Abstract Book Society of Surgical Oncology th 68 Annual Cancer Symposium Houston, Texas March 25-28, 2015 Electronic supplement to Annals of Surgical Oncology An Oncology Journal for Surgeons
th
Cancer
68 ANNUAL
SYMPOSIUM Society of Surgical Oncology March 25-28, 2015 y Houston, Texas
Annals of Surgical Oncology An Oncology Journal for Surgeons The Official Journal of the Society of Surgical Oncology
Abstract Book Society of Surgical Oncology 68th Annual Cancer Symposium Houston, Texas March 25-28, 2015
CONTENTS Volume 22, Supplement 1, February 2015
S3: Session Titles and Abstracts Contents S5: Abstracts Accepted for Plenary and Parallel Presentations S37: Abstracts Accepted for Video Presentations S43: Abstracts Accepted for Poster Presentations S180: Conflict of Interest Disclosures S187: Author Index
This supplement was not sponsored by outside commercial interests.
Session Titles and Abstract Contents Session Title
Abstract Numbers
Pages
Abstracts Accepted for Plenary and Parallel Oral Presentations Plenary Session I Plenary Session II Parallel Session: Colorectal Cancer Parallel Session: Sarcoma Parallel Session: Thoracic/Esophageal Parallel Session: Breast Cancer 1 Parallel Session: Upper Gastrointestinal Cancer Parallel Session: Melanoma Parallel Session: Breast Cancer 2 Parallel Session: Endocrine Cancer Parallel Session: Quality Improvement/Clinical Outcomes Parallel Session: Hepatobiliary Cancer
1–3 4–7 8 – 17 18 – 22 23 – 27 28 – 37 38 – 47 48 – 57 58 – 67 68 – 75 76 – 83 84 – 91
S6 – S7 S7 – S8 S8 – S11 S11 – S13 S13 – S14 S15 – S18 S18 – S22 S22 – S25 S25 – S28 S29 – S31 S31 – S34 S34 – S36
Abstracts Accepted for Video Presentations Top Rated Videos Videos in Exhibit Hall
V1 – V8 LBV1 – LBV7
S38 – S39 S39 – S41
Abstracts Accepted for Poster Presentations Posters: Breast Cancer Posters: Colorectal Cancer Posters: Endocrine Cancer Posters: Head & Neck Cancer Posters: Hepatobiliary Cancer Posters: Melanoma Posters: Quality Improvement/Clinical Outcomes Posters: Sarcoma Posters: Thoracic/Esophageal Posters: Upper Gastrointestinal Cancer
P1 – P100 P101 – P156 P157 – P175 P176 – P177 P178 – P209 P210 – P261 P262 – P301 P302 – P321, P414 P322 – P340 P341 – P413
S44 – S76 S76 – S93 S93 – S99 S99 – S100 S100 – S111 S111 – S127 S128 – S142 S142 – S149 S149 – S155 S155 – S179
Presentations Withdrawn 39, P8, P10, P16, P50, P101, P108, P187, P189, P195, P204, P213, P251, P304, P328, P379, P396, P410
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ABSTRACTS Accepted for PLENARY and PARALLEL 35(6(17$7,216
68th Annual Cancer Symposium Society of Surgical Oncology March 25–28, 2015 Houston, Texas
Ann Surg Oncol (2015) 22:S6–S198 DOI 10.1245/s10434-015-4372-z
1
Risk after Local Excision Alone for DCIS Patients E. Rakovitch,1* S. Nofech-Mozes,1 W. Hanna,1 R. Saskin,2 A. Tuck,3 S. Sengupta,4 L. Elavathil,5 P. Jani,6 M. Bonin,7 M.C. Chang,8 E. Slodkowska,1 L. Paszat.1 1. Sunnybrook Health Sciences Centre, Toronto, ON, Canada; 2. Institute for Clinical Evaluative Science, Toronto, ON, Canada; 3. London Health Sciences Centre, London, ON, Canada; 4. Kingston General Hospital, Kingston, ON, Canada; 5. Henderson General Hospital, Hamilton, ON, Canada; 6. Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; 7. Health Sciences North Sudbury, Sudbury, ON, Canada; 8. Mount Sinai Hospital, Toronto, ON, Canada. Background: The DCIS Score (DS) was validated as a predictor of ipsilateral breast recurrence (IBR; DCIS or invasive) in 327 E5194 pts treated by breast-conserving surgery (BCS) without radiation (RT) (Solin,2013). This Ontario population-based study of 3320 women with DCIS from 1994 to 2003 (Rakovitch,2013) test the DS as a predictor of IBR risk in a broader and more contemporary population of pts treated with BCS alone w/ and w/o clear margins (CM). Methods: Breast pathologists centrally reviewed all H&E slides. The DCIS Score was obtained by standardized quantitative RT-PCR using fixed paraffin embedded tumor. The pre-specified primary objective was to determine the relationship (HR/50 units) between the risk of an IBR and the continuous DS (using Cox models) in pts treated with BCS alone with ER+ tumors and CM (no ink on tumor). The association between the continuous DS in all patients with BCS alone w/ & w/o CM was explored. Results: Blocks were collected for 1751 pts (53% of parent cohort); 718 had BCS alone (N=571 w/CM). Median follow-up was 9.4 years. Among 718 pts w/BCS alone, 136 pts had an IBR (DCIS, N=57; invasive, N=80). Among 571 pts w/CM, 100 had IBR (DCIS,N=44; invasive,N=57). In the primary analysis, among 571 pts treated by BCS alone w/CM the continuous DS was significantly associated with IBR in ER+ pts (HR 2.26; 95%CI 1.41,3.59; P=0.001) and in all pts (HR 2.15;95%CI 1.43,3.22;P=18) on ODX are associated with LRR. Although not typically used for LRR, ODX RS result may impact adherence to endocrine therapy recommendations and surveillance/follow-up for LRR in select pts.
P5
Interaction between CD47 and SIRPA in BM and in PB Predicts Poor Prognosis in Breast Cancer Subtypes M. Nagahara,1* M. Mori.2 6XUJLFDO2QFRORJ\7RN\R0HGLFDODQG'HQWDO8QLYHUVLW\ 7RN\R-DSDQ 2VDND8QLYHUVLW\2VDND-DSDQ Introduction: Focused on CD47 expression in bone marrow (BM) and peripheral blood (PB), we found the correlation between breast cancer subtypes and CD47 expression, which may indicate important implications for prognostic factor. Moreover, CD47 expression is strongly correlated with SIRPA expression in both the BM and PB of breast cancer and it indicates that the poor prognosis of breast cancer with high expression of CD47 is due to an active CD47/SIRPA signaling pathway in circulating cells. Experimental Design: Quantitative real-time PCR was used to evaluate CD47 mRNA and SIRPA mRNA expression in BM and in PB from 452 cases of breast cancer. Results: In Her2 enriched patients with high CD47 expression in BM and PB, survival was significantly poorer compared to patients with low CD47 expression. Furthermore, high CD47 expression group in Her2 enriched of multivariate analysis showed significance as an independent variable for poorer prognosis in DFS (BM: P = 0.002, PB: P = 0.01) and in OS (BM: P=0.02, PB: P=0.008). On the other hand, in triple negative patients with high CD47 expression in BM, survival was significantly poorer compared to patients with low CD47 expression group. CD47 expression was strongly correlated with SIRPA expression in both the BM and PB of breast cancer patients (BM: P < 0.0001; PB: P < 0.0001). In particular, CD47 expression was more strongly correlated with SIRPA expression in luminal types (Spearman correlation: 0.88). Conclusions: Overexpression of CD47 in BM correlated with the recurrence in Her2
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The Effect of HER2 Amplification in HER2+ Breast Cancer M.K. Lee,* S.A. Hurvitz, B.N. Tran, Y. Fu, D.U. Chung, J. Gornbein, S.K. Apple, H.R. Chang. UCLA, Los Angeles, CA. ,QWURGXFWLRQ +(5 RYHUH[SUHVVLRQ DFFRXQWV IRU RI EUHDVW FDQFHUV 7KH SRRU SURJQRVLV KLVWRULFDOO\ DVVRFLDWHG ZLWK +(5 RYHUH[SUHVVLRQ KDV VLJQLILFDQWO\ LPSURYHG ZLWK WKH DGGLWLRQ RI +(5WDUJHWHG WKHUDS\ WR VWDQGDUG FKHPRWKHUDS\ 2XU REMHFWLYHV ZHUH WR HYDOXDWH LI +(5 DPSOLILFDWLRQLVDVVRFLDWHGZLWKGLIIHUHQWFOLQLFRSDWKRORJLFDOIHDWXUHVDQG WR GHWHUPLQH LI DPSOLILFDWLRQ DIIHFWV UHFXUUHQFHIUHH VXUYLYDO 5)6 DIWHU VWDQGDUGWUHDWPHQWMethods We retrospectively analyzed 153 patients with HER2+ breast cancer who