Serum Creatinine-Cystatin C Based Screening of Sarcopenia in Community Dwelling Older Adults: A Cross-Sectional Analysis

OBJECTIVES

To compare the discriminative capabilities for the manifestation of sarcopenia or physical frailty between serum creatinine- and cystatin C-derived indices among community-dwelling older adults.

DESIGN

Cross-sectional study.

SETTING

Primary Care and Community.

PARTICIPANTS

We utilized a subset of data from the Frail Elderly in the Sasayama-Tamba Area (FESTA) study, which was initiated in 2015 to gather comprehensive information on various health-related parameters among community-dwelling older individuals (age ≥65 years).

MEASUREMENTS

Five serum creatinine-cystatin C based indices including the Sarcopenia Index, the serum creatinine/cystatin C ratio, the disparity between serum cystatin-C-based and creatinine-based estimated GFR, the total body muscle mass index (TBMM), and the prediction equation for skeletal muscle mass index (pSMI) were employed. Sarcopenia and physical frailty were identified based on the Asian Working Group for Sarcopenia criteria and the revised Japanese version of the Cardiovascular Health Study criteria, respectively. The receiver operating characteristic (ROC) and logistic regression analyses were performed to assess the discriminative abilities of these tools.

RESULTS

In the analysis of 954 participants, 52 (5.5%) were identified with sarcopenia and 35 (3.7%) with physical frailty. Regarding sarcopenia discrimination, TBMM and pSMI both exhibited area under the curve (AUC) values exceeding 0.8 for both men and women. Concerning the identification of physical frailty, AUC values ranged from 0.61 to 0.77 for males and 0.50 to 0.69 for females. In the multivariate logistic regression analyses, only TBMM and pSMI consistently displayed associations with sarcopenia, irrespective of sex (P<0.001, respectively). On the other hand, no consistent associations were observed between the indices and physical frailty.

CONCLUSIONS

This study provides a robust association of a serum creatinine- and cystatin C-derived indices, especially TBMM and pSMI, with sarcopenia among community-dwelling older adults. Conversely, the application of these indices for the screening of physical frailty has its constraints, necessitating further investigation.

Clinically amyopathic dermatomyositis manifested after the allogeneic haematopoietic stem cell transplantation: Case presentation and literature review

Clinically amyopathic dermatomyositis (CADM) lacks muscle symptoms, associated with rapidly progressive interstitial lung disease. Anti-melanoma differentiation-associated gene 5 (MDA-5) antibody has been identified as a disease-labelling autoantibody. We report two cases of CADM manifested after the allogeneic haematopoietic stem cell transplantation (allo-HSCT)-Case 1: a 56-year-old man with acute leukaemia received the allo-HSCT and Case 2: a 45-year-old female patient with lymphoma received the allo-HSCT. She received donor lymphocyte infusion because of a post-transplant relapse. After allo-HSCT or donor lymphocyte infusion, Gottron papules emerged, and both patients were diagnosed as CADM based on dermatological findings coupled with the positivity of anti-MDA-5 antibody, accompanied by interstitial shadows consistent with ILD on chest computed tomography. Case 2 was initially diagnosed as a kind of chronic graft versus host disease. Their symptoms were improved by the combination of immunosuppressive agents with a concomitant decrease in anti-MDA-5 antibody levels. For Case 2, rituximab was subsequently started for relapse of lymphoma, resulting in a substantial decrease in the level of anti-MDA-5 antibody and improvement in rash and ILD. Our cases raise a possibility that CADM emerges after the HSCT, highlighting the importance of early diagnosis to avoid fated progression into ILD.

Trend in the prevalence of atrial fibrillation 7 years after the Great East Japan Earthquake

Background

The age-adjusted prevalence rate of atrial fibrillation (AF) had kept increasing until 2-year after the Great East Japan Earthquake (reported in ESC2017). Whether the elevated prevalence was tentative or not has not been sufficiently elucidated yet.

Methods

Community dwellers aged 40 to 74 years living in Iwate Prefecture who underwent annual health checkups (2010 (n=17490), 2011 (n=174236), 2012 (n=183612), 2013 (n=188429), 2014 (n=188424), 2015 (n=193610), 2016 (n=194882), 2017 (n=195428) account for approximately 30% of total population) were enrolled. Participants were divided into two age categories (40–64, 65–74 years). Direct age-adjusted prevalence rate of AF in each year was estimated using the 2010 population as the reference.

Result

Data are shown in the figure.

Conclusion

Prevalence rates of AF increased only in elderly people for up to 3 years after the disaster. This indicated that accelerated development of AF in elderly people due to stressful life after the disaster would not end within a short term and lasted at least 3 years after the disaster.

Figure 1

Funding Acknowledgement

Type of funding source: None

P3772Risk factors for future development of atrial fibrillation are not evident among apparently healthy individuals with paroxysmal atrial fibrillation

Background

Atrial fibrillation (AF) is one of the important factors of cardiovascular morbidity and mortality and to find not only patients with persistent AF but also individuals with paroxysmal AF among apparently healthy people is a crucial strategy for decreasing number of patients with serious cardio-embolic stroke. However, screening ability using previously known risk factors for future development of AF has not been examined in individuals with paroxysmal AF.

Methods

A total of 59730 male individuals, aged 40 years or older who underwent multiple comprehensive physical check-ups including 12 lead electrocardiogram (ECG) from 2012 to 2015 were enrolled. Persistent AF was defined a case that consecutively manifested AF till the last checkup. Paroxysmal AF was defined as a case who transiently manifested AF in each of the checkup and subsequently manifested sinus rhythm at the last checkup. Non-AF was defined as a case that never manifested AF in any of checkup. Age-adjusted prevalence rates and their 95% confidence intervals of known-risk factors in the first survey were estimated by logistic regression analysis separately by the three groups (non-AF (n=58602), paroxysmal AF (n=392) and persistent AF (736)).

Results

Age-adjusted prevalence rates (95% confidence interval) of risks factors for AF are shown in the table. Already known risk factors were evidently manifested in persistent AF group, however, prevalence rates of these factors in paroxysmal AF group were not different from the rates in non-AF group.

