Intracranial failure after hippocampal-avoidance prophylactic cranial irradiation in limited-stage small-cell lung cancer patients

We evaluated intracranial failure after hippocampus-avoidance-prophylactic cranial irradiation (HA-PCI) for limited-stage small-cell lung cancer (SCLC). Data of 106 patients who received PCI with 25 Gy were retrospectively reviewed. The patients were divided into two groups based on whether they underwent HA-PCI: the HA-PCI group (n = 48) and the conventional PCI (C-PCI) group (n = 58). Twenty-one patients experienced intracranial failure: 11 and 10 patients in the C-PCI and HA-PCI groups, respectively. Using the log-rank test, the intracranial failure rate was not significantly different between the groups (p = 0.215). No clinical factor was significantly associated with intracranial failure in multivariate Cox regression analysis, but HA-PCI tended to be associated with increased incidence of intracranial failure (HR 2.87, 95% CI 0.86–9.58, p = 0.087). Among patients who received HA-PCI, two developed peri-hippocampal recurrence. A higher thoracic radiotherapy dose (≥ 60 Gy) was significantly associated with DFS (HR 0.52, p = 0.048) and OS (HR 0.35, p = 0.003). However, HA-PCI was associated with neither DFS nor OS. Although HA-PCI may be associated with an increased risk of intracranial failure, HA-PCI did not impair disease control or survival. Future prospective randomized trials are needed to reach a definite conclusion.

Abstract 4946: Comprehensive molecular profiling reveals distinct immunemicroenvironment subtypes of oropharyngeal cancers

Background The oropharyngeal cancer (OPC) constitutes a distinct clinical subset of head and neck squamous cell carcinoma with high prevalence of HPV-associated tumorigenesis. However, the relationship between tumor molecular types and immune microenvironment has not been systematically delineated in OPCs. In this study, we classified the OPCs into three different molecular subtypes regarding their immunological character by comprehensive molecular profiling by RNA-seq and multiplexed immunohistochemistry (IHC).

Methods The 37 surgically resected primary OPC tumors were analyzed, and the HPV status was evaluated by p16 IHC. The transcriptome profiling of tumors by RNA-seq classified OPCs into three molecular subtypes based on t-SNE plotting. The immune microenvironment of each subtype was investigated using VECTRA spectral imaging system in terms of CD8 T cell and macrophage infiltration patterns, as well as T cell exhaustion maker expressions. The 10 OPC patients treated with anti-PD-1/PD-L1 blockade were also classified into three subtypes and their therapy response was compared.

Results We divided OPCs into Immune-rich (IR), mesenchymal (MS), and classical (CL) subtypes by RNA-seq clustering analysis. All IR type tumors were HPV-positive, whereas most CL types (7 out of 8) were HPV-negative. MS type showed mixed HPV status (HPV-positive in 5/14). The IR type showed favorable prognosis compared with poor prognosis of CL type, and MS type showed intermediate survival outcome. The IR type tumors showed high enrichment of adaptive immune response, T cell exhaustion, and cell cycle gene signature implying their highly immunogenic properties. The multiplexed IHC confirmed plenty of PD-1+CD8 T cells and type I macrophages infiltrating tumor nest in IR types. The MS type was characterized by upregulation of muscle, extracellular matrix, and TGF-β signatures with scant CD8 T cell signature expression. The IHC analysis of MS type showed exclusion of CD8 T cells from tumor nest that might be related to their high TGF-β-response signature (TBRS) score. CL types were related to high xenobiotic catabolism signatures, and showed low level of CD8 T cell infiltrations with focal CD73 expression. Among 10 OPC patients with anti-PD-1/PD-L1 blockade treatment, the IR type patients showed durable therapy response (3 of 4 patients), whereas CL type patients showed early progression on the treatment (3 of 4 patients).

Conclusions Our comprehensive analysis reveals that OPCs can be classified into three distinct subtypes based on their immune microenvironment properties. The three molecular subtypes showed distinct therapy response on anti-PD-1/PD-L1 blockade. These findings are pertinent to develop predictive markers on immunotherapy and to design combination immunotherapy strategies in OPC patients.

