Results from a multicenter, open-label, pivotal phase II study of chidamide in relapsed or refractory peripheral T-cell lymphoma

BACKGROUND

Chidamide is a novel benzamide type of subtype-selective histone deacetylase (HDAC) inhibitor with unique mechanisms of action compared with marketed HDAC inhibitors. This phase II study was to evaluate the efficacy and safety of chidamide in relapsed or refractory peripheral T-cell lymphoma (PTCL) in Chinese population.

PATIENTS AND METHODS

Patients with relapsed or refractory PTCL of different subtypes received chidamide of 30 mg orally twice per week. The primary end point was overall response rate (ORR). Responding patients should be confirmed at least 4 weeks after the criteria of the response were first met, and were reviewed by an independent review committee.

RESULTS

Eighty-three patients were enrolled and 79 patients with eligible PTCL histology were for efficacy assessments. Patients enrolled over 10% were with subtypes of PTCL not otherwise specified (34%), anaplastic large-cell lymphoma (22%), extranodal natural killer (NK)/T-cell lymphoma, nasal type (20%), or angioimmunoblastic T-cell lymphoma (AITL, 13%). The ORR was 28% (22 of 79) including 14% (11 of 79) with complete response/unconfirmed complete response (CR/CRu). Median progression-free survival and overall survival were 2.1 and 21.4 months, respectively. AITL patients tended to have higher ORR (50%) and CR/CRu rate (40%), as well as more durable responses, to chidamide treatment. Most adverse events (AEs) were grade 1 or 2, and AEs ≥grade 3 that occurred in ≥10% patients were thrombocytopenia (22%), leucopenia (13%) and neutropenia (11%), respectively.

CONCLUSION

Chidamide represents a novel oral benzamide class of HDAC inhibitor with significant single-agent activity and manageable toxicity in relapsed or refractory PTCL, and provides a much needed treatment option in this indication in China. Results led to China Food and Drug Administration approval of chidamide in this indication.

PROX1 promotes hepatocellular carcinoma proliferation and sorafenib resistance by enhancing β-catenin expression and nuclear translocation

Aberrant activation of the Wnt/β-catenin pathway is frequent in hepatocellular carcinoma (HCC) and contributes to HCC initiation and progression. This abnormal activation may result from somatic mutations in the genes of the Wnt/β-catenin pathway and/or dysregulation of the Wnt/β-catenin pathway. The mechanism for the latter remains poorly understood. Prospero-related homeobox 1 (PROX1) is a downstream target of the Wnt/β-catenin pathway in human colorectal cancer and elevated PROX1 expression promotes malignant progression. However, the Wnt/β-catenin pathway does not regulate PROX1 expression in the liver and HCC cells. Here we report that PROX1 promotes HCC cell proliferation in vitro and tumor growth in HCC xenograft mice. PROX1 and β-catenin levels are positively correlated in tumor tissues as well as in cultured HCC cells. PROX1 can upregulate β-catenin transcription by stimulating the β-catenin promoter and enhance the nuclear translocation of β-catenin in HCC cells, which leads to the activation of the Wnt/β-catenin pathway. Moreover, we show that increase in PROX1 expression renders HCC cells more resistant to sorafenib treatment, which is the standard therapy for advanced HCC. Overall, we have pinpointed PROX1 as a critical factor activating the Wnt/β-catenin pathway in HCC, which promotes HCC proliferation and sorafenib resistance.

Prospective controlled study of the safety and oncological outcomes of ELAPE procure with definitive anatomic landmarks versus conventional APE for lower rectal cancer

BACKGROUND

The use of extra-levator abdominoperineal resection (ELAPE) procedure for lower rectal cancer is controversial. It is unclear whether the ELAPE procedure could improve surgical safety and lead to better oncological outcomes.

METHODS

Sixty-nine lower rectal cancer patients who underwent ELAPE (36 cases) or conventional abdominoperineal resection (APE; 33 cases) between June 2011 and February 2013 were prospectively investigated. Clinicopathological variables including blood loss, intraoperative perforation (IOP) rate, circumferential resection margin (CRM) involvement, lymph node harvest, the postoperative complications, urinary and sexual function, quality of life (QOL), local recurrence rate and survival were recorded and compared.

RESULTS

Blood loss (P = 0.021), perineal wound complication (P = 0.039), IOP rate (P = 0.028), local recurrence (P = 0.034) were significantly less frequent in the ELAPE group. There was greater CRM involvement in the conventional APE group but no statistical difference between the two groups. Urinary function, sexual function and QOL were not significantly different between the two groups. Overall survival and progression-free survival were not significantly different between two groups, even when survival was analyzed according to TNM stage, T stage, N stage, and with or without neoadjuvant chemoradiotherapy. In patients who underwent ELAPE there was no statistical difference in postoperative complications between younger and elderly patients (age ≥60).

CONCLUSIONS

ELAPE procedure with definitive anatomic landmarks demonstrated surgical safety and decreased local recurrence for lower rectal cancer patients including the elderly, but there were no survival improvements in compared to conventional APE procedure.