had surgery at our institution from 2002-2010. Determined by recursive partitioning, a HER2/CEP17 ratio of 7.2 predicted survival. We compared demographics, surgery and systemic treatment, pathology, and RFS in patients with ratio ) 7.2 versus > 7.2. Results Of HER2+ cases, 63 (39%) had a HER2/CEP17 ratio ) 7.2. Median follow-up was 75 months. Most patients (71%) received standard systemic treatment with chemotherapy and trastuzumab. There was no difference in age, race, menopausal status, and family history of breast cancer between groups. Compared to lower amplification tumors, those with a high level were associated with decreased PR positivity (47.8% vs. 68.3%, p=0.01), increased Ki67 (median 33% vs. 25%, p=0.03), and smaller size (T1 52.2% vs. 30.2%, p=0.02). There was no difference in tumor differ-entiation/grade, ER status, lymphovascular invasion, nodal stage, and type of surgery or systemic treatment. In multivariate classification tree survival analysis, ratio ) 7.2 and positive nodal status were independent predictors for recurrence/ death. Tree modeling identified the highest risk group for recur-rence/death to be patients with node positive disease and ratio 5.6-7.2 (n=8, HR=12.2, p0.05). While 5-year log-rank OS was comparable among mtKRAS(41.6%) vs. wtKRAS(48.5%), on multivariable Cox survival analysis mtKRAS was asso-ciated with worse OS(HR, 1.65; 95%CI, 1.07-2.54). Moreover, among patients who experienced a recurrence, 5-year OS was worse among those patients who had mtKRAS(mtKRAS, 28.1% vs. wtKRAS, 44.5%; P=0.004; Figure). After controlling for tumor factors, as well as receipt of chemotherapy, mtKRAS sta-tus remained independently associated with a worse outcome among patients who recurred(HR 2.07, 95% CI 1.31-3.27; P=0.002). Conclusion: mtKRAS was noted in one-third of patients with CLM. While KRAS status did not impact pattern of recurrence, mtKRAS was an independent predictor of worse OS among patients who experienced a recurrence following resection of CLM.
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S104
Abstracts: Poster Presentations
P188 Management and Outcomes of Patients with Recurrent Intrahepatic Cholangiocarcinoma following Previous Curative Intent Surgical Resection G. Spolverato,10* Y. Kim,10 S. Alexandrescu,1 H. Marques,2 L. Aldrighetti,3 T. Gamblin,4 C. Pulitano,5 T.W. Bauer,6 F. Shen,7 C. Sandroussi,5 G.A. Poultsides,8 S.K. Maithel,9 T.M. Pawlik.10 1. Fundeni Clinical Institute, Bucharest, Romania; 2. Curry Cabral Hospital, Lisbon, Portugal; 3. San Raffaele, Milan, Italy; 0HGLFDO&ROOHJHRI:LVFRQVLQ0LOZDXNHH:, 8QLYHUVLW\RI6\G QH\6\GQH\16:$XVWUDOLD 'HSDUWPHQWRI6XUJHU\8QLYHUVLW\ RI9LUJLQLD&KDUORWWHVYLOOH9$ (DVWHUQ+HSDWRELOLDU\6XUJHU\ +RVSLWDO6KDQJKDL&KLQD 6WDQIRUG8QLYHUVLW\6WDQIRUG&$ (PRU\8QLYHUVLW\$WODQWD*$ -RKQV+RSNLQV+RVSLWDO %DOWLPRUH0' Background: Many patients develop recurrence following resection of intrahepatic cholangiocarcinoma(ICC). Management and outcomes of patients with recurrent ICC following previous curative-intent surgery are not well documented. We sought to characterise the treatment of patients with recurrent ICC and define therapy-specific outcomes. Methods: Between 1990-2013, 542 patients who underwent surgery for ICC were identified from an international database. Data on clinicopathological characteristics, operative details, recurrence and recurrence-related management were recorded and analyzed. Results: At initial surgery, treatment was resection only (96.1%) or resection+RFA (3.9%). Overall 5-year survival was 25.9% 376 (69.4%) patients recurred with a median disease-free survival of 11.0 months. Vascular invasion (hazard ratio [HR]=1.43), nodal metastasis (HR=1.40) and poor differentiation (HR=1.30) were predictive of recurrence (all P 5 cm, high grade and recurrent sarcomas
