Transverse upper abdominal scars in DIEP flaps: pushing the limit of donor site abdominal skin perfusion

We present two immediate breast reconstruction cases utilising deep inferior epigastric perforator (DIEP) flaps in the presence of upper transverse abdominal scars and their outcomes. The available evidence in relation to its impact on abdominal skin perfusion and published clinical experience is reviewed.

P1-09-05: A 3′UTR Functional Variant in BRCA1: A Predictor of Poor Outcome in Breast Cancer

Background: MicroRNAs (miRNAs) are class of gene regulators which exert their effects through binding with partial complementarity to sequences in the 3'untranslated region (3'UTR) of the target mRNA. Single nucleotide polymorphisms (SNPs) in the 3'UTR of target mRNA have the potential to disrupt or create new illegitimate miRNA targets and have been associated with cancer predisposition as well as tumor biology. An association between rs8176318 and risk for familial breast and ovarian cancer as well as risk for triple negative breast cancer in African American women has previously been established. We aimed to evaluate the phenotypic effect of rs8176318 in a west of Ireland breast cancer cohort, and also its role as a biomarker of prognosis.

Methods: DNA from 727 unselected breast cancer cases and 387 controls were extracted from whole blood and genotyped for rs8176318 in the 3'UTR of the BRCA1 oncogene. The association with disease specific parameters and outcome were evaluated.

Results: Overall, there was a significant difference in the distribution of the three genotypes between cases and controls (p=0.035). The dominant variant model was predictive of breast cancer (OR=1.4, 95% CI 1.1−1.8). Fifty-two percent of breast cancer cases had the variant, with similar prevalence between subtypes: Luminal A (279 [54%] of 519 cases), Luminal B (37 [43%] of 85 cases), HER2 (21 [53%] of 40 cases) and triple negative breast cancer (41 [49%] of 83 cases). Comparing the prevalence of the variant within respective subtypes with controls however, Luminal A breast cancer was most strongly associated with rs8176318 (OR=1.5, 95%CI 1.1−1.9). The variant was not significantly associated with disease free survival (DFS) in all cancer cases (Log-rank test=0.084). However, rs8176318 was predictive of a poorer DFS (Log-rank test=0.041) in Luminal A patients with a 10-year DFS of 54% (95% CI 0.4−0.7) and 77% (95%CI 0.7−0.9) for the variant versus the non-variant, respectively. In addition, patients with Stage IV disease had a 6-fold increased risk of carrying the variant (p = 0.035), with 17 (73%) of 23 patients with metastasis at presentation positive for the variant compared to 324 (50%) of 642 patients without metastasis (p=0.034). Luminal A patients with Stage IV disease had a 13-fold risk of carrying the variant (p=0.043) in regression analysis, controlling for all other clinicopathological variables. Similarly, the variant was associated with distant metastasis in Luminal A patients, with 11 (92%) of 12 patients with metastasis positive for the variant compared to 242 (52%) of 463 patients without metastasis (p=0.028).

Conclusion: These findings suggest that rs8176318, a variant in the 3'UTR of BRCA1, is a genetic marker for modest breast cancer risk but aggressive tumor biology in breast cancer, and highlights the need for further clinical and biological evaluation of such markers.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-09-05.

P2-12-15: GAINS: A Breast Cancer Prognostic Index Utilizing Lymph Node Ratio

Introduction: Axillary lymph node status is an important predictor of overall survival (OS), hence its inclusion in clinical prognostic tools. The Nottingham Prognostic Index (NPI) which incorporates Lymph Node (LN) stage, tumor size and grade generates a score which predicts a percentage 10-year survival. Despite its status as a benchmark model for breast cancer prognosis, newer prognostic factors do exist. Lymph Node Ratio (LNR) is a superior prognostic indicator compared to absolute positive lymph node number, warranting re-evaluation of breast cancer prognostication. The aims of this study were threefold: identify the strength of LNR as a prognostic indicator compared to LN stage and NPI; establish a new prognostic index (Galway Index of Survival [GAINS]), taking into account the effect of LNR and breast cancer subtype on traditional clinicopathological features in breast cancer prognostication; and evaluate the prognostic efficacy of the new index compared to NPI.

Methods: Two cohorts were used: Galway Cohort-a prospectively compiled cohort of 1668 cases with histologically proven Stage 1, 2 and 3 primary operable breast cancer treated between 1990–2010 in a single institution; and ONCOPOOL-a retrospectively compiled database of 16944 cases treated across 12 European breast cancer units between 1990–1999. A Cox Proportional Hazards model was fitted to evaluate the strength of LNR compared to LN stage (within the NPI model) in both cohorts. The effect of clinicopathological variables on OS was analyzed using multivariable analysis in the Galway cohort. Three models were created (Model 1: Traditional prognostic variables excluding NPI and LNR; Model 2: Model 1 and LNR; Model 3: Model 1 and NPI) and compared using Likelihood-ratio tests.

The untold truth about "bath salt" highs: A case series demonstrating local tissue injury

The epidemic of injecting cathinone derivatives, marketed as "bath salts", by intravenous drug users among inner city Dubliners led to an associated rise in soft tissue complications. The spectrum of the cases encountered, ranging from self-limiting cellulitis to extensive abscess formation, at a single institution is described.