Apical Node Research Articles

Prognostic Utility of Apical Lymph Node Metastasis in Patients With Left-sided Colorectal Cancer.

Unlike the tumor nodes metastasis (TNM) lymph node classification, based solely on counts of nodal metastases, the Japanese system of classifying colorectal carcinoma (CRC) focuses on regional lymph node spread. In this study, we explored the prognostic utility of inferior mesenteric artery (IMA) apical lymph node (APN) metastasis. This was a retrospective study of patients with stage III left-sided CRC. All enrollees were subjected to D3 resection between April 2007 and December 2016 at the International Medical Center of Saitama Medical University and then stratified by histologic presence (APN+ group) or absence (APN- group) of tumor in APNs examined postoperatively. Ultimately, propensity score matching was invoked (1:2) and COX regression analysis was conducted, determining group rates of relapse-free survival (RFS) and cancer-specific survival (CSS). A total of 498 patients were studied, grouped as APN+ (19/498, 3.8%) or APN- (479/498, 96.2%). Prior to matching, the APN+ (vs. APN-) group showed significantly more lymphatic involvement (73.7% vs. 47.8%; p=0.023), deep (T3/T4) tumor infiltration (100% vs. 78.9%; p=0.024), and nodal metastasis (N2: 84.2% vs. 27.6%; p<0.001). In addition, para-aortic nodal recurrences were significantly increased (15.7% vs. 2.0%; p<0.001), conferring worse RFS (p<0.001) and CSS (p=0.014) rates. Once baseline factors were matched, the two groups appeared similar in RFS (p=0.415) and CSS (p=0.649). Multivariate regression analysis indicated that elevated carcinoembryonic antigen (CEA) level and deep tumor infiltration were independent risk factors for RFS, whereas postoperative complications and tumor-positive node counts were independent risk factors for CSS. APN+ status was not a significant risk factor for RFS or CSS. APN positivity may thus constitute a regional rather than systemic manifestation. The TNM staging based on the number of metastatic lymph nodes seems to be more reasonable than the regional lymph node classification method.

Prognostic importance of the outcomes of updating staging system in patients with stage II breast cancer

Breast cancer is the most common cancer in women. Staging plays an important role in treatment planning. In the staging system published by AJCC in 2002, micrometastasis, the total number of metastatic lymph nodes, internal mammarian and supraclavicular lymph node metastases, and level III (apical) lymph node metastases were incorporated to the staging system. These modifications are likely to cause upstaging and changes in treatment plans, precisely in patients previously considered as stage II. This study aimed to investigate the outcomes of update in staging system in terms of mortality and morbidity. The records of 150 patients who underwent surgery for stage II breast cancer were retrospectively reviewed. The patients who were accepted as stage II according to the previous staging systems and planned to be treated accordingly were re-evaluated according to the newly updated staging system. Patients with and without stage change were compared in terms of mortality, local and systemic recurrence, and disease-free survival. We found that 41 (27.3%) of the patients who were accepted as stage II according to the previous staging systems had been upstaged in the new staging system. The relationship between stage migration and tumor diameter was statistically significant. Thirty-one patients (20.7%) had recurrence during follow-up. We found that most of the patients with recurrence (77.4%) had stage migration. There was a statistically significant relationship between apical lymph node involvement and recurrence. Updates in staging system of breast cancer cause stage migration in a significant proportion of patients with stage II breast cancer and are likely to lead to a change in treatment plans in some patients. Stage migration also has an impact on prognosis. In fact, recurrence is more common in patients with stage migration.

A network of shoots: effects of ontogeny and light availability on growth units in Chandler walnuts

