of PLIF in different ages, providing a reference for clinical treatment.

Methods

The clinical data of 1 136 patients, who were more than 55 years old and underwent PLIF between June 2013 and June 2016, were retrospectively analyzed. According to the age of patients undergoing surgery, they were divided into 3 groups as 55-64 years old, 65-74 years old, and ≥75 years old. The general characteristics, comorbidities, and surgical data of the three groups were compared, with comparison the morbidity of complications. According to the minimal clinical important difference (MCID), the improvement of patient's pain visual analogue scale (VAS) score and the Oswestry disability index (ODI) score were compared. Univariate logistic regression analysis was used to analyze the difference of complications and the improvement of VAS and ODI scores. Multivariate logistic regression analysis was performed for the risk factors of complications.

Results

There were significant differences in the number of surgical fusion segments and osteoporosis between groups ( P<0.05); there was no significant difference in gender, body mass index, operation time, preoperative American Society of Anesthesiologists (ASA) classification, and comorbidities between groups ( P>0.05). All patients were followed up 6-62 months with an average of 27.4 months. Among the results of postoperative complications, there were significant differences in the total incidence of intraoperative complications, systemic complications, minor complications, and the percentage of improvement of ODI score to MCID between groups ( P<0.05); but there was no significant difference in the total incidence of complications at the end of long-term follow-up and the percentage of improvement of VAS score to MCID between groups ( P>0.05). Univariate logistic regression analysis showed that after adjusting the confounding factors, there were significant differences in intraoperative complications and the percentage of improvement of ODI score to MCID between 55-64 and 65-74 years old groups ( P<0.05); systemic complications, minor complications, complications at the end of long-term follow-up, and the percentage of improvement of ODI score to MCID in ≥75 years old group were significantly different from those in the other two groups ( P<0.05). Multivariate logistic regression analysis showed that age was a risk factor for systemic complications, minor complications, and complications at the end of long-term follow-up. Except for age, long operation time was a risk factor for intraoperative complications, increased number of fusion segments was a risk factor for systemic complications, the number of comorbidities was a risk factor for minor complications, and osteoporosis was a risk factor for complications at the end of long-term follow-up.

Conclusion

The risk of surgical complications is higher in the elderly patients (≥75 years) with lumbar degenerative diseases than in the middle-aged and older patients (<75 years), while the improvements of postoperative VAS and ODI scores were similar. Under the premise of fully assessing surgical indications, PLIF has a positive effect on improving the elderly patients' quality of life.

[Effect of pre-existing adjacent segment degeneration on short-term effectiveness after lumbar fusion surgery]

Objective

To analyze the prospective effect of pre-existing spinal stenosis of adjacent segment on the short-term effectiveness after lumbar fusion surgery.

Methods

A prospective comparative study was conducted to divide 183 patients with L ₄-S ₁ lumbar spinal stenosis who met the selection criteria between July 2015 and December 2017 into two groups according to the status of adjacent segment degeneration (ASD) judged by preoperative disc degeneration and spinal stenosis. There were 98 patients in group A (no degeneration of adjacent segments before operation) and 85 patients in group B (adjacent segments degenerated before operation). There was no significant difference in gender, American Society of Anesthesiologists (ASA) grade, body mass index (BMI), combined spondylolisthesis, and preoperative visual analogue scale (VAS) score of low back pain and leg pain, Japanese Orthopaedic Association (JOA) score, and Oswestry disability index (ODI) score between the two groups ( P>0.05); the age of group A was significantly younger than that of group B ( t=-3.560, P=0.000). The operation time, intraoperative blood loss, hospitalization stay, and perioperative complications were recorded and compared. The VAS score of low back pain and leg pain, JOA score, and ODI score at last follow-up were used to evaluate the effectiveness. The incidence of ASD after operation was compared between the two groups, and logistic regression was used to analyze the independent risk factors affecting the occurrence of ASD after operation.