Conclusion

The repeated measurements of ECG study indicated that individuals who would develop paroxysmal AF in the near future did not have typical risk factors for AF and a screening test using risk factors for AF have no chance to find a high-risk individual for paroxysmal AF.

Adipose tissue-derived mesenchymal stem cells ameliorate bone marrow aplasia related with graft-versus-host disease in experimental murine models

Graft-versus-host disease (GVHD) constitutes the most frequent complications after the allogeneic hematopoietic stem cell transplantation for a variety of hematological malignancies. In the present study, we explored the prophylactic potential of adipose tissue-derived mesenchymal stem cells (AD-MSCs) in controlling GVHD in murine models with a special focus on bone marrow aplasia related with acute GVHD. The CB6F1 mice were induced GVHD by the injection intravenously of C57BL/6 (B6-Ly-5.1) splenocytes without conditioning irradiation or chemotherapy. AD-MSCs from C3H mice were injected intravenously via tail veins. GVHD was assessed using flowcytometry analysis of peripheral blood cells and histopathologic analysis of target organs. Histopathological analyses revealed that AD-MSCs markedly suppressed the infiltration of lymphocytes into liver as well as the aplasia in bone marrow. This study is the first to clarify the effectiveness of AD-MSCs against bone marrow aplasia in GVHD, supporting a rationale of AD-MSCs for ameliorating bone marrow suppression and infectivity after allo-HSCT in human clinics.

Abstract P5-01-03: Comparison of mammography findings between dense and non dense breast in Japanese subjects: The potential limitation of routine mammography

Introduction

Recently “Dense breast” has attracted numerous attention because of diagnostic difficulty in mammography among those harboring dense breast, which is far more frequent in Asian than Caucasian women. Therefore, in this study, we retrospectively evaluated the risks of subsequent development of malignancy through comparing the detailed mammographic characteristics between Japanese subjects harboring dense and non dense breasts.

Methods

We retrospectively examined mammorgraphic findings taken from March 2013 to March 2016 at Nahanishi Clinic, Okinawa, Japan. We stratified its density according to the suggestion of the Japan Central Organization on Quality Assurance of Breast Cancer Screening, which was defined by the proportion of fat area as follows; extremely high dense:10-20%, heterogeneously dense:40-50%, scattered fatty:70-90%, fatty: almost all the breast fat. “Dense breast” includes extremely high and heterogeneous dense. We evaluated the detailed radiological findings of each phenotypes including the characteristics of the mass, calcification and focal asymmetric density(FAD) and architectural distortion. We also compared the rates of subsequent cancer development and sensitivity of detecting cancer between those harboring dense and non dense breasts.

Results

We reviewed the mammography findings of 7747 Japanese women including 857 with breast cancers. When adjusted for age, the rate of dense breast was significantly associated with age, 88.6% in women in their 20s(vs40s p&lt;0.001 OR3.402), with incremental decrease, 80.4% in 30s(P&lt;0.001 OR1.802), 69.5% in 40s, 55.9% in 50s(P&lt;0.001 OR0.512), 32.3% in 60s(P&lt;0.001 OR 0.108), 19.5% in 70s(P&lt;0.001 OR 0.106) and 5.3% in over 80s(P&lt;0.001 OR0.024). The rate of malignancies was 9.1% (385) in dense and 13.6% (472) in non dense breasts. We then compared the mammographic findings between dense and non dense breast. Abnormal calcifications were detected more frequent(7.6%vs5.3% P&lt;0.001 OR1.478) but masses less so(16.4%vs23.7% P&lt;0.001 OR 0.632) in dense breast, while no significant differences detected in FADs(4.9%vs4.6% P=0.35 OR1.074) and distortions(1.2%vs1.4% P=0.29 OR=0.859) between dense and non dense breast. The rate of carcinoma was less frequent in dense breast among those associated with mammographic calcification(19%vs27.3% P&lt;0.01 OR0.626) but more frequently in dense breast among those with masses (13%vs19% P&lt;0.001 OR0.628). The rate of carcinoma was not different between dense and non dense breast in those with FADs (21.6vs20.6% P=0.72 OR1.067) and distortions(71.7%vs74.7% P=0.64 OR0.857). In addition, among 37 breast cancer patients who did not harbor the mammographic findings above (26 dense and 11 non dense breasts), the average mass length was significantly larger in dense (13.6mm) than non-dense breast (9.9mm) (P=0.018 used Welch's t test), respectively.

Conclusion

Results of our present study did demonstrate that detection of malignancy in those with mammographic dense breast is more difficult. Therefore, in those harboring dense breast in mammography, addition of other modalities such as US could improve the detection of breast carcinoma.

Citation Format: Takigami N, Tamaki K, Kamada Y, Uehara K, Terukina S, Ishida T, Miyashita M, McNamara KM, Tamaki N, Sasano H. Comparison of mammography findings between dense and non dense breast in Japanese subjects: The potential limitation of routine mammography [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-01-03.

Evaluation of two prognostic indices for adult T-cell leukemia/lymphoma in the subtropical endemic area, Okinawa, Japan

Aggressive adult T-cell leukemia/lymphoma (ATL) has an extremely poor prognosis and is hyperendemic in Okinawa, Japan. This study evaluated two prognostic indices (PIs) for aggressive ATL, the ATL-PI and Japan Clinical Oncology Group (JCOG)-PI, in a cohort from Okinawa. The PIs were originally developed using two different Japanese cohorts that included few patients from Okinawa. The endpoint was overall survival (OS). Multivariable Cox regression analyses in the cohort of 433 patients revealed that all seven factors for calculating each PI were statistically significant prognostic predictors. Three-year OS rates for ATL-PI were 35.9% (low-risk, n = 66), 10.4% (intermediate-risk, n = 256), and 1.6% (high-risk, n = 111), and those for JCOG-PI were 22.4% (moderate-risk, n = 176) and 5.3% (high-risk, n = 257). The JCOG-PI moderate-risk group included both the ATL-PI low- and intermediate-risk groups. ATL-PI more clearly identified the low-risk patient subgroup than JCOG-PI. To evaluate the external validity of the two PIs, we also assessed prognostic discriminability among 159 patients who loosely met the eligibility criteria of a previous clinical trial. Three-year OS rates for ATL-PI were 34.5% (low-risk, n = 42), 9.2% (intermediate-risk, n = 109), and 12.5% (high-risk, n = 8). Those for JCOG-PI were 22.4% (moderate-risk, n = 95) and 7.6% (high-risk, n = 64). The low-risk ATL-PI group had a better prognosis than the JCOG-PI moderate-risk group, suggesting that ATL-PI would be more useful than JCOG-PI for establishing and examining novel treatment strategies for ATL patients with a better prognosis. In addition, strongyloidiasis, previously suggested to be associated with ATL-related deaths in Okinawa, was not a prognostic factor in this study.