In adult walnut trees, poor light environments increase the number of catkins on a shoot, reducing the probability of bearing fruits. Growth units become shorter with the aging of the tree, tending to reach a stable length. Tree architecture results from the functioning of populations of meristems across consecutive periods of extension or growing cycles. The study of growth units (GUs) and the type of their axillary meristem lead to a better understanding of tree growth and allow the prediction of tree development under different environmental conditions. To study the effect of position inside the canopy on branch development and the relationship between parent wood and new shoots, 348 GUs from 14 five-to-six-year-old limbs (7 from upper/exposed and 7 from lower/shaded zones within the canopy) were analyzed. Each node was classified according to its axillary meristem type as: 0 (bud, dormant bud, bud scar and dead bud), 1 (fruit and fruit peduncle scar), 2 (male inflorescence or “catkin”, catkin scar and dead catkin) and 3 (branch and branch scar). Data were analyzed through a multinomial logistic model to summarize the distribution of axillary meristem type as a function of explanatory variables. Length of GUs and the number of catkins were modeled through a generalized linear mixed model, whereas the probability of finding fruit on apical nodes was analyzed through generalized additive models. Results show that axillary meristem type is affected by zone, node rank and wood age. On GUs of wood age two or younger, apical buds from upper/exposed zones showed higher probabilities of producing fruits compared with apical buds from lower/shaded zones. The latter was not observed for older wood. In upper/exposed zones, the slope of the relationship between the length of GUs and the length of parent wood increased with wood age. The number of catkins was higher in the lower/shaded than in the upper/exposed zone. The results of this study improve our understanding about walnut tree growth as affected by factors like ontogenetic changes and different light conditions within the tree canopy and might be useful to address tree managements such as training and pruning systems.

Oncological Impact of High Vascular Tie After Surgery for Rectal Cancer: A Nationwide Cohort Study.

The purpose of this study was to investigate the impact of tie level on oncological outcomes in rectal cancer surgery. Theoretically, a high tie of the inferior mesenteric artery could facilitate removal of apical node metastases and improve tumor staging accuracy. However, no appropriately sized randomized controlled trial exists and results from observational studies are not consistent. All stage I-III rectal cancer patients who underwent abdominal surgery with curative intention in 2007 to 2014 were identified and followed, using the Swedish Colorectal Cancer Registry. Primary outcome was cancer-specific survival, whereas overall and relative survival, locoregional and distant recurrence, and lymph node harvest were secondary outcomes, with high tie as exposure. We used propensity score matching to emulate a randomized controlled trial, and then performed Cox regression analyses to estimate hazard ratios (HRs) with confidence intervals (CIs). Some 8287 patients remained for analysis, of which 37% had high tie surgery. After propensity score matching, the 5-year cancer-specific survival rate was overall 86% and we found no association between the level of tie and cancer-specific (HR 0.92, 95% CI 0.79-1.07) or overall (HR 0.98, 95% CI 0.89-1.08) survival, nor to locoregional (HR 0.85, 95% CI 0.59-1.23) or distant (HR 1.01, 95% CI 0.88-1.15) recurrence, nor to relative survival (HR 1.05, 95% CI 0.85-1.28). Stratification and sensitivity analyses were similarly insignificant, after adjustment for confounding. Total lymph node harvest was, however, increased after high tie surgery (P < 0.01), but no differences were seen regarding positive nodes (P = 0.72). In this nationwide cohort study, the level of tie did not influence any patient-oriented oncological outcome, neither overall nor in node-positive patients. This would allow the patient's anatomical configuration and the surgeon's preferences to determine the level of tie.

532PD - Pre-operative FOLFOX chemotherapy in advanced colon cancer: Pathology analysis of the FOxTROT trial

BackgroundThe phase III international FOxTROT trial assessed the effectiveness of pre-operative chemotherapy in locally advanced colon cancer. Patients were randomised across 85 centres to pre- and post-operative FOLFOX-based chemotherapy (pre-op) or to post-operative FOLFOX chemotherapy alone (post-op) in a 2:1 ratio. MethodsCentral pathological review was performed on scanned H&E stained slides in 904 out of 1,052 cases (86%) to include reassessment of the core pathology endpoints and an additional assessment of novel prognostic and immunological markers according to trial arm. ResultsThe pre-op group showed a lower pT stage (pT0-pT2 rate 18% vs 8%, p<0.0001), lower pN stage (pN0 rate 64% vs. 52%, p=0.0002), smaller tumour diameter (40mm vs. 51mm, p<0.0001), and greater R0 rate (99% vs. 96%, p=0.02). The pre-op group showed a lower rate of apical node metastases (3% vs. 8%, p=0.002), extracapsular spread (8% vs. 19%, p<0.0001), intramural venous invasion (20% vs. 33%, p<0.0001), extramural venous invasion (35% vs. 44%, p=0.004) and lymphatic invasion (46% vs. 55%, p=0.002). The percentage of the patients with high-grade tumour budding was lower in pre-op group (5% vs. 14%, p<0.0001). Significantly greater numbers of stromal tumour infiltrating lymphocytes (TILs) (14% vs. 9%, p<0.0001) and eosinophils (6% vs. 3%, p<0.0001) were observed in the pre-op group, however, intratumoural TILs were equivalent (5% vs. 5%, p=0.63). Significantly lower numbers of neutrophils (5% vs. 10%, p<0.0001) and reduced abscess formation (11% vs. 21%, p<0.0001) was seen in the pre-op group. The average area of all uninvolved lymph nodes was smaller in the preoperative group as was the average tumour area in metastatic nodes. ConclusionsPre-op chemotherapy in locally advanced colon cancer is associated with a significant reduction in many high-risk pathological features and potential mechanisms of metastatic spread. There is also a clear effect on tumour immunology. The association with 2 year DFS is currently being performed and will be presented at the meeting. Legal entity responsible for the studyUniversity of Birmingham. FundingAmgen. DisclosureAll authors have declared no conflicts of interest.