Results

There was no significant difference in operation time, intraoperative blood loss, and hospitalization stay between the two groups ( P>0.05). The incidence of perioperative complications in groups A and B was 13.3% and 20.0%, respectively, with no significant difference ( χ ²=1.506, P=0.220). Two groups of patients were followed up, the follow-up time of groups A and B was (24.9±8.8) months and (24.8±7.8) months, respectively, there was no significant difference ( t=0.050, P=0.960). At last follow-up, no adjacent segment disease was found in either group. There was no significant difference in Pfirrmann grade between the two groups at last follow-up ( P>0.05), and there was significant difference in Pfirrmann grade between the two groups before operation and at last follow-up ( P<0.001). At last follow-up, 21 cases (21.4%) in group A and 53 cases (62.4%) in group B had ASD, with significant difference ( χ ²=31.652, P=0.000). The main cause of ASD was the severity of adjacent spinal canal stenosis. The clinical scores of the two groups at last follow-up were significantly improved when compared with those before operation ( P<0.05). The JOA score of group A was significantly higher than that of group B at last follow-up ( P<0.05). In group B, the VAS score of low back pain and ODI score in patients with ASD after operation at last follow-up were significantly higher than those in patients without ASD ( P<0.05). logistic regression analysis showed that preoperative pre-existing degeneration and BMI were independent risk factors for ASD after operation ( P<0.05).

Conclusion

Pre-existing mild spinal stenosis in adjacent segment can significantly affect the effectiveness, and can significantly increase the risk of ASD early after operation. The main pathological type of ASD was the severity of adjacent segment spinal stenosis. For preoperative assessment of pre-existing degeneration, we should evaluate the overall degeneration of the adjacent segment of the spinal canal, rather than simply evaluating the degeneration of the adjacent disc and facet joints.

[Clinicopathological significance of poorly differentiated clusters in colorectal adenocarcinoma]

Objective: To investigate the correlation between poorly differentiated clusters (PDCs) in colorectal adenocarcinomas with clinicopathological parameters and its clinicopathological significance. Methods: One hundred and eighty-three colorectal adenocarcinomas resected by radical proctocolecomy were collected at Nanjing Hospital(Nanjing First Hospital), Nanjing Medical University, from January to December 2017. There were 122 male and 61 female patients with age ranging from 42 to 89 years (mean of 68 years). Tumor diameter ranged from 2 to 14 cm (mean 4.5 cm). There were 124 colon cancers and 59 rectal cancers. The number and grade of PDCs in the colorectal adenocarcinoma were evaluated by H-E staining. The overall peritumoural inflammatory reaction was also evaluated. The relationship between PDCs and tumor grades and clinicopathological features and overall peritumoural inflammatory reaction of colorectal adenocarcinoma was analyzed. Results: Of 183 cases of colorectal adenocarcinoma, PDCs were seen in 104 cases (56.8%), of which 36 cases (19.7%) were grade 1, 28 cases (15.3%) were grade 2, and 40 cases (21.9%) were grade 3. PDCs were positively correlated with lymph node metastasis, vascular invasion, degree of differentiation, depth of invasion, and pTNM staging(P<0.05). The detection rate of PDCs in colon cancer was higher than that of rectal cancer(P<0.05). PDCs was unrelated to age, gender, tumor size, and degree of overall peritumoural inflammatory reaction (P>0.05). Among clinicopathological parameters, the grade of PDCs was correlated with lymph node metastasis and vascular invasion (higher than those without lymph node metastasis and vascular invasion, P<0.05); There was a positive correlation between the grade of PDCs and age, tumor differentiation and pTNM staging(P<0.05), and no significant difference between the grade of PDCs and gender, tumor size, tumor location, and depth of invasion was seen (P>0.05). There was no correlation between the grade of PDCs and the degree of overall peritumoural inflammatory reaction (P>0.05). Conclusions: PDC is a histological feature that predicts the aggressiveness of colorectal adenocarcinoma. Evaluation of PDC grade can better predict the biological behavior of colorectal cancer and more accurately guide the treatment and evaluate prognosis.

Abstract P1-09-09: Octogenerian breast cancer was associated with higher infiltration of M2 macrophages and tregs and worse disease free survival

Backgrounds: It is known that elderly patients have worse prognosis of breast cancer and commonly the blame is on their medical comorbidities and access to care. We question this dogma and hypothesized that extreme elderly (octogenerians over 80 years old) have biologically worse cancer that can be defined by mutation load, tumor heterogeneity, and its tumor immune microenvironment.

Patients and Methods: Two groups; Control (patients aged 40-65), and octogenerians (age over 80) at the time of breast cancer diagnosis were compared in The Cancer Genomic Atlas (TCGA; n=1093) and the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC; n=2506) cohorts. Cytolytic activity score (CYT), CIBERSORT analysis, tumor mutation load, as well as mutant-allele tumor heterogeneity (MATH) score were conducted as previously published.

