Chie Toshikawa

Predictive Factors for Non-Sentinel Lymph Node Metastasis in the Case of Positive Sentinel Lymph Node Metastasis in Two or Fewer Nodes in Breast Cancer

Background In breast cancer, recent clinical trials have shown that sentinel lymph node biopsy (SLNB) alone without axillary lymph node dissection results in excellent prognosis if there is sentinel lymph node (SLN) metastasis in two or fewer nodes. The aim of the present study was to investigate the association between non-SLN metastasis and clinicopathological factors in case of SLN metastasis in two or fewer nodes in breast cancer. Methods Patients who underwent SLNB for invasive breast cancer and were found to have positive SLN in two or fewer nodes were evaluated. The associations between non-SLN metastasis and clinicopahological factors were examined. Statistical analyses were performed using the Mann-Whitney and Chi-square tests, with statistical significance set at P < 0.05. Results A total of 358 patients were enrolled during the study period and all of these patients were female and 54 patients had SLN metastasis (15%). Positive SLN in two or fewer nodes was identified in 44 patients (81.5%). Among these patients, 17 (38.6%) were found to have non-SLN metastasis. Non-SLN metastasis was associated with invasive tumor size (P = 0.015) and lymphatic involvement (P = 0.035). Multivariate analysis showed that tumor size (P = 0.011) and lymphatic involvement (P = 0.019) remained significant independent predictors of non-SLN metastasis, and that an invasive tumor size cut-off point of 28 mm was useful for dividing patients with positive SLN in two or fewer nodes into non-SLN-positive and non-SLN-negative groups. Conclusions Non-SLN metastasis was found in more than 30% of patients with SLN metastasis present in two or fewer nodes. Large tumor size and the presence of lymphatic involvement were significantly associated with non-SLN metastasis.

Amplification of Genomic DNA for Decoy Receptor 3 Predicts Post-Resection Disease Recurrence in Breast Cancer Patients

Background Decoy receptor 3 (DcR3), a member of the tumor necrosis factor receptor (TNFR) superfamily, shows inhibitory effects on Fas-mediated apoptosis. Currently, data are lacking on the correlation between DcR3 and the recurrence of breast cancer. The authors examined DcR3 mRNA expression and genomic amplification in breast cancer, and investigated the effect of DcR3 gene amplification on prognosis of patients. Methods A total of 95 patients formed the basis of the current retrospective study. DcR3 mRNA expression in breast cancer tissues was examined by RNase protection assay and in situ hybridization. DcR3 gene amplification was examined by quantitative polymerase chain reaction. The correlation between DcR3 gene amplification status and clinicopathological factors was examined and also the relationship between DcR3-Amp and relapse and survival. Results The relative copy numbers of DcR3 genomic DNA correlated significantly with the levels of DcR3 mRNA expression (ρ = 0.755, P = 0.0067). In addition, lymphatic invasion correlated significantly with DcR3 gene amplification (P = 0.012). However, there was no correlation between the remaining clinicopathological factors and DcR3 gene amplification. In the univariate analysis, the recurrence-free survival (RFS) rate of patients who were positive for DcR3 gene amplification was significantly lower than that of patients who were negative for DcR3 gene amplification (P = 0.0271). Multivariate analysis showed that DcR3 gene amplification (P = 0.028) and disease stage (P < 0.001) remained significant independent predictors of RFS. Conclusions DcR3 gene amplification was significantly correlated with lymphatic invasion, and also DcR3 gene amplification predicts recurrence after resection, which may be an important prognostic factor in breast cancer patients.