Effect of pruning strategy on 'Syrah' bud necrosis and fruitfulness in Brazilian subtropical Southeast

The change of wine grape harvest from wet season (summer) to dry season (winter) by changing the pruning management has improved quality of wines produced in the Brazilian Southeast. However, the vines need to be spur pruned twice a year, i.e. with a 1st pruning in August (winter pruning) for a vegetative cycle during the hot and wet summer, and a 2nd pruning in January (summer pruning) for a productive cycle during the cold and dry season. This double pruning strategy is made necessary by the fact that latent buds developed during the dry season cycle are not fruitful to support a productive cycle in the following year. This histological study, performed in the South of Minas Gerais State (Brazil), showed that annual single pruning done in the wet season (in January) displayed a high rate of necrosis on primary and secondary buds (bud necrosis – BN). In April, 99 days after summer pruning (DASP), the rates of BN were 40 % and 50 % at basal and apical node positions, respectively, reaching 80 % of BN in December (322 DASP). As a consequence of BN, bud potential fertility was drastically reduced from 0.5 inflorescence primordial (IP) per bud (in July) to 0.06 (in December) and bud burst in the next cycle from secondary and tertiary bud axes. Vines managed by double pruning system (submitted to summer and winter pruning) displayed a much higher fruitfulness potential, i.e. 1.46 IP per bud in December (112 days after winter pruning) and limited BN occurrence (20 %). On single pruned vines, we also observed a significant decrease of starch content in canes, trunks and roots. Internal bud anatomy showed that a random cell breakdown started 70 days DASP. At 211 DASP, all buds showed a large starch granule concentration, raphides and crystals of calcium oxalate inside idioblasts of leaf primordia and also in cortical parenchyma of the vegetative axis. The bud starch content was increased and a positive correlation between necrosis and starch accumulation was observed. The impact of carbohydrate availability on bud necrosis development was discussed. This study showed that the necrosis development towards secondary and tertiary axis of the dry season buds is the main reason of unfruitfulness in the vineyards managed by single pruning in the wet season, making the double pruning compulsory.

Abstract 2012: Interrogating the in vivo anti-metastatic action of tinzaparin and simvastatin in an orthotopic surgical resection mouse model of triple negative breast cancer