Results: The total number of patients in the control group and octogenarians were 675 and 54 in TCGA, and 1001 and 121 in METABRIC, respectively. Octogenerians had significantly worse disease free survival in addition to overall survival in both cohorts (p&lt;0.01 in both), which suggested that they had worse cancer biology. In terms of subtypes, octogenerians had significantly higher rate of ER positive cancers than control group in both cohorts (75.3% vs 87.0%, p&lt;0.01 in TCGA, 72.9% vs 90.0%, p&lt;0.01 in METABRIC), but there was no significant deference in PgR or Her2 positivity. With regard of PAM50 classification, luminal-A and B subtypes were significantly higher in octogenarians (44.6% vs 34.7%, 31.4% vs 20.5%, respectively, p&lt;0.01), whereas basal (7.4% vs 11.2%) and claudin-low (2.5% vs 11.8%) subtypes were significantly lower (p&lt;0.05) in octogenarians in METBRIC cohort. Given that octogenerians had subtype with favorable prognosis, we examined whether they had higher mutation load or heterogeneity of the tumor. There were no significant difference in tumor mutation load and MATH score that reflect tumor heterogeneity in both cohorts. On the other hand, breast tumors of octogenerians were significantly associated with immune-suppressive cells, such as M2 type macrophages and regulatory T cells in both cohorts (p&lt;0.05), whereas they were negatively associated with immune- eliminating cells, such as activated memory CD4 T-cells and M1 type of macrophages in METABRIC cohort (p&lt;0.05). There was no significant difference in CYT in TCGA cohort.

Conclusion: Our result demonstrated that octogenerians breast tumors were infiltrated with more immune-suppressive cells that may contribute to their biologically worse behavior.

Citation Format: Okano M, Elkhanany A, Qi Q, Yan L, Takabe K. Octogenerian breast cancer was associated with higher infiltration of M2 macrophages and tregs and worse disease free survival [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-09-09.

Abstract P2-01-19: Sphingosine-1-phosphate affects tumor-associated macrophages in breast cancer patients

Background: Tumor-associated macrophages (TAMs) are considered to be one of the key players in the tumor microenvironment, which regulates cancer invasion and metastases. TAMs can be divided into two phenotypes with opposite functions. While M1 macrophages are known to exert anti-tumor activity by promoting pro-inflammatory effects and immune responses such as intereukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), M2 macrophages influence an anti-inflammatory response, wound healing, and pro-tumorigenic properties. A bioactive lipid mediator, sphingosine-1-phosphate (S1P) has emerged as a key regulatory molecule in cancer progression. We previously demonstrated that S1P generated by sphingosine kinase 1 (SPHK1), is a crucial mediator of breast cancer-induced angiogenesis and lymphangiogenesis, and promotes its metastasis. In particular, we found that SPHK1 is highly expressed in HER2 negative breast cancer, and the patients who developed lymph node metastasis demonstrated significantly higher levels of S1P (J Surg Res 2016). Although we have previously reported the role of S1P in recruitment of TAMs in vivo (Cancer Res 2018), its relevance in patients is yet to be uncovered. Here, we test our hypothesis that S1P signaling affects TAMs in human patients with breast cancer.

Materials and Methods: The expression level of each enzyme-encoding gene involved in S1P production was evaluated by retrieving RNA sequencing and gene expression quantification data using the Genomics Data Commons (GDC) data portal of the The Cancer Genome Atlas cohort. Gene expression levels were derived using normalization methods provided in the DESeq2 package. We compared the difference in expression levels of tumor associated macrophage related genes, including CD68, CD163, IL-6, andTNF-α between SPHK1-high breast tissue, and SPHK1-low breast tissue in the group of HER2 negative or positive patients. Unpaired t-tests were performed to compare expression differences between SPHK1-high and SPHK1-low breast tissue. All tests were two-sided and P values &lt; 0.05 were considered statistically significant.

Results: CD68, pan-macrophage marker, is significantly increased in SPHK1-high breast cancer tissues both in HER2 negative and positive breast cancer patients (p=&lt;0.001, &lt;0.01). CD163 which is a scavenger receptor that is regarded as highly specific for M2 macrophages is significantly increased in SPHK1-high breast cancer tissues in HER2 negative breast cancer patients, but not in HER2 positive breast cancer patients (p=&lt;0.001, 0.2). IL-6, which characterize M1 phenotype is significantly increased in SPHK1-high breast cancer tissues both in HER2 negative and positive breast cancer patients (p=&lt;0.001, &lt;0.001). TNF-α, which also characterizes M1 phenotype, is significantly increased in SPHK1-high breast cancer tissues in HER2 negative breast cancer patients, but not in HER2 positive breast cancer patients (p=&lt;0.001, 0.05).

