Abstract 3700: Prognostic value of the expression of NKG2D and CD96 in early stage non-small cell lung cancer (NSCLC)

Background: Immune checkpoint inhibitors showed impressive activity in advanced NSCLC and are expected to be effective in postoperative treatment of early disease. New therapies aimed at T and NK cell activation are in development to expand treatments options. It is conceivable that markers of ‘inflamed’, ‘immune system ignorant’ and ‘immune system excluding’ tumor phenotypes may be predictive for specific immune-targeting therapies.

Aim: We assessed prognostic value of expression of CD8(+) T and NK cell markers: CD96 and NKG2D in early stage NSCLC. In addition, we analyzed expression of 11 transcripts of APOBEC genes with hypothesis that APOBEC induced mutation burden may affect tumor immunogenicity or host adaptive immunity responsiveness.

Methods: mRNA levels were measured by RT-PCR in frozen tumor tissue from 65 NSCLC stage I-IIIA patients who underwent pulmonary resection (75% lung adenocarcinoma, 33% never-smokers, 44% with subsequent dissemination), and in 11 NSCLC cell-lines. The relative gene expression (vs. 5 normalization genes) was compared between groups that did and did not disseminate, and in relation to clinico-pathological features.

Results: After Bonferroni correction for multiple testing, NKG2D and CD96 mRNA expression was significantly lower in tumors with subsequent dissemination (p.adj.=0.045). Out of 11 APOBEC genes, expression of AICDA, APOBEC3A and APOBEC3G was lower in tumors with subsequent dissemination (p.unadj.=0.025). The NSCLC lines did not express NKG2D, CD96, AICDA or APOBEC3A. The Spearman corr. coeff. between the expression of NKG2D, CD96 and APOBEC3G were ≥0.8. AICDA expression was correlated with CD96, NKG2D and APOBEC3G with Spearman corr. coeff. in the range of 0.5-0.62. Expression of CD96 and NKG2D was significantly lower in tumors with vs. without subsequent brain metastasis (p.unadj.=0.048). The negative prognostic impact of low NKG2D and CD96 expression was independent from patient smoking status (FC <1, irrespective of smoking status). In the subset of never-smokers, the fold difference of NKG2D expression between tumors with vs. without subsequent dissemination was particularly pronounced (HR=0.37; p.unadj.=0.023). In multivariate Cox analysis including stage, CD96 and NKG2D expression was significantly correlated with distant metastasis free survival (p=0.028). The expression of CD96, NKG2D and APOBEC genes was not related to gender or NSCLC histological type. IHC co-localization and mRNA expression experiments at the background of other more established markers are planned.

Conclusions: Low expression of CD96 and NKG2D in early stage NSCLC may be predictive for high propensity to dissemination, including metastasis to the brain. The expression of APOBEC transcripts does not seem to correlate with metastatic potential.

Citation Format: Marcin Skrzypski, Michał Marczyk, Amelia Szymanowska, Anna Kowalczyk, Agnieszka Maciejewska, Ryszard Pawlowski, Wojciech Biernat, Joanna Polańska, Jacek Jassem. Prognostic value of the expression of NKG2D and CD96 in early stage non-small cell lung cancer (NSCLC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3700. doi:10.1158/1538-7445.AM2017-3700

Insulin-like growth factor receptor 1 (IGF1R) gene copy number is associated with survival in operable non-small-cell lung cancer: a comparison between IGF1R fluorescent in situ hybridization, protein expression, and mRNA expression

PURPOSE

The purpose of this study was to characterize insulin-like growth factor-1 receptor (IGF1R) protein expression, mRNA expression, and gene copy number in surgically resected non-small-cell lung cancers (NSCLC) in relation to epidermal growth factor receptor (EGFR) protein expression, patient characteristics, and prognosis.

PATIENTS AND METHODS

One hundred eighty-nine patients with NSCLC who underwent curative pulmonary resection were studied (median follow-up, 5.3 years). IGF1R protein expression was evaluated by immunohistochemistry (IHC) with two anti-IGF1R antibodies (n = 179). EGFR protein expression was assessed with PharmDx kit. IGF1R gene expression was evaluated using quantitative reverse transcription polymerase chain reaction (qRT-PCR) from 114 corresponding fresh-frozen samples. IGF1R gene copy number was assessed by fluorescent in situ hybridization using customized probes (n = 181).

RESULTS

IGF1R IHC score was higher in squamous cell carcinomas versus other histologies (P < .001) and associated with stage (P = .03) but not survival (P = .46). IGF1R and EGFR protein expression showed significant correlation (r = 0.30; P < .001). IGF1R gene expression by qRT-PCR was higher in squamous cell versus other histologies (P = .006) and did not associate with other clinical features nor survival (P = .73). Employing criteria previously established for EGFR copy number, patients with IGF1R amplification/high polysomy (n = 48; 27%) had 3-year survival of 58%, patients with low polysomy (n = 87; 48%) had 3-year survival of 47% and patients with trisomy/disomy (n = 46; 25%) had 3-year survival of 35%, respectively (P = .024). Prognostic value of high IGF1R gene copy number was confirmed in multivariate analysis.

