Underwent Tumor Resection Research Articles

Abstract 3404: Single nuclei RNAseq analysis of recurrent high-grade glioma tumors from patients in the phase 0/1 ‘trigger’ trial of ribociclib plus everolimus

Abstract Background: The RB-CDK4/6 and mTOR signaling pathways are deregulated in high-grade glioma (HGG) and mTOR activation is a potential mechanism of resistance to CDK4/6 inhibition. This study evaluates the tumor pharmacokinetics (PK) and pharmacodynamics (PD) of combined CDK4/6 and mTOR inhibition in recurrent HGG patients. Furthermore, single nuclei RNA sequencing (snRNAseq) provides further insight on the transcriptomic and cell state change in all patients enrolled in the Phase 0 trial. Methods: Eligible patients had recurrent HGG with (1) RB+, (2) CDKN2A/B deletion or CDK4/6 amplification, and (3) PTEN loss or PIK3CA mutations. Six patients received five days of ribociclib (400mg QD) plus everolimus (2.5mg QD) and underwent tumor resection at 2, 8 or 24 hours following the last dose. Six dose-escalation cohorts (n=3 each) reached a dose-level of ribociclib (600mg QD) plus everolimus (70mg QW). Tumor tissue, CSF, and plasma were collected. Total and unbound drug concentrations were determined using validated LC-MS/MS methods. Tumor PD effects were compared to matched archival tissue. A PK ‘trigger’ (i.e., unbound concentration > 5-fold biochemical IC50) and a PD ‘trigger’ (>30% decrease in both pRB and pS6) in Gd-nonenhancing tissue were set to qualify patients for expansion. Single nuclei cell analysis was performed on 21 fresh frozen surgical tumor samples to capture transcriptional and cell state changes. Results: 24 patients with WHO Grade III (n=2) and Grade IV (n=22) gliomas were enrolled. No dose-limiting toxicities were observed. Following presurgical drug, all patients demonstrated marked decrease in Gd-enhancement on preoperative MRI. In Gd-nonenhancing tumor regions, the median unbound concentration of ribociclib was 561 nM whereas no unbound everolimus concentrations were detected. Across all dose-levels, 57% (13/23) and 43% (10/23) of tumors demonstrated RB and S6 phosphorylation decrease, respectively. snRNAseq analysis revealed significant downregulation of mTOR signaling only in endothelial cells at higher dose levels of everolimus. Amongst the tumor cells, the neural progenitor-like cell state was decreased whereas oligodendrocyte progenitor-like cell state was increased compared to standard-of-care cohort, suggesting a possible inhibition of CDK4-driven neural progenitor-like cell state. Conclusion: In adult HGG, ribociclib achieves pharmacologically-relevant concentrations in Gd-nonenhancing tumor. Everolimus exhibits limited penetration into human glioma tissue. Phase 0 surgical tumor tissue is shown to be great resource for identifying pharmacodynamic treatment effect at the single nuclei level. Our study supports further development of ribociclib, but not everolimus, for the treatment of glioma patients. Citation Format: Nader Sanai, An-Chi Tien, Kevin Johnson, Jun Jiang, Yu-Wei Chang, Chelsea Montgomery, Anita DeSantis, Yoko Fujita, Seongho Kim, Jing Li, Roel Verhaak, Shwetal Mehta. Single nuclei RNAseq analysis of recurrent high-grade glioma tumors from patients in the phase 0/1 ‘trigger’ trial of ribociclib plus everolimus [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3404.

CCT6A is associated with CDC20, Enneking stage and prognosis in osteosarcoma, and its knockdown suppresses osteosarcoma cell viability and invasion.