Sustainable synthesis of highly efficient sunlight-driven Ag embedded AgCl photocatalysts

Microbe-free broth synthesis was performed under solar light to give Ag nanoparticle embedded AgCl in 5 minutes with superior performance than P25 for organic pollutant degradation.

Role of extrinsic arbuscular mycorrhizal fungi in heavy metal-contaminated wetlands with various soil moisture levels

This study presents an efficient heavy metal (HM) control method in HM-contaminated wetlands with varied soil moisture levels through the introduction of extrinsic arbuscular mycorrhizal fungi (AMF) into natural wetland soil containing indigenous AMF species. A pot culture experiment was designed to determine the effect of two soil water contents (5-8% and 25-30%), five extrinsic AMF inoculants (Glomus mosseae, G. clarum, G. claroideum, G. etunicatum, and G. intraradices), and HM contamination on root colonization, plant growth, and element uptake of common reed (Phragmites australis (Cav.) Trin. ex Steudel) plantlets in wetland soils. This study showed the prevalence of mycorrhizae in the roots of all P. australis plantlets, regardless of extrinsic AMF inoculations, varied soil moisture or HM levels. It seems that different extrinsic AMF inoculations effectively lowered HM concentrations in the aboveground tissues of P. australis at two soil moisture levels. However, metal species, metal concentrations, and soil moisture should also be very important factors influencing the elemental uptake performance of plants in wetland ecosystems. Besides, the soil moisture level significantly influenced plant growth (including height, and shoot and root dry weight (DW)), and extrinsic AMF inoculations differently affected shoot DW.

Subtypes of major depression: latent class analysis in depressed Han Chinese women

BACKGROUND

Despite substantial research, uncertainty remains about the clinical and etiological heterogeneity of major depression (MD). Can meaningful and valid subtypes be identified and would they be stable cross-culturally?

METHOD

Symptoms at their lifetime worst depressive episode were assessed at structured psychiatric interview in 6008 women of Han Chinese descent, age ⩾ 30 years, with recurrent DSM-IV MD. Latent class analysis (LCA) was performed in Mplus. RESULTS; Using the nine DSM-IV MD symptomatic A criteria, the 14 disaggregated DSM-IV criteria and all independently assessed depressive symptoms (n = 27), the best LCA model identified respectively three, four and six classes. A severe and non-suicidal class was seen in all solutions, as was a mild/moderate subtype. An atypical class emerged once bidirectional neurovegetative symptoms were included. The non-suicidal class demonstrated low levels of worthlessness/guilt and hopelessness. Patterns of co-morbidity, family history, personality, environmental precipitants, recurrence and body mass index (BMI) differed meaningfully across subtypes, with the atypical class standing out as particularly distinct.

CONCLUSIONS

MD is a clinically complex syndrome with several detectable subtypes with distinct clinical and demographic correlates. Three subtypes were most consistently identified in our analyses: severe, atypical and non-suicidal. Severe and atypical MD have been identified in multiple prior studies in samples of European ethnicity. Our non-suicidal subtype, with low levels of guilt and hopelessness, may represent a pathoplastic variant reflecting Chinese cultural influences.

Does the addition of targeted biological agents to first-line chemotherapy for advanced colorectal cancer increase complete response? A systematic review and meta-analysis

AIM

The study assessed whether the addition of monoclonal antibodies (MoAbs) to first-line chemotherapy for advanced colorectal cancer (CRC) increases the complete response (CR) compared with controls.

METHOD

PubMed was reviewed for randomized clinical trials (RCTs) with approved MoAbs (bevacizumab, cetuximab and panitumumab) vs non-MoAbs as first-line therapy for patients with advanced CRC. The incidence and ratio of CR events were calculated in patients assigned to MoAbs compared with controls.

RESULTS

A total of 3790 patients from nine RCTs were included for analysis. The overall incidence of CR in patients treated with MoAbs was 2.4% (95% CI: 1.7-3.3%) compared with 1.3% (95% CI: 0.8-2.2%) in controls. Comparison of the different types of MoAbs showed that the incidence of CR was higher for bevacizumab (3.1%, 95% CI: 2.1-4.3%) than for cetuximab (0.8%, 95% CI: 0.4-1.8%). The addition of MoAbs to chemotherapy significantly increased the OR of obtaining a CR compared with controls (OR = 1.96; 95% CI: 1.12-3.46; P = 0.02). No significant differences in the OR were observed in any of the subgroups.

CONCLUSION

The CR is a rare event in advanced CRC; however, the addition of MoAbs to first-line chemotherapy significantly increases the curative rate of metastatic disease compared with controls.

Nuclear factor erythroid 2-related factor 2 rescues the oxidative stress induced by di-N-butylphthalate in testicular Leydig cells

Aim:

This study aimed to determine whether nuclear factor erythroid 2-related factor 2 antagonized the oxidative stress induced by di- N-butylphthalate (DBP) in testicular Leydig cells.