CONCLUSION

IGF1R protein expression is higher in squamous cell versus other histologies and correlates with EGFR expression. IGF1R protein and gene expression does not associate with survival, whereas high IGF1R gene copy number harbors positive prognostic value.

Prognostic value of microRNAs (miRNAs) profiling in early-stage squamous cell lung cancer (SqCLC)

7594

Background: About 50% of NSCLC patients (pts) will develop distant metastases following pulmonary resection. Currently, apart from clinical stage at diagnosis, there are no reliable clinical factors to select high risk pts for adjuvant chemotherapy. miRNAs profiling is expected to indicate pts with aggressive disease and to provide prognostic information. Confounding effect of NSCLC pathology heterogeneity justifies searching for prognostic miRNAs separately in SqCLC and adenocarcinoma. Methods: Fresh frozen tumor tissue was obtained from 30 SqCLC stage I-II pts during curative pulmonary resection. Of those, 15 pts developed distant metastases and 15 had no relapse after a median follow-up of 5.4 years (range, 3.1–6.9 years). RNA was isolated from tumor sections containing ≥60% of tumor cells per section. Expression of 380 miRNAs was analyzed by RT-PCR arrays (TLDAs-Appliedbiosystems). Raw data were normalized vs. the expression of U6 RNA and calibrated by ΔΔCt method. Results: Expression of 300 miRNAs was detected in tumor tissues. Expression of three miRNAs (193a[5p], 146b[5p] and 10b) differed between groups with and without metastases (t-Student test, p<0.05). Due to the limited number of samples, proportional hazard regression for survival (Cox analysis) could not be performed on the full data set of 300 variables. Cox analysis performed for the top 5 miRNA identified with t-Student test showed significant correlation for 10b (p<0.02). The internal consistency of data sets was tested using PCA, and three samples were excluded. In this modified test set, the top 10 miRNAs (ranked according to p-value of t test) revealed two significantly correlated miRNAs in Cox analysis: 484 and 146b (5p). Similar results were obtained for miRNAs expression defined as continuous or categorized variables. Conclusions: Four miRNAs: 10b, 146b, 193a(5p) and 484 are potentially related to high metastatic propensity of early stage SqCLC. Further validation is necessary to confirm their prognostic relevance in this tumor.

No significant financial relationships to disclose.

[Smoking and lung cancer]

In this review we presented a relation between cigarette smoking and lung cancer. We characterized molecular alterations resulting from carcinogens present in the cigarette smoke and presented the constitutive genetic profiles related to the increased risk of lung cancer. We also discussed a possible use of these profiles in the selection of high risk groups among the heavy smokers. Finally, a positive impact of quitting smoking in lung cancer patients, including those who have undergone curative resection, was presented.

Analysis of safety, risk factors and pretreatment methods during rush hymenoptera venom immunotherapy

BACKGROUND

The safety profile of venom immunotherapy is a relevant issue. We evaluated the frequency of severe adverse events (SAE), associated risk factors, retrospective comparison of pretreatment protocols including solely H1 receptor blockers and a combination of H1 and H2 receptor blockers during rush Hymenoptera venom immunotherapy.

METHODS

The study group comprised 118 patients. The treatment was initiated according to a 5-day rush protocol with the use of standardized venom allergens of either wasp or honeybee.

RESULTS

During the rush induction, side effects occurred in 18 patients (15.2%), whereas SAE were present in 7 patients (5.9%). Twelve out of 18 (66.6%) developed anaphylactic reactions on the fourth day of the rush protocol, with the majority of cases at a dose of 40 or 60 microg of the venom extract (p = 0.001). The frequency of SAE was also significantly higher on the fourth day than thereafter (p = 0.0001) as well as in patients allergic to bee venom (p = 0.049). All systemic side effects were more frequent in women (p = 0.0065). However, this relation was not true when SAE were consider (p = 0.11). A higher percentage of SAE was observed in the subjects pretreated with both H1 and H2 receptor antagonists than in those pretreated with H1 blocker only (8.8 vs. 4.1%); however, the difference was not significant.

CONCLUSIONS

Considerable severity of allergic adverse events requires particular attention to patients allergic to bee venom and during rush phase, especially when rapidly increasing doses are administered. Pretreatment with H2 blockers is debatable and warrants further investigation.

Detection of Clostridium difficile in stool samples from patients in the early period after liver transplantation

OBJECTIVE

We examined the frequency of detection of Clostridium difficile (CD) toxins compared with the recovery of C. difficile in stool specimen cultures among orthotopic liver transplant (OLT) patients with nosocomial diarrhea in the early period.

MATERIALS AND METHODS

The study included stool samples obtained during the first 30 days after OLT in adults who were suspected of CD-associated diseases. The identification of cultured CD strains was performed by standard microbiological methods. The presence of CD toxins was assayed using a commercial immunoassay.

RESULTS

All patients were followed prospectively for CD infections from the date of OLT for the first 4 weeks after surgery. Among 54 samples, 16.7% were culture-positive for CD. CD toxins were tested on 54 samples, yielding 63% toxin-positive samples and 30% toxin- and culture-negative results. In the first week after OLT, samples from 19 patients were subjected to CD investigation. Among 19 samples positive for toxin, 52.6% of all samples were culture-negative. We analyzed 35 samples from the second to the fourth week after OLT in 31 recipients. Among 35 samples, 68.6% and 25.7% were positive for CD toxin and for culture, while 20% of samples were negative for toxin and culture.