Abstract P6-11-01: Final results of the randomized trial of exercise intervention vs. usual care for breast cancer patients with aromatase inhibitor to prevent and improve the aromatase inhibitor induced arthralgia

Aromatase inhibitors (AIs) have been used in the adjuvant treatment of postmenopausal women with hormone receptor positive early breast cancer as a consequence of the significant benefit in DFS and OS when compared with tamoxifen. However the patients who receive AIs have an increased risk of arthralgia, at most 50% of patients did not take AIs and the 20% of the discontinued patients were within the first year of use. The HOPE study demonstrated that exercise was effective in improving AI-induced arthralgia. We conducted the AIAI (Arthralgia Improvement for the patients with Aromatase Inhibitors) study using wider eligibility criteria that the HOPE study to assess the impact on AI induced arthralgia in breast cancer patients.

Patients were randomly assigned, in a 3:1 ratio, to exercise intervention or usual care. Following randomization participants could choose from 3 types of exercise including group 1 (120-150 minutes per week of walking or running), group 2 (daily NIPPON HOSO KYOKAI: NHK broadcast exercise in Japan) and group 3 (going up the stairs- frequency, etc). The primary endpoint was the arthralgia change at 6 and 12 months, which was assessed using the BPI (Brief Pain Inventory). Secondary endpoints included the BPI according to the completion rate of exercise (70% and more or less than 70%), the BPI change of the patients with arthralgia (the patients who had arthralgia at the time they enrolled this study; BPI worst pain 3≤), the BPI of the each exercise group, the BPI according to the duration of AIs therapy (24 months and more or less than 24 months), the correlation between the BMI change and the BPI change, adherence of AIs and safety.

102 were randomly assigned to exercise intervention group (22 patients dropped out of this study) and 37 to usual care group (9 patients dropped out of this study).Trends for differentiations of pain interference at 12 months was detected between exercise intervention group and usual care group, but the differences did not reach statistical significance (p = .067). There was statistically better pain interference of the 70% and more exercise completion group than the usual care group at 12 months (-0.29±1.22 for exercise intervention group and 0.33±0.88 for usual care group, p= .002). The change of pain interference was statistically better for the exercise intervention group than the usual care group at 12 months (p= .017, -0.61±0.69 for exercise intervention group and 1.14±1.56 for usual care group). There was statistically significant difference of pain interference between group 1 exercise intervention group and the usual care group at 12 months (-0.14±0.68 for group 1 exercise intervention group and 0.33±0.88 for the usual care group, p= .009). Tendencies were detected in the AIs therapy less than 24 months group. Trends for the correlation between BPI and BMI were detected in worst pain at 6 month, pain severity at 6 month and pain interference at 12 month. There was a statistically significant difference of AIs adherence between the exercise intervention group (99%) and the usual care group (92%) (P=0.03).

Exercise may be effective in improving and preventing AI-induced arthralgia.

Citation Format: Tamaki K, Takaesu M, Nagamine S, Terukina S, Kamada Y, Uehara K, Takigami N, Arakaki M, Yamashiro K, Miyashita M, Ishida T, McNamara KM, Tamaki N, Sasano H. Final results of the randomized trial of exercise intervention vs. usual care for breast cancer patients with aromatase inhibitor to prevent and improve the aromatase inhibitor induced arthralgia [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-11-01.

External validation of prognostic indices for aggressive adult T-cell leukemia/lymphoma (ATL-PI/JCOG-PI) in Okinawa

e19036

Background: Aggressive adult T-cell leukemia/lymphoma (aATL) has an extremely poor prognosis (median OS, 8-10 months). Okinawa, Japan’s only subtropical region, is hyperendemic for aATL. Recently, we demonstrated poorer outcomes among aATL patients in Okinawa compared with patients elsewhere in Japan, and a possible association of strongyloidiasis with ATL-related death. Two prognostic indices (PIs)—ATL-PI and JCOG-PI—have been developed using a database of national surveys and clinical trials. However, aATL patients in Okinawa were not included. This study aimed to validate these PIs using an Okinawa database. We also investigated the impact of strongyloidiasis on aATL patient survival. Methods: We constructed a clinical database of aATL patients from 7 institutions in Okinawa diagnosed between January 2002 and December 2011. The study endpoint was OS. Standard survival analysis methods (Kaplan-Meier method, log-rank test, and Cox proportional-hazards model) were used. Results: The study involved 433 evaluable patients (median OS, 6 months). Risks according to the two PIs in each patient were not always consistent (Table), but both PIs stratified aATL patients by risk. Three-year OS rates for ATL-PI were 35.9% (low-risk, n=66), 10.4% (intermediate-risk, n=256), and 1.6% (high-risk, n=111); rates for JCOG-PI were 22.4% (moderate-risk, n=176) and 5.3% (high-risk, n=257). Strongyloidiasis had little impact on OS (HR and 95% CI from univariate Cox analysis, 1.22 and 0.90-1.66, respectively). Multivariable Cox analysis returned almost the same factors as had been screened out in the previous studies to construct the two PIs. Conclusions: ATL-PI and JCOG-PI were well reproducible in Okinawa database. Strongyloidiasis did not affect prognosis in aATL patients. ATL-PI identifies low-risk aATL patients more clearly than JCOG-PI, and both identify high-risk patients with extremely poor prognosis. These will be useful to devise novel treatment strategies based on risk stratification of all Japan/world aATL patients. [Table: see text]

Clinical usefulness of FDG-PET/CT for the evaluation of various types of adult T-cell leukemia

PURPOSE

The aim was to explore undefined useful indices for clinically grading adult T-cell leukemia (ATL) using [¹⁸F] 2-fluoro-2-deoxyglucose (FDG) - positron emission tomography/computed tomography (PET/CT).