Citation Format: Min Hwan Kim, Jae-Hwan Kim, Dong Min Jung, Jae Woo Choi, Soo Jin Heo, Kyoung-Ho Pyo, Min Hee Hong, Byoung Chul Cho, Hye Ryun Kim. Comprehensive molecular profiling reveals distinct immunemicroenvironment subtypes of oropharyngeal cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4946.

Treatment for gastric ‘indefinite for neoplasm/dysplasia’ lesions based on predictive factors

BACKGROUND

Gastric ‘indefinite for neoplasm/dysplasia’ (IFND) is a borderline lesion that is difficult to diagnose as either regenerative or neoplastic. There is a need for guidance in the identification of a subset of patients, who have an IFND lesion with a higher risk of malignant potential, to enable risk stratification and optimal management.

AIM

To determine the clinical and pathologic factors for the accurate diagnosis of gastric IFND lesions.

METHODS

In total, 461 gastric lesions diagnosed via biopsy as IFND lesions were retrospectively evaluated. Endoscopic resection (n = 134), surgery (n = 22), and follow-up endoscopic biopsy (n = 305) were performed to confirm the diagnosis. The time interval from initial biopsy to cancer diagnosis was measured, and diagnostic delays were categorized as > 2 wk, > 2 mo, > 6 mo, and > 1 year. The IFND lesions presenting as regenerating atypia (60%) or atypical epithelia (40%) at initial biopsy were adenocarcinomas in 22.6%, adenomas in 8.9%, and gastritis in 68.5% of the cases.

RESULTS

Four clinical factors [age ≥ 60 years (2.445, 95%CI: 1.305-4.580, P = 0.005), endoscopic size ≥ 10 mm (3.519, 95%CI: 1.891-6.548, P < 0.001), single lesion (5.702, 95%CI: 2.212-14.696, P < 0.001), and spontaneous bleeding (4.056, 95%CI: 1.792-9.180, P = 0.001)], and two pathologic factors [atypical epithelium (25.575, 95%CI: 11.537-56.695, P < 0.001], and repeated IFND diagnosis [6.022, 95%CI: 1.822-19.909, P = 0.003)] were independent risk factors for gastric cancer. With two or more clinical factors, the sensitivity and specificity for carcinoma were 91.3% and 54.9%, respectively. Ten undifferentiated carcinomas were initially diagnosed as IFND. In the subgroup analysis, fold change (5.594, 95%CI: 1.458-21.462, P = 0.012) predicted undifferentiated or invasive carcinoma in the submucosal layers or deeper. Diagnostic delays shorter than 1 year were not associated with worse prognoses. Extremely well-differentiated adenocarcinomas accounted for half of the repeated IFND cases and resulted in low diagnostic accuracy even on retrospective blinded review.

CONCLUSION

More than two clinical and pathologic factors each had significant cut-off values for gastric carcinoma diagnosis; in such cases, endoscopic resection should be considered.

Potentially modifiable risk factors for atrial fibrillation following lung resection surgery: a retrospective cohort study

Atrial fibrillation is the most frequent arrhythmia after thoracic surgery and is associated with increased hospital costs, morbidity and mortality. In this study, we aimed to identify potentially modifiable risk factors for postoperative atrial fibrillation following lung resection surgery and to suggest possible measures to reduce risk. We retrospectively reviewed the medical records of 4731 patients who underwent lobectomy or more major lung resection over a 6-year period. Patients who developed atrial fibrillation postoperatively and required treatment were included in the postoperative atrial fibrillation group, while the remaining patients were assigned to the non-postoperative atrial fibrillation group. Risk factors for postoperative atrial fibrillation were analysed by multivariate analysis and propensity score matching. Overall, 12% of patients developed postoperative atrial fibrillation. Potentially modifiable risk factors for postoperative atrial fibrillation were excessive alcohol consumption (odds ratio (OR) = 1.48, 95% CI 1.08-2.02, p = 0.0140), red cell transfusion (2.70(2.13-3.43), p < 0.0001), use of inotropes (1.81(1.42-2.31), p < 0.0001) and open (vs. thoracoscopic) surgery (1.59(1.23-2.05), p < 0.0001). Compared with inotrope use, vasopressor administration was not related to postoperative atrial fibrillation. Use of steroids or thoracic epidural anaesthesia did not reduce the incidence of postoperative atrial fibrillation. We conclude that high alcohol consumption, red cell transfusion, use of inotropes and open surgery are potentially modifiable risk factors for postoperative atrial fibrillation. Pre-operative alcohol consumption needs to be addressed. Avoiding red cell transfusion and performing lung resection via video-assisted thoracoscopic surgery may reduce the incidence of postoperative atrial fibrillation and the administration of vasopressors rather than inotropes is preferred.