Abstract Background: One of the key events in the progression of cancer metastasis is the migration of tumor cells through the vascular endothelium. Tumors induce abnormal endothelial permeability to promote cancer cell invasion. Recently, inhibition of tumor-induced vascular permeability has been shown to attenuate metastasis in vivo (Tichet M et al. Nat Commun. 2015;6:6993). Low molecular weight heparins (LMWHs) inhibit metastasis in vivo (Klerk et al. J Clin Oncol. 2005;23(10):2130-5) but may cause bleeding complications when used at effective doses. Consequently, LMWHs are unlikely to be used for prevention of metastatic progression unless bleeding side-effects can be diminished. To address this issue, we have recently demonstrated that a LMWH/statin combination (tinzaparin and simvastatin) attenuates abnormal vascular permeability and reduces epithelial cell transmigration at concentrations unlikely to cause bleeding side-effects in vivo. (Kevane et al. Res Pract Thromb Haemost. 2017;1(1)). Here, we aim to interrogate the anti-metastatic effect of the LMWH/statin combination (tinzaparin and simvastatin) in an orthotopic surgical resection model of triple negative breast cancer implementing a LMWH/stain dose that does not increase bleeding risk. Methods: NOD/SCID mice were surgically implanted with 5x105 MDA-MB-231-LUC2 triple negative breast cancer cells in the right inguinal mammary fat pad. Tumors were allowed to grow until they reached 250mm3. Subsequently, primary tumors were surgically resected. 5 days post-resection, mice were randomized into 4 groups (group 1: 0.5% methylcellulose (vehicle), group 2: 150IU/kg TNZ, group 3: 3mg/kg SVS and group 4: TNZ (150IU/kg) and SVS (3mg/kg)) and treated daily for 4 weeks. Post-resection metastatic progression was monitored by weekly bioluminescence imaging (BLI) [IVIS Spectrum]. Animals that displayed metastatic progression or significant regrowth of primary tumour were euthanized. At time of death, apical lymph nodes and lungs were removed and fixed in 10% formalin for quantification of metastatic burden Results: Prior to study commencement it was determined that a combination of 150IU/kg TNZ and 3mg/kg SVS did not significantly increase bleeding time in a cohort of tumour naïve animals. Following primary tumor resection, BLI assessment of metastatic progression revealed that 150IU/kg TNZ, 3mg/kg SVS and combination therapy of 150IU/kg TNZ and 3mg/kg SVS significantly (P= 0.0373, P=0.0086 and P=0.0409 respectively N=11) increased the time to metastasis compared to the vehicle treated animals. Conclusion: For the first time we demonstrate that tinzaparin and simvastatin may be combined to significantly delay time to metastasis while diminishing the associated bleeding risk of LMWHs in a clinically relevant mouse model of aggressive triple negative breast cancer. Citation Format: Ian S. Miller, Liam P. Shiels, Grace Buckley, Kate Connor, Annette T. Byrne, Fionnuala Ní Ainle. Interrogating the in vivo anti-metastatic action of tinzaparin and simvastatin in an orthotopic surgical resection mouse model of triple negative breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2012.

PO-1116 Set-up in locoregional breast irradiation: reduced margins for subclavicular and axilar lymph nodes.

PO-1116 Set-up in locoregional breast irradiation: reduced margins for subclavicular and axilar lymph nodes.

Effect of crop load, fruit position and shoot vigour on yield and quality of Annona atemoya × Annona squamosa in India

ABSTRACT The effect of crop load, position of the fruit on the shoots and vigour of the shoots on yield and quality of Annona atemoya × A. squamosa hybrid ‘Arka Sahan’ was investigated in India over two years. The trees were hand-pollinated and thinned to 20, 40, 60, 80 or 100 fruit after fruit set. Information was collected on total and marketable yield, yield efficiency, average fruit fresh weight, peel weight, the number of seeds per 100 g of pulp, pulp content in the fruit, total soluble solids (TSS) and total titratable acidity. In other experiments, fruit were harvested from weak, medium or vigrous shoots, or from basal, middle or apical nodes. Total yield increased up to 60 or 80 fruit per tree and marketable yield increased up to 60 fruit per tree. Average fruit weight and peel weight increased as cropping increased. These results suggest that optimum productivity and quality is associated with 60 fruit per tree or 0.17 to 0.19 kg cm2 trunk-cross sectional area. The quality of the fruit in different positions on the shoots or on the different types of shoots was highly variable and generally not affected by the various treatments.

Preservation versus non-preservation of left colic artery in colorectal cancer surgery