Conclusion: Our results suggest that S1P affects TAMs in breast cancer patients, which implicate the important roles of S1P in the complicated immune system related to tumor progression. Our results also indicate that S1P have a large role in HER2 negative breast cancer patients. Further investigations are needed to understand the underlying mechanisms.

Citation Format: Tsuchida J, Nagahashi M, Moro K, Ikarashi M, Koyama Y, Sakata J, Kobayashi T, Kameyama H, Qi Q, Yan L, Takabe K, Wakai T. Sphingosine-1-phosphate affects tumor-associated macrophages in breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-01-19.

Abstract P3-06-15: Young breast cancer patients demonstrate worse survival associated with aggressive oncogene expression but not with mutation load, tumor heterogeneity or pro-tumor immune cell infiltrations

INTRODUCTION: Young breast cancer patients have more aggressive subtypes and higher mortality rates. This study investigates the biologic, immunologic, and oncogenic differences between Young (≤40 yo) and Non-Young (&gt;40 yo) patients with breast cancer.

MATERIALS/METHODS: The Cancer Genome Atlas (TCGA; n=1095) and the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC; n=1894) were used for analysis. Gene Set Enrichment Analysis (GSEA) was performed on breast cancer patients in TCGA. We calculated mutation load using both TCGA and METABRIC. We also calculated the Cytolytic Activity Score (CYT), Mutant-Allele Tumor Heterogeneity (MATH), T-Cell Receptor (TCR)-Richness, and Ki67 mRNA expression in TCGA.

RESULTS: There were 97 and 116 Young patients and 994 and 1788 Non-Young patients in the TCGA and METABRIC databases respectively. Young patients had a lower DFS (p=0.012) in TCGA. Young patients had a lower DSS (p&lt;0.001) in METABRIC. There were less Stage I (13.5% vs 17.3%) and II (54.2% vs 58.3%) patients and more Stage III (31.2% vs 22.4%) patients in the Young group. There were more basal-like subtypes in the Young in TCGA (17.8% vs 16.1%) and METABRIC (28.4% vs 9.3%). Mutation load in TCGA was lower in the Young (p=0.030), but not significantly different in the METABRIC database. MATH, which reflects tumor heterogeneity, was not significantly different between the groups. These results were unexpected since Young patients have a higher proportion of basal-like subtype which is known to be rich in mutations and more immunogenic. In TCGA, Young patients were found to have higher amounts of activated dendritic cells (p=0.049). In METABRIC, Young patients had higher amounts of Plasma cells (p=0.016), CD4 memory-activated T-cells (p&lt;0.001), NK resting cells (p=0.015), and M1 Macrophages (p=0.002). We also found that regulatory T-cells (p=0.029), activated NK cells (p=0.016), M2 Macrophages (p&lt;0.001), and resting Mast cells (p=0.006) were lower in the Young. This unexpectedly showed that anti-tumor immune cells were more enriched in Young patients. Indeed, the CYT, which reflects tumor killing activity, and TCR-Richness, which reflects T-cell function, were both significantly higher in Young patients (p=0.034, p=0.004, respectively), which was opposite from what we expected due to its biological aggressiveness. GSEA was then used to analyze the TCGA database to clarify gene sets that are enriched in Young patients. Of the 50 Hallmark gene sets analyzed, 4 gene sets were found to be enriched in Young patients; G2M Checkpoint (p=0.002), Hallmark MYC Targets V1 (p=0.004), HALLMARK E2F Targets (p=0.035), and Hallmark Unfolded Protein Response (p=0.038). Ki67 which reflects cell proliferation was significantly higher in Young vs Non-Young patients (p=0.004).

CONCLUSIONS: Both TCGA and METABRIC cohorts demonstrated that Young patients have more basal-like subtype and significantly worse survival. Our results support the notion that Young patients have more aggressive cancer not because of mutations, tumor heterogeneity or immune cell infiltrations, but because of aggressive oncogene expressions.