Abstracts: Poster Presentations
S147
and chemotherapy for high grade sarcomas) were analyzed for incidence of systemic relapse, site distribution and risk factors for systemic relapse including primary site, histopathology subtype, grade and stage. Results: A total of 435 patients with STS were analysed and 375 patients having a curative resection were included for analysis. Seventy six out of 375 (20.26%) had distant relapse, of which 7 (9.21%) also had locoregional relapse. Median time to relapse was 11.76 months. Overall 26% (66/254) of extremity sarcoma patients and 8% (10/126) of non extremity sarcoma patients developed distant metastases. Sixty two out of 76 (81.57%) patients had pulmonary metastasis and 14 (11.29%) had extrapulmonary metastasis (liver-5, bone-3, brain-1, distant nodes-2, orbit-1, peritoneum-2). Amongst 62 patients with pulmonary metastases 55 (88.70%) had isolated pulmonary only, while 7 (11.29%) had additional sites. Majority of patients with systemic relapse had MSKCC stage III (83%) and high grade tumors (97%). Synovial Sarcoma was predominant histology seen in 42 % (32/76), followed by Malignant Peripheral Nerve Sheath Tumor (12/76) and Malignant Fibrous Histiocytoma (9/76). Only 9 patients with pulmonary metastases could be salvaged with metastatectomy and others received palliative treatment only.
P315
Is F-18 fluoro-2-deoxy-D-glucose Positron Emission Tomography (FDG-PET/CT) of Value in Soft Tissue Sarcoma Management? W.S. Orr,1* K. Watson,1 R. Feig,1 N. Ikoma,1 N. De Rosa,1 G. Giacco,2 V. Ravi,3 R.S. Benjamin,3 J.E. Madewell,4 J.N. Cormier,1 K.K. Hunt,1 C.L. Roland,1 B.W. Feig,1 K. Torres.1 1. Surgical Oncology, UT MD Anderson Cancer Center, Houston, TX; 2. Tumor Registry, UT MD Anderson Cancer Center, Houston, TX; 3. Sarcoma Medical Oncology, UT MD Anderson Cancer Center, Houston, TX; 4. Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, TX. Background: Positron emission tomography (FDG-PET/CT) is being used with increasing frequency in the staging and treatment response management of soft tissue sarcoma patients. In this study, we evaluate the value of FDG-PET/CT to assess whether initial maximum standardized uptake values (SUVmax) correlate with tumor grade and outcomes. Methods: 323 patients that underwent FDG-PET/CT scans were retrospectively evaluated. The SUVmax of tumors were compared for various histologic subtypes and correlated with histopathologic grade. The SUV change ([SUVmax prior to neoadjuvant therapy] – [SUVmax post neoadjuvant therapy]) was also correlated with histopathologic tumor necrosis and size change based on imaging studies. Results: Primary tumors had a mean SUVmax of 11.2. No significant difference was found in the mean SUVmax for recurrent or metastatic tumors when compared to primary tumors (p=0.4). Tumor SUVmax differed significantly among tumor grades; high grade tumors had a mean SUVmax of 14.8 which was higher than intermediate (mean, 7.9, p
th
Cancer
68 ANNUAL
SYMPOSIUM Society of Surgical Oncology March 25-28, 2015 y Houston, Texas
Annals of Surgical Oncology An Oncology Journal for Surgeons The Official Journal of the Society of Surgical Oncology
Abstract Book Society of Surgical Oncology 68th Annual Cancer Symposium Houston, Texas March 25-28, 2015
CONTENTS Volume 22, Supplement 1, February 2015
S3: Session Titles and Abstracts Contents S5: Abstracts Accepted for Plenary and Parallel Presentations S37: Abstracts Accepted for Video Presentations S43: Abstracts Accepted for Poster Presentations S180: Conflict of Interest Disclosures S187: Author Index
This supplement was not sponsored by outside commercial interests.