Methods:

Mouse TM3 testicular Leydig cells were treated with Nrf2 knockdown (KD) or overexpression in the presence and absence of DBP. Oxidative profiles were examined. Nrf2 target antioxidant genes were studied, and the effects of Nrf2 inducer sulphoraphane (SFN) were tested.

Results:

DBP induced intracellular oxidative stress to a similar extent with Nrf2 KD. Expression and protein levels of Nrf2 were increased together with its target genes, namely heme oxygenase 1, nicotinamide adenine dinucleotide phosphate quinone oxidoreductase 1 and peroxiredoxin 6, following DBP stimulation. Use of SFN not only restored the intracellular oxidative toxicity but also cell proliferation and testosterone secretion in response to DBP.

Conclusion:

Increased Nrf2 activity, for example, by SFN can effectively antagonize the oxidative stress in testicular Leydig cells caused by DBP.

The structure of the symptoms of major depression: exploratory and confirmatory factor analysis in depressed Han Chinese women

BACKGROUND

The symptoms of major depression (MD) are clinically diverse. Do they form coherent factors that might clarify the underlying nature of this important psychiatric syndrome?

METHOD

Symptoms at lifetime worst depressive episode were assessed at structured psychiatric interview in 6008 women of Han Chinese descent, age ⩾30 years with recurrent DSM-IV MD. Exploratory factor analysis (EFA) and confirmatoryfactor analysis (CFA) were performed in Mplus in random split-half samples.

RESULTS

The preliminary EFA results were consistently supported by the findings from CFA. Analyses of the nine DSM-IV MD symptomatic A criteria revealed two factors loading on: (i) general depressive symptoms; and (ii) guilt/suicidal ideation. Examining 14 disaggregated DSM-IV criteria revealed three factors reflecting: (i) weight/appetite disturbance; (ii) general depressive symptoms; and (iii) sleep disturbance. Using all symptoms (n = 27), we identified five factors that reflected: (i) weight/appetite symptoms; (ii) general retarded depressive symptoms; (iii) atypical vegetative symptoms; (iv) suicidality/hopelessness; and (v) symptoms of agitation and anxiety.

CONCLUSIONS

MD is a clinically complex syndrome with several underlying correlated symptom dimensions. In addition to a general depressive symptom factor, a complete picture must include factors reflecting typical/atypical vegetative symptoms, cognitive symptoms (hopelessness/suicidal ideation), and an agitated symptom factor characterized by anxiety, guilt, helplessness and irritability. Prior cross-cultural studies, factor analyses of MD in Western populations and empirical findings in this sample showing risk factor profiles similar to those seen in Western populations suggest that our results are likely to be broadly representative of the human depressive syndrome.

Clinical significance of polypeptide N-acetylgalactosaminyl transferase-5 (GalNAc-T5) expression in patients with gastric cancer

BACKGROUND

The family of polypeptide N-acetylgalactosaminyl transferases is responsible for the altered O-linked glycosylation occurring during the development of various cancers and their progression via altering O-glycan biosynthesis. Our studies were designed to investigate the expression and prognostic values of GalNAc-T5 and improve the risk stratification in patients with gastric cancer.

METHODS

Tissue samples from a training set and a validation set of patients with gastric adenocarcinoma from China were used for analyses. GalNAc-T5 expression was retrospectively analysed by immunohistochemistry. Results were assessed for association with clinicopathological parameters and overall survival by using Kaplan-Meier analysis. Prognostic values of GalNAc-T5 expression and clinical outcomes were evaluated by Cox regression analysis. A molecular prognostic stratification scheme incorporating GalNAc-T5 expression was determined by using receiver operating characteristic analysis.

RESULTS

GalNAc-T5 expression was markedly reduced in gastric cancer tissues compared with non-malignant gastric mucosa. Low intratumoral GalNAc-T5 density, which was associated with tumour cell differentiation, T classification, N classification, and TNM stage in the two independent sets, was an independent prognosticator for poor prognosis of gastric cancer patients. Applying the prognostic value of intratumoral GalNAc-T5 density to the conventional clinicopathologic TNM stage system showed a better prognostic value in patients with gastric cancer.

CONCLUSIONS

Intratumoral GalNAc-T5 expression was recognised as an independent prognostic marker for the overall survival of gastric cancer patients. Detection of GalNAc-T5 expression in gastric cancer tissues might add some prognostic information for patients with this disease and lead to a more accurate classification under the TNM stage system.

