Development of a Screening Nomogram for Regional Lymph Node Metastasis Development in Muscle Invasive Bladder Cancer after Multiagent Systemic Therapy

PURPOSE/OBJECTIVE(S)

A reliable method of identifying clinically node negative bladder cancer patients at greater risk of developing lymph node metastasis and may require intensified therapy is needed. The purpose of this study was to create a nomogram to quantify the risk for regional lymphatic involvement in non-metastatic muscle invasive bladder cancer.

MATERIALS/METHODS

Usingthe National Cancer Database, patients with clinical T2-4N0M0 urothelial carcinoma of the bladder between the years of 2004 - 2020 were selected. All patients completed multiagent chemotherapy followed by surgery for pathologic nodal staging to determine presence or absence of nodal disease. No neoadjuvant radiation therapy was allowed and patients with history of prior malignancies were excluded. Following a 70:30 training to testing data split, baseline variables were assessed using univariate logistic regression. Variables were selected for inclusion in the multivariate logistic regression model using a combination of previously reported findings in the literature and/or if found to have a p-value < 0.05 on univariate analysis. A nomogram was constructed using this final model with assessment using calibration plots and the area under the receiver operating characteristics curve (AUC), respectively. An empiric cut point was chosen at 95% sensitivity to identify patients at "high" and "low" risk for pathologic nodal disease with overall assessment in both cohorts using chi-square.

RESULTS

A total of 6194patients were identified for study with a median age of 65 years (IQR = 58 - 71 years). Most patients were male (68.0%) with T2 disease (81.2%). The final multivariate model included age at time of diagnosis (OR = 0.99; 95% CI = 0.99 - 1.00; p = 0.172), time from diagnosis to initiation of chemotherapy (OR = 1.00; 95% CI = 1.00 - 1.01; p = 0.005), papillary histology (OR = 0.85; 95% CI = 0.72 - 1.01; p = 0.068), and clinical T stage (Table 1). Model calibration demonstrated excellent goodness-of-fit with good discrimination (AUC = 0.644). Within the training data, high risk patients were seen to have a twofold increase in pathologic nodal disease (N = 835/3924, 21.2%) when compared to those identified as low risk (N = 38/347, 9.9%) (p < 0.001). Validation within the testing data set demonstrated similar results with pathologic node rates of 22.8% and 7.8% for high- and low-risk patients, respectively (AUC = 0.645, p < 0.001).

CONCLUSION

This study demonstrates a clinically applicable risk stratification tool for identifying patients at risk for developing lymphadenopathy in T2-4 bladder cancer and may help guide future research in selecting patients eligible for escalation of therapy. Future studies should aim to externally validate this tool within prospective cohorts, and seek to determine if this nomogram may provide further prognostic utility.

Prognostication of Overall Survival in Muscle Invasive Bladder Cancer: An Application of a Lymph Node Metastasis Nomogram

PURPOSE/OBJECTIVE(S)

The purpose of this study was to determine if a previously developed nomogram predictive of developing pathologic lymph node metastasis after multiagent chemotherapy for clinical node-negative muscle invasive bladder cancer may also prognosticate overall survival (OS) in patients treated with definitive chemoradiotherapy (CRT).

MATERIALS/METHODS

Using the National Cancer Database, we identified all patients with cN0 muscle invasive urothelial carcinoma of the bladder treated with definitive CRT from 2004 to 2020. Patient probability of occult nodal disease was assessed using a previous nomogram developed from those treated with multiagent chemotherapy alone followed by pathologic nodal assessment. Following a 70:30 training and testing data split, variables were assessed for association with OS using the log-rank test, with those with p < 0.05 deemed eligible for inclusion within a multivariate Cox proportional hazards model. Patients were then stratified as high-, medium-, or low-risk for death using the hazard function's prognostic index. The proportional hazards assumption was checked using Schoenfeld residuals and discrimination assessed using dynamic area under the receiver operating characteristics curves (AUC). Validation was assessed within the testing and a retrospectively collected institutional cohort of 15 patients treated from 2014 - 2020 with CRT.