METHODS

A total of 28 patients with ATL (indolent, 9; aggressive, 19) were enrolled; all patients with aggressive ATL underwent FDG-PET/CT before chemotherapy. Patients with indolent ATL underwent FDG-PET/CT at the time of suspected disease progression and/or transformation; some received lymph node biopsy. The quantitative parameters maximum standardized uptake values (SUVmax), and mean and peak SUV, metabolic tumor volume (MTV), and volume-based total lesion glycolysis were calculated with the margin threshold as 25%, and 50% of the SUVmax for all lesions.

RESULTS

All parameters except for MTV-25% showed significant differences (P ≤ 0.05) in differentiating the aggressive type from the indolent type of ATL. Areas under the curve for receiver-operating characteristic (ROC) analysis regarding the series of parameters investigated ranged from 0.75 to 0.92; this indicated relatively high accuracy in distinguishing the aggressive type from the indolent type. No malignant findings were detected in lymph node biopsies in indolent ATL patients with lymphadenopathy.

DISCUSSION

We performed evaluation of a line of parameters of FDG-PET, thereby demonstrating their significantly high accuracy for grading malignancy in ATL patients. In particular, low accumulation of FDG in indolent ATL patients with lymphadenopathy might predict that it is not a sign of disease transformation, but rather a reactive manifestation.

CONCLUSION

FDG-PET/CT findings could be useful for clinically grading ATL.

Abstract P5-12-01: Randomized trial of exercise intervention vs. usual care for breast cancer patients with aromatase inhibitor to prevent and improve the aromatase inhibitor induced arthralgia

Purpose: Arthralgia sometimes occurs in the breast cancer patients treated with aromatase inhibitors (AIs). It is one of the most important reasons for poor AIs adherence.

Background; The HOPE study previously demonstrated that exercise was effective in improving AI-induced arthralgia in breast cancer patients. However, recruitment to this study was limited to severe cases (Criteria; physically inactive, &gt;6 months AT treatment, &gt;2 months arthralgia). To asses if these findings were more generalizable to all breast cancer contexts we conducted a randomized trial of exercise intervention using wider eligibility criteria that the hope study to assess the impact on AI induced arthralgia in breast cancer patients.

Methods: We examined Japanese breast cancer patients operated at Nahanishi Clinic, Okinawa, Japan. Following the informed consent the patients were randomly assigned to a 3:1 ratio to exercise intervention or usual care, . Eligibility criteria included receiving an AI for 0-4 years, no metastases, any arthralgia level and any exercise habits. Following randomization participants could choose from 3 types of exercise including strong (120-150 minutes per week of walking or running), intermediate (gentle calisthenics (daily NIPPON HOSO KYOKAI: NHK broadcast exercise)) and weak (going up the stairs- frequency). Arthralgia was assessed using the Brief Pain Inventory (BPI), in which the patients completed a baseline, 6month and 12 month BPI assessment. Primary endpoint was BPI change at 12 months.

Results: Among 227 women screened, we randomized 108 women, with 80 to exercise intervention (46 of strong, 19 of intermediate and 15 of weak) and 28 to usual care. Base line BPI were well balanced between exercise intervention and usual care. Overall exercise intervention reduced BPI scores relative to control. The BPI changes of worst pain, least pain, average pain and pain right now were 0.09, -0.25, -0.14 and 0 for exercise intervention group and 0.21, 0.46, 0.07 and 0.61 for usual care group, respectively. There was a statistically significant difference of AIs adherence between exercise intervention group (99%) and usual care group (92%) (P=0.03).

Conclusion: Exercise intervention tends to improve the AI-induced arthralgia and has a positive effect on AIs adherence.

Citation Format: Tajaesu M, Tamaki K, Nagamine S, Kamada Y, Uehara K, Arakaki M, Tamatsu Y, Yamashiro K, Miyashita M, Ishida T, Ohuchi N, McNamara K, Terukina S, Sasano H, Tamaki N. Randomized trial of exercise intervention vs. usual care for breast cancer patients with aromatase inhibitor to prevent and improve the aromatase inhibitor induced arthralgia [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-12-01.

An atypical case of late-onset systemic lupus erythematosus with systemic lymphadenopathy and severe autoimmune thrombocytopenia/neutropenia mimicking malignant lymphoma

Here, we report a rare case of systemic lupus erythematosus (SLE) with conspicuous manifestation of hematological abnormalities. At onset, the 52-year-old male patient showed systemic lymphadenopathy and splenomegaly, severe autoimmune thrombocytopenia, and autoimmune neutropenia. Bone marrow examination and lymph node biopsy excluded the possibility of malignant lymphoma. Based on laboratory findings, he was finally diagnosed with combined autoimmune cytopenia coupled with SLE. Atypical clinical manifestations of SLE prompted us to explore the possibility of autoimmune lymphoproliferative syndrome (ALPS). However, we did not detect an increased number of CD4^-/CD8^-, CD3⁺, TCRαβ⁺ double-negative T cells in the circulating blood or dysfunctional T cell apoptosis in the Fas/Fas ligand pathway due to mutations in the FAS, FASLG or CASP10 genes. Combined autoimmune cytopenia is a rare clinical entity that in some cases co-occurs with other autoimmune diseases. Given that most SLE patients presenting atypical hematological manifestations at an early stage subsequently exhibit typical systemic manifestations, the present case raises the possibility that initial hematological abnormalities may be signs of unexpected SLE manifestations.