CONCLUSION

In our study, 63% of samples were toxin-positive with 16.7% yielding growth of CD and 30% being negative for toxins and cultures.

Surgical site infections in liver recipients in the early posttransplantation period: etiological agents and susceptibility profiles

OBJECTIVE

This study evaluated the frequency of microbial isolates and their susceptibility profiles from cultures at the surgical site of 83 liver recipients in the early posttransplantation period.

PATIENTS AND METHODS

We prospectively collected microbiologic culture data on 83 adult patients undergoing orthotopic liver transplantation (OLT) using standard procedures and commercially available tests. Susceptibility of the strains to antibacterial agents was performed by the Clinical and Laboratory Standards Institute (CLSI) guidelines.

RESULTS

All patients were followed prospectively for the first 4 weeks after surgery. Among 284 microbial isolates from clinical surgical site samples in 80 liver recipients, cultures were positive in 110 samples. The most commonly isolated species were: Gram-positive cocci (n = 222 isolates, 78%) with dominance of methicillin-resistant coagulase-negative staphylococci (MRCNS; 42%) and high-level aminoglycoside-resistant enterococci (HLAR strains; 24.3%). Gram-negative bacteria were identified in 21.5% of positive cultures, including 30 strains (24%) from the Enterobacteriaceae family, with 13.3% of extended spectrum beta-lactamase producers [ESBL(+)]. Significant differences (P = .0012) were observed during the analysis of changes in the occurrence of Gram-positive bacteria isolated from the surgical site in the first week versus the second to the end of the fourth week.

CONCLUSION

Gram-positive bacteria predominated as 78% of isolates.

BRCA1: a novel prognostic factor in resected non-small-cell lung cancer

BACKGROUND

Although early-stage non-small-cell lung cancer (NSCLC) is considered a potentially curable disease following complete resection, patients have a wide spectrum of survival according to stage (IB, II, IIIA). Within each stage, gene expression profiles can identify patients with a higher risk of recurrence. We hypothesized that altered mRNA expression in nine genes could help to predict disease outcome: excision repair cross-complementing 1 (ERCC1), myeloid zinc finger 1 (MZF1) and Twist1 (which regulate N-cadherin expression), ribonucleotide reductase subunit M1 (RRM1), thioredoxin-1 (TRX1), tyrosyl-DNA phosphodiesterase (Tdp1), nuclear factor of activated T cells (NFAT), BRCA1, and the human homolog of yeast budding uninhibited by benzimidazole (BubR1).

METHODOLOGY AND PRINCIPAL FINDINGS

We performed real-time quantitative polymerase chain reaction (RT-QPCR) in frozen lung cancer tissue specimens from 126 chemonaive NSCLC patients who had undergone surgical resection and evaluated the association between gene expression levels and survival. For validation, we used paraffin-embedded specimens from 58 other NSCLC patients. A strong inter-gene correlation was observed between expression levels of all genes except NFAT. A Cox proportional hazards model indicated that along with disease stage, BRCA1 mRNA expression significantly correlated with overall survival (hazard ratio [HR], 1.98 [95% confidence interval (CI), 1.11-6]; P = 0.02). In the independent cohort of 58 patients, BRCA1 mRNA expression also significantly correlated with survival (HR, 2.4 [95%CI, 1.01-5.92]; P = 0.04).

CONCLUSIONS

Overexpression of BRCA1 mRNA was strongly associated with poor survival in NSCLC patients, and the validation of this finding in an independent data set further strengthened this association. Since BRCA1 mRNA expression has previously been linked to differential sensitivity to cisplatin and antimicrotubule drugs, BRCA1 mRNA expression may provide additional information for customizing adjuvant antimicrotubule-based chemotherapy, especially in stage IB, where the role of adjuvant chemotherapy has not been clearly demonstrated.

Increased BRCA1 mRNA: An independent prognostic variable in completely resected chemo-naive non-small cell lung cancer (NSCLC) patients (p)

