Extent of lymph node dissection in patients with gallbladder cancer

Background

Definitions of regional lymph nodes for gallbladder cancer differ according to staging system. Hence, the appropriate extent of lymph node dissection has not yet been standardized.

Methods

Pathological stages and disease-specific survival (DSS) of patients who had undergone surgical resection of gallbladder cancer between 1990 and 2016 were reviewed. Patients with nodal metastases limited to the hepatoduodenal ligament or common hepatic artery, extending to the posterosuperior pancreatic head lymph nodes (PSPLNs), or in nodes along the coeliac axis or superior mesenteric vessels were grouped as having Na, Nb and Nc disease respectively. Metastases beyond these regions were defined as distant metastases (M1). Absence of distant metastasis was expressed as M0.

Results

A total of 259 patients were evaluated. There were 74, 31 and nine patients respectively in the Na, Nb and Nc groups. Twenty-five, nine and four patients in the respective groups had M1 disease (P = 0·682). The 5-year DSS rate was comparable between patients with Na M0 and those with Nb M0 disease (36 versus 34 per cent respectively; P = 0·950), whereas the rate in patients with Nc M0 status (0 per cent) was worse than that of patients with Nb M0 (P = 0·017) and comparable to that of patients with M1 disease (14 per cent; P = 0·590). Among 22 patients with Nb M0 disease, the 5-year DSS rate did not differ between those who had undergone pancreatoduodenectomy and those who had had dissection of PSPLNs without pancreatoduodenectomy (50 versus 30 per cent respectively; P = 0·499).

Conclusion

PSPLNs and nodes along the hepatoduodenal ligament and hepatic artery should be considered regional nodes for gallbladder cancer, and should be resected.

Associations of sensitive cardiac troponin-I with left ventricular morphology, function and prognosis in end-stage renal disease patients with preserved ejection fraction

Sensitive cardiac troponin I (cTnI) predicts all-cause and cardiovascular mortality in various clinical settings. However, its clinical significance in hemodialysis (HD) patients with preserved left ventricular ejection fraction (LVEF) has not been fully elucidated. This study investigated the association of cTnI with LV morphology and function, and its long-term outcome in HD patients with preserved LVEF. This prospective study consists of 96 HD patients with preserved LVEF (69 ± 8 years and 63% male) who underwent two-dimensional echocardiographic examination and biomarker tests including cTnI, brain natriuretic peptide, and high-sensitive C-reactive protein. The primary endpoint was all-cause death and secondary endpoint was cardiovascular death. Factors independently associated with cTnI were systolic blood pressure (β = - 0.239, p = 0.011), heart rate (β = 0.216, p = 0.021), LV mass index (β = 0.231, p = 0.020), and E to e' ratio (β = 0.237, p = 0.016). During a mean follow-up of 3.6 years, primary and secondary endpoints were observed in 23 (24%) and 18 (19%) patients, respectively. In the multivariate Cox proportional hazard analysis, the upper cTnI tertile has significantly increased risk of all-cause mortality [hazard ratio (HR), 2.69; 95% confidence interval (CI), 1.139-6.386; p = 0.024] and that of cardiovascular death (HR, 4.56; 95% CI 2.021-16.968; p = 0.006) independent of echocardiographic measures and other serum biomarkers. In HD patients with preserved LVEF, serum cTnI levels were significantly associated with diastolic function and risk of mortality independent of echocardiographic variables and other biomarkers.

Hard x-ray photoemission study of Yb1-x Zr x B12: the effects of electron doping on the Kondo insulator YbB12

We have carried out hard x-ray photoemission spectroscopy (HAXPES) of Yb_1-x Zr _x B₁₂ ([Formula: see text]) to study the effects of electron doping on the Kondo insulator YbB₁₂. The Yb valences of Yb_1-x Zr _x B₁₂ at 300 K estimated from the Yb 3d HAXPES spectra decreased after substituting Yb with Zr from 2.93 for YbB₁₂ to 2.83 for Yb_0.125Zr_0.875B₁₂. A temperature dependent valence decrease was found upon cooling for all doping concentrations. We found peak shifts of the B 1s and Zr 3d_5/2, and Yb³⁺ 4f spectra toward the deeper binding-energy with increasing Zr concentration, which indicates a shift of the Fermi level to the higher energy and that of the Yb 4f hole level close to the Fermi level, respectively, due to electron doping. These results qualitatively show the enhanced hybridization between the Yb 4f and conduction-band states with Zr substitution, consistent with magnetic susceptibility measurements.

Rotatable high-resolution ARPES system for tunable linear-polarization geometry

A rotatable high-resolution angle-resolved photoemission spectroscopy (ARPES) system has been developed to utilize tunable linear-polarization geometries on the linear undulator beamline (BL-1) at Hiroshima Synchrotron Radiation Center. By rotating the whole ARPES measurement system, the photoelectron detection plane can be continuously changed from parallel to normal against the electric field vector of linearly polarized undulator radiation. This polarization tunability enables us to identify the symmetry of the initial electronic states with respect to the mirror planes, and to selectively observe the electronic states based on the dipole selection rule in the photoemission process. Specifications of the rotatable high-resolution ARPES system are described, as well as its capabilities with some representative experimental results.