Background:It remains unclear whether or not preservation of the left colic artery (LCA) for colorectal cancer surgery. The objective of this updated systematic review and meta-analysis is to evaluate the current scientific evidence of LCA non-preservation versus LCA preservation in colorectal cancer surgery.Methods:A systematic search was conducted in the Medline, Embase, PubMed, Cochrane Library, ClinicalTrials, Web of Science, China National Knowledge Infrastructure and Chinese BioMedical Literature Database, and reference without limits. Quality of studies was evaluated by using the Newcastle–Ottawa scale and the Cochrane Collaboration's tool for assessing the risk of bias. Effective sizes were pooled under a random- or fixed-effects model. The funnel plot was used to assess the publication bias. The outcomes of interest were oncologic consideration including the number of apical lymph nodes, overall recurrence, 5-years overall survival, and 5-years disease-free survival (DFS); safety consideration including overall 30-day postoperative morbidity and overall 30-day postoperative mortality; anatomic consideration including anastomotic circulation, anastomotic leakage, urogenital, and defaecatory dysfunction.Results:Twenty-four studies including 4 randomized controlled trials (RCTs) and 20 cohort studies with a total of 8456 patients (4058 patients underwent LCA non-preservation surgery vs 4398 patients underwent LCA preservation surgery) were enrolled in this meta-analysis. The preservation of LCA was associated with significantly less anastomotic leakage (odds ratio 1.23, 95% confidence interval 1.02–1.48, P = .03). In term of sexual dysfunction, urinary retention, the number of apical lymph nodes, and long-term oncologic outcomes, there were no significant differences between the LCA non-preservation and LCA preservation group. It was hard to draw definitive conclusions on other outcomes including operation time, blood loss, the first postoperative exhaust time, and perioperative morbidity and mortality for insufficient data and highly significant heterogeneity among studies.Conclusions:The pooled data provided evidence to support the LCA preservation preferred over LCA non-preservation in anastomotic leakage. Future more large-volume, well-designed RCTs with extensive follow-up are needed to draw a definitive conclusion on this dilemma.

Apical lymph node dissection of the inferior mesenteric artery with preservation of left colic artery in colorectal cancer

Background: Nowadays, surgery for colorectal cancer has been standardized both ways in open and laparoscopic approaches but there are still debates regarding the level of ligation of the IMA at its origin from aorta (high ligation) or below the origin of left colic artery (low ligation). The technique of apical lymph node dissection with preservation of LCA has the advantage of both, better lymph node harvest and lower postoperative complications. It is controversial whether a high or low ligation of the inferior mesenteric artery (IMA) is superior. The former allows an extended lymph node clearance whereas the latter preserves the distal vascular supply via the left colic artery (LCA). Apical lymph node dissection of the IMA (ALMA) harvests nodal tissue along the IMA proximal to the LCA whilst performing a low ligation. This anatomically replicates the oncological benefit of high ligation and the vascular preservation of low ligation. This study evaluates the nodal yield of ALMA and the short-term outcome of this technique.Methods: Author retrospectively studied 40 patients with operable sigmoid and rectal cancer who admitted to general surgery department in Menoufia University Hospitals from May 2016 to May 2018. All patient underwent curative surgical resection with ALMA. The lymph node yield from the dissection (the ALMA specimen) was compared with the total lymph node yield. Data on the LCA anatomy, time required to perform ALMA, complications and postoperative recovery were evaluated.Results: Results ALMA was successful in 36 patients. Median postoperative hospitalization was 5 (2-26) days without ALMA-related morbidity or mortality. The median lymph node yield was 20 (9-41) and a median of 14.3 (0-80)% were harvested with ALMA. Two patients not having neoadjuvant chemoradiotherapy had fewer than 12 lymph nodes, excluding nodes harvested from ALMA. The average time required for ALMA was 20min.Conclusions: ALMA (lymph node dissection around the IMA preserving the root of the IMA and LCA) was feasible by this method without compromising operation time, blood loss or the number of harvested lymph nodes with accepted rate of postoperative complications.

Effects of delayed winter pruning on vine performance and grape composition in cv. Merlot

Delaying winter pruning until after budburst is a technique that can retard vine phenological phases and reduce grape sugar concentration at harvest. Given these characteristics, many studies have recently been conducted to verify the ability of pruning after budburst to contrast the negative effects of climate change. In our trial, vines of the cv. Merlot, trained to a VSP spur pruned cordon, were pre-pruned leaving 8 nodes per shoot and hand finished when the shoots sprouted by the apical nodes were at BBCH13 (treatment LP) and BBCH18 stage (treatment VLP). Vines refinished during winter were used as control (WP). Anthocyanins and tannins of skin and seeds were analysed after both exhaustive extraction (total content) and extraction conducted with a hydroalcoholic solution (extractable portion). Vines refinished after budburst showed reduced leaf area, yield, cluster and berry weights; technological maturity of these vines was delayed as lower sugar concentration and pH were observed at harvest. Treatment VLP had a stronger effect than LP on these parameters. Considering phenolic compounds, the skin and seed tannin concentration increased only in VLP, while no effect was found on anthocyanins. In conclusion, delaying pruning until after budburst revealed interesting prospects for contrasting the negative effects of climate change.