Session Titles and Abstract Contents Session Title
Abstract Numbers
Pages
Abstracts Accepted for Plenary and Parallel Oral Presentations Plenary Session I Plenary Session II Parallel Session: Colorectal Cancer Parallel Session: Sarcoma Parallel Session: Thoracic/Esophageal Parallel Session: Breast Cancer 1 Parallel Session: Upper Gastrointestinal Cancer Parallel Session: Melanoma Parallel Session: Breast Cancer 2 Parallel Session: Endocrine Cancer Parallel Session: Quality Improvement/Clinical Outcomes Parallel Session: Hepatobiliary Cancer
1–3 4–7 8 – 17 18 – 22 23 – 27 28 – 37 38 – 47 48 – 57 58 – 67 68 – 75 76 – 83 84 – 91
S6 – S7 S7 – S8 S8 – S11 S11 – S13 S13 – S14 S15 – S18 S18 – S22 S22 – S25 S25 – S28 S29 – S31 S31 – S34 S34 – S36
Abstracts Accepted for Video Presentations Top Rated Videos Videos in Exhibit Hall
V1 – V8 LBV1 – LBV7
S38 – S39 S39 – S41
Abstracts Accepted for Poster Presentations Posters: Breast Cancer Posters: Colorectal Cancer Posters: Endocrine Cancer Posters: Head & Neck Cancer Posters: Hepatobiliary Cancer Posters: Melanoma Posters: Quality Improvement/Clinical Outcomes Posters: Sarcoma Posters: Thoracic/Esophageal Posters: Upper Gastrointestinal Cancer
P1 – P100 P101 – P156 P157 – P175 P176 – P177 P178 – P209 P210 – P261 P262 – P301 P302 – P321, P414 P322 – P340 P341 – P413
S44 – S76 S76 – S93 S93 – S99 S99 – S100 S100 – S111 S111 – S127 S128 – S142 S142 – S149 S149 – S155 S155 – S179
Presentations Withdrawn 39, P8, P10, P16, P50, P101, P108, P187, P189, P195, P204, P213, P251, P304, P328, P379, P396, P410
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ABSTRACTS Accepted for PLENARY and PARALLEL 35(6(17$7,216
68th Annual Cancer Symposium Society of Surgical Oncology March 25–28, 2015 Houston, Texas
Ann Surg Oncol (2015) 22:S6–S198 DOI 10.1245/s10434-015-4372-z
1
Risk after Local Excision Alone for DCIS Patients E. Rakovitch,1* S. Nofech-Mozes,1 W. Hanna,1 R. Saskin,2 A. Tuck,3 S. Sengupta,4 L. Elavathil,5 P. Jani,6 M. Bonin,7 M.C. Chang,8 E. Slodkowska,1 L. Paszat.1 1. Sunnybrook Health Sciences Centre, Toronto, ON, Canada; 2. Institute for Clinical Evaluative Science, Toronto, ON, Canada; 3. London Health Sciences Centre, London, ON, Canada; 4. Kingston General Hospital, Kingston, ON, Canada; 5. Henderson General Hospital, Hamilton, ON, Canada; 6. Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; 7. Health Sciences North Sudbury, Sudbury, ON, Canada; 8. Mount Sinai Hospital, Toronto, ON, Canada. Background: The DCIS Score (DS) was validated as a predictor of ipsilateral breast recurrence (IBR; DCIS or invasive) in 327 E5194 pts treated by breast-conserving surgery (BCS) without radiation (RT) (Solin,2013). This Ontario population-based study of 3320 women with DCIS from 1994 to 2003 (Rakovitch,2013) test the DS as a predictor of IBR risk in a broader and more contemporary population of pts treated with BCS alone w/ and w/o clear margins (CM). Methods: Breast pathologists centrally reviewed