Isolation of a Campylobacter lanienae-like bacterium from laboratory chinchillas (Chinchilla laniger)

Routine necropsies of 27 asymptomatic juvenile chinchillas revealed a high prevalence of gastric ulcers with microscopic lymphoplasmacytic gastroenteritis and typhlocolitis. Polymerase chain reaction (PCR) analysis using Campylobacter genus-specific partial 16S rRNA primers revealed the presence of Campylobacter spp. DNA in the faeces of 12 of 27 animals (44.4%). Species-specific partial 16S rRNA PCR and sequencing confirmed that these animals were colonized with Campylobacter lanienae, a gram-negative, microaerophilic bacterium that was first identified on routine faecal screening of slaughterhouse employees and subsequently isolated from faeces of livestock. Campylobacter lanienae was isolated from the faeces of six PCR-positive animals and identified with species-specific PCR and full 16S rRNA sequencing. Phylogenetic analysis showed that these isolates clustered with C. lanienae strain NCTC 13004. PCR analysis of DNA extracted from gastrointestinal tissues revealed the presence of C. lanienae DNA in the caecum and colon of these chinchillas. Gastrointestinal lesions were scored and compared between C. lanienae-positive and C. lanienae-negative animals. There was no correlation between colonization status and lesion severity in the stomach, liver, duodenum, or colon. Possible routes of C. lanienae infection in chinchillas could include waterborne transmission and faecal-oral transmission from wild mice and rats or livestock. Based on these findings, the authors conclude that C. lanienae colonizes the lower bowel of chinchillas in the absence of clinical disease. This is the first report of C. lanienae in any rodent species. Campylobacter lanienae isolates from different mammalian species demonstrate heterogeneity by 16S rRNA sequence comparison. Analysis using rpoB suggests that isolates and clones currently identified as C. lanienae may represent multiple species or subspecies.

Host immunological response and factors associated with clinical outcome in patients with the novel influenza A H7N9 infection

In March 2013, an influenza outbreak caused by the novel avian-origin H7N9 influenza A virus emerged in eastern China and had caused 43 fatalities by 31 July 2013, although the basis for disease pathogenesis still remains unclear. To assess the immunological and viral factors associated with disease severity, viral RNA and inflammatory cytokines were quantified for 18 H7N9 patients in Shanghai, China. Detailed clinical information was collected and clinical laboratory investigations were performed for all patients. H7N9 infection is characterized by high pharyngeal virus load and frequent detection of viral RNA in blood. High pharyngeal virus load persisted through the first 10 days of antiviral therapy in fatal cases. Genetic characterization of the H7N9 virus revealed an Arg292Lys mutation in the neuraminidase gene associated with oseltamivir-resistance. Pronounced lymphopenia and high chemokine and cytokine levels were observed in H7N9-infected patients, particularly in those where disease was fatal. Serum levels of interleukin-6 (IL-6), IL-8 and macrophage inflammatory protein-1β in our subjects also correlated positively with pharyngeal virus load. Lymphocyte counts <0.5 × 10(9)  cells/L, and serum IL-6 >97 pg/mL, IL-8 >40 pg/mL and C-reactive protein >90 mg/L were identified as being connected with adverse clinical outcome through univariate logistic analysis. Significant survival differences were also observed between patients with serum C-reactive protein <90 mg/L or creatinine <90 μmol/L and those with higher levels. Our data demonstrated that high viral load, and the resulting intense inflammatory responses, played an important role in H7N9 pathogenesis. Though immunomodulatory treatment has potential benefits, the focus of clinical management should be on preventing the intense cytokine response by early diagnosis and effective antiviral treatment.

Abstract P1-01-13: Intraoperative evaluation of sentinel lymph nodes using touch imprint cytology in patients with early-stage breast cancer: A series of 4367 procedures

Background: As the screening for breast cancer becomes common in China, an increasing number of early-stage breast cancer has been detected. For those patients, especially the ones with cliniaclly negetive lymph nodes, sentinel lymph node biopsy (SLNB) plays an important role in the assessment of the axillary status, while minimizing the mobidity of axillary lymph node dissection(ALND). Accurate intraoperative assessment of SLN metastases enables the selection of patients for ALND during the same operation. Touch imprint cytology (TIC) serves as a main intraoperative evaluation of SLNs in our institute since Feb-2005. The purpose of this study is to evaluate its clinical value.

Methods: Early-stage breast cancer patients treated in our institute between Feb-2005 and Apr-2013 enrolled in this study. To avoid breast tissue contamination, all patients had an intraoperative SLNB performed before undergoing lumpectomy or mastectomy. The fresh SLNs were sectioned into 1.5-3.0mm pieces along the short axis, TIC was performed on both surfaces of each piece, its result was correlated with the histological assessments with Hematoxylin-Eosin (H&E) staining, which considered as the gold standard.

Results: A total of 4,367 early-stage breast cancer patients enrolled in the study, and 14,112 SLNs were successfully harvested. Among those, 917 (21.0%) patients were confirmed to have at least one SLN positive for metastases, and 1343 (9.5%) positive SLNs were removed. Based on the final H&E report, the sensitivity, specificity and overall accuracy of TIC was 71.4%, 99.2% and 93.6%, respectively on a per patient basis, and 69.6%, 99.5% and 96.6%, respectively on a per node basis. The sensitivity for macrometastasis and micrometastasis was 74.8% and 26.5%, respectively on a per patient basis, and 78.9% and 25.2%, respectively on a per node basis. To discuss the influence of error results on the surgery procedure, we further reviewed the detail medical records of the patients enrolled in the recent 3 years. Of all the 3290 patiens treated between Jun-2010 and Apr-2013, 207(6.5%) patients needed a second opereation to have the ALN dissected. Meanwhile, 20(0.6%) patients had undergone extra ALND because of the false positive results of TIC.