Salvage hepatectomy for local recurrence of hepatocellular carcinomas offers survival comparable to that of matched patients who undergo primary hepatectomies

BACKGROUND

The feasibility of salvage hepatectomy for locally recurrent hepatocellular carcinomas (HCCs) is unclear, especially for patients with viable parts of previously multinodular tumors.

METHODS

We reviewed charts of patients who underwent initial hepatectomies between 2000 and 2014 to select those with local recurrences (LR) after non-surgical treatments. Their postoperative outcomes, including morbidity, recurrence-free survival (RFS), and overall survival (OS) were compared with matched patients who underwent initial hepatectomies for primary HCCs (PR). Their local recurrence patterns were divided into recurrent solitary tumors (Subgroup A); and recurrent parts of multinodular tumors (Subgroup B).

RESULTS

Among 664 patients, hepatectomy for LR was performed in 62 patients. Matched 59 patients were selected as PR. Clinicopathologic profiles at initial surgery were comparable between the LR and PR groups. Incidence of major morbidity (LR vs. PR, 7% vs. 5%, P = 1.00), 5-year RFS (21% vs. 37%, P = 0.28), and 5-year OS (69% vs. 69%, P = 0.62) were comparable. In the LR group, Subgroup B showed worse 5-year RFS (A vs. B, 29% vs. 0%, P < 0.01) and 5-year-OS (80% vs. 53%, P = 0.01). Postoperative recurrence occurred in 46 patients, but local and extrahepatic recurrence was seen only in 2 patients and 2 patients, respectively.

CONCLUSION

Salvage hepatectomy for locally recurrent HCCs is feasible, and results in prognosis comparable with hepatectomy for primary HCCs. Although the risk of postoperative recurrence was high in Subgroup B, rare local recurrence suggests the usefulness of salvaging uncontrolled tumor by nonsurgical treatment.

Abstract P2-01-20: The non-invasive treatment for sentinel lymph node metastasis by photodynamic therapy using a verteporfin solubilized phospholipid polymer aggregate

Introduction:

Sentinel lymph node biopsy (SLNB) has become a standard procedure for axillary lymph node evaluation in clinically node-negative breast cancer patients. Recent trial suggested that patients with 1or 2 sentinel lymph nodes (SLNs) involvement could be treated with SLNB alone.

Although SLNB is much less invasive procedure comparing with axillary lymph node dissection (ALND), it is still associated with complications such as lymph edema, numbness and pain.

Photodynamic therapy (PDT) against cancer is a non-invasive optical therapeutic method in which the topical or systemic delivery of photosensitizing drugs is followed by its subsequent activation with broadband red light.

In this study, the usefulness of PDT for treating SLN metastasis was evaluated in murine model.

Materials and Methods:

Verteporfin, a hydrophobic photosensitizer (PS) forms a soluble conjugate in aqueous medium with a water-soluble and amphiphilic PMB polymer as a solubilizer. The PMB forms stable and well-dispersed molecular aggregate when its concentration is over 1.0 mg/mL based on the hydrophobic interactions among polymer chains. The verteporfin can form conjugate (PMB-vertepoffin) with hydrophobic domain in the PMB aggregate. The PMB-verteporfin was injected at dorsum manus of BALB/c nude mice. The concentrations of verteporfin in tissues were determined by measuring the fluorescence emitted at 700 nm (with excitation at 430 nm). To develop a murine SLN metastasis model, 5 x 105 human epidermoid carcinoma A431 cells with stable expression of GFP were injected to the forearm of BALB/c nude mice. Seven days after inoculation of cancer cells, 20 μL of PMB-verteporfin was injected at dorsum manus of BALB/c nude mice and 75 J of light energy was delivered using a 640 nm diode laser for a total treatment time of 1 min. Fifty-three mice were randomly assigned to the combination of PMB-verteporfin injection and light exposure (A), light exposure alone (B), PMB-verteporfin injection alone (C), and no treatment (D) groups. Ten days after PDT, brachial lymph nodes, which were considered as SLNs were harvested and evaluated by stereoscopic fluorescence microscope. And, DNA was extracted from harvested lymph node. Human Alu family sequence was detected by 7300 Real Time PCR system (Applied Biosystems, Carlsbad CA USA) to estimate metastatic volume.

Results:

The concentration of verteporfin in SLN was siginificantly higher than other organs including lung, liver, kidney and brachial skin.

The group A significantly reduced the SLN metastasis (13%) comparing with , group B (57%), group C (46%) and group D (52%).

The Ct value in a PCR of the combination of group A (Ct=29.17) significantly reduced the SLN metastasis comparing with group B (Ct=22.45, p=0.018), group C (Ct=25.58, p=0.018) and group D (Ct=25.54, p=0.005).

Conclusions:

These data suggested that PDT using PMB as a nanotransporter of verteporfin could be a minimally invasive treatment of SLN metastasis in breast cancer, and represent a potential alternative procedure to SLNB.