Citation Format: Young JS, Asaoka M, Katsuta E, Kawaguchi T, Qi Q, Liu S, Yan L, Takabe K. Young breast cancer patients demonstrate worse survival associated with aggressive oncogene expression but not with mutation load, tumor heterogeneity or pro-tumor immune cell infiltrations [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-06-15.

Estimation on Formation Time of Thrombus

OBJECTIVES

To observe the changes of the formation time of venous thrombus in rats, and to provide new ideas and methods for the estimation on thrombus formation time of the forensic cases died from thrombosis.

METHODS

Totally 80 rats were randomly divided into 10 groups （0 h, 3 h, 6 h, 12 h, 1 d, 3 d, 1 week, 2 weeks, 3 weeks and 4 weeks after operation）. A vein thrombosis model was established by the "narrow" method. The processes of thrombosis, organization, recanalization and the features of change on hemosiderin and calcium salt were observed by HE stain, Perls stain and Von Kossa stain. The expression changes of CD61, α-SMA and CD34 were observed by immunohistochemical staining technique.

RESULTS

Platelets adhered to the exposed blood vessel intima 3 h after operation, and platelet trabeculae were formed by the repeated accumulation of platelets 1 d after operation. The thrombus organization formed through the fibroblasts from vessel wall that grew into the interior of the thrombus 3 d after operation. Endothelial cells covered the surface of thrombus and then the new blood vessels were reformed, and the vessels were reconstructed. The expression of CD61 upregulated at the stages of the thrombus formation （3 h） and thrombus reformation （4 weeks）, and reached the peak 1 d after thrombus formation. The release of hemosiderin and the initial expression of α-SMA were detected 3 d later. Calcium deposit and expression of CD34 were observed 1 week later.

CONCLUSIONS

The hemosiderin, calcium salt, CD61, α-SMA and CD34 show time-dependent changing characteristics, which is expected to provide a reference for the estimation on thrombus formation time of the forensic cases died from thrombosis.

Long non-coding RNA CCAT1 as a diagnostic and prognostic molecular marker in various cancers: a meta-analysis

PURPOSE

Long non-coding RNA colon cancer-associated transcript-1 (CCAT1) is newly found to be related with diagnoses and prognosis of cancer. This meta-analysis was performed to investigate the relationship between CCAT1 expression and clinical parameters, including survival condition, lymph node metastasis and tumor node metastasis grade.

MATERIALS AND METHODS

The primary literatures were collected through initial search criteria from electronic databases, including PubMed, OVID Evidence-based medicine Reviews and others (up to May 12, 2017). Eligible studies were identified and selected by the inclusion and exclusion criteria. Data was extracted and computed into Hazard ratio (HR) for the assessment of overall survival, subgroup analyses were prespecified based on the digestive tract cancer or others. Analysis of different CCAT1 expression related with lymph node metastasis or tumor node metastasis grade was conducted. Risk of bias was assessed by the Newcastle-Ottawa Scale.

RESULTS

9 studies were included. This meta-analysis showed that high CCAT1 expression level was related to poor overall survival, the pooled HR was 2.42 (95% confidence interval, CI: 1.86-3.16; P < 0.001; fix- effects model), similarly in the cancer type subgroups: digestive tract cancer (HR, 2.42; 95% CI, 1.79-3.29; P < 0.001; fix- effects model) and others (HR, 2.42; 95% CI, 1.42-4.13; P = 0.001; fix- effects model). The analysis showed that high CCAT1 was strongly related to positive lymph node metastasis (Odds ratio, OR: 3.24; 95% CI, 2.04-5.16; P < 0.001; fix- effects model), high tumor node metastasis stage (OR, 3.87; 95% CI, 2.53-5.92; P < 0.001; fix- effects model).

CONCLUSIONS

In conclusion, this meta-analysis revealed that CCAT1 had potential as a diagnostic and prognostic biomarker in various cancers.

Abstract P2-05-14: Young breast cancer patients (&lt;40 yo) have unfavorable subtypes, higher stage and worse survival

BACKGROUND:

Over the last 40 years, the incidence of breast cancer in young women in the U.S. has been relatively low and stable, but the absolute number of young women with breast cancer is increasing because of the growing population. Some epidemiological studies have shown that breast cancer diagnosed before age 40 have significantly worse overall 5-year survival. Disease free survival is also inferior in young women, and they have more aggressive cancers in general. This study aims to validate these findings using genomic analysis of large databases.