Conclusion: The sensitivity of TIC seems a little lower then the ones reported previously, but the overall accuracy still remains acceptable. In addition, only 7.1% patients were influenced by the error results of TIC, along with the advantages, such as the shorter preparation time and the less cost of cytological specimens, we consider TIC a feasible method, and believe it can serve well in the intraoperative evaluation of SLNs for early-stage breast cancer patients.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-01-13.

Abstract P2-19-07: Current trends of breast reconstruction after mastectomy for breast cancer patients in China

Background: To ascertain the current trends of breast reconstruction (BR) for breast cancer patients in China, we conducted a retrospective study in Committee of Breast Cancer Society, Chinese Anti-Cancer Association.

Methods: We designed a questionnaire for this study, and it included questions on surgeon demographics, number of mastectomy and BR, type and timing of BR, reconstructive choices in the setting of preoperative or postoperative radiotherapy (RT) or chemotherapy, complication, oncoplastic surgery, fat grafting, physician and patient satisfaction, etc. All data were collected until 2012. Questionnaires were sent to 52 members of Committee of Breast Cancer Society by e-mail. By Jun-2013, 30 questionnaires (response rate 57.7%) had been returned. Among all, 3 were excluded for not performing BR. Finally, 27 respondents were included.

Results: All but one of these 27 hospitals were Class Three Grade A hospitals in China. A total of 402 surgeons worked in the general surgery or oncological surgery department, among them, only 84 (20.9%) were able to perform BR. Surgeons from 10 hospitals would also choose to cooperate with the plastic department to finish the complicated reconstructive procedure. In 2012, 21026 mastectomies were performed; among them, 679 (3.2%) received immediate BR, 102 (0.5%) received delayed BR while 192 (0.9%) received delayed-immediate one. At the same time, 414 (2.0%) had their breast reconstructed by implant while 393 (1.9%) chose the autologous ones, the choices of reconstructive type were not recorded for other 166 (0.8%) cases. According to these 27 respondents, 88.9% predominantly performed prosthetic (1265 cases in all) or latissimus dorsi myocutaneous flap (LDMF) with or without an implant (1571 cases in all) BR from the time of their first BR operation to the end of 2012. During the same period, 327 pedicled transverse rectus abdominis myocutaneous (TRAM) BR were performed in 20 hospitals, while 169 free TRAM BR, which requiring technique of microsurgery, were carried out in 9 hospitals (68.6% were performed by a single surgeon from Nov-2006). The overall complication rate of BR was 12.4%. As RT had low to medium effect on increasing the operational difficulties and influencing the esthetic outcomes of BR, about 75% surgeons would choose delayed autologous BR in patients who had previous RT. Autologous flaps were also recommended for patients who need postoperative RT, but the timing still remained controversial. The overall cosmetic outcomes of the reconstructed breasts satisfied the majority of physicians and patients.

Conclusion: With the growing number of breast cancer patients who need to undergo mastectomy, more and more BR are needed to improve the quality of life for them, but the ratio is still low in China, partially because of the lack of qualified plastic surgeons. As free flap BR requiring microsurgical techniques seems still complicated for most surgeons, implant and LDMF BR are the most common choices for patients nowadays in China. In addition, the effect of radiotherapy will be an important consideration when deciding the type and timing of BR.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-19-07.

Cognitive trio: relationship with major depression and clinical predictors in Han Chinese women

BACKGROUND

Previous studies support Beck's cognitive model of vulnerability to depression. However, the relationship between his cognitive triad and other clinical features and risk factors among those with major depression (MD) has rarely been systematically studied.

METHOD

The three key cognitive symptoms of worthlessness, hopelessness and helplessness were assessed during their lifetime worst episode in 1970 Han Chinese women with recurrent MD. Diagnostic and other risk factor information was assessed at personal interview. Odds ratios (ORs) were calculated by logistic regression.

RESULTS

Compared to patients who did not endorse the cognitive trio, those who did had a greater number of DSM-IV A criteria, more individual depressive symptoms, an earlier age at onset, a greater number of episodes, and were more likely to meet diagnostic criteria for melancholia, postnatal depression, dysthymia and anxiety disorders. Hopelessness was highly related to all the suicidal symptomatology, with ORs ranging from 5.92 to 6.51. Neuroticism, stressful life events (SLEs) and a protective parental rearing style were associated with these cognitive symptoms.

CONCLUSIONS

During the worst episode of MD in Han Chinese women, the endorsement of the cognitive trio was associated with a worse course of depression and an increased risk of suicide. Individuals with high levels of neuroticism, many SLEs and high parental protectiveness were at increased risk for these cognitive depressive symptoms. As in Western populations, symptoms of the cognitive trio appear to play a central role in the psychopathology of MD in Chinese women.