7551

Background: Following surgical resection in operable NSCLC, 5-year survival is 60% in stage I, 39% in stage IIB and 23% in stage IIIA, with relapse commonly as distant metastases. The average benefit of adjuvant chemotherapy is 5%, ranging from nil in stage I to 15% in stage II-IIIA. Caretaker genes involved in keeping genetic alterations to a minimum include the nucleotide excision repair genes ERCC1 and myeloid zinc finger 1 (MZF1), which mediates ERCC1 expression, and other stability genes, such as BRCA1, which control processes involving large portions of chromosomes. Thioredoxin-1 (TRX1) is a redox protein overexpressed in NSCLC that is correlated with poor prognosis, and TWIST contributes to metastasis by promoting epithelial-mesenchymal transition. Methods: In order to identify p with a high risk of relapse, we investigated the expression of these 5 transcripts in frozen resected tumors from 126 resected NSCLC p by real-time quantitative PCR. Gene expression was normalized using β-actin and 18SrRNA expression as internal references. Results: Adenocarcinoma (adeno), 33 p; squamous cell carcinoma (SCC), 93 p. Stage: IA, 18 p; IB, 53 p; IIB, 33 p; IIIA, 22 p. Tumoral transcript expression with β-actin: ERCC1, 1.23; MZF1, 0.53; BRCA1, 3.65; TRX1, 1.82; TWIST, 7.75. A strong correlation was observed between the expression of ERCC1, MZF1 and BRCA1 (P<0.001). Expression of each of the 5 transcripts was higher in SCC than in adeno (P<0.001). Median survival (MS): low ERCC1 (<1.5) = not reached (NR), high ERCC1 = 33 months (m) (P=0.21); low MZF1 (<0.5) = NR, high MZF1 = 33 m (P=0.04); low BRCA1 (<5) = NR, high BRCA1 = 22 months (m) (P=0.01); low TRX1 (<0.8) = NR, high TRX1 = 39.5 m (P=0.02); no differences in MS according to levels of TWIST. In a multivariate Cox model for survival, BRCA1 and stage emerged as independent prognostic variables ( Table ). Conclusion: Increased BRCA1 is associated with shorter survival, and BRCA1 assessment could be useful for customizing adjuvant chemotherapy.

No significant financial relationships to disclose.

[Table: see text]

Gene expression levels of ribonucleotide reductase subunit M1 (RRM1), tyrosyl-DNA phosphodiesterase (Tdp1), nuclear factor of activated T-cells (NFAT), and BubR1 mRNA expression in completely resected chemo-naive non-small cell lung cancer (NSCLC) patients

18016

Background: A relationship between gene transcripts and survival in operable NSCLC is now emerging. RRM1 is involved in DNA repair, Tdp1 is implicated in the repair of CPT-induced topoisomerase damage, and NFAT promotes cancer invasion. BubR1 is a key spindle checkpoint gene, and altered BubR1 mRNA levels are associated with lymph node metastasis and chromosome instability. Methods: In order to identify p with a high risk of relapse, we examined the expression of these four genes in frozen resected tumors from 126 resected NSCLC p by real-time quantitative PCR. Gene expression was normalized using β-actin expression as internal reference. Results: Adenocarcinoma (adeno), 33 p; squamous cell carcinoma (SCC), 93 p. Stage: IA, 18 p; IB, 53 p; IIB, 33 p; IIIA, 22 p. Tumor transcript expression: RRM1, 2.10; Tdp1, 1.77; NFAT, 0.56; BubR1, 16.40. Expression of RRM1, Tdp1 and BubR1 was higher in SCC than in adeno (P<0.001). Median time to relapse (TTR) was longer for p with low levels of RRM1 (P=0.11), Tdp1 (P=0.86), NFAT (P=0.29), or BubR1 (P=0.44) (Table). A significant trend towards longer survival was also observed in stage I p with low RRM1 P=0.06). In a multivariate Cox model, tumor size > 4 cm and stage III predicted shorter TTR and survival. Conclusion: Increased mRNA expression of these genes is associated with shorter TTR; this knowledge could be useful for customizing adjuvant chemotherapy.

[Table: see text]

No significant financial relationships to disclose.

High insulin-like growth factor 1 receptor (IGF1R) expression is associated with poor survival in surgically treated non-small cell lung cancer (NSCLC) patients (pts)

7550

Background: IGF1R represents a novel molecular target in NSCLC. We aimed to evaluate the association between IGF1R expression, clinical characteristics and survival in operable NSCLC pts. Methods: 184 consecutive surgically treated pts (median follow up of 32 months [range: 13–51 months]) were included in the study. There were 23% females, 55% pts with squamous cell carcinoma, 28% with adenocarcinoma, 3% with large cell carcinoma, 13% with mixed carcinoma and 1% with other types, 5% were never-smokers. Median age was 64 years (range: 37–85 years). Pathological stage I was diagnosed in 41%, stage II –22%, stage III –33% and stage IV –4% pts. Induction or adjuvant treatment was not routinely used. IGF1R was evaluated in tissue microarray by immunohistochemistry and scored by two observers according to H-score, taking into account proportion of cells with positive staining times staining intensity (scale 0–400). Results: IGF1R IHC expression was low in analyzed samples (median H-score 20, range: 0–223). Higher IGF1R score was observed in adenocarcinomas vs. squamous-cell carcinomas (p=0.02) and never-smokers vs. smokers (p=0.02). IGF1R score did not depend on stage (p=0.98) and sex (p=0.83). When analyzed as a continuous variable, IGF1R score tended to associate with worse survival in the entire cohort (p=0.10), and was significantly associated with inferior survival in patients with complete (R0) resections (p=0.04). When categorized with cut-off point of 50 (30% of patients positive), IGF1R expression was again associated with poor survival (p=0.05). This association was confined to pathological stage I (hazard ratio, HR=3.07; 95% confidence interval, CI=1.41–6.70, p=0.005) vs. all other stages (HR=1.03; 95% CI=0.63–1.70, p=0.90), and to patients with adenocarcinoma histology (HR=2.67; 95%CI=1.17–6.70, p=0.02 vs. all other histologies (HR=1.28; 95%CI=0.79–2.11, p=0.32). Conclusion: In this cohort of operable NSCLC pts, high IGF1R expression was associated with never-smoking history, adenocarcinoma histology, and poor survival, particularly in stage I disease and in patients with adenocarcinoma. These results support involvement of IGF pathway in the progression of early-stage NSCLC.

