Anthropogenic litter in marine waters and coastlines of Arctic Canada and West Greenland

Despite much interest and research into marine litter (including plastic debris) on beaches globally, relatively little is known about the density and distribution of this pollutant in Arctic environments, particularly Arctic Canada and West Greenland. We used two sources of data, observations of floating litter from vessels at sea, and quadrat surveys of litter on low slope beaches, to establish the first measures of anthropogenic litter densities in this region. Most litter observed (73%) was plastic, predominantly fragments, threads and sheets, with a mean density of 1.0 ± 1.7 (SD) items·m^-2 along sandy/gravel beaches (median 1), and items were observed on the ocean surface as far as 78°N. Litter densities were significantly greater for sites within 5 km of communities, and much of the litter near remote communities was clearly from local sources. However, contrary to our predictions, we did not find that litter densities decreased with increasing latitude. Collectively, our results confirm that this global pollutant is distributed around much of this portion of the Arctic, and that better waste management strategies in a number of sectors may help reduce its occurrence in this remote region.

Abstract P2-10-19: Are the mitotic factors Mitotic Activity Index (MAI) and Phosphohistone 3 (PPH3) stronger prognostic proliferation factors than Ki67 in node-negative breast cancer?

Background: The prognostic value of proliferation in node-negative breast cancer, either in the form of Ki67 or as the main common denominator in different gene expression profiles, has become clearer over the last years. The St Gallen guidelines recommend the use of Ki67 to distinguish between the luminal A and luminal B-like subtypes. Also, data have shown that Ki67 can separate patients with histological grade 2 into two groups with significant difference in prognosis. However, there is no consensus on the methodology for Ki67, and genetic profiling is still expensive. Previous studies have shown a strong prognostic value of the mitosis- and late G2-specific proliferation factors Phosphohistone H3 (PPH3) and mitotic activity index (MAI) in node-negative breast cancer. The present study was set up to study the value of these two factors compared to Ki67, alone and combined.

Material and methods: In 221 consecutive premenopausal node-negative breast cancer patients, of whom 87% had received no adjuvant medical treatment, PPH3 was assessed on tissue microarray (TMA), and MAI on whole sections. TMA-data on Ki67 was already available. Cut-offs for MAI, PPH3, and Ki67 were predefined. Cox proportional hazards regression was used to model the impact of the prognostic factors on distant disease-free survival (DDFS). The follow-up was restricted to the first 5 years after diagnosis, a time period during which 34 patients developed distant recurrences.

Results: In univariate analysis the strongest prognostic proliferation factor for DDFS was MAI (HR 5.1 95%CI 2.4–11, p < 0.0001), followed by PPH3 (HR 3.7 95%CI 1.8–7.5, p < 0.0001), and Ki67 (HR 2.7 95%CI 1.3–5.4, p = 0.005). ER, PR, HER2, histological grade, and age were also significant prognostic factors. When adding PPH3 to MAI, the prognostic value of MAI was strengthened (HR 6.3 95%CI 2.6–15, p < 0.0001). This corresponded to a 5-year DDFS of 95% for the 57% of the patients who were low risk (95%CI 88–98%), and 71% (95%CI 60–80%) for the 43% high risk patients. Ki67 did however not add any prognostic value to MAI. When stratifying for ER status and histological grade, MAI was a significant prognostic factor in the ER+ patients (HR 15 95%CI 5.1–41, p < 0.0001), as well as in patients with histological grade 2 (HR 11 95%CI 3.2–38, p < 0.0001). In multivariate analysis including HER2, age, and ER, and one proliferation factor at a time, MAI was the only proliferation factor that added independent prognostic value (HR 3.6 95%CI 1.1–11, p = 0.028).

Discussion: The present study on node-negative breast cancer patients confirms the strong prognostic value of the proliferation factors MAI and PPH3, in all patients, and more specifically in ER+ patients, and patients with histological grade 2. The study also suggests that by combining two proliferation factors, MAI and PPH3, an even stronger prognostic value is found. Ki67 however, did not add any prognostic value to MAI. Taken together, MAI and PPH3, alone and in combination may be helpful for prognostic considerations and for selection of adjuvant medical treatment.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-10-19.