Expression of STAT3 and IGF2 in adrenocortical carcinoma and its relationship with angiogenesis

OBJECTIVE

The aim of this study was to determine the correlation between human adrenocortical carcinoma and the proteins involved in tumor angiogenesis, and to evaluate the angiogenic status of adrenocortical carcinoma.

METHODS

The expression of signal transducer and activator of transcription 3 and insulin-like growth factor 2 as well as microvessel density was measured in a series of tissue samples from 44 human sporadic adrenocortical tumors by immunohistochemistry. These specimens were classified as adenomas (n = 20) and carcinomas (n = 24) according to the histological criteria defined by Weiss.

RESULTS

A total of 19 of 24 (79.17 %) malignant cases showed positive staining for signal transducer and activator of transcription 3 and 4 of 20 (20.00 %) benign cases showed positive, the difference of signal transducer and activator of transcription 3 expression between adrenocortical adenomas and adrenocortical carcinomas was statistically significant (P < 0.001). Similarly, insulin-like growth factor 2 staining was seen in 70.83 % (17/24) of the malignant cases versus 25.00 % (5/20) of the benign, the difference of insulin-like growth factor 2 expression among two groups was statistically significant (P = 0.002). Malignant cases showed higher microvessel density compared to benign tumors (84.70 ± 12.44 vs 21.05 ± 8.07, P < 0.001). Signal transducer and activator of transcription 3 and insulin-like growth factor 2 expression were positively correlated with microvessel density in all specimens (r_s = 0.832, P < 0.001; r_s = 0.703, P = 0.001).

CONCLUSIONS

This study has confirmed that adrenocortical carcinoma overexpress signal transducer and activator of transcription 3 and insulin-like growth factor 2; these results suggest that angiogenesis of human adrenocortical carcinoma may be mediated by these proteins and they could represent selective targets for the molecularly targeted treatments of adrenocortical carcinoma.

Evaluation of the expression and role of IGF pathway biomarkers in human sarcomas

Recent studies have shown that insulin-like growth factor (IGF) signaling components have been involved in the pathogenesis and progression of different types of sarcomas. There has been some evidence to indicate the differential expression of IGF2 and insulin-like growth factor 1 receptor (IGF1R) in human sarcomas. The present study utilized immunohistochemistry (IHC) and in situ hybridization (ISH) to determine the expression of IGF2 and IGF1R in eighty-two cases of human sarcoma specimens and eight cases of non-tumor tissue (NTT). IGF2/IGF1R signaling was blocked by recombinant adenovirus-mediated IGF1R small hairpin RNA (shIGF1R), which was used to transfect into human osteosarcoma (OS) MG-63 cells. The expression of IGF2, IGF1R, matrix metallopeptidase-2 (MMP-2) and MMP-9 was detected by Real-time PCR. Cell migration was evaluated by wound healing assay. As a consequence, the expression of IGF1R and IGF2 was found in human OS with higher strong reactivity rate compared with the NTT (85.0 percent vs 50.0 percent, P=0.022; 95.0 percent vs 100.0 percent, P=0.042), elevating with the ascending order of tumor malignancy. Also, IGF1R had differential expression in different types of sarcomas (P=0.002), while IGF2 had no significant difference (P=0.105). Targeted blockade of IGF2/IGF1R signaling decreased the expression of IGF2, IGF1R, and MMP-2/-9, and diminished the migration capabilities of MG-63 cells. In conclusion, IGF1R is differentially-expressed in different types of human sarcomas, and targeted blockade of IGF1R pathway may inhibit human OS migration through down-regulation of MMP-2/-9 expression. IGF1R pathway may represent a significant therapeutic modality for the treatment of sarcomas.

[[Screening of differentially expressed miRNAs related to muscle strain and their target genes]

Muscle strain is one of the most common muscle injuries seen in the office of a practicing physician. To get a better understanding of this injury, we identified the differentially expressed miRNAs in muscle stem cells collected from injured muscle tissues of mouse. In this study, we downloaded the gene expression microarray (GSE26780) from Gene Expression Omnibus database. The dataset contained a total of 12 samples (murine muscle stem cells), including normal controls and samples collected from tissues at different time points after the injury. Differentially expreesed miRNAs were identified by LIMMA package and target genes of mmu-miR-143 were found by TargetScan. Then, a protein-protein in- teraction (PPI) network was constructed for the products of these target genes by using KUPS. Finally, Cytoscape and its plugins were used to identify and analyze the modules in this network. According to the results, 121, 136 and 148 differentially expressed miRNAs were identified in injured samples at each time point, and among them, 60 miRNAs were overlapping between all three groups. The expression values of mmu-miR-143 were most significantly altered over time at 36-72 h after the injury. Therefore, 510 target genes of mmu-miR-143 were found and a PPI network for the products of these target genes was constructed. Moreover, two modules were identified in the PPI network. Together with the previous studies, we suppose that proteins in module B, most of which are collagens or integrins, most likely participate in healing of strain injuries through cell adhesion processes.