No significant financial relationships to disclose.

Expression profile of 29 genes by real-time quantitative PCR (RT-QPCR) in early-stage (I-IIIA) squamous cell carcinoma of the lung (SCCL)

7612

Background: 5-year survival for surgically resected SCCL patients (p) is still limited. cDNA microarray studies have identified gene expression patterns that correlate with survival. We have examined the expression pattern of 29 genes selected by these studies to test their clinical prognostic value in early-stage SCCL. Methods: From 2000 to 2004, freshly frozen primary tumor specimens were obtained at the time of surgery from 66 Polish SCCL p. Sections were taken from blocks of tumor tissue for RNA extraction, and gene expression of the 29 genes was assessed by RT-QPCR (AB7900HT) using low density arrays (LDAs, Applied Biosystems). Expression values were dichotomized using the median value as the cut-off. Results: The univariate analysis showed 10 genes with prognostic value: PH4 (P=0.01); macrophage- colony stimulating factor (CSF1) (P=0.002); EGFR (P=0.05); KIAA0974 (P=0.02); ANLN (P=0.02); carbonic anhydrase IX (CA IX) (P=0.007); VEGFC (P=0.03); neurotrophic tyrosine receptor kinase 1 (P=0.04); fibronectin (P=0.002); insulin receptor (P=0.03). In the multivariate analysis of survival, CSF1, EGFR, CA IX and tumor size emerged as significant variables ( Table ). Conclusions: Tumor cells secrete CSF1, which attracts macrophages and induce them to express EGF, which in turn binds to EGFR in tumor cells. CA IX is regulated by hypoxia and plays a role in chemoresistance. Our findings highlight the relevance of tumor size and these markers in selecting p to receive adjuvant chemo- and targeted therapy.

No significant financial relationships to disclose.

[Table: see text]

Quality of Life of Patients with Asthma Which Has Been Well and Poorly Controlled

Introduction: The aim of the study was to assess the quality of life of patients with asthma who were well and poorly controlled. Material and methods: 70 patients with diagnosed asthma, aged from 18 to 40, were included into the study between November 2005 and February 2006 at the Specialist Hospital in Chojnice and Allergy out-patient Clinic of Medical University of Gdańsk. The diagnosis and stage of asthma, as well as the assessment of the control of disease was performed by the physician. Quality of life was assessed with the use of St. George Respiratory Questionnaire (SGRQ). Statistical analysis was made with the use of computer statistical program Statistica. Results: According to GINA in 26 patients mild asthma was diagnosed, in 31—moderated and in 13—severe disease. 41 patients were assessed as well controlled and 29—as poorly controlled. Older age and longer duration of the disease were related to severe asthma, p = 0.01 and p = 0.003, respectively. In well controlled patients overall score for SGRQ was 48.86, whereas in poorly controlled was—74.4. There was a significant difference between the overall quality of life in well and poorly controlled patients with asthma, p = 0.0001. This difference was found in all three domains: for symptoms, activity and impact on life, p = 0.014, p = 0.035 and p = 0.003, respectively. Conclusions: Quality of life is strongly dependent on the control of symptoms in asthmatic patients.

[Quality of life of patients with asthma which has been well and poorly controlled]

INTRODUCTION

The aim of the study was to assess the quality of life of patients with asthma who were well and poorly controlled.

MATERIAL AND METHODS

70 patients with diagnosed asthma, aged from 18 to 40, were included into the study between November 2005 and February 2006 at the Specialist Hospital in Chojnice and Allergy out-patient Clinic of Medical University of Gdańsk. The diagnosis and stage of asthma, as well as the assessment of the control of disease was performed by the physician. Quality of life was assessed with the use of St. George Respiratory Questionnaire (SGRQ). Statistical analysis was made with the use of computer statistical program Statistica.

RESULTS

According to GINA in 26 patients mild asthma was diagnosed, in 31 - moderated and in 13 - severe disease. 41 patients were assessed as well controlled and 29 - as poorly controlled. Older age and longer duration of the disease were related to severe asthma, p = 0.01 and p = 0.003, respectively. In well controlled patients overall score for SGRQ was 48.86, whereas in poorly controlled was - 74.4. There was a significant difference between the overall quality of life in well and poorly controlled patients with asthma, p = 0.0001. This difference was found in all three domains: for symptoms, activity and impact on life, p = 0.014, p = 0.035 and p = 0.003, respectively.

CONCLUSIONS

Quality of life is strongly dependent on the control of symptoms in asthmatic patients.

