Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey

BACKGROUND

The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study.

METHODS

This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term outcomes of patients with and without liver cirrhosis were compared after propensity score matching by centre volume, demographic and tumour characteristics, and extent of resection.

RESULTS

Among 3150 patients included, LLR was performed in 774 patients with (24·6 per cent) and 2376 (75·4 per cent) without cirrhosis. Severe complication and mortality rates in patients with cirrhosis were 10·6 and 2·6 per cent respectively. Posthepatectomy liver failure (PHLF) developed in 3·6 per cent of patients with cirrhosis and was the major cause of death (11 of 20 patients). After matching, patients with cirrhosis tended to have higher rates of severe complications (odds ratio (OR) 1·74, 95 per cent c.i. 0·92 to 3·41; P = 0·096) and PHLF (OR 7·13, 0·91 to 323·10; P = 0·068) than those without cirrhosis. They also had a higher risk of death (OR 5·13, 1·08 to 48·61; P = 0·039). Rates of cardiorespiratory complications (P = 0·338), bile leakage (P = 0·286) and reoperation (P = 0·352) were similar in the two groups. Patients with cirrhosis had a longer hospital stay than those without (11 versus 8 days; P = 0·018). Centre expertise was an independent protective factor against PHLF in patients with cirrhosis (OR 0·33, 0·14 to 0·76; P = 0·010).

CONCLUSION

Underlying cirrhosis remains an independent risk factor for impaired outcomes in patients undergoing LLR, even in expert centres.

Abstract 4211: Detection and quantification of minoritary subclones of KRAS in metastatic colorectal cancers by digital microfluidics: therapeutic implications

KRAS mutations are associated with an absence of response to EGFR-targeting treatments in colorectal cancer. These therapies are restricted to patients with a KRAS wild type tumor but only 50% of these patients present an objective response. It has been recently demonstrated that secondary resistance was associated with appearance of a KRAS mutation. The presence of a low fraction of KRAS-mutated cells within tumors, not detectable by commonly used procedures, could explain these false negative and these secondary resistances.

To understand the importance of mutated subclones in the apparition of resistance to therapy targeting EGFR, a retrospective study including 95 patients with a metastatic colorectal cancer have been performed. All these patients, refractory to irinotecan were treated either with a combination of anti-EGFR and irinotecan or by anti-EGFR in monotherapy. These patients consisted of 54 men and 41 women with an average age of 62 years ± 11. Thirty-six patients were classified as responders according to RECIST criteria and 59 as non responders. Within this historitical serie, 27 patients were previously characterized as bearing a KRAS mutation by bulk Taqman analysis. DNA extracted from the tumors was analyzed by multiplex droplet-based microfluidics. This method, by segregating individual DNA molecules within million of aqueous microdroplets acting as independent microreactors, allows to perform precise quantitative experiments, for the 7 most frequent mutations of KRAS.

All tumors reported as bearing a mutated KRAS were detected as positives in droplets with proportions of mutated DNA from 10 to 64% (mean of 34,7% ± 17,9%). Two of them (KRAS G12D) were bearing additional subclones (KRAS G12V; KRAS G12S) detected only in droplets. With the 68 negative tumors, 18 were found positive in droplets with KRAS proportions from 0,013% to 86% (mean of 8.6% ± 20). Only 4 patients had a proportion of mutated DNA higher than 10% (86%, 24.5%, 12.7% and 10%), all presented low quantities of amplifiable DNA. We observed an inverse correlation between the proportion of mutated DNA and the frequency of anti-EGFR responses (P< 0.03). The percentage of mutated DNA was 11.6% and 28,4% for responders and non-responders respectively. Survival free progression of patients was significantly different depending on the level of mutated DNA within the tumor. The survival free progression of patients with tumor presenting less than 5% of mutated KRAS was identical to the one of non mutated patients with both technics. HRs were of 0.54±0.2 NS, 3.1±0.9, (P<0.001) 4.9±1.7 (P<0.001) for patients with tumor containing less than 5%, between 5 and 25% or more than 25% of mutated DNA respectively. This work highlights the importance of a quantitative approach for detection of mutation of the KRAS oncogene.