Incidence and risk of hemorrhagic events with vascular endothelial growth factor receptor tyrosine-kinase inhibitors: an up-to-date meta-analysis of 27 randomized controlled trials

BACKGROUND

We aimed at determining the overall incidence and risk of hemorrhagic events associated with vascular endothelial growth factor receptor-tyrosine-kinase inhibitors (VEGFR-TKIs).

METHODS

We searched PubMed, EMBASE and Cochrane library databases for relevant prospective, randomized controlled trials (RCTs). Statistical analyses were conducted to calculate the summary incidence, relative risks (RRs) and 95% confidence intervals (CIs) by using either random-effects or fixed-effects models according to the heterogeneity of included studies.

RESULTS

The overall incidence of all-grade and high-grade hemorrhagic events was 9.1% (95% CI: 6.8-12.1%) and 1.3% (95% CI 0.8% to 2.1%), respectively. And the use of VEGFR-TKIs was associated with an increased risk of hemorrhagic events, with a relative risk (RR) of 1.67 (95% CI 1.19-2.33, P = 0.003), but not for high-grade hemorrhagic events (RR 1.23, 95% CI 0.86-1.77, P = 0.25). The risk of developing all-grade hemorrhagic events varied significantly with tumor types (P < 0.001) and different VEGFR-TKIs (P < 0.001). Additionally, the most common causes of all-grade hemorrhagic events were hemoptysis (48.6%) and epistaxis (20.7%), while hemoptysis (41.8%) and CNS hemorrhage (13.4%) was the most common cause of high-grade hemorrhagic events.

CONCLUSIONS

While the use of VEGFR-TKIs is associated with a significantly increased risk of developing hemorrhagic events in cancer patients, this is primarily for lower grade events.

First Report of Puccinia emaculata Infection on Switchgrass in Virginia

During the spring of 2007, approximately 2,000 switchgrass plants, representing 168 core switchgrass germplasm, were established in a field nursery at the Virginia Tech Kentland Farm Research Center in Montgomery County, VA. These germplasms were originally obtained from the USDA Plant Genetic Resources Conservation Unit (Griffin, GA) and included both lowland and upland ecotypes. After planting, the switchgrass plants were allowed to establish for 3 years. In the summers of 2009, 2010, and 2011, a substantial infection of a foliar rust pathogen was observed on more than 90% of switchgrass lines in the field. The infected leaves had dark brown pustules that were arranged in a linear fashion between the veins and mainly located on the adaxial surface of the leaf. We observed the infected leaf samples under a microscope and isolated the urediniospores. The urediniospores were brown, round, and averaged 26.08 ± 1.67 μm long and 24.65 ± 1.66 μm wide. Teliospores were observed late in the summers of 2009 and 2010. The teliospores were two-celled, oblong to ellipsoid in shape, and averaged 32.23 ± 3.07 μm in length. The apical cell width averaged 17.6 ± 1.83 μm and the basal cell width averaged 15.08 ± 1.75 μm. The morphology of both the urediniospores and teliospores were similar to Puccinia emaculata Schw. (P. emaculata) (2,3). Using previously established rust disease scoring methods (1), the infected switchgrass lines were evaluated and scored for infection severity on a 0 to 9 scale based on the percentage of leaf area infected, with 0 being either highly resistant or escaping infection and 9 being highly susceptible. The majority of upland switchgrass cultivars, including Caddo, Cave-in-rock, Blackwell, Sunburst, Pathfinder, and Dacotah, were moderately to highly susceptible to this rust pathogen and on average, scored between 7 and 8. However, the majority of lowland switchgrass cultivars, including Alamo, Kanlow, TEM-SEC, TEM-SLC, and TEM-LoDorm, were moderately to highly resistant and scored on average between 3 and 4. This result is consistent with previous reports that show that lowland ecotypes are more resistant to rust diseases (1). To further validate the identity of the rust pathogen, we designed two primers (5'-CCAGTAACGGCGAGTGAAGAG-3' and 5'-CGACTTCCATGGCCACCGTGCGGCTGTCT-3') based on the 18S rDNA sequence of P. emaculata (3). DNA was extracted from bulk infected leaf material for PCR amplification. The 1.2 kb PCR product was isolated and sent for DNA sequencing. The DNA sequence was 98% identical to the 18S rDNA sequence of P. emaculata (EU915294.1). To our knowledge, this study represents the first report of rust on a wide range of various switchgrass cultivars in Virginia. References: (1) D. M. Gustafson et al. Crop Sci. 43:755, 2003. (2) R. L. Hirsch et al. Plant Dis. 94:381, 2010. (3) J. Zale et al. Plant Dis. 92:1710, 2008.

Abstract P6-07-35: Dragonfly Effect or Ironic Paradox: Prognostic Implication of Postsurgical Drain in Breast Cancer Patients

Background: Surgical removal of primary breast cancer may result in subsequent alterations of host milieu. Massive clinical data have indicated that surgical extirpation favorably modifies the natural history for some patients, but it may also precipitate the metastatic outgrowth for others. Drainage fluid, harvested from a post-surgical wound, appears to be a physiological response to surgical trauma. However, few clinicians have recognized that the volume of wound drain might mirror the postoperative recurrence kinetics.

