Omar Picado

Distal pancreatectomy for benign and low grade malignant tumors: Short-term postoperative outcomes of spleen preservation—A systematic review and update meta-analysis

The value of spleen preservation with distal pancreatectomy (DP) for benign and low grade malignant tumors remains unclear. The aim of this study was to evaluate the short‐term postoperative clinical outcomes in patients undergoing DP with splenectomy (DPS) or spleen preservation (SPDP).

Extent of regional lymph node surgery and impact on outcomes in patients with early-stage breast cancer and limited axillary disease undergoing mastectomy

PurposeManagement of the axilla in patients with early-stage breast cancer (ESBC) has evolved. Recent trials support less extensive axillary surgery in patients undergoing mastectomy. We examine factors affecting regional lymph node (RLN) surgery and outcomes in patients with ESBC undergoing mastectomy.MethodsWomen with clinical T1/2 N0 M0 invasive BC who underwent mastectomy with 1–2 positive nodes were selected from the National Cancer Database (2004–2015). Axillary surgery was defined by number of RLNs examined: 1–5 sentinel LN dissection (SLND), and ≥ 10 axillary LND (ALND). Binary logistic regression and survival analyses were performed to assess the association between axillary surgery and clinical characteristics, and overall survival (OS), respectively.Results34,243 patients were included: 13,821 SLND (40%) and 20,422 ALND (60%). SLND significantly increased from 21% (2004) to 45% (2015) (p < .001). Independent factors associated with SLND were treatment year, non-Academic centers, geographic region, tumor histology, and postmastectomy radiotherapy (PMRT). Multivariable survival analysis showed that ALND was associated with better OS (HR 0.78, 95% CI 0.72–0.83, p < .001) relative to SLND; however, there was no difference in patients with LN micrometastases treated without RT (HR 0.87, 95% CI 0.73–1.05, p = .153) or patients receiving PMRT (HR 0.92, 95% CI 0.76–1.13, p = .433).ConclusionsSLND has significantly increased in patients undergoing mastectomy with limited axillary disease and is influenced by patient, tumor, and treatment factors. Survival outcomes did not differ by axillary treatment for patients with LN micrometastases treated without RT or patients who received PMRT. SLND may be considered in select patients with ESBC and limited axillary disease undergoing mastectomy.

Abstract 4292: Indole-3-carbinol (I3C) enhances efficacy of Gemcitabine in leiomyosarcoma

Introduction: Adjuvant Gemcitabine have recently been shown to improve progression free survival in some types of leiomyosarcoma. Adequate cellular uptake of the drug remains a challenge. We aimed to evaluate the role of nucleoside transporter activator (I3C) in increasing the in vitro efficacy of gemcitabine in the treatment of leimyosarcoma. Methods: Leiomyosarcoma cells (SKLMS) were incubated with DMEM+10% FBS + 1% Antibiotics. Dose response curves were generated for gemcitabine and I3C to identify the IC-50 values. Triplicates of cells were then plated in 96 well plates (3000 cells/well) and allowed to adhere. The adherent cells were further treated with gemcitabine in the presence or absence of I3C and compared with controls (DMSO treatment). MTS cell viability assays were done and absorbance was monitored in a micro-plate reader. Flow cytometry was performed with Propidium Iodide (PI) staining. Scratch assays were done to assess cell migration. Results: Viability assay showed significant increase in the cytotoxicity of gemcitabine in presence of I3C compared to controls. Flow cytometry data showed gemcitabine alone treatment has arrested the cell cycle at G0/G1 phase without increase of cell death. On the contrary, use of gemcitabine in combination with I3C increased the cell death by at least three folds compared to control as well as gemcitabine alone treated cell population. Scratch assay over a 16 hour period showed that the rate of cellular migration significantly dropped by 1.5 folds upon treatment with gemcitabine combined with I3C compared to gemcitabine alone. Western blots showed increased expression of membrane transporter hENT-1 with I3C treatment. Conclusion: The use of I3C enhanced cellular uptake, transport and cytotoxicity of gemcitabine in SKLMS cells. Further studies are warranted and underway to elaborate on intracellular mechanisms of action to optimize the use of I3C as a potential adjunct in preclinical and clinical leiomyosarcoma treatment. Note: This abstract was not presented at the meeting. Citation Format: Sujit Suwal, Alexandra Moran, Ana Paz-Mejia, Lorena Flor, Omar Picado, Basem Azab, Jonathan Trent, Fiorella Pendola, Alan S. Livingstone, Danny Yakoub. Indole-3-carbinol (I3C) enhances efficacy of Gemcitabine in leiomyosarcoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4292. doi:10.1158/1538-7445.AM2017-4292

Unresectable hepatocellular carcinoma: Is radio-embolization an alternative for chemo-embolization?

323 Background: Transarterial Radio-embolization (TARE) has emerged as a newer regional technique to Transarterial Chemo-embolization (TACE) for treatment of unresectable hepatocellular carcinoma (HCC). The aim of this study is to evaluate clinical outcomes of both techniques. Methods: Online search for studies comparing TARE to TACE from 2005 to present was performed. Primary outcome was overall survival rate for up to 4 years. Secondary outcomes included post-treatment complications and treatment response. Quality of included studies was evaluated by STROBE criteria. Relative Risk (RR) and 95% Confidence Intervals (CI) were calculated from pooled data. Results: The search strategy yielded 172 studies, 5 met our selection criteria and included 653 patients undergoing embolization for unresectable HCC. Of these patients, 284 underwent TACE and 269 underwent TARE. Median age was 63 and 64 years for TACE and TARE, respectively. Meta-analysis showed no statistically significant difference in survival for up ...