Use of Receiver Operating Characteristic (ROC) Analysis To Determine the Most Optimal Prognostic Threshold for Adjuvant! in Lymph Node Negative Breast Cancer Patients < 55 Years

Background: Adjuvant!1 is a web based tool to predict the 10-year relapse free survival (RFS), breast cancer specific survival (BCSS) and overall survival (OS) probabilities using age, tumor size (pT), lymph node status (pN), histological grade (Grade 1-3), Estrogen receptor (ER) status in the estimation. A challenge is to find optimal cut-off values of the Adhuvant probabilities to compare the predictions with other prognostic factors.Patients and methods: In the Dutch nationwide Multicenter Morphometric Mamma Carcinoma Project 3472 patients have been enroled2, of which 516 <55 years with T1-3N0M0 underwent surgery and local radiation therapy when indicated. Adjuvant systemic treatment was not given according to the Dutch guidelines at that time. Median follow-up is 10 years. The 10-year RFS, BCSS and OS probabilities were evaluated with Adjuvant! Since these estimated predicted probabilities are continuous, optimal thresholds can be evaluated by the Receiver Operating Characteristic (ROC) analyses. Concordances between the Adjuvant predicted outcomes and, classical prognosticators were evaluated by the Spearman-correlation test.Results: The optimal cut-points for Adjuvant-RFS, Adjuvant-BCSS and Adjuvant-OS were 62% (Area Under the Curve=AUC==0.603, p=0.0004), 86% (AUC=0.635, p=0.0001) and 72% (AUC=0.598, p=0.0002) respectively. Using these thresholds, a moderate correlation was found between all the Adjuvant! endpoints and pT, Grade 1-3 and ER status (r=0.34 – 0.63). In the univariate survival analysis (Kaplan Meier) the above Adjuvant thresholds were highly prognostic. For Adjuvant-RFS >63/≤63 the 14-year survival was 77% and 64% respectively (p=0.001; log-rank). Moreover, for Adjuvant-BCSS (≥86/<86) the corresponding numbers were 82% and 67% ( P < 0.0001; log-rank). For Adjuvant-OS (≥72/<72) the survivals were 77% and 64% respectively (p<0.0001; log-rank). With multivariate analyses, Adjuvant! variables were part of the model only for BCSS and OS. However, Grade1-3 was prognostically stronger than Adjuvant! regarding both BCSS and OS. Furthermore, when the three features that constitute grade (tubular formation, nuclear atypia and mitosis count), only the latter was included in the final model.Discussion: ROC analysis can obtain optimal prognostic threshold values from web-based prognostic tools using time dependent endpoints3. A high grade of dependency between Adjuvant! and its’ underlying variables must be taken into account when the multivariate model is put up. Mitotic activity in the tumor seems to overrule Adjuvant!. This should be further explored.1 www.adjuvantonline.com2 Baak JPA, et al.: Pathol Res Pract 185:664-70, 19893 Zlobec I, et al.:J Clin Pathol 60:1112-1116, 2007.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3178.

Mitotic Activity Index Identifies Both Over- and Undertreated Lymph Node Negative Breast Cancer Patients < 55 Year According to the Norwegian Treatment Guidelines

Background: It is a challenge to avoid under- and overtreatment of breast cancer patients in the adjuvant setting. Patients who have not received adjuvant systemic treatment and with a known outcome demonstrate the natural course of the disease after surgery. Such patients may be re-evaluated in specific guidelines like the Norwegian Breast Cancer Group (NBCG) based on the St. Gallen criteria. NBCG classify the patients in a low-risk group which should not receive systemic treatment, and a high-risk group which should be offered such therapy. New factors may be evaluated in these two strata, possibly discriminating groups of under- or overtreated patients. The aim of this study was to explore if the previous established marker of proliferation, the mitotic activity index (MAI), could give any additional information.Patients and methods: The study comprised 516 lymph node negative patients < 55 years from the Dutch prospective Multicenter Morphometric Mammary Carcinoma Project (MMMCP; 1987-1989)1. No adjuvant systemic treatment was given after surgery to these patients. The guidelines from NBCG-2005 were used to classify the patients in “NBCG low-risk” group (n=100) defined as pT1/Grade 1, all ages and pT1a-b/Grade 2-3, >35 years, all hormone receptor positive. The rest of the patients (n=416) was grouped as “NBCG high-risk”. Breast Cancer Specific Survival (BCSS) was estimated by the Kaplan-Meier method. MAI was analyzed after a standardized protocol in the invasive front of the tumor. The previous established thresholds of MAI with low (<3), intermediate (3-9) and high (≥10) proliferation were used in the calculations.Results: In the “NBCG low-risk” group 10 % of the patients had MAI ≥10. These had a 14-years BCSS of 50 % (HR=15.47, 95 % CI=3.61-66.30) and may be regarded as undertreated patients. Patients with MAI <3 and 3-9 had a BCSS of 95 % and 83 % respectively. In the “NBCG high-risk”group 24 % of the patients with MAI<3 had a 14-years BCSS of 92 % indicating overtreatment. Furthermore, patients with MAI 3-9 and ≥10 had a BCSS of 74 % and 63 % (p-trend <0.0001).Discussion: MAI represents the “converging mitotic drive” from all cellular signal pathways in the peripheral growing zone of the tumor, where also micro-environmental factors are known to influence proliferation of cancer cells. This may explain why MAI gives original information strong enough to identify subgroups breast cancer patients who would not get optimal adjuvant treatment. A disadvantage of this study is that the HER-2 status in this MMMCP material is not known. National prospective studies are needed to verify our results.1 Baak, JPA et al: Pathol Res Pract 185:664-70,1989.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3182.