Methods: A total of 1439 patients were selected retrospectively from a large database of patients who underwent surgery between Jan 1, 2000 and Dec 31, 2002 in Fudan University Shanghai Cancer Center, Shanghai, China. The Spearman rank correlation analysis was conducted to evaluate the association between drainage volume of postoperative day 1 (POD1) and clinicopathological parameters, which included age at diagnosis, body weight at diagnosis, total number of excised axillary lymph nodes (ALNs), time to drainage volume less than 30ml (TTV30), total protein and albumin concentrations in serum. Survival curves were performed with Kaplan–Meier method and annual recurrence hazard was estimated by hazard function.

Results: Drainage volume of POD1 was positively correlated with age at diagnosis (Spearman's P &lt; 0.001), weight at diagnosis (P &lt;0 .001) and number of excised ALNs (P &lt;0 .001) and TTV30 (P &lt;0 .001), whereas it was inversely correlated with total protein concentration in serum (p = 0.028). We also observed that drainage volume of POD1 was significantly higher in patients with larger tumors (P &lt; 0.001) and ALNs involvement (P = 0.030).

In the univariate survival analysis, there was less recurrence and death in patients with lower drainage volume of POD1 (both p = 0.006). Cox proportional hazards regression analysis revealed that drainage volume of POD1 was an independent predictor of recurrence-free survival (RFS; p = 0.035) and overall survival (OS; p = 0.047). Additionally, triple negative patients with larger volume of POD1 seemed to have poorer RFS (log-rank p = 0.022; Cox model P &lt; 0.05) and OS (log-rank p = 0.015; Cox model P &lt; 0.05).

Conclusions: Our study suggests that postsurgical drainage volume was strongly correlated with prognosis in breast cancer patients. The aim of this study was not only to enlighten novel prognostic factors, but also to infer that some host related characteristics such as extent of reaction to surgery play very important roles in the growth of micro-metastases. Therefore, integration of both host and tumor related factors be more precise to predict relapse risk than current modalities such as the St Gallen criteria, Oncotype-21 and Mammaprint etc. Further research on the underlying mechanism of this phenomena may lead the way to new adjuvant treatment targets and strategies.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-35.

Visualizing orbital angular momentum of plasmonic vortices

Plasmonic vortices (PVs) are generated by focusing a radially polarized optical vortex (OV) beam onto a metal surface. The intensity distribution of the PV is registered with a near-field scanning optical microscopy and agrees well with a theoretical prediction as well as numerical calculation. Beside the dark central spot, the numerical calculation also shows an azimuthal Poynting vector belonging to the PV, implying that the orbital angular momentum (OAM) was transferred from the radially polarized OV. To directly verify the OAM, plasmonic trapping experiments with gold micrometer particles are performed and the particle rotation is visualized. Further experiments by varying the topological charge of radially polarized OVs show the corresponding changes in rotation in terms of speed and radius.

HGFK1 inhibits bone metastasis in breast cancer through the TAK1/p38 MAPK signaling pathway

Breast cancer metastasis to bone represents a devastating complication of advanced breast cancer, frequently resulting in significant increases in morbidity and mortality. An understanding of the mechanisms that govern breast cancer metastasis at the molecular level should lead to more effective therapies. Recently, the kringle 1 domain of human hepatocyte growth factor (HGFK1) was identified as a candidate metastasis suppressor gene. Here, we investigated whether HGFK1 is a key regulator of breast cancer bone metastasis. Of the 193 human breast carcinoma tissue samples examined, HGFK1 expression was relative higher in 82 (42.4%) by western blot and in 84 (43.5%) by quantitative real-time PCR. The higher expression of HGFK1 was significantly associated with a better prognostic value (P<0.001) and inversely correlated with bone metastasis (P=0.003). The efficacy of adeno-associated virus carrying HGFK1 (AAV-HGFK1) in osteolytic bone metastasis was then evaluated using an in vivo bone metastasis model. AAV-HGFK1 significantly inhibited osteolytic bone metastasis and prolonged the survival of mice in this model (P<0.01). In vitro, HGFK1 expression resulted in significant anti-invasion effects, enhanced the phosphorylation of TAK1 (transforming growth factor-β-activated kinase 1), p38 MAPK (mitogen-activated protein kinase) and MAPKAPK2 (MAPK-activated protein kinase 2) and decreased the expression of receptor activator of nuclear factor-κB (RANK), which was abrogated by the p38 MAPK inhibitor SB203580. This study shows for the first time that HGFK1 significantly inhibits the metastasis of breast cancer to bone by activating the TAK1/p38 MAPK signaling pathway and inhibiting RANK expression. Thus, AAV-HGFK1 treatment represents a potential therapy for bone metastasis in breast cancer.