Application of ultrasound technique for cistern size measurement in dairy goats (short communication)

Abstract. The aim of the study was to compare ultrasound measurements of the gland cistern in goats obtained by various methods. The tests were conducted on goats of the Polish White Improved breed. Four ultrasound devices were used in the experiment, which were equipped with 4 different types of probes. The most similar measurements, rp from .729 to .927, were obtained with the use of a SonoVet2000 with a linear probe with the frequency of 5 MHz, applied to the middle part of the udder base, penetrating the opposite udder half and a Hitachi EUB 405+ with a 5.0 MHz convex probe applied to the middle part of the base of the diagnosed udder half, directing the emission surface of the probe towards the teat.

Increased risk of non-small cell lung cancer and frequency of somatic TP53 gene mutations in Pro72 carriers of TP53 Arg72Pro polymorphism

The aim of this study was to assess whether the TP53 Arg72Pro polymorphism is associated with an increased risk of non-small cell lung cancer (NSCLC). Additionally, in NSCLC patients, we investigated a potential association between this polymorphism and somatic TP53 gene mutations in tumour cells. The study group included 240 NSCLC patients who underwent curative pulmonary resection. The control group (576 healthy subjects) was matched for sex and cigarette smoking. TP53 Arg72Pro polymorphism was determined by denaturing high-performance liquid chromatography. Tumours from 157 NSCLC patients were analysed for mutation in TP53 exons 5-8 by single strand conformation polymorphism, followed by sequencing of samples with different band pattern. Tumours from the remaining 83 patients were subjected to a direct sequencing of TP53 exons 5-8. The proportion of Pro homo/heterozygotes versus Arg homozygotes was significantly higher in NSCLC patients (54%) than in controls (46%, p = 0.034). The crude odds ratio for NSCLC development in Pro72 allele carriers was 1.39 (95% CI: 1.03-1.88). When adjusted for sex, age and smoking status in the multivariate logistic regression model, odds ratio for NSCLC development was 1.28 (95% CI: 0.91-1.80). Somatic TP53 mutations were found in 62 out of 240 NSCLC patients (26%), more frequently in Pro carriers (31%) than in Arg homozygotes (20%, p = 0.06). These results indicate that the TP53 codon 72 Pro allele may increase the risk of NSCLC. Additionally, the correlation between Pro72 and somatic TP53 mutations suggests that Pro72 allele carriers may be predisposed to tumour development along a p53 associated form of NSCLC, a finding that warrants further investigations.

[Thymectomy in myasthenia gravis]

OBJECTIVES AND METHODS

To evaluate the results of thymectomy in myasthenia gravis we performed retrospective analysis of 82 consecutive patients in the mean age of 39 +/- 15 treated between 1991 and 2001. All patients underwent extended thymectomy by median sternotomy. Follow-up was assessed in 74 of 81(91.4%) patients, in the mean age of 39 +/- 15, discharged from the Department.

RESULTS

Fifty three (71.6%) patients had symptoms of myasthenia gravis for less than 2 years. According to Osserman's classification 8 (10.8%) patients were assessed as class I, 32 (43.2%) as IIA 26 (35.2%) as IIB and 8 (10.8%) as IIC. In the postoperative period 8 (10.8%) patients had respiratory insufficiency, 5 (6.8%) were reoperated for bleeding. One patient died (1.4%) due to bilateral pneumonia and pulmonary insufficiency. After thymectomy the improvement of patient's clinical status was observed in 46 patients (86.4%) and complete remission was in 13 patients (17.6%). Prompt improvement after thymectomy (p = 0.008) and short duration of symptoms (p = 0.036) are positive predictive factors. Patients in class I had significantly better prognosis concerning complete remission (p = 0.036). Age, gender, histology of the thymus, and type of the thymoma had no influence on long time follow up.

CONCLUSIONS

Extended thymectomy is a safe procedure leading to the improvement in majority of patients treated for myasthenia gravis.

[Analysis of prognostic value of TP53 gene mutations in non-small cell lung cancer]

The aim of this study was to assess the frequency and prognostic value of TP53 gene somatic mutations in non-small cell lung cancer. The study group included 240 NSCLC patients who underwent pulmonary resection at the Department of Thoracic Surgery, Medical University of Gdańsk. Tumour samples were evaluated for the presence of TP53 gene mutations in exons 5-8. In 157 cases SSCP method was used as a screening followed by sequencing of positive samples. In the remaining 83 patients mutations were analysed by direct sequencing. A total of 76 mutations (32%) were found, of those a missense type was dominant (67%), followed by silent and null type mutations (14% and 10%, respectively). There was no correlation between mutations and clinical characteristics, including age, sex, histological subtype, differentiation, tumour size, lymph node metastases, pTNM stage and smoking status. A multivariate Cox analysis demonstrated that tumour differentiation and pTNM stage were independent prognostic factors, whereas TP53 gene mutations were not. The results of this study indicate that TP53 gene mutations in NSCLC patients are not correlated with clinical characteristics and have no impact on survival.