RESULTS

A total of 1047 patients were identified for this study with median age of 78 years (IQR = 70-83 years) and follow-up of 31.3 months (IQR = 16.0 - 56.6 months). Cox analysis revealed patient age (HR = 1.03; 95% CI = 1.02 - 1.04; p < 0.001), Charlson-Deyo Score, and predicted probability of developing future lymphadenopathy (HR = 4.47; 95% CI = 1.83 - 10.93; p = 0.001) were significantly associated with OS. Median OS for those identified as high, medium, and low risk for death on Cox analysis was 34.2 months (IQR = 21.3 - 40.6 months), 38.9 months (IQR = 31.4 - 47.2 months), and 77.8 months (IQR = 56.1 - 100.3 months), respectively (AUC range = 0.615 - 0.870) (p < 0.001). Similar discrimination was seen within the testing cohort as well with significant differences between median OS across each group (AUC range = 0.580 - 0.726) (p < 0.001). Notably, among patients within the institutional cohort, only one patient stratified as high (N = 1/2; 50.0%) or medium risk (N = 0/5; 0.0%) remained alive at time of final follow-up, whereas 88.9% (N = 7/8) of low-risk patients survived (p = 0.051). Similarly, significant differences in OS were again seen between risk groups, with a median OS of 51.3 months and 19.9 months for high- and medium-risk patients, respectively, while median OS for low-risk patients was not reached (p = 0.006).

CONCLUSION

This study demonstrates the prognostic utility of a previously reported nomogram in predictions of OS. Investigation is warranted to explore how radiation and chemotherapy may offset worse OS in those at high risk for occult nodal disease progression.

P-180 Alterations of methylation level of H19/IGF2 DMR differentially methylated region(DMR) in human blastocysts following re-vitrification

Study question

Does re-vitrification affect on methylation level of H19/IGF2 DMR differentially methylated region(DMR) in human in vitro-produced blastocysts?

Summary answer

The results of this study showed that re-vitrification had no significant effect on the methylation level of H19 / IGF2 DMR region in human blastocysts.

What is known already

Nowadays, re-vitrification seems to be a successful and useful method to prevent the discarding of extra embryos. Several reports have indicated that the embryo manipulations during ART may result in epigenetic errors. This has been attributed to the concurrency of the ART manipulations and epigenetic events after fertilization. The effect of embryo re-vitrification on epigenetic changes has not been studied so far. The aim of this study is to evaluate the effect of embryo re-vitrification on methylation level of H19/IGF2 differentially methylated region (DMR) in donated human blastocysts.

Study design, size, duration

The effect of re-vitrification on methylation level of H19/IGF2 DMR was evaluated in 9 ICSI-derived human embryos individually and the expressions of H19 and IGF2 were assessed in 15 embryos individually. Embryos were donated from fertile couples referring for family balancing program. Donated embryos were cultured to blastocyst stage and high quality blastocyst (AA-AB) assigned to three groups: fresh, vitrified and re-vitrification. Scoring of blastocysts were according to Gardner et al. (2012) grading system.

Participants/materials, setting, methods

Collected blastocysts were vitrified on Cryotech carriers, with the method described by Kuwayama. After warming of blastocysts and 4-5 hours culturing of them, expression of H19 and IGF2 genes in blastocysts evaluated with Real time PCR and methylation levels of H19/IGF2 DMR in blastocysts were analyzed by Bisulfite Sequencing PCR (BSP) technique. 10 clones were sequenced per replicate. Methylation status of lymphocyte was used as control to verify the credibility of our analysis system.

Main results and the role of chance

The results showed that the overall percentage of methylated CpGs of H19/IGF2 DMR in the control, vitrification, re-vitrification groups and lymphocyte were 42.71, 40.90, 39.23% and 49.30 %. respectively. There was no significant difference in methylation level of H19/IGF2 DMR between the groups. H19 and IGF2 expression did not show a significant difference in vitrified group compared to the control and in re-vitrified group compared to vitrified.

Limitations, reasons for caution

- Small number of samples examined due to difficult access to human blastocysts donated by fertile couples.

- Evaluation of high-quality embryos donated by healthy fertile couples while embryos of infertile couples may respond differently.

Wider implications of the findings

According to the obtained results, embryo re-vitrification did not have a significant change on the methylation level of H19/IGF2 DMR and expression of H19 and IGF2 genes. However, that further studies on the effect of re-vitrification on epigenetic errors in low-quality embryos and the embryos of infertile couples are needed.

