In-Ho Kim

Neutrophilic panniculitis following azacitidine treatment for myelodysplastic syndromes.

Myelodysplastic syndromes (MDS) comprise a heterogeneous roup of clonal hematopoietic stem cell disorders. The clinical specrum ranges from a stable condition to manifestation of entities ith increased morbidity and mortality because of bone marrow ailure or evolution to acute myelogenous leukemia (AML). Among arious newer therapeutic options, azacitidine (AZA) is a first FDApproved drug for the treatment of MDS that has demonstrated mprovements in overall survival and success in delaying progresion to AML [1]. AZA appears to be well tolerated with the most ommon grade 3 or 4 adverse events being hematological compliations of peripheral blood cytopenias. Injection site complications ccur in about 13–43% of cases and are the most common nonematological complications in subcutaneous administration of the rug [2]. The majority of injection site complications are typically ild erythema, and grade 3 or 4 toxicities occurs in <1% of the reated patients. Although these adverse events are usually comletely and spontaneously reversible, efforts should be given for ifferential diagnosis of other causes of skin lesions such as Sweet’s yndrome, for which aggressive treatment should be considered 3]. We here describe two MDS patients with neutrophilic panniulitis (NP) following AZA treatment who were initially thought to ave NP, but were later recognized to have drug-associated NP, and ho successfully treated with steroids.

Clinical significance of changes in systemic inflammatory markers and carcinoembryonic antigen levels in predicting metastatic colorectal cancer prognosis and chemotherapy response

Metastatic colorectal cancer (mCRC) is associated with poor prognosis, and biomarkers are required for predicting survival and chemotherapy response. This study aimed to evaluate the significance of changes in systemic inflammatory markers and carcinoembryonic antigen (CEA) levels in predicting mCRC prognosis and chemotherapy response.

Different clinical characteristics in sporadic young-age onset colorectal cancer.

Abstract The incidence of colorectal cancer (CRC) is increasing in young-age patients, but the clinical history is not established. Authors analyzed the clinical characteristics of young-age onset CRC to support basic information for setting treatment policies. Between January 2006 to January 2014, 100 CRC patients diagnosed at the age of 10 to 39 were analyzed. The clinicopathologic characteristics were reviewed based on medical records. Survival outcomes including overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS) were analyzed. This study was conducted as a retrospective, observation study. Among 100 patients, 86 patients were diagnosed as CRC at their thirties. Seventy-nine patients had no familial history of cancer. At initial diagnosis, 59 patients showed the normal CEA level (⩽3 ng/mL), and 61 patients were diagnosed as advanced CRC (40% stage III, 21% stage IV). Sixty-four patients had lower location-sigmoid colon, rectosigmoid junction, or rectum. Recurrence rate was 7.9% in stage I to III CRC. Although median OS was not reached, patients with normal CEA level showed better survival outcome (Pu200a=u200a0.013) and patients with perineural invasion showed poorer survival (Pu200a=u200a0.011). The 5-year survival rate of total patient population was estimated as 75%. However, median OS of stage IV patients were 19 months (range 7.9–60.63 months), shorter than historical data of >24 months. Young-age CRC was most commonly diagnosed at their thirties, with no familial history, normal range of CEA and located below sigmoid colon. In young-age onset stage IV CRC, patients showed inferior OS compared to historical data. Based on our data, different surveillance program other than serum CEA level (e.g., sigmoidoscopy) is needed in young-age patient population.

The neutrophil-to-lymphocyte ratio prechemotherapy and postchemotherapy as a prognostic marker in metastatic gastric cancer

Background/Aims Markers of inflammation have been associated with outcomes in various cancers. The purpose of this study was to evaluate whether systemic inf lammatory markers and their f luctuations can predict survival and chemotherapy response in patients with metastatic gastric cancer (mGC). Methods We retrospectively reviewed the records of 502 patients who received first-line palliative chemotherapy for mGC between 2007 and 2013. The neutrophil-to-lymphocyte ratio (NLR) and modified Glasgow prognostic score (mGPS) were assessed before and after chemotherapy to evaluate their association with survival. The NLR values were categorized into two groups based on a cut-off value of 3; mGPS values were classified as high versus low. Results High prechemotherapy NLR was significantly associated with poor overall survival on univariate analysis (p = 0.002). On multivariate analysis, high prechemotherapy NLR (hazard ratio, 1.43; p < 0.001) was an independent prognostic factor for poor overall survival. However, the prechemotherapy mGPS was not significantly associated with survival. Continuously high NLR or a shift to high NLR postchemotherapy was associated with poor chemotherapy response as well as survival, while NLR reduction was associated with a good response (linear by linear association, p < 0.001) and a favorable prognosis. Conclusions Prechemotherapy NLR can be used as a prognostic factor in mGC, while the postchemotherapy NLR value may predict the chemotherapeutic response and prognosis. In contrast, mGPS has limited prognostic utility in mGC.