A gas chromatography-tandem quadrupole mass spectrometric analysis of policosanols in commercial vegetable oils

Reportedly policosanols (PCs) have various beneficial functionalities on health. A gas chromatography-tandem mass spectrometry (GC-MS/MS) with a low limit of detection (LOD), and high specificity, recovery, and precision was successfully established for the PC analysis in vegetable oils. The LODs for the PCs were in the range of 0.002 to 0.016 μg/mL. The relative standard deviation (RSD) for the repeated analysis of PCs was less than 3.356%. The mean recoveries for spiked heptacosanol and octacosanol in vegetable oil were 102.3% and 106.3%, respectively. The total PC contents in the vegetable oils varied from 3.01 to 427.83 mg/kg oil. Perilla seed, grape seed, and rice bran oils were found to be highly rich sources of PCs, containing 427.83, 245.15, and 171.17 mg PCs/kg oil, respectively. Corn, sesame, and soybean oils contained only a negligible quantity of PCs. The PC composition in vegetable oils was greatly source dependent. In perilla seed oil, octacosanol was the single most predominant component, representing 55.93% of the total PC. In grape seed oil, however, hexacosanol is the most abundant PC, followed by octacosanol, tetracosanol, and triacontanol in a decreasing order. The major PCs in rice bran oil were triacontanol, octacosanol, hexacosanol, and tetracosanol, which constituted over 87.3% of the total PC. This represents the 1st report on the composition and contents of PC in most vegetable oils analyzed here.

PRACTICAL APPLICATION

The information might be used for the development of vegetable oil products with beneficial functionality.

Study of interactions between food phenolics and aromatic flavors using one- and two-dimensional (1)H NMR spectroscopy

Changes in flavor release and aroma characteristics in a medium including food phenolics may be attributed to an intermolecular interaction between flavor compounds and phenolics. To investigate the interaction, one- and two-dimensional NMR studies have been carried out on the binding of two phenolics, gallic acid and naringin, with three aroma compounds, 2-methylpyrazine, vanillin, and ethyl benzoate. Evaluation of thermodynamic parameters and intermolecular nuclear Overhauser effects reveals that gallic acid can interact more strongly with aromatic flavors than naringin. The supramolecular complexation is also dependent on the structural nature of the flavors, with 2-methylpyrazine and vanillin interacting more strongly than ethyl benzoate. The interaction is principally pi-pi stacking between the galloyl ring and the aromatic ring of the aroma compounds, but secondary hydrogen-bonding effects help to stabilize the complex and enhance the specificity.

Energy-dependent Loading of Amino Acids and Sucrose into the Phloem of Soybean

Radioactive sucrose, l-leucine, l-glutamate, and gamma-aminobutyrate were applied exogenously to abraded areas of soybean leaves. The three amino acids were translocated with similar velocities and mass transfer rates on a molar basis, although they were metabolized differently in the sink tissue. The concentration dependence of leucine translocation showed a triphasic saturation response, while sucrose translocation showed a biphasic saturation response to increasing concentration. Apparent K(m) and V(max) for leucine and sucrose loading in the phloem differed. Both leucine and sucrose translocation were inhibited by uncouplers, high K(+), and p-chloromercuribenzenesulfonic acid. Treatment with 0.8 m sorbitol had little effect on sucrose translocation but stimulated leucine translocation, indicating an apoplastic route of loading for leucine. No effect on mass transfer rates was observed when sucrose and amino acids were applied exogenously together. These data provide evidence that phloem loading of amino acids and sucrose is mediated by different and separate carriers, both being dependent on an energy-requiring mechanism.