Recurrence of Psoriasis Vulgaris Accompanied by Treatment with C-C Chemokine Receptor Type 4 (CCR4) Antibody (Mogamulizumab) Therapies in a Patient with Adult T cell Leukemia/ Lymphoma: Insight into Autoinflammatory Diseases

Adult T cell leukemia / lymphoma (ATL) is one of the most aggressive hematological malignancies caused by human T-lymphotropic virus type-I (HTLV-1). Mogamulizumab is a new defucosylated humanized monoclonal antibody agent which targets C-C chemokine receptor type 4 (CCR4) expressed occasionally on the surface of ATL cells. However, adverse events such as drug eruptions have also been highlighted, at least in part, via the dysfunction of regulatory T cells (Tregs). We herein report a pronounced recurrence of systemic psoriasis vulgaris accompanied by the treatment of mogamulizumab in a patient with ATL. Pathological examinations may suggest a mechanistic link between the recurrence of autoinflammatory diseases and anti-CCR4 antibody therapies.

Fatal pneumonia and viremia due to human parainfluenza virus type 1 in a patient with adult T-cell leukemia-lymphoma treated with mogamulizumab

We report a case of fatal pneumonia and viremia due to human parainfluenza virus type 1 (HPIV-1) in a 65-year-old male patient with adult T-cell leukemia–lymphoma (ATL) treated with mogamulizumab, a brand-new therapeutic agent for ATL. To our knowledge, this is the first report describing viremia due to HPIV-1. After administering mogamulizumab, lymphocyte count in the blood was drastically decreased and the patient suffered from complicated infections including gram-negative bacterial sepsis, cytomegalovirus antigenemia and aspergillosis. Although these infections were successfully controlled by broad spectrum antimicrobial therapy, patchy ground-grass opacities in the both lungs were gradually worsened. He finally died due to acute respiratory failure. Since findings of the chest CT was consistent with typical patterns of viral pneumonia, we screened major respiratory viruses in the peripheral blood with multiplex PCR, and it turned out that RNA of HPIV-1 was positive. Although ATL cells were not detected in the autopsied lungs and a variety of other tissues, cytoplasmic inclusion bodies, which are commonly observed in RNA viral infection, were abundantly observed in the autopsied lung tissue. These findings suggest that mogamulizumab accomplished complete remission of ATL, while the chemotherapy-induced prolonged lymphopenia caused fatal pneumonia and viremia due to HPIV-1. As it has been well recognized that community respiratory viruses including HPIV-1 often cause fatal pneumonia in patients with leukemia, but also there is no specific treatment for HPIV-1, we have to enforce standard precautions especially when we treat leukemic patients with intensively immunosuppressive agents such as mogamulizumab.

Giant Septic Lymphadenitis with Marked Gas Formation Caused by Bacteroides fragilis in a Patient with Adult T-cell Leukemia/lymphoma

Adult T-cell leukemia/lymphoma (ATL) sometimes causes opportunistic infections. A 53-year-old woman with systemic lymphadenopathies was diagnosed with ATL by inguinal lymph node biopsies and underwent oral chemotherapy. Two months later, high grade fever, lower abdominal pain and lymphadenopathy recurred. Computed tomography revealed the presence of lymphadenopathy with marked gas formation in the pelvic lesion. Blood cultures were suggestive of septic lymphadenitis by Bacteroides fragilis (BF). This represents the first demonstration of giant lymphadenitis with gas formation caused by BF in a patient with ATL. Notably, septic lymphadenitis is pivotal in the differential diagnosis of systemic lymphadenopathy in ATL.

Long-term Follow-up Study of Onychomycosis: Cure Rate and Dropout Rate with Oral Antifungal Treatments

The "complete cure" of onychomycosis requires long-term treatment with a systemic antifungal agent. Therefore, to properly assess the effects of an antifungal agent on onychomycosis requires a long follow-up. We have conducted a retrospective analysis of the patients treated with griseofulvin (GRF) from 1962 to 1992 and a clinical study to compare the long-term effect of GRF with that of a new oral antifungal agent, itraconazole (ITCZ), for patients who received treatment from 1992 to 1995. For the retrospective study, 281 patients who were microscopically diagnosed as having onychomycosis at the Department of Dermatology, Faculty of Medicine, University of Tokyo, and received GRF administration in 1962, 1972, 1982, and 1992, were evaluated for cure rate and dropout rate. The total cure rate was 29.2%, but the cure rate was 68.8% for the patients who continued their medication for more than one year. For the comparative study, 139 patients who received the treatment at the same institution between 1992 and 1995 were evaluated. The cure rate and the dropout rate for GRF were found to be 23.8% (23/97) and 52.6% (51/97) respectively. The cure rate and the dropout rate for ITCZ were found to be 50.0% (21/42) and 38.1% (15/42). When the two treatment protocols were compared for their long-term effects, we found that most of the patients treated with ITCZ were cured within 3 years, and about 30% of the patients treated with GRF remained uncured even after long-term administration of the agent. Furthermore, from a multiple regression analysis, the GRF/ITCZ administration required to cure onychomycosis was estimated to be 3.92 + 0.161 [Age (years)] + 0.635 [Number of infected toenails] months. The results of this study suggest that the biggest problem associated with the treatment of onychomycosis with an oral antifungal agent is compliance in long-term therapy. Notably, the final cure rate of ITCZ therapy went over 90%, suggesting that the low dose continuous therapy, the standard treatment protocol in Japan, was a key contributing factor for the higher cure rate for ITCZ.

A rare case of septic pulmonary embolism caused by infection-associated catheter removal in a patient with Hodgkin's lymphoma

As a reflection of the considerable increase in the number of cancer patients treated with chemotherapy, indications for the use of implanted venous catheters are rapidly growing. However, in some cases, implanted venous catheters induce unwelcome complications. We herein report a rare case of septic pulmonary embolism (SPE) caused by local infection-associated catheter removal during the administration of ABVd combination chemotherapy consisting of adriamycin, bleomycin, vinblastine and dacarbazine in a patient with Hodgkin's lymphoma of the mixed cellularity type. During the course of treatment with chemotherapy administered via implanted venous catheters, think it is crucial to monitor for the potential occurrence of SPE.