Discordancy and changes in the pattern of programmed death ligand 1 expression before and after platinum-based chemotherapy in metastatic gastric cancer

BackgroundOur goal was to evaluate changes in PD-L1 expression in primary tumours of metastatic gastric cancer before and after chemotherapy.MethodsWe evaluated the PD-L1 expression of 72 patients with primary gastric cancer, before and after palliative first-line platinum-based chemotherapy, between January 2015 and March 2017. The PD-L1 ratio was defined as pre-chemotherapy PD-L1 expression divided by the post-chemotherapy PD-L1 expression.ResultsIn 30 patients with PD-L1 negative pre-chemotherapy, 12 (40%) were positive post-chemotherapy; among the 42 patients with PD-L1 positive pre-chemotherapy, 24 (57.1%) were negative post-chemotherapy. The degree of PD-L1 expression decreased from 58.3% before chemotherapy to 41.7% after chemotherapy (Pu2009=u20090.046). Among patients with complete response/partial response (CR/PR), the degree of PD-L1 expression decreased (Pu2009=u20090.002), as well as PD-L1 positivity with statistical significance (Pu2009=u20090.013) after chemotherapy, but not among patients with stable disease/progressive disease (SD/PD). Higher disease control rates (CR/PR/SD) were observed in patients with an elevated PD-L1 ratio (Pu2009=u20090.043). Patients with a high PD-L1 ratio (>u20091) were found to be associated with a better progression-free survival (HR 0.34, 95% CI 0.17–0.67, Pu2009=u20090.002).ConclusionsPD-L1 expression can change during chemotherapy. Moreover, changes in patterns of PD-L1 expression might be associated with patient prognosis and response to chemotherapy.

Clinical Significance of Discordance Between Carcinoembryonic Antigen Levels and RECIST in Metastatic Colorectal Cancer

Purpose The purpose of this study was to investigate the prognostic implications of carcinoembryonic antigen (CEA) levels that are inconsistent with Response Evaluation Criteria in Solid Tumor (RECIST) responses in metastatic colorectal cancer patients. Materials and Methods We retrospectively evaluated 360 patients with at least one measurable lesion who received first-line palliative chemotherapy. CEA-response was defined as CEA-complete response (CR; CEA normalization), CEA-partial response (PR; ≥ 50% decrease in CEA levels), CEA-progressive disease (PD; ≥ 50% increase in CEA levels), and CEA-stable disease (SD; non-CR/PR/PD). Overall survival (OS) and progression-free survival (PFS) were evaluated according to CEA-response. Results In RECIST-PR patients, poorer CEA-response was associated with disease progression at the subsequent evaluation. In RECIST-SD patients, CEA-CR and -PR were associated with lower disease progression rates than CEA-PD at the subsequent evaluation. Correlations between survival outcome and CEA-response in same-category RECIST patients were assessed. In RECIST-PR patients, discordant CEA-response (CEA-PD/SD) was associated with poorer survival than CEA-CR/PR (median OS and PFS, 44.0 and 15.4 [CEA-CR], 28.9 and 12.5 [CEA-PR], 21.0 and 9.8 [CEA-SD], and 13.0 and 7.0 [CEA-PD] months, respectively; all p < 0.001). In RECIST-SD patients, favorable CEA-response produced better survival (median OS and PFS, 26.8 and 21.0 [CEA-CR], 21.0 and 11.0 [CEA-PR], 16.1 and 8.2 [CEA-SD], and 12.2 and 6.0 [CEA-PD] months, respectively; all p < 0.001). RECIST-PD patients with CEA-CR showed longer OS than those with CEA-PD. Multivariate analysis demonstrated that discordant CEA-response is a powerful prognostic factor for RECIST-PR and RECIST-SD patients. Conclusion Among patients of the same RECIST-response categories, CEA-response patterns are significantly prognostic and strongly predictive of subsequent evaluation outcomes.