The first experience of fluorescence laparoscopy for cholecystectomy, the bile ducts and the colon surgery

The aim — to analyse of the first experience with the use of fluorescence laparoscopy (FL) in technically difficult cholecystectomies, revision of the choledochus, lymphodection, colon resection and to assess the blood supply of the anastomosis sites.Materials and methods. Fluorescence laparoscopy was applied in 7 cholecystectomies for acute calculous cholecystitis, 6 common bile duct laparoscopic revisions to estimate the patency (first‑time used technique), laparoscopic right‑side hemicolectomy for estimation the blood supply of anastomosing intestinal areas and open resection of the transverse colon during limfodissections.Results and discussion. In cholecystectomies (fluorescence cholangiography), the duration of the operation and the average time to achieve a «critical type of safety» were reduced to 30 minutes compared with the comparison group (45 minutes). During the intraoperative revision of the choledochus in 1 case of fluorescence in the duodenum was not detected, which showed its obstruction (calculus inclusions). In other cases, the choledochal patency was preserved, which was associated with transient choledocholithiasis. With right‑sided hemicolectomy by fluorescent angiography, adequate blood supply to the colon stump has been proven. With open resection of the transverse colon, fluorescence lymphography was successfully used to visualize the apical lymph nodes at the mouth of the middle colon artery.Conclusions. The first experience showed that fluorescence laparoscopy allows to facilitate and accelerate dissection in case of technically difficult cholecystectomies, to assess the passage of the common bile duct in distinct cases (for example, transient choledocholithiasis), to evaluate the blood supply of the anastomotic sites in colon resections, and to monitor the adequacy of lymph node dissection.

In vitro propagation of Cataloglu Apricot (Prunus armeniaca L.) cultivar using apical node as explant

Apricot (Prunus armeniaca L.) is highly nutritious fruit and micro propagation of apricot plant has high economic value. The current study reports micro propagation of cultivar Cataloglu using apical node explants on Murashige and Skoog (MS) medium containing different combinations of BAP+NAA supplemented with 3% sucrose and solidified with 0.65% agar. The results showed a significant effect of concentrations of BAP+NAA on callus induction, shoot regeneration and their length. Rooting percentage was not affected on all shoots regenerated on any concentration of BAP+NAA. However, number of roots per explants and their length had clear implications of the concentrations of BAP+NAA used for regenerating shoots. Optimum shoot regeneration was noted on MS medium containing 1 mg/l BAP + 0.25 mg/l NAA; which were rooted on MS medium containing 1 mg/l IBA. The rooted plantlets were acclimatized in pots containing soil:sand (3:1) ratio under greenhouse conditions. It is concluded that the study will serve as reference for future apricot breeding studies and genetic transformation studies.

Relationship between post-surgery detection of methylated circulating tumor DNA with risk of residual disease and recurrence-free survival.

Methylation in IKZF1 and BCAT1 are common events in colorectal cancer (CRC). They are often detected in blood as circulating tumor DNA (ctDNA) at diagnosis and disappear after surgery in most CRC patients. A prospective study was conducted to determine the relationship between detection of these markers following surgery and risk for residual disease and for recurrence. ctDNA status with methylated BCAT1 and IKZF1 was determined within 12months of surgical resection of CRC, and was related to presence of or risk for residual disease (margins involved, metastases present or nature of node involvement), and to recurrence-free survival. Blood was collected from 172 CRC patients after surgery and 28 (16%) were ctDNA positive. Recurrence was diagnosed in 23 of the 138 with clinical follow-up after surgery (median follow-up 23.3months, IQR 14.3-29.5). Multivariate modeling indicated that features suggestive of residual disease were an independent predictor of post-surgery ctDNA status: cases with any of three features (close resection margins, apical node involved, or distant metastases) were 5.3 times (95% CI 1.5-18.4, p = 0.008) more likely to be ctDNA positive. Multivariate analysis showed that post-surgery ctDNA positivity was independently associated with an increased risk of recurrence (HR 3.8, 1.5-9.5, p = 0.004). CRC cases positive for methylated ctDNA after surgery are at increased risk of residual disease and subsequently recurrence. This could have implications for guiding recommendations for adjuvant therapy and surveillance strategies. Randomized studies are now indicated to determine if monitoring cases with these biomarkers leads to survival benefit.