Abstract P3-06-20: The correlation between body mass index (BMI) and breast cancer in both premenopausal and menopausal women in Okinawa

Introduction

Much of the longevity advantage in Okinawa is thought to be related to a healthy lifestyle including traditional foods which is low in calories and dense in nutrition. However, dietary change since World War II has been largely deleterious, with younger Okinawan people developing a higher risk of obesity and other chronic disease risk factors than older Okinawan people. In addition, breast cancer incidence and mortality are gradually increasing in Okinawa. Therefore we examined the correlation between BMI and breast cancer in both premenopausal and postmenopausal women in Okinawa.

Methods

The cases were 3422 female breast cancer patients without any previous breast cancer history, and the control subjects were 5622 women, who initially visited Nahanishi Clinic Okinawa in Okinawa, Japan, between May 1996 and March 2013. The median ages were 53 years old (21-99) in the breast cancer group and 44 years old (18-90) in the control group. Based on the World Health Organization classification, 25≤BMI&lt;30 is considered as overweight and 30≤BMI as obesity. We examined the association between BMI and breast cancer risk by odds ratio. In addition, we also stratified and examined the BMI according to menstruation and age by student t test.

Results

Table.1 summarized the results of the association between BMI and breast cancer risk.

Association between BMI and breast cancer risk. CancerControlP ValueOdds[95%CI]All patients34225622  Overweght10201028p&lt;0.0011.89 [1.72-2.10]Obesity285253p&lt;0.0011.93[1.62-2.30]Overweight+Obesity13051281p&lt;0.0012.09[1.90-2.29]Premenopausal    Overweight146498p = 0.0021.37[1.12-1.67]Obesity44141p = 0.0641.41[0.99-1.99]Overweight+Obesity190639p&lt;0.0011.42[1.18-1.70]Postmenopausal    Overweight618527p&lt;0.0011.59[1.38-1.83]Obesity179112p&lt;0.0011.96[1.54-2.51]

Being overweight, or obese, increased the odds of breast cancer, as well as these put together, in the postmenopausal group (p&lt;0.001, respectively). As for the premenopausal group, being overweight and also overweight grouped with obese increased the odds of breast cancer significantly (p = 0.002 and p&lt;0.001, respectively) and a tendency was detected in the obese (p = 0.064). Table.2 summarized the results of BMI according to menstruation and age.

BMI according to menstruation and age CancerControlp valueTotal24.3±4.122.7±3.8p&lt;0.001Premenopausal22.9±3.922.1±3.7p&lt;0.001Postmenopausal25.4±4.123.9±3.7p&lt;0.001Year&lt;3021.1±0.520.7±0.1p = 0.53930≤year&lt;4022.5±3.921.7±3.6p&lt;0.00140≤year&lt;5023.2±3.822.7±3.5p&lt;0.00150≤year&lt;6024.6±0.123.7±6.1p&lt;0.00160≤year&lt;7025.5±3.924.5±3.8p&lt;0.00170≤25.7±4.224.7±3.5p&lt;0.001

The BMI of the breast cancer group were statistically higher than that of the control group in those over 30 years old, and in the pre and post menopausal (p&lt;0.001, respectively).

Conclusion

The results of this study suggested that weight gain and consequently being overweight or obese might increase the odds for breast cancer in both premenopausal and postmenopausal women ages over 30 years old in Okinawa.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-06-20.

Abstract P2-12-07: The correlation between Myriad Genetic Laboratories, Inc. mutation prevalence table and clinicopathological characteristics of breast cancer patients in Okinawa

Introduction

The two major susceptibility genes for breast cancer and ovarian cancer, BRCA1 andBRCA2 were discovered in 1994 and 1995, respectively. Various risk prediction algorithms and models have been developed to identify putative BRCA1/2 mutation carriers. Myriad Genetic Laboratories, Inc. released Mutation Prevalence Tables (http://www.myriad.com/lib/brac/brca-prevalence-tables.pdf#search = ‘Myriad+Genetic+Laboratories%2C+Inc.+Mutation+Prevalence+Table’) through its clinical testingservice. To the best of our knowledge, this is the first study to examine the correlation between this risk prediction model and clinicopathological characteristics of breast cancer patients.

Methods

The cases were 148 female breast cancer patients without any previous breast cancer history who initially visited Nahanishi Clinic Okinawa in Okinawa, Japan, between May 2012 and March 2013. The median ages were 55 years old (26-84). We examined the correlation between Myriad Genetic Laboratories, Inc. released Mutation Prevalence Tables and clinicopathological characteristics including age, ER, PgR, HER2, triple negative status, histological grade and Ki67. The presence of ER and PgR was determined by nuclear staining with positive cases defined as more than 1% staining according to ASCO CAP. With regard to HER2 evaluation, membranous staining was graded as 0-1+, 2+, and 3+. Samples scored as 2+ were subjected to FISH. Positivity was defined as a HER2:CEP17 signal ratio&gt;2.2. Ki-67 labeling index was obtained by selecting the hot spots after evaluation at low power magnification and counting 1000 tumor cells in the hotspots.

Results

There was statistically negative correlation between the risk prediction rates and age (r = -0.480, r2 = 0.230, p&lt;0.001). The risk prediction rates of ER negative and positive were 2.93±4.12% and 4.06±9.53% with statistically significant differences (p = 0.049).On the other hand, tendency was detected in PgR status (p = 0.058), and the risk prediction rates were 3.21±1.92% of PgR negative and 4.24±3.34% of PgR positive, respectively. The risk prediction rates of triple negative cases and non triple negative cased were 2.58±0.94% and 4.06±3.11% with statistically significant differences (p&lt;0.001). There were not statistically significant differences in HER2 status, histological grade and Ki67, respectively.

Conclusion

Previous studies demonstrated that BRCA1/2 mutation was associated with triple negative and high grade malignant breast cancer. However, the results of this study suggested that Myriad Genetic Laboratories, Inc. released Mutation Prevalence Tables was not associated with triple negative and/or high risk breast cancer patients in Okinawa.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-12-07.