MDM2 gene amplification: a new independent factor of adverse prognosis in non-small cell lung cancer (NSCLC)

The prognostic impact of MDM2 amplification in non-small cell lung cancer (NSCLC) remains unknown. In this study, we investigated the occurrence of MDM2 amplification in surgically treated NSCLC patients. Molecular data were correlated with clinicopathological factors and evaluated for their prognostic value. The study group included 116 NSCLC patients who underwent pulmonary resection between 1996 and 1999. MDM2 amplification was assessed by real-time PCR using hybridization probe format on a LightCycler (Roche). The calculated ratio was a MDM2 value normalized to the amplification of the housekeeping gene phenylalaninhydroxylase (PAH). Survival curves were drawn according to the Kaplan-Meier method and compared with the use of the log-rank test. Multivariate analysis was based on Cox regression analysis. MDM2 amplification was found in 24 patients (21%). There was no relationship between MDM2 amplification and clinicopathological factors, such as sex, age and stage of disease, pT, pN, histology and tumor differentiation. Median disease-free survival (DFS) in patients with and without MDM2 amplification was 3 and 31 months, and 5-year DFS 24 and 33%, respectively (log-rank, P = 0.02). Likewise, median overall survival (OS) in patients with and without MDM2 amplification was 9 and 33 months, respectively, and 5-year OS 24 and 39%, respectively (log-rank, P = 0.01). The strong prognostic relevance of MDM2 amplification for both DFS and OS was confirmed in multivariate analysis (P < 0.01 for both comparisons). Our results suggest that MDM2 gene amplification analysis provides additional prognostic information in surgically treated NSCLC patients.

P53and K-rasmutations are frequent events in microscopically negative surgical margins from patients with nonsmall cell lung carcinoma

BACKGROUND

The objective of the current study was to determine whether tumor cells harboring P53 and K-ras mutations could be detected in histopathologically tumor-free surgical margins in patients with nonsmall cell lung carcinoma who underwent complete pulmonary resection.

METHODS

In 118 consecutive patients, DNA obtained from primary tumors and from surgical margins was extracted for molecular analysis. A fragment of P53 gene encompassing exons 5-8 and codon 12 of the K-ras gene were amplified with the polymerase chain reaction technique and were assayed for the presence of mutations.

RESULTS

P53 and K-ras mutations were found in 30% and 39% of primary tumors, respectively, and in 11 (9%) and 22 (18%) apparently tumor-free surgical margins, respectively. At least 1 of those mutations was found in surgical margins in 29 patients (25%), and both mutations were found in 2 patients (1.7%). P53 mutations in surgical margins accompanied mutations in primary tumors in 9 of 35 patients (26%), and K-ras mutations accompanied mutations in primary tumors in 20 of 46 patients (44%). Among patients with either mutation in primary tumors, the incidence of at least 1 mutation in surgical margins was 43% (28 of 65 patients). In four patients, mutations (two K-ras mutations and two P53 mutations) were found in surgical margins despite the absence of the corresponding mutations in primary tumors. The presence of mutations in primary tumors and in surgical margins was not related significantly to clinical characteristics or to patient outcomes.

CONCLUSIONS

P53 and K-ras mutations are frequent events in surgical margins determined to be tumor free on light microscopy. The clinical relevance of these findings remains to be established.

The influence of blood transfusion on survival in operated non-small cell lung cancer patients

BACKGROUND

It has been postulated that allogeneic transfusions have immunosuppressive effects that can promote tumor growth and metastasis formation. Despite the variety of publications on this controversial topic, the influence of blood transfusion on survival is not yet clearly identified. The impact of autologous blood transfusion on survival has only occasionally been analyzed in cancer patients.

OBJECTIVE

To determine the effect of perioperative allogeneic and autologous blood transfusions on survival in non-small cell lung cancer patients treated with curative pulmonary resection.

METHODS

Of 493 consecutive patients, 185 (37.5%) received allogeneic blood products and 145 (29.4%) received autologous blood products, whereas 163 patients (33.1%) received no blood products. Survival analysis included univariate log-rank test and multivariate Cox regression model.

RESULTS

Three-year survival probabilities in allogeneic, autologous, and nontransfused groups were 40%, 48%, and 61%, respectively, and the estimated 5-year survival probabilities were 34%, 38%, and 48%, respectively. In the univariate analysis there was a reduced survival in allogeneic versus nontransfused group (P <.01). In the multivariate analysis stage (P <.01), initial hemoglobin level (P =.01) and sedimentation rate (P =.03) remained significant factors, whereas the type of blood transfusion (allogeneic versus autologous) was no longer significant. There was no significant impact of transfusion in the multivariate analysis when patients in stage III or patients who underwent pneumonectomy were excluded.

CONCLUSION

Neither allogeneic nor autologous blood transfusion has independent, adverse survival impact in non-small cell lung cancer patients treated with radical pulmonary resection.

[Serum anti-P53 antibodies (AB-anti-P53) in patients with advanced non-small cell lung cancer (NSCLC)]

The aim of the study was to assess the frequency of serum Ab-anti-p53 in 39 patients with advanced NSCLC and to evaluate the predictive value of the test. Antibodies were present in 10 (25.6%) of patients. There was no correlation between Ab-anti-p53 and clinical characteristics including age, gender, and histological type of tumor. In 17 patients response to chemotherapy (CT) was obtained (in one patient--complete, and in 16--partial response). The percentage of patients responding to CT in group with and without serum antibodies did not differ significantly (33% and 48%, respectively; p = 0.48). The results of the study indicate that serum Ab-anti-p53 are relatively often present in advanced NSCLC patients, however the clinical value of this test needs further evaluation.