Two and five year survival for colorectal cancer after resection with curative intent: A retrospective cohort study

IntroductionColorectal cancer is a major cause of illness, disability and death in the United Kingdom. The stage of disease at diagnosis has a major impact on survival rates. The aim of this study is to assess whether the survival rates of patients receiving curative treatment in our centre are comparable with national results published by Cancer Research UK, National Bowel Cancer Audit Annual Report 2016, and NCIN Colorectal Cancer Survival by Stage Data Briefing. MethodsThe study involved a retrospective survival analysis of consecutive patients who underwent colorectal cancer resections with curative intent performed by two surgeons between January 2009 and March 2012. Patients were identified from a prospectively collected database. Data was collected via hospital computer systems including patient notes, laboratory, pathology, and radiology systems. Exclusion criteria included all patients with advanced disease who underwent surgery with palliative intent. ResultsA total of 281 patients were included. The median age at operation was 71. Overall 2-year survival was 82.6% and overall 5-year survival was 69%. 2-year and 5-year survival, respectively, for Dukes A was 93.7% and 92%, Dukes B was 85.6% and 76.7%, Dukes C1 was 81.1% and 57.8%, Dukes C2 was 56.3% and 25%, and Dukes D was 61.9% and 47.6%. ConclusionOur data demonstrates that our survival rates compare favourably with current published national survival rates. Dukes C2 patients had the poorest five year survival, highlighting the significance of a positive apical node. Dukes D patients had a particularly good outcome which indicates good patient selection by the multi-disciplinary meeting (MDT) and high quality oncology and tertiary surgical support.

Abstract ES1-2: Guidelines for postmastectomy radiotherapy

Abstract A joint panel of the American Society of Clinical Oncology (ASCO), American Society for Radiation Oncology (ASTRO), and Society of Surgical Oncology (SSO) convened in 2015 to develop an update of the prior ASCO guideline (J Clin Oncol 2001;19:1539-1569) concerning the use of postmastectomy radiation therapy (PMRT). This effort focused on common scenarios where there have been substantial controversy. Their conclusions and supporting evidence have been published (J Clin Oncol 2016;34:4431-4442). The Panel unanimously agreed that PMRT reduces the risks of local-regional failure (LRF), any recurrence, and breast cancer mortality for patients with T1-2 breast cancer with 1-3 positive axillary nodes. However, some subsets of these patients are likely to have such a low risk of LRF that the absolute benefit of PMRT is outweighed by its potential toxicities. The Panel however could not find sufficient evidence to recommend a specific formula or method of how to combine clinical, pathologic, and biologic data to calculate the risk of LRF. In addition, the acceptable ratio of benefit to toxicity varies among patients and physicians. Thus, the decision to recommend PMRT or not requires a great deal of clinical judgement. The Panel agreed clinicians making such recommendations for an individual patient should consider factors that may decrease the risk of LRF, attenuate the benefit of reduced breast cancer-specific mortality, and/or increase the risks of complications from PMRT. When clinicians and patients elect to omit axillary dissection after a positive sentinel node biopsy, the Panel recommended that these patients receive PMRT only if there is already sufficient information to justify its use without needing to know that additional axillary nodes are involved. Patients with axillary nodal involvement following neoadjuvant systemic therapy should receive PMRT. The role of PMRT in other patients with clinical Stage I or II breast cancer is uncertain. Finally, the Panel recommended that radiation therapy generally be given to both the internal mammary nodes and the supraclavicular-axillary apical nodes in addition to the chest wall or reconstructed breast when PMRT is used. However, there may be subgroups that will have limited, if any, benefits from treating both these nodal areas compared to treating only one of them or, perhaps, treating only the chest wall or reconstructed breast. There is insufficient evidence at this time to define such subgroups in detail. This lecture will address selected elements of the data leading to the Panel's decisions. Citation Format: Recht A. Guidelines for postmastectomy radiotherapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr ES1-2.