Abstract P2-03-02: A non-invasive modality the US virtual touch tissue quantification (VTTQ) for evaluation of breast cancer

Introduction

Acoustic radiation force impulse (ARFI) imaging is a newly developed ultrasound-based modality which could evaluate the wave propagation speed and tissue stiffness more precisely and objectively. ARFI does not require any external compression, and so even in deep tissues could, provide complementary information to conventional ultrasound (US), potentially improving the characterization of tissue and focal lesions. The generated waves can provide quantification of the shear wave velocity, termed Virtual Touch Tissue Quantification (VTTQ). VTTQ is an intrinsic and reproducible property of the tissue, and this tissue quantification could provide objective and reproducible data. This is the first study to evaluate the biological features of breast tissues using newly developed non-invasive diagnostic system VTTQ.

Methods

180 patients including 115 invasive ductal carcinoma (IDC), 30 ductal carcinoma in situ (DCIS), 4 mucinous carcinoma, 7 invasive lobular carcinoma (ILC), 8 fibroadenoma (FA), 12 fibrocystic change (FCC) and 4 intraductal papilloma were studied at Nahanishi Clinic Okinawa. We first compared results of VTTQ according to each histological subtype, and determined the optimal cutoff values for VTTQ to distinguish benign from malignant tissues using the receiver operating characteristic (ROC) method. In addition, we also examined the correlation between VTTQ velocities and Ki-67, estrogen receptor (ER), progesterone receptor (PgR) or human epidermal growth factor receptor 2 (HER2) in the cases of IDC using the linear regression analyses and Student's t test.

Results

There were statistically significant differences of VTTQ velocities between IDC and DCIS (P = 0.003), mucinous carcinoma (P = 0.009), FA (P&lt;0.001), papilloma (P&lt;0.001) or FCC (P&lt;0.001). There were significant differences between DCIS and FA (P = 0.016), papilloma (P&lt;0.001) or FCC (P&lt;0.001). Significant differences were also detected between mucinous carcinoma and papilloma (P&lt;0.001) or FCC (P = 0.003), between ILC and papilloma (P = 0.012) or FCC (P = 0.003) and between FA and papilloma (P = 0.030). VTTQ velocities were statistically higher in malignant cases than in benign cases (p&lt;0.05, respectively) and the best cutoff value for the VTTQ velocity which could differentiate benign from malignant cases was 2.89 m/second. There were statistically significant correlations between VTTQ velocity and Ki-67 labeling index (r = 0.338, r2 = 0.114 and P&lt;0.001), and significant inverse correlations between VTTQ and ER (r = -0.311, r2 = 0.097 and P&lt;0.001) or PgR (r = -0.361, r2 = 0.131 and P&lt;0.001) status of IDC. There was also a significant differences of the average velocities between HER2 positive (6.39±1.44 m/second) and negative (4.43±1.41 m/second) cases (P&lt;0.001).

Conclusion

VTTQ was valuable for examination of breast cancer pathology in a non-invasive fashion. The results still could suggest the value of VTTQ examination in the clinical management of breast cancer patients. VTTQ has huge potential for examining axillary lymph node status instead of sentinel lymph node biopsy, and examining the responsiveness of neoadjuvant chemotherapy in midcourse evaluation without invasive biopsy.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-03-02.

Abstract P6-05-14: Estrogen-induced genes in ductal carcinoma in situ(DCIS): their comparison with invasive ductal carcinoma

It is well known that estrogens play important roles in both the pathogenesis and development of invasive ductal carcinoma (IDC) of human breast. However, molecular features of estrogen actions have remained largely unclear in pure ductal carcinoma in situ (pDCIS), regarded as a precursor lesion of many IDCs. This is partly due to the fact that gene expression profiles of estrogen-responsive genes have not been examined in pDCIS. Therefore, we first examined the profiles of estrogen-induced genes in estrogen receptor (ER)-positive pDCIS and DCIS (DCIS-c) and IDC (IDC-c) components of IDC cases (n = 4, respectively) by microarray analysis. Estrogen-induced genes identified in this study were tentatively classified into three different groups in the hierarchical clustering analysis, and 33% of the genes were predominantly expressed in pDCIS rather than DCIS-c or IDC-c cases. Among these genes, the status of MYB (c-MYB), RBBP7 (RbAp46) and BIRC5 (survivin) expression in carcinoma cells was significantly higher in ER-positive pDCIS(n = 53) than that in ER-positive DCIS-c (n = 27) or IDC-c (n = 27) by subsequent immunohistochemical analysis of the corresponding genes (P &lt; 0.0001, P = 0.03 and P = 0.0003, respectively). In particular, the status of c-MYB immunoreactivity was inversely (P = 0.006) correlated with Ki-67 in the pDCIS cases. These results suggest that expression profiles of estrogen-induced genes in pDCIS may be different from those in IDC, and c-MYB, RbAp46 and survivin may play particularly important roles among estrogen induced genes in ER-positive pDCIS.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-05-14.

The weather dependence of particle size distribution of indoor radioactive aerosol associated with radon decay products

This study was performed to measure the activity size distribution of aerosol particles associated with short-lived radon decay products in indoor air at Nagoya University, Nagoya, Japan. The measurements were performed using a low pressure Andersen cascade impactor under variable meteorological conditions. The results showed that the greatest activity fraction was associated with aerosol particles in the accumulation size range (100-1000 nm) with a small fraction of nucleation mode (10-100 nm). Regarding the influence of the weather conditions, the decrease in the number of accumulation particles was observed clearly after rainfall without significant change in nucleation particles, which may be due to a washout process for the large particles.

Field test of quantum key distribution in the Tokyo QKD Network

A secure communication network with quantum key distribution in a metropolitan area is reported. Six different QKD systems are integrated into a mesh-type network. GHz-clocked QKD links enable us to demonstrate the world-first secure TV conferencing over a distance of 45km. The network includes a commercial QKD product for long-term stable operation, and application interface to secure mobile phones. Detection of an eavesdropper, rerouting into a secure path, and key relay via trusted nodes are demonstrated in this network.