[P53 and P16 gene mutations in non-small cell lung cancer]

The aim of this study was to assess prospectively the occurrence of p53 and p16 mutations (considered separately and together) in NSCLC in terms of their clinical and prognostic relevance. Study group included 87 patients who underwent pulmonary resection for cure. p53 and p16 mutations were found in 22 (25%) and 14 (16%) cases, respectively. In eight patients (9%) both mutations were present, and the tendency for their common occurrence was significant (p = 0.02). There was no relation between mutation and clinical characteristics. Median survival in the entire group was 17 months and the 3-year survival probability--41%. There was no correlation between the occurrence of any mutation (considered separately or together) and survival. These results indicate that p53 and p16 gene mutations tend to occur together in NSCLC, however these alterations seem not to have noteworthy clinical and prognostic significance.

[Use of PCR for evaluating detection of coa and nuc genes in methicillin-resistant, coagulase-negative strains of Staphylococcus aureus (MRSA-CN)]

Strains showing a negative reaction in tube test for coagulase constitute 10 to 20% of all Staphylococcus aureus isolated from patients of Hospital of Infant Jesus in Warsaw. Most of them are MRSA. In 42 MRSA strains showing negative reaction for coagulase, the presence of coagulase (coa) and nuclease (nucA) genes was checked. Determination of whole cell DNA with PCR reaction was performed. The obtained results revealed that all 42 strains possessed gene nucA, but only 39 strains possessed the coa gene.

Results of surgical treatment of non-small cell lung cancer: validation of the new postoperative pathologic TNM classification

OBJECTIVE

Prognostic relevance of the current TNM stage grouping for lung cancer is still a matter of debate.

METHODS

To validate the new pathologic TNM classification for non-small cell lung cancer, we analyzed the survival data of 586 patients who underwent complete pulmonary resection and pathologic staging at one institution.

RESULTS

The current TNM stage grouping well reflected the long-term prognostic hierarchy. There was a good distinction between new substages IA and IB (5-year survivals of 66% and 53%, respectively). The subdivision of stage II led to an under-representation of stage IIA (6 patients [1.0%]), and therefore the appropriateness of this modification could not be verified. Five-year survival in the T3 N0 category (30%) was significantly better than that found in the new stage IIIA (15%). No difference was found between T3 N0 and T2 N1, the categories constituting new stage IIB. Within stage IIIA there was a significant survival difference between T3 N2 (6%) and the remaining T and N designations (18%). Moreover, the 5-year survival in the T3 N1 category (35%) was similar to that found in the new stage IIB (27%) and better than in any T N2 tumors (12%).

CONCLUSION

Most of our findings confirmed prognostic relevance of the current pTNM stage grouping in patients with resectable non-small cell lung cancer. However, despite recent modifications, there is still a significant heterogeneity that flaws stage IIIA.

Heavy metals in three lakes in West Poland

Concentrations of heavy metals (Ni, Cr, Co, Zn, Mn, Pb, Cd, Cu, Hg, Fe) as well as macronutrients (P, Ca, Mg) were measured in water, bottom sediments, and plants of three lakes in West Poland (southwest of Poznan). The plants collected were Nymphaea alba, Nuphar luteum, Ceratophyllum demersum, Phragmites communis, Typha latifolia, and Schoenoplectus lacustris. These plants contained elevated levels of Co, Zn, Pb, Cd, Cr, and Hg. Analyses of water and bottom sediments indicated that the lakes were polluted with Zn, Cd, Cu, and Pb and partly with Ni and Hg. Strong positive correlations were found between concentrations of Cd in water and in plants, between concentrations of Cd in bottom sediments and in plants, between concentrations of Cr in water and in plants, between concentrations of Cr in bottom sediments and in plants, and between concentrations of Fe in water and in plants, indicating the potential of plants for pollution monitoring for these metals. A negative correlation was found between biomass production and Pb and Mn content in water and Pb and Mn content in bottom sediments. Cr and Cd accumulated in plants at a higher rate from bottom sediments than from water. The accumulation rate of Fe in plant tissues was higher with an increase in Fe in water than with an increase in Fe in bottom sediments.

[Production of staphylokinase and hemolysin by coagulase-negative staphylococcus]

The ability to staphylokinase production by the representative of the six of fifteen investigated species of staphylococci was detected: S. epidermidis, S. lentus, S. sciuri, S. lugdunensis, S. xylosus and S. hominis. The frequency of occurrence of this feature was different among the investigated species. Relatively, the least frequently this feature was observed with S. epidermis (2.3%) and S. xylosus (8.3%) strains. This property most frequently occurred among S. lentus--all the examined strains of this species produced staphylokinase. The hemolysins synthesis was shown among 13 of 15 investigated coagulase-negative species of staphylococci. The only two species of the examined representatives did not produce any hemolysin: S. hyicus and S. schleiferi. Complete correlation between staphylokinase synthesis and the absence of beta-hemolysin production was observed among strains: S. lugdunensis and S. lentus as with the lysogenic S. aureus strains with the double converting phages.