all H&E slides. The DCIS Score was obtained by standardized quantitative RT-PCR using fixed paraffin embedded tumor. The pre-specified primary objective was to determine the relationship (HR/50 units) between the risk of an IBR and the continuous DS (using Cox models) in pts treated with BCS alone with ER+ tumors and CM (no ink on tumor). The association between the continuous DS in all patients with BCS alone w/ & w/o CM was explored. Results: Blocks were collected for 1751 pts (53% of parent cohort); 718 had BCS alone (N=571 w/CM). Median follow-up was 9.4 years. Among 718 pts w/BCS alone, 136 pts had an IBR (DCIS, N=57; invasive, N=80). Among 571 pts w/CM, 100 had IBR (DCIS,N=44; invasive,N=57). In the primary analysis, among 571 pts treated by BCS alone w/CM the continuous DS was significantly associated with IBR in ER+ pts (HR 2.26; 95%CI 1.41,3.59; P=0.001) and in all pts (HR 2.15;95%CI 1.43,3.22;P=18) on ODX are associated with LRR. Although not typically used for LRR, ODX RS result may impact adherence to endocrine therapy recommendations and surveillance/follow-up for LRR in select pts.
P5
Interaction between CD47 and SIRPA in BM and in PB Predicts Poor Prognosis in Breast Cancer Subtypes M. Nagahara,1* M. Mori.2 6XUJLFDO2QFRORJ\7RN\R0HGLFDODQG'HQWDO8QLYHUVLW\ 7RN\R-DSDQ 2VDND8QLYHUVLW\2VDND-DSDQ Introduction: Focused on CD47 expression in bone marrow (BM) and peripheral blood (PB), we found the correlation between breast cancer subtypes and CD47 expression, which may indicate important implications for prognostic factor. Moreover, CD47 expression is strongly correlated with SIRPA expression in both the BM and PB of breast cancer and it indicates that the poor prognosis of breast cancer with high expression of CD47 is due to an active CD47/SIRPA signaling pathway in circulating cells. Experimental Design: Quantitative real-time PCR was used to evaluate CD47 mRNA and SIRPA mRNA expression in BM and in PB from 452 cases of breast cancer. Results: In Her2 enriched patients with high CD47 expression in BM and PB, survival was significantly poorer compared to patients with low CD47 expression. Furthermore, high CD47 expression group in Her2 enriched of multivariate analysis showed significance as an independent variable for poorer prognosis in DFS (BM: P = 0.002, PB: P = 0.01) and in OS (BM: P=0.02, PB: P=0.008). On the other hand, in triple negative patients with high CD47 expression in BM, survival was significantly poorer compared to patients with low CD47 expression group. CD47 expression was strongly correlated with SIRPA expression in both the BM and PB of breast cancer patients (BM: P < 0.0001; PB: P < 0.0001). In particular, CD47 expression was more strongly correlated with SIRPA expression in luminal types (Spearman correlation: 0.88). Conclusions: Overexpression of CD47 in BM correlated with the recurrence in Her2