MATERIALS AND METHODS:

The Cancer Genome Atlas (TCGA; n= 1095) and the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC; n=1894) were used for analysis. We divided the database into the Young (&lt;40 yo) and Non-Young (&gt;40 yo) cohorts, based on age at diagnosis. The following analysis will give the TCGA and METABRIC results in each category, respectively.

RESULTS:

There were 8.9% (98) and 6% (116) patients who were found to be Young. In the Young cohort, 69.5% (64) and 37.9% (44) were ER(+), whereas 77.9% (742) and 79.5% (1415) in the Non-Young cohort were ER(+). Further, 60.8% (56) and 31.9% (37) were PR(+) in the Young cohort, compared to 68.4% (641) and 54.4% (972) in the Non-Young cohort. Her2(+) cancers were noted in 22.2% (12) and 25% (29) in the Young cohort, whereas 22.6% (152) and 11.6% (207) were Her2(+) in the Non-Young cohort. Our group developed a pipeline to calculate PAM50 from the RNA-Seq dataset. Utilizing this calculated PAM50 in TCGA, we found that there were less Luminal A and B patients in the Young cohort, 41.6% (42) and 17.8% (18) compared to 49.7% (377) and 22.9% (174) in the Non-Young cohort. This was also the case in METABRIC where 17.2% (20) and 9.5% (11) were Luminal A and B, compared to 36.9% (659) and 25.2% (450) in the Non-Young group. In contrast, there were more basal-like subtypes in the Young group, 17.8% (18) and 28.4% (33), as compared to the Non-Young group, 16.1% (122) and 9.3% (166). These results agree with previous epidemiological studies that showed that hormone receptor positive tumors increase and basal-like subtypes decrease with age. The number of Stage I patients was lower in Young patients 13.5% (13) and 25.3% (22), than in Non-Young patients 17.3% (169) and 34.4% (453). Similarly, there were less Stage II patients in the Young 54.2% (52) and 58.6% (51) compared to 58.3% (569) and 56.9% (749) in the Non-Young. This reverses in Stage III where the incidence is increased in the Young at 31.2% (30) and 16.1% (14) compared to 22.4% (219) and 7.7% (101) in the Non-Young. Young patients had a lower median disease-free survival than Non-Young patients (NA vs 214.7 mo, p=0.027); however, there was no statistical significance in median survival. Young patients had a lower median disease-specific survival than non-young patients of 221.1 months vs 282.6 months (p=0.00123) in METABRIC.

CONCLUSION: We used large datasets to examine survival in very young breast cancer patients (&lt;40 yo) vs older patients and found that young patients are likely to have unfavorable subtypes, higher stage, and a lower overall survival and DFS as compared to their older counterparts. Further analysis with genomics is needed.

Citation Format: Young JS, Kawaguchi T, Yan L, Qi Q, Liu S, Takabe K. Young breast cancer patients (&lt;40 yo) have unfavorable subtypes, higher stage and worse survival [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 P2-05-14.

Abstract P1-07-31: Integrated transcriptomics analyses identify novel three microRNAs signature to predict poor prognosis and metastasis in breast cancer

Backgrounds: MicroRNA (miRNA) play a crucial role in cancer progression, and altered miRNA expression has been demonstrated to be associated with breast cancer. MiRNA is also known to be stably detectable not only in tissue but peripheral circulation; therefore it could be a feasible and potential biomarker of breast cancer in clinical settings. However, few studies have been reported to identify promising miRNA profiles as predictive biomarker using statistically satisfied large cohorts of breast cancer patients. The aim of this study is to identify miRNA signature that can predict patient survival utilizing integrated and unbiased transcriptomics analyses.

Methods: Integrated and unbiased transcriptomics approach was conducted on genomic and clinicopathological information of 2580 breast cancer patients. We utilized The cancer Genome Atlas (TCGA) to identify miRNA signature that could significantly associated with clinical relevance including prognosis and metastatic information, followed by validation analyses with the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) and Gene Expression Omnibus (GEO)