Citation Format: Shimada K, Matsuda S, Jinno H, Konno T, Ito A, Arai T, Ishihara K, Kitagawa Y. The non-invasive treatment for sentinel lymph node metastasis by photodynamic therapy using a verteporfin solubilized phospholipid polymer aggregate [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 P2-01-20.

Abstract P4-21-25: The importance of hormone receptor status on biomarker expression and the efficacy of lapatinib plus capecitabine therapy after progression on trastuzumab in HER2 positive recurrent and advanced breast cancer

Background: Anti-HER2 treatment using trastuzumab (Tmab) has contributed to improving the clinical outcome of HER2-positive breast cancerpatients. However, some patients do not respond to Tmab therapy and the combination of Lapatinib and capecitabine (LC) is an effective treatment option after progression on Tmab. Hormone receptor status is also an important factor for deciding if the patient should be treated with endocrine therapy as well. The aim of this study was to investigate the clinical significance of hormone receptor status in biomarker expression and to evaluate the efficacy of lapatinib therapy.

Materials and Methods: Eighty patients with HER2 positive breast cancer refractory to Tmab were enrolled in this prospective trial (KBC-SG 1107) between December 2011 and March 2014. The following treatment began after enrollment; lapatinib 1250-mg tablets were administered orally once daily and capecitabine (2000 mg/m2 per day) on days 1 to 14 every 21 days until disease progression or until severe adverse events. Total HER2 (H2T), p95HER2 (p95), and total HER3 (H3T) expression levels were quantified in formalin-fixed paraffin embedded samples using VeraTag assays. ER and progesterone receptor (PgR), PTEN and p95 expressions were evaluated using immunohistochemistry (IHC) and PIK3CA mutation using direct sequencing. Statistical analyses were performed using SPSS (ver. 21). A two-sided P&lt;0.05 was considered a statistically significant difference.

Results: The ER- and PgR-positive rates were 55.0% and 33.8%, respectively. The response rate to LC was 30% (CR: 1 case; PR: 23 cases), the clinical benefit rate was 51.3% and the median progression-free survival (PFS) was 174.5 days. Both ER and PgR negativity significantly correlated with higher H2T (cutoff: 13.8), p95HER2 (cutoff: 2.8) and PTEN expression levels (cutoff: H score of 100). Lower H2T expression levels and PIK3CA mutation rates were often observed in the non-responders (both: p=0.087). The ER and PgR status did not correlate with response. A high p95 and PTEN expression significantly correlated with longer PFS in ER and/or PgR positive cases (p=0.02 and 0.03), respectively. The overall survival (OS) after LC significantly correlated with the number of recurrence organs (p=0.0002) but not with the p95 and PTEN expression levels.

Conclusion: LC therapy was effective in Tmab-refractory HER2 positive breast cancer. Moreover, the biomarker expression differed depending on the ER/PgR status and a high p95 and PTEN expression correlated with longer PFS in ER and/or PgR positive cases. Further study is necessary to validate these findings.

Citation Format: Arima N, Nishimura R, Toh U, Tanaka M, Saimura M, Okumura Y, Saito T, Tanaka T, Teraoka M, Shimada K, Koga T, Kurashita K, Todoroki H, Ueo H, Ohi Y, Toyoshima S, Mitsuyama S, Tamura K. The importance of hormone receptor status on biomarker expression and the efficacy of lapatinib plus capecitabine therapy after progression on trastuzumab in HER2 positive recurrent and advanced 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 P4-21-25.

The signal intensity of coronary culprit lesions on T1-weighted magnetic resonance imaging is directly correlated with the accumulation of vulnerable morphologies

BACKGROUND

In the magnetic resonance T1-weighted imaging, some investigators have shown that coronary artery high-intensity signals (HISs) are associated with vulnerable plaque morphology and an increased risk of future cardiac events. Although previous studies used different PMR (the ratio between the signal intensities of coronary plaque and cardiac muscle) cutoff values to detect HIS, the association between PMR itself and plaque morphology has not been fully investigated.

METHODS AND RESULTS

We prospectively investigated the association between PMR values and plaque morphology detected by optical coherence tomography in consecutive 106 patients with angina pectoris. The lesions with almost all of the vulnerable features such as lipid-rich, thin-cap fibroatheroma, plaque rupture, thrombus, macrophage infiltrations, intimal vasculature, and absence of calcification had significantly higher PMR; the only exception was the presence of cholesterol crystals. PMR increases linearly with the number of vulnerable features (p<0.0001, Rho=0.504). Stepwise multiple linear regression analysis revealed that the absence of calcification (p=0.0027), and the presence of thrombus (p=0.0071) and intimal vasculature (p=0.019) were independently associated with higher log-transformed PMR. There was a stepwise increase in PMR of the culprit lesions in proportion to the accumulation of the number of adverse plaque characteristics defined as non-calcified plaque, thrombus, and/or intimal vasculature.

CONCLUSION

These results suggest that not only the presence of HIS, but also the elevated PMR itself may be used as a quantitative marker of plaque vulnerability in clinical evaluation.