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The Effect of HER2 Amplification in HER2+ Breast Cancer M.K. Lee,* S.A. Hurvitz, B.N. Tran, Y. Fu, D.U. Chung, J. Gornbein, S.K. Apple, H.R. Chang. UCLA, Los Angeles, CA. ,QWURGXFWLRQ +(5 RYHUH[SUHVVLRQ DFFRXQWV IRU RI EUHDVW FDQFHUV 7KH SRRU SURJQRVLV KLVWRULFDOO\ DVVRFLDWHG ZLWK +(5 RYHUH[SUHVVLRQ KDV VLJQLILFDQWO\ LPSURYHG ZLWK WKH DGGLWLRQ RI +(5WDUJHWHG WKHUDS\ WR VWDQGDUG FKHPRWKHUDS\ 2XU REMHFWLYHV ZHUH WR HYDOXDWH LI +(5 DPSOLILFDWLRQLVDVVRFLDWHGZLWKGLIIHUHQWFOLQLFRSDWKRORJLFDOIHDWXUHVDQG WR GHWHUPLQH LI DPSOLILFDWLRQ DIIHFWV UHFXUUHQFHIUHH VXUYLYDO 5)6 DIWHU VWDQGDUGWUHDWPHQWMethods We retrospectively analyzed 153 patients with HER2+ breast cancer who had surgery at our institution from 2002-2010. Determined by recursive partitioning, a HER2/CEP17 ratio of 7.2 predicted survival. We compared demographics, surgery and systemic treatment, pathology, and RFS in patients with ratio ) 7.2 versus > 7.2. Results Of HER2+ cases, 63 (39%) had a HER2/CEP17 ratio ) 7.2. Median follow-up was 75 months. Most patients (71%) received standard systemic treatment with chemotherapy and trastuzumab. There was no difference in age, race, menopausal status, and family history of breast cancer between groups. Compared to lower amplification tumors, those with a high level were associated with decreased PR positivity (47.8% vs. 68.3%, p=0.01), increased Ki67 (median 33% vs. 25%, p=0.03), and smaller size (T1 52.2% vs. 30.2%, p=0.02). There was no difference in tumor differ-entiation/grade, ER status, lymphovascular invasion, nodal stage, and type of surgery or systemic treatment. In multivariate classification tree survival analysis, ratio ) 7.2 and positive nodal status were independent predictors for recurrence/ death. Tree modeling identified the highest risk group for recur-rence/death to be patients with node positive disease and ratio 5.6-7.2 (n=8, HR=12.2, p0.05). While 5-year log-rank OS was comparable among mtKRAS(41.6%) vs. wtKRAS(48.5%), on multivariable Cox survival analysis mtKRAS was asso-ciated with worse OS(HR, 1.65; 95%CI, 1.07-2.54). Moreover, among patients who experienced a recurrence, 5-year OS was worse among those patients who had mtKRAS(mtKRAS, 28.1% vs. wtKRAS, 44.5%; P=0.004; Figure). After controlling for tumor factors, as well as receipt of chemotherapy, mtKRAS sta-tus remained independently associated with a worse outcome among patients who recurred(HR 2.07, 95% CI 1.31-3.27; P=0.002). Conclusion: mtKRAS was noted in one-third of patients with CLM. While KRAS status did not impact pattern of recurrence, mtKRAS was an independent predictor of worse OS among patients who experienced a recurrence following resection of CLM.
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patients with an elevated PLR had a higher risk of death (HR=2.14)(P=0.01) (Figure). Conclusion: Patients with a high NLR or PLR had an increased risk of a perioperative complication. Elevated PLR was also a predictor of worse survival among patients with HPB malignancy undergoing resection.