Abstract P3-10-38: Histopathological Subclassification of Triple Negative Breast Carcinoma Using Prognostic Scoring System

Purpose: Triple negative breast carcinoma (TNBC) is currently being required to be classified pluralistically in order to provide the most appropriate therapy to the patients. We attempted to subclassify TNBC cases into subgroups based on clinical outcome or prognosis of the patients with TNBC using archival specimens. Materials and Methods: We analyzed 102 Japanese cases of invasive TNBC who underwent surgery between January 1998 and December 2007. The clinicopathological factors and clinical information of these patients were retrospectively retrieved from charts of the patients. Immunohistochemical staining was performed for estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2), epidermal growth factor receptor 1 (EGFR1), CK5/6, Ki-67 and CD31 for microvessel density (MVD). Results: Median follow-up time of the patients was 68.5 months. Multivariable analysis demonstrated that the pathologic node status was the most significantly associated with relapse-free survival (RFS) and breast cancer-specific survival (BCSS) of the patients. Pathological tumor size, basal-like type, Ki-67 labeling index (LI) and MVD were also independently associated with RFS and BCSS. Based on these results, we devised the Risk Score system reflecting Hazard ratios (HRs) of these prognostic factors above.

Multivariate analysis and the Risk Score for TNBC patients.

With this system, TNBC patients in this study were classified into three subgroups; patients with score 0-3 are in low risk group, score 4-7 in intermediate risk group and score 8- in high risk group. These three groups had statistically significant differences for risk of relapse and breast cancer-specific death, respectively.

Conclusions: We propose the Risk Score system, which incorporated pathologic nodal status, size of the primary tumor, the presence or absence of basal-like features, Ki67 LI and MVD of the patients in order to predict postoperative clinical course of the Japanese patients with TNBC. Such a classification which can be performed in diagnostic pathology laboratory can be useful as a decision-making tool for triple negative patients.

Abstract P1-02-01: Vasohibin-1 in Human Breast Carcinoma: A Potential Negative Feedback Regulator of Angiogenesis

Background: Vasohibin-1 is a recently identified negative feedback regulator of angiogenesis induced by vascular endothelial growth factor (VEGF)-A. This is the first study to evaluate immunoreactivity and mRNA expression of Vasohibin-1 in human breast disorders. Material and Methods: We examined 251 breast specimens including invasive ductal carcinoma (IDC: 148), ductal carcinoma in situ (DCIS:62), fibroadenoma (FA:16), inflammatory lesion (6), fibrocystic change(9) and non-pathological breast tissue(7). We immunolocalized vasohibin-1 and compared its immunoreactivity to that of VEGF-A, VEGF receptor 2 (Flk-1), CD31 and Ki-67. The correlation of vasohibin-1 immunoreactibity with overall survival (OS), and disease free survival (DFS) of the breast carcinoma patients was also evaluated. In addition, we evaluated Ki-67 and CD31, and Ki-67 and vasohibin-1 double-immunostaining for further characterization of neovascularization. We also evaluated mRNA expression of Vasohibin-1 using a real-time quantitative RT-PCR with LightCycler system.

Results: Vasohibin-1 was detected in endothelial cells of human breast and its immunodensity was significantly higher in IDC and inflammatory lesion than the other types (P&lt;0.001). As for DCIS, there was a significant positive correlation between vasohibin-1 expression level and nuclear grade or Van Nuys classification of carcinoma cells (P&lt;0.001). In addition, a significant positive correlation was detected between vasohibin-1 and VEGF-A, Flk-1 or Ki-67 (P&lt;0.001). There was also positive associations between vasohibin-1 and OS (P=0.004) and DFS (P&lt;0.001). Results of double-immunostaining demonstrated the ratio of Ki-67-positive cells among vasohibin-1-positive endothelial cells (46.5%) was significantly higher than those among CD31-positive cells (23.5%). In addition, there was a significant positive correlation between Vasohibin-1 mRNA level and Ki-67 or high nuclear grade(P&lt;0.001).

Discussion: This is the first study demonstrating the status of vasohibin-1 in human breast lesions, which indicates that vasohibin-1 is associated with neovascularization and may especially play important roles in the regulation of intratumoral angiogenesis in human breast cancer. Vasohibin-1 is supposed to be induced in the downstream of VEGF-A/Flk-1 signaling pathway and considered an appropriate biomarker for intratumoral neovascularization. In addition, these results clearly indicated that vasohibin-1 expression may become one of the prognostic markers for metastasis and prognosis, and also become one of the appropriate biomarker of the potential of subsequent stromal invasion of carcinoma cells.

Figures available in online version.

Impact of smoking as a risk factor for developing rheumatoid arthritis: a meta-analysis of observational studies

OBJECTIVES

To assess whether smoking is a risk factor for developing rheumatoid arthritis (RA).

DESIGN

Meta-analysis.

METHOD

DATA SOURCES

were observational studies that examined the association between smoking history and the risk of developing RA identified through Medline and EMBASE (from 1966 to December 2006), relevant books and a reference search. Two authors independently extracted the following: authors' names, publication year, sample size, participant characteristics, odds ratios (OR) or relative risks, adjustment factors, study design and area where the study was conducted. Data syntheses were based upon random effects model. Summarised syntheses effects were expressed by OR.

RESULTS

Sixteen studies were selected from among 433 articles. For men, summary OR for ever, current and past smokers were 1.89 (95% CI 1.56 to 2.28), 1.87 (1.49 to 2.34) and 1.76 (1.33 to 2.31), respectively. For rheumatoid factor-positive (RF+) RA, summary OR for ever, current and past smokers were 3.02 (2.35 to 3.88), 3.91 (2.78 to 5.50) and 2.46 (1.74 to 3.47), respectively. Summary OR for 20 or more pack-years of smoking was 2.31 (1.55 to 3.41). For women, summary OR for ever, current and past smokers were 1.27 (1.12 to 1.44), 1.31 (1.12 to 1.54) and 1.22 (1.06 to 1.40), respectively. For RF+ RA, summary OR for ever, current and past smokers were 1.34 (0.99 to 1.80), 1.29 (0.94 to 1.77) and 1.21 (0.83 to 1.77). Summary OR for 20 or more pack-years of smoking was 1.75 (1.52 to 2.02).

CONCLUSION

Smoking is a risk factor for RA, especially RF+ RA men and heavy smokers.