Apical Lymph Nodes in the Distant Metastases and Prognosis of Patients with Stage III Colorectal Cancer with Adequate Lymph Node Retrieval Following FOLFOX Adjuvant Chemotherapy.

The aim of the study was to assess apical lymph nodes (APNs) for predicting distant metastases in patients with stage III colorectal cancer (CRC) curatively treated with FOLFOX adjuvant chemotherapy and adequate lymph node retrieval. We investigated the correlation between APN metastasis and clinical outcomes. This retrospective study examined 97 patients. All patients were followed until death, loss to follow-up, or May 2017. Clinicopathological variables, including the APN status, were assessed. Multivariate logistic regression model was used to identify the independent risk factors for APN and distant metastases, and Cox proportional regression model was used to evaluate the association between APN metastasis and oncologic outcomes. Multivariate analyses revealed the N2 stage as an independent predictor of APN metastasis [P = 0.036; odds ratio (OR): 3.016; 95% confidence interval (CI): 1.076-8.499], while APN metastasis was an independent risk factor for distant metastases (P < 0.001; OR: 13.876; 95% CI: 3.815-50.475). Furthermore, APN metastasis was an independent risk factor for poorer disease-free survival (DFS) and overall survival (OS) (P < 0.001 and P = 0.005, respectively). The liver (31.6%) was the most common site of distant metastases in patients with APN metastases. APN metastasis is an important prognostic factor for node-positive CRC; it enhanced the distant metastases in patients with stage III CRC curatively treated with adequate lymph node retrieval following FOLFOX adjuvant chemotherapy. Therefore, for patients with stage III CRC involving APN metastasis, prospectively randomized trials are mandatory to investigate different therapeutic strategies in addition to conventional FOLFOX adjuvant chemotherapy.

Carbon Partitioning in Potted Post-V eraison Vitis vinifera L. CV. Riesling Vines: Effect of Dormant Cane Length

To investigate the movement of photoassimilates within a wine canopy, potted Vitis vinifera L. cv. Riesling grapevines were pruned to two different dormant cane lengths of 100 mm and 900 mm. Shoots on these canes were vertically trained with one non-fruitbearing shoot growing from the apical node and one fruit-bearing shoot growing from the basal node for each treatment .. Known quantities of 1'C02 were loaded into the source leaf located at leaf node position 10 on the apical shoot. Bi-directional translocation of 14C photoassimilates was demonstrated. Minimal translocation of 1'C photoassimilates from source leaves on non-fruit-bearing shoots was directed towards the clusters located on the lower shoot. The non-fruit-bearing shoots are, however, contributing to the carbohydrate reserves in the roots, where an allocation of over 50% of the exported C photoassimilates to the roots was demonstrated in both treatments.

The third glume phenotype is associated with rachilla branching in the spikes of tetraploid wheat (Triticum L.)

We investigated the new inflorescence architectural character “three glumes” and a new status of ramification in tetraploid wheat. Using 9 tetraploid accessions with “turgidum type of branching”, the segregation of branched spike and the third glume indicated the complete linkage of genes for both phenotypes. The rachilla were elongated and bore florets at basal nodes while bearing spikelets at the apical nodes in T. durum Desf. TRI 9644 and T. turgidum L. PI 67339. The phenotype was different from “sham-ramification” in Triticum jakubzineri Udacz. et Schachm., with florets at basal and apical nodes of elongated spikelet rachilla. We confirmed a new status of ramification, “false-true ramification”. It was considered that the “false-true ramification” was determined by the shr2 gene in the long arm of chromosome 2A because the ramification of PI 67339 and TRI 9644 was supposed to be allelic. The segregation of “sham-ramification” and the third glume also indicated the complete linkage of genes for both phenotypes. Thus we concluded that the presence of third glume phenotype is associated with rachis and rachilla branching in the spikes of tetraploid wheat. The present study confirmed the existence of three distinct types of spike ramification, whose classification is not entirely unified: (a) “true ramification”—“branched spike”—“genuine branching”—“turgidum type of branching”, (b) “false ramification”—“pseudo-branched spike”—“sham ramification”—“vavilovii type of branching” and (c) “false-true ramification”.