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Abstracts: Poster Presentations
P188 Management and Outcomes of Patients with Recurrent Intrahepatic Cholangiocarcinoma following Previous Curative Intent Surgical Resection G. Spolverato,10* Y. Kim,10 S. Alexandrescu,1 H. Marques,2 L. Aldrighetti,3 T. Gamblin,4 C. Pulitano,5 T.W. Bauer,6 F. Shen,7 C. Sandroussi,5 G.A. Poultsides,8 S.K. Maithel,9 T.M. Pawlik.10 1. Fundeni Clinical Institute, Bucharest, Romania; 2. Curry Cabral Hospital, Lisbon, Portugal; 3. San Raffaele, Milan, Italy; 0HGLFDO&ROOHJHRI:LVFRQVLQ0LOZDXNHH:, 8QLYHUVLW\RI6\G QH\6\GQH\16:$XVWUDOLD 'HSDUWPHQWRI6XUJHU\8QLYHUVLW\ RI9LUJLQLD&KDUORWWHVYLOOH9$ (DVWHUQ+HSDWRELOLDU\6XUJHU\ +RVSLWDO6KDQJKDL&KLQD 6WDQIRUG8QLYHUVLW\6WDQIRUG&$ (PRU\8QLYHUVLW\$WODQWD*$ -RKQV+RSNLQV+RVSLWDO %DOWLPRUH0' Background: Many patients develop recurrence following resection of intrahepatic cholangiocarcinoma(ICC). Management and outcomes of patients with recurrent ICC following previous curative-intent surgery are not well documented. We sought to characterise the treatment of patients with recurrent ICC and define therapy-specific outcomes. Methods: Between 1990-2013, 542 patients who underwent surgery for ICC were identified from an international database. Data on clinicopathological characteristics, operative details, recurrence and recurrence-related management were recorded and analyzed. Results: At initial surgery, treatment was resection only (96.1%) or resection+RFA (3.9%). Overall 5-year survival was 25.9% 376 (69.4%) patients recurred with a median disease-free survival of 11.0 months. Vascular invasion (hazard ratio [HR]=1.43), nodal metastasis (HR=1.40) and poor differentiation (HR=1.30) were predictive of recurrence (all P 5 cm, high grade and recurrent sarcomas
Abstracts: Poster Presentations
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and chemotherapy for high grade sarcomas) were analyzed for incidence of systemic relapse, site distribution and risk factors for systemic relapse including primary site, histopathology subtype, grade and stage. Results: A total of 435 patients with STS were analysed and 375 patients having a curative resection were included for analysis. Seventy six out of 375 (20.26%) had distant relapse, of which 7 (9.21%) also had locoregional relapse. Median time to relapse was 11.76 months. Overall 26% (66/254) of extremity sarcoma patients and 8% (10/126) of non extremity sarcoma patients developed distant metastases. Sixty two out of 76 (81.57%) patients had pulmonary metastasis and 14 (11.29%) had extrapulmonary metastasis (liver-5, bone-3, brain-1, distant nodes-2, orbit-1, peritoneum-2). Amongst 62 patients with pulmonary metastases 55 (88.70%) had isolated pulmonary only, while 7 (11.29%) had additional sites. Majority of patients with systemic relapse had MSKCC stage III (83%) and high grade tumors (97%). Synovial Sarcoma was predominant histology seen in 42 % (32/76), followed by Malignant Peripheral Nerve Sheath Tumor (12/76) and Malignant Fibrous Histiocytoma (9/76). Only 9 patients with pulmonary metastases could be salvaged with metastatectomy and others received palliative treatment only.
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Is F-18 fluoro-2-deoxy-D-glucose Positron Emission Tomography (FDG-PET/CT) of Value in Soft Tissue Sarcoma Management? W.S. Orr,1* K. Watson,1 R. Feig,1 N. Ikoma,1 N. De Rosa,1 G. Giacco,2 V. Ravi,3 R.S. Benjamin,3 J.E. Madewell,4 J.N. Cormier,1 K.K. Hunt,1 C.L. Roland,1 B.W. Feig,1 K. Torres.1 1. Surgical Oncology, UT MD Anderson Cancer Center, Houston, TX; 2. Tumor Registry, UT MD Anderson Cancer Center, Houston, TX; 3. Sarcoma Medical Oncology, UT MD Anderson Cancer Center, Houston, TX; 4. Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, TX. Background: Positron emission tomography (FDG-PET/CT) is being used with increasing frequency in the staging and treatment response management of soft tissue sarcoma patients. In this study, we evaluate the value of FDG-PET/CT to assess whether initial maximum standardized uptake values (SUVmax) correlate with tumor grade and outcomes. Methods: 323 patients that underwent FDG-PET/CT scans were retrospectively evaluated. The SUVmax of tumors were compared for various histologic subtypes and correlated with histopathologic grade. The SUV change ([SUVmax prior to neoadjuvant therapy] – [SUVmax post neoadjuvant therapy]) was also correlated with histopathologic tumor necrosis and size change based on imaging studies. Results: Primary tumors had a mean SUVmax of 11.2. No significant difference was found in the mean SUVmax for recurrent or metastatic tumors when compared to primary tumors (p=0.4). Tumor SUVmax differed significantly among tumor grades; high grade tumors had a mean SUVmax of 14.8 which was higher than intermediate (mean, 7.9, p