Citation Format: Deniz Pekin, Corinne Normand, Steve Kotsopoulos, Li Xinyu, Leonor Benhaim, O. Bouche, T. Lecomte, D. Le Corre, T. Hor, Z. El Harrak, P. Nizard, D. LINK, B. HUTCHISON, P. LAURENT-PUIG, Valerie Taly. Detection and quantification of minoritary subclones of KRAS in metastatic colorectal cancers by digital microfluidics: therapeutic implications. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4211. doi:10.1158/1538-7445.AM2013-4211

Urinary albumin excretion in patients with diabetes after renal transplantation

BACKGROUND

Many studies support microalbuminuria screening as the cornerstone of early detection of nephropathy in patients with diabetes mellitus (DM), but there are no studies that address its utility in the follow-up of renal transplant recipients with DM.

MATERIALS AND METHODS

We retrospectively studied 104 subjects with DM who had undergone renal transplantation. Sixty three had a history of preexisting DM and 41 developed posttransplant diabetes (PTDM). We collected data on random urine albumin/creatinine (A/C) ratio, systolic blood pressure (SBP), serum creatinine concentration (Cr), and HBA1C.

RESULTS

Mean subject age was 58 +/- 9.8 years; 63% received cadaveric grafts while 37% received living donor grafts. Mean follow-up was 7 years (range 1.6 to 15.6). Seventy percentage developed proteinuria over time; of these 62% developed microalbuminuria (A/C ratio 30 to 300 microg albumin/mg creatinine) and 38% developed macroalbuminuria (A/C ratio >300 microg/mg). Subjects with preexisting DM were as likely to develop an elevated A/C ratio as those with PTDM. Higher A/C ratios correlated with higher SBP (P < .01), with higher HBA1C (P < .036), and with higher Cr (P < .01). Lower A/C ratios correlated with more stable Cr over time (P < .01).

CONCLUSIONS

Strict SBP and glycemic control are associated with a significantly lower A/C ratio in patients with DM after renal transplantation. Annual monitoring of A/C ratio in patients with DM after renal transplantation can identify candidates for stricter glycemic and blood pressure control, similar to current recommendations for all other patients with DM.

Identification of Miranda protein domains regulating asymmetric cortical localization, cargo binding, and cortical release

An important question in cellular and developmental biology is how a cell divides to produce daughter cells with different fates. Drosophila neuroblasts are a model system for studying asymmetric cell division: at each division, neuroblasts retain stem cell-like features, whereas their sibling ganglion mother cell (GMC) has a more restricted fate. Establishing neuroblast/GMC differences involves the asymmetric localization of proteins (Inscuteable, Miranda, Prospero, and Staufen) and RNA (prospero). All of these factors are apically localized during interphase, and all except Inscuteable move to the basal cortex at mitosis prior to being partitioned solely into the GMC. In this study, we show that Miranda is colocalized with Staufen and Prospero in neuroblasts, and is required for the asymmetric cortical localization of both proteins. Analysis of miranda mutants reveals three functional domains within the Miranda protein: (1) an N-terminal domain (1-290 aa) sufficient for association of Miranda with the cell cortex and basal localization in mitotic neuroblasts; (2) a central domain (446-727 aa) necessary for apical localization in interphase neuroblasts as well as for "cargo binding" of Prospero, Staufen, and prospero mRNA; and (3) a C-terminal domain (727-830 aa) necessary for the timely degradation of Miranda and release of its cargo from the cortex of the newborn GMC. In addition, Miranda is asymmetrically localized in epithelial cells that lack Inscuteable and divide symmetrically; thus the mechanism regulating Miranda localization is common to epithelial cells and neuroblasts, and Inscuteable is not an obligate component. Finally, we define a C-terminal domain of Staufen sufficient for Miranda-dependent cortical localization in neuroblasts.