Trial registration number

not applicable

Correlation of Histamine Receptors and Adrenergic Receptor in Broilers Appetite

The current study was conducted to investigate the interaction between the central adrenergic and histaminergic systems and the broiler chick's feed intake. In the first experiment, the intracerebroventricular (ICV) injection of solutions was conducted which included 10 nmol of prazosin (an α₁-receptor antagonist), 300 nmol of histamine, co-injection of prazosin and histamine. Experiments two to five were conducted similarly the same as the first experiment, in which chickens were ICV injected with 13 nmol of yohimbine (an α₂-receptor antagonist), 24 nmol of metoprolol (a β₁ adrenergic receptor antagonist), 5 nmol of ICI 118,551 (a β₂ adrenergic receptor antagonist), and 20 nmol of SR 59230R (a β₃ adrenergic receptor antagonist). The injected solutions in the sixth experiment included 300 nmol of noradrenaline, 250 nmol of α-FMH (an alpha fluoromethyl histidine), noradrenaline, and α-FMH. Seventh to ninth experiments were similar to the sixth experiment, except that the chickens were ICV injected with 300 nmol of chlorpheniramine (a histamine H₁ receptors antagonist), 82 nmol of famotidine (a histamine H₂ receptors antagonist), and 300 nmol of thioperamide (a histamine H₃ receptors antagonist), rather than α-FMH. Afterward, the cumulative food intake was measured 120 min after injection. Based on the obtained results, both histamine ICV injection and noradrenaline injection reduced food intake (P<0.05). Moreover, co-injection of histamine and ICI 118,551 (P<0.05), and co-injection of noradrenaline and Chlorpheniramine reduced food intake (P<0.05). In addition, noradrenaline and Thioperamide co-injection improved hypophagic effect of noradrenaline in neonatal chicken (P<0.05). These findings suggested the effect of interconnection between adrenergic and histaminergic systems, which may be mediated by H₁ and H₃ histaminergic and β₂ adrenergic receptors, on the regulation of food intake in the neonatal broiler chicken.

Characterization of ear fluid isolates of Alloiococcus otitidis from patients with recurrent otitis media

Nineteen isolates of Alloiococcus otitidis from ear fluid samples collected by tympanostomy from patients at four geographic locations were identified by phenotypic characterization and genetic relatedness. Initial growth of A. otitidis isolates occurred after 3 days at 37 degrees C on brain heart infusion (BHI) agar with 5% rabbit blood. Heavy growth occurred in BHI broth supplemented with 0.07% lecithin and 0.5% Tween 80 after 4 days of incubation. The isolates were gram-positive cocci that divided on an irregular plane and produced metabolic lactic acid, pyrrolidonyl arylamidase, and leucine aminopeptidase. These cocci grew sparsely in 6.5% NaCl-BHI broth, were asaccharolytic on both fermentative and oxidative bases, and were cytochrome negative by the iron-porphyrin test. The cellular fatty acid profile of A. otitidis was distinguished from those of related genera and characterized by major amounts ( > or = 14%) of 16:0, 18:2, 18:1 omega 9c, and 18:0 and smaller amounts of 14:0, 16:1 omega 7c, 17:0, and 18:1 omega 7c. Fifteen isolates demonstrated > 69% relatedness by DNA-DNA hybridization. Four isolates plus the original 15 were confirmed as A. otitidis by dot blot hybridization with a digoxigenin-labeled nucleotide probe specific for this species. The intergenic space between the genes coding for the 16S and 23S rRNAs of alloiococci was amplified by PCR, analyzed by restriction fragment length polymorphism, and determined to consist of three different genetic types. Although beta-lactamase negative, A. otitidis demonstrated intermediate levels of resistance to beta-lactams, including expanded-spectrum cephalosporins, and were resistant to trimethoprim-sulfamethoxazole and erythromycin.

Recognition of Dermabacter hominis, formerly CDC fermentative coryneform group 3 and group 5, as a potential human pathogen

Thirty strains of fermentative coryneform-like bacteria designated CDC fermentative coryneform group 3 and coryneform group 5 were compared biochemically by cellular fatty acid analysis and by DNA relatedness with the type strain of Dermabacter hominis, ATCC 49369. DNA from 22 strains of both CDC groups showed 69 to 96% relatedness (hydroxyapatite method) to labeled DNA from ATCC 49369 and to DNA from CDC group 3 strain G4964, and the strains are considered to belong to D. hominis. The remaining eight strains were genetically but not phenotypically differentiable from D. hominis. They were genetically heterogeneous, but hybridization results indicated that they probably belong to the genus Dermabacter. Thirteen of the 22 D. hominis strains and all 8 of the other Dermabacter strains had been isolated from blood, which indicates the pathogenic potential of this species and genus.

Human infections caused by Brevibacterium casei, formerly CDC groups B-1 and B-3

Forty-one clinical strains of CDC coryneform groups B-1 and B-3 were compared biochemically, by analysis of cell wall sugars, amino acids, and cellular fatty acids, and by DNA relatedness to the type strains of Brevibacterium casei, Brevibacterium epidermidis, and Brevibacterium linens. Twenty-two strains were shown to be B. casei, while five other strains formed a phenotypically inseparable genomospecies in the same genus. The remaining isolates were genetically heterogeneous, and most are probably members of the genus Brevibacterium. They were not further identified, but they were biochemically distinguishable from B. casei. Eleven of the clinical strains of B. casei were isolated from blood, and two each were isolated from cerebrospinal fluid and from pleural fluid. At least five isolates were from multiple blood or cerebrospinal fluid cultures. To our knowledge, these strains are the first described clinical isolates identified as B. casei, which was previously considered to be a nonpathogenic species.