New chromosomal regions with high-level amplifications in squamous cell carcinomas of the larynx and pharynx, identified by comparative genomic hybridization

Squamous cell carcinomas of the head and neck generally exhibit complex karyotypes. To gain better knowledge of the changes in the subgroup of laryngeal and pharyngeal squamous cell carcinoma, chromosomal gains and losses were investigated in 42 predominantly late-stage tumours, using comparative genomic hybridization. On average, 11.2 gains and 6.8 losses were found. Gains were detected in high frequencies at 1q, 3q, 5p, 7q, 8q, 11q13, 17q, and 18p, and losses at 3p, 4p, 5q, 11qter, and 18q. Neither the number nor the type of abnormalities, nor the occurrence of specific chromosome changes, was found to be related to DNA ploidy, tumour stage, or degree of differentiation. Apart from low-level gains, many high-level amplifications were identified, in particular 3q24-qter (15 cases). Other regions recurrently involved were 11q13 (7 cases), 18p (5 cases), 18q11.2 (4 cases), and 8q23-24 and 11q14-22 (3 cases). Many of these amplified regions have not been reported before. Over half of all loci harbour genes coding for growth factors and growth factor receptors, suggesting an important role for such genes in squamous cell tumourigenesis and in the progression of late-stage tumours.

Molecular and biological factors in the pathogenesis of ovarian cancer

BACKGROUND

The classic prognostic parameters are insufficient for predicting the prognosis of the individual patient. Knowledge of molecular and biological factors which are responsible for the development and progression of ovarian cancer may improve the prediction of prognosis.

MATERIALS AND METHODS

Recent data both on factors associated with the development and control of ovarian cancer cells and on DNA ploidy have been reviewed.

RESULTS

Observations suggest that steroid and peptide hormones have a role in disease etiology and progression, and that peptide growth factors and cytokines, oncogenes and tumor suppressor genes, by their impact on mitosis and cell number may influence the rate of mutations, which could confer malignant transformation. DNA ploidy is an objective independent prognostic factor. DNA aneuploidy indicates high risk, diploidy low risk. Only tumours shown to be DNA diploid by flow-cytometry and image cytometry are considered diploid. S-phase fraction is currently not reliable.

CONCLUSION

Understanding the mechanisms involved in ovarian cancer development and growth will allow opportunities for the rational design of effective anti-tumour treatment modalities. More objective and reproducible prognostic variables will improve the predictiveness of prognosis.

Advanced epithelial ovarian cancer: 1993 consensus statements

BACKGROUND

Over the last few days of a 5-day international workshop held in June 1993, a group of specialists in the field of advanced epithelial ovarian cancer tried to reach consensus on a number of issues with implications for standard practice and for research.

METHODS

Five groups of experts considered several issues which included: biologic factors, prognostic factors, surgery, management recommendations, dose intensity, supportive care, drug resistance, second-line treatment, investigational drugs, and tumour markers. Discussing the management recommendations, the group attempted to arrive at answers to four questions: Is there in fact a cure rate for advanced ovarian carcinoma? Are there prognostic factors which help to identify patients who will not do well with current therapy? What is the current best therapy for advanced ovarian carcinoma? What directions should research take in advanced ovarian cancer? In a plenary meeting these issues were discussed.

RESULTS

Consensus statements were achieved on all topics mentioned above. This article reports on the statements written by the chairmen and approved by the consensus group.

Proposal for therapeutic approach based on prognostic factors including morphometric and flow-cytometric features in stage III-IV ovarian cancer

In 73 patients with International Federation of Gynecology and Obstetrics (FIGO) Stage III and IV ovarian cancer the prognostic significance of morphometric and flow-cytometric features has been evaluated in comparison with more commonly used prognostic factors such as stage and tumor mass. Single features associated with prognosis were as follows: FIGO stage, bulky disease, mean and standard deviation of nuclear area, cellular DNA content, mitotic activity index, and volume percentage epithelium. Multivariate analysis showed that the most significant prognostic combination of features consisted of mean nuclear area, presence or absence of bulky disease, and FIGO stage (in sequence of decreasing importance; Mantel-Cox = 23.07, P less than 0.00001). On the basis of these factors patients with a poor prognosis can be identified. On the other hand two features were associated with an excellent prognosis namely a low mitotic index and a low-volume percentage epithelium. It is concluded that morphometric and flow-cytometric analysis in combination with clinical features can provide significant information to predict the prognosis of patients with advanced ovarian cancer treated with debulking surgery and platinum-based chemotherapy. On the basis of our data a tentative proposal for future therapeutic approaches is made.