Actionable Gene Alterations in an Asian Population With Triple-Negative Breast Cancer

Purpose It has been suggested that the biological characteristics of breast cancer may differ among different geographic or ethnic populations. Indeed, triple-negative breast cancer (TNBC), the most lethal breast cancer subgroup, has been reported to show a higher incidence in Japan than in the US. However, most genomic studies of these tumors are from Western countries and the genomic landscape of TNBC in an Asian population has not been thoroughly investigated. Here, we sought to elucidate the geographic and ethnic diversity of breast cancer by examining actionable driver alterations in TNBC tumors from Japanese patients and comparing them with The Cancer Genome Atlas (TCGA) database, which gather data primarily from non-Asian patients. Materials and Methods We performed comprehensive genomic profiling, including an analysis of 435 known cancer genes on Japanese TNBC patients (N=53) and compared the results to independent data obtained from TCGA (N=123). Results Driver alterations were identified in 51 out of 53 Japanese patients (96%). Although the overall alteration spectrum of Japanese patients was similar to that of the TCGA, we found significant differences in the frequencies of alterations in MYC and PTK2. We identified three patients (5.7%) with a high tumor mutation burden, although no microsatellite instability was observed in any of the Japanese patients. Importantly, pathway analysis revealed that 66.0% (35/53) of Japanese patients, as well as 66.7% (82/123) of the TCGA cohort, had alterations in at least one actionable gene targetable by an FDA-approved drug. Conclusion Our study identified actionable driver alterations in Japanese patients with TNBC, revealing new opportunities for targeted therapies in Asian patients.

PP093-SUN: Validity of Low Fat-Containing Elemental Formula for Prevention of Chylous Leak During Postoperative Early Enteral Nutrition After Esophagectomy

low or below reference ranges. Vitamin A was associated with sex, metastases, CRP and albumin (all p < 0.01). Vitamin B1 was associated with venous invasion and WCC (p < 0.05 and <0.01 respectively). Vitamin B2 was associated with body mass index (p < 0.05). Vitamin D was associated with tumour site and albumin (both p < 0.05). Vitamin E was associated sex, CRP and albumin (p < 0.05, <0.05 and <0.01 respectively). Vitamin B6, lutein and a-carotene were all associated with CRP and albumin (all p < 0.05). Lycopene was associated with age, nodal status, CRP and albumin (p < 0.05, <0.05, <0.001 and <0.01 respectively). b-carotene was associated with age, sex and CRP (p < 0.05, <0.01 and <0.01 respectively). Zinc was associated with albumin (p < 0.01). Conclusion: In patients with colorectal cancer, plasma micronutrients were consistently associated with a marker of the SIR whether present in normal or low concentrations. Other factors, especially tumour related, did not appear to impact on their concentration.

PP212-SUN VALIDITY OF EARLY ENTERAL NUTRITION FOR POSTOPERATIVE ESOPHAGEAL CANCER PATIENTS

Rationale: Early enteral nutrition, defined as starting enteral nutrition (EN) within 3 days after surgery, has become popular, because it has been revealed that early EN for surgical patients can decrease postoperative complication, reduce mortality. In the present study, we retrospectively examined EN received esophageal cancer patients to clarify the validity of early EN for postoperative course compared with delayed EN. Methods: A total of 103 patients who received thoracic esophagectomy for esophageal cancer at Niigata University Hospital during 1996 2010 were entered. The patients were divided into 2 groups; Group E contained the patients who received EN within postoperative day 3, and Group L contained the patients who received EN after postoperative day 3. The clinical factors such as days for first gas passage (Day-FGP), the dose of postoperative albumin-drug used (Dose-Alb), difference of serum albumin value between day 7 and pre-operation (Dalb), duration of systematic inflammatory response (SIRS), incidence of postoperative infectious complication (PIC), and use of total parenteral nutrition were compared between the groups. The statistical analysis were performed by Mann-Whitney U test and Chi square test. The statistical significance was defined as p < 0.05. Results: There was positive correlation between the days for EN start and Day-FGP and Dose-Alb. TPN use was less frequent in Group E compared with Group L (p < 0.0001). Moreover, Group L showed fewer days for first gas passage (p < 0.0001), lesser dose of postoperative albumin-drug used (p = 0.0002), and shorter duration of SIRS (p < 0.0013) compared with Group L. However, there was not significant difference on incidence of PIC between the 2 groups. Conclusion: Our results showed that early EN is safe and valid for postoperative esophageal cancer patients because it might decrease albumin-drug or TPN use, and promote early recovery of intestinal movement.