Results: A novel risk scoring model including three miRNAs signature (miR-19a, miR-93, and miR-106a) was identified using Cox model. This miRNA score was able to extract the patient population with extremely poor prognosis in TCGA (5-yr overall survival rate, 49.2 %, p=0.0005). This result was validated with another three completely independent cohorts with microarray dataset accompanied with sufficient clinical information and miRNA expression (GSE19536, n=96, p=0.0009; GSE22220, n=210, p=0.0003; METABRIC, n=1223, p=0,0023). Interestingly, the subtype stratification with PAM-50 classification using bioinformatics pipeline demonstrated that this miRNA score could predict poor overall or disease-free survival especially in the population with luminal A, B or normal like subtype (p=0.0300 and p=0.0001, respectively). In addition, competing risk analysis for tumor recurrences demonstrated that the risk scoring using three miRNAs signature could be significantly associated with bone metastasis (p=0.0052). Finally, Gene Set Enrichment Analysis (GSEA) identified that high risk score using three miRNAs associated significantly with several critical gene sets related to metastatic formation such as angiogenesis (p &lt;0.0001), epithelial mesenchymal transition (EMT) (p = 0.0155), focal adhesion (p &lt;0.0001), TGF-beta signaling pathway (p = 0.0025), and ECM receptor interaction (p = 0.0068).

Conclusions: We demonstrated a promising miRNAs signature score system for predicting extremely poor prognosis and metastatic potentiality in breast cancer using novel integrated transcriptomics concept.

Citation Format: Takabe K, Kawaguchi T, Yan L, Qi Q, Peng X, Young J, Liu S. Integrated transcriptomics analyses identify novel three microRNAs signature to predict poor prognosis and metastasis in 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 P1-07-31.

Abstract P5-07-07: Prognostic relevance of microRNA-155 and microRNA-21 in breast cancer patients

Introduction

MicroRNAs (miRNAs) are short noncoding RNA sequences that degrade or prevent the translation of their target messenger RNA (mRNA). Altered regulation of miRNAs is implicated in different cellular processes. Some miRNAs, such as miRNA-155 (miR155) and miRNA-21 (miR21), are implicated in both immunity and cancer progression. Previous studies show that both miR155 and -21 are oncogenic, as their overexpression promotes invasion, proliferation and migration of breast cancer cells in vitro. Their overexpression within patient cohorts (n= 40-173 patients) reveals a worse prognosis for miR21 and varying associations with prognosis for miR155. By using the Cancer Genome Atlas (TCGA), which contains data from over a thousand patients, we want to clarify whether high expression of miR155 or -21 is associated with an improved or worse survival within breast tumor samples. Because both miR155 and -21 are described as oncogenic, we hypothesize that high expression of these miRNAs would portend a worse survival.

Methods

Within the breast cohort, 1052/1097 patients within TCGA contained both clinical and miRNA sequence data, acquired via the Genomic Data Common (GDC) data portal. The patients were separated into a high and low expression group for both miR155 and miR21, and associations with overall survival were obtained using the Cox proportional hazard model. Furthermore, a sub-analysis was conducted based on estrogen, progesterone and Her-2 receptor status (ER, PR, Her-2) as well as TNM staging (AJCC 7th edition).

Results

General patient characteristics within the breast cancer cohort of TCGA included: 70% Caucasian, 73% &gt;50 years old, 75% with TNM stage I and II breast cancers, 74% ER positive, and 33% Her-2 positive. We unexpectedly found that miR155 and miR21 high expression was associated with an improved survival (p=0.05 and 0.038 respectively). In the sub-analysis, a positive association with survival was seen for miR155 high expression in ER negative, and Stage I-II breast cancers (p=0.025, 0.0013 respectively), but not in Stage III-IV. The sub-analysis for miR21 found an association with improved survival for miR21 high expression in ER negative, and stage I-II patients (p=0.033, 0.0015 respectively), but not in Stage III-IV. Although not statistically significant, a trend towards improved survival was found in ER and PR positive subgroups, for both miR155 and -21. For the Her-2 negative subgroup, there was a trend for improved survival in miR155 high expression, but not in miR21 high expression. Knowing that ER negative tumors can attract more immune cells, and that miR155 and -21 can be expressed in immune cells and tumor associated fibroblasts respectively, we speculate that their high expression was concentrated within cells from the tumor microenvironment rather than the cancer cells.

Conclusion

Using TCGA as a large validation cohort, we found that high expression of miR155 and miR21 was associated with an improved survival, which was contrary to what we predicted. Future experiments using computational biology to determine the cell type composition within the TCGA tumor samples will be performed in an effort to determine whether the tumor microenvironment influenced the survival patterns we observed in the high expression groups of miR155 and -21.

Citation Format: Kim SY, Kawaguchi T, Yan L, Young J, Qi Q, Takabe K. Prognostic relevance of microRNA-155 and microRNA-21 in breast cancer patients [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 P5-07-07.