Chaperonin-containing tailless complex polypeptide 1 subunit 6A (CCT6A) regulates the proliferation, invasiveness and stemness of numerous types of cancer, and may interact with cell division cycle 20 (CDC20); however, its implication in osteosarcoma remains unclear. The present study aimed to investigate the relationship between CCT6A and CDC20, and their association with clinical features and prognosis. Subsequently, the present study explored the effects of their knockdown on osteosarcoma cell malignant behaviors. A total of 52 patients with osteosarcoma underwent tumor resection were retrospectively analyzed. CCT6A and CDC20 expression levels in tumor and nontumor tissues were detected by reverse transcription-quantitative PCR and immunohistochemistry. In addition, CCT6A and CDC20 small interfering RNA molecules were transfected into osteosarcoma cell lines. The results revealed that the mRNA (P<0.001) and protein (P<0.001) expression levels of CCT6A were elevated in tumor tissues compared with those in nontumor tissues. Tumor CCT6A mRNA expression was correlated with elevated CDC20 mRNA expression (P<0.001), higher Enneking stage (P=0.039), abnormal lactate dehydrogenase (LDH) level (>300 U/l) (P=0.048), lower pathological response (P=0.024) and worse disease-free survival (DFS) (P=0.015). Tumor CCT6A protein expression was also associated with increased CDC20 protein (P<0.001), elevated Enneking stage (P=0.005), abnormal LDH (P=0.019), decreased pathological response (P=0.014), shorter DFS (P=0.030) and overall survival (OS) (P=0.027). After adjustment by multivariate Cox analyses, tumor CCT6A mRNA expression was shown to independently predict lower pathological response (P=0.033) and poor DFS (P=0.028), but not OS. Regarding CDC20, it was associated with a higher Enneking stage and lower pathological response (both P<0.05), whereas it failed to estimate DFS or OS. In vitro experiments demonstrated that CCT6A and CDC20 knockdown inhibited proliferation and invasion, and enhanced apoptosis in U-2 OS and Saos-2 cells (all P<0.05). In conclusion, CCT6A is associated with CDC20, Enneking stage and prognosis of osteosarcoma, and its knockdown decreases the viability and invasion of osteosarcoma cells.

The Exercise Intervention as Part of Rehabilitation in Intracranial Myxoid Chondrosarcoma: A Case Report

Malignant tumors after surgical trauma are frequently presented with unavoidable complications, such as physical dysfunction, decreased motor endurance, bowel disorders and cognitive impairment, and other symptoms. Due to the presence of malignant tumors, patients suffer from not only physical discomfort but also the presence of psychological and mental stress. Trauma often leads to poor emotional control and cannot cooperate with treatment. Exercise can not only change the function of the limbs but also have a positive effect on emotions. This case reports a 28-year-old male who experienced a decline in cognitive function and activities of daily living after undergoing tumor resection and radiotherapy. A year later, he was hospitalized and completed a four-week activity of daily living and exercise rehabilitation training. What’s more, his mood was managed along with the reintegration therapy. As the patient's mood improved, training coordination increased, quality of life and daily living ability gradually improved, and he recovered well during the follow-up period. Given this single case, multi-modal exercise rehabilitation can maintain or improve functional performance and QOL domains even during heavy treatments. When the patient is undergoing exercise rehabilitation, he also needs emotional management, and emotional intervention is required for the patient. Therefore, exercise and the emotional management of patients with malignancy are of great importance.

Occlusive wound closure prevents prolonged wound discharge-A randomised controlled trial in patients undergoing tumour resection and endoprosthetic reconstruction of the proximal femur because of metastatic bone disease.

Prolonged wound discharge is a common postoperative complication of orthopaedic procedures and a risk factor for implant-related infection. Occlusive wound closure methods have previously been suggested to reduce or even prevent this complication. We performed a randomised controlled trial on 70 patients who underwent surgical treatment for metastatic bone disease involving the proximal femur at our centre between January 2017 and August 2018. At conclusion of the tumour resection and endoprosthetic reconstruction procedure, patients were randomised to either occlusive wound closure (n=35), using the Dermabond Prineo-22 skin closure system, or routine wound closure with conventional skin staples (n=35). Skin closure with occlusive wound closure resulted in a lesser degree (P < .0001) and shorter duration of postoperative wound discharge (HR 2.89 [95% CI 1.6-5.05], P < .0018). Compared with staples, surgical wounds were already dry after a mean of 3.5 days [95% CI 3.2-3.9] versus 6.1 days [95% CI 4.8-7.3] (P < .0001). Prolonged wound discharge for 7 days or more was observed in 23% of patients (n=8) in the Staples-group but was entirely absent in the occlusive wound closure group (P < .003). This study provides strong evidence that occlusive wound closure reduces frequency, degree, and duration of wound discharge in a patient population at particularly high risk for this complication.

Effectiveness analysis of resection and reconstruction of primary bone tumor in pelvic zone Ⅱ

To investigate the effectiveness of complete resection of bone tumor in pelvic zone Ⅱ and reconstruction with allogeneic pelvis, modular prosthesis, and three-dimensional (3D) printing prosthesis. The clinical data of 13 patients with primary bone tumor in pelvic zone Ⅱ who underwent tumor resection and acetabular reconstruction between March 2011 and March 2022 were retrospectively analyzed. There were 4 males and 9 females with an average age of 39.0 years ranging from 16 to 59 years. There were 4 cases of giant cell tumor, 5 cases of chondrosarcoma, 2 cases of osteosarcoma, and 2 cases of Ewing sarcoma. The Enneking classification of pelvic tumors showed that 4 cases involved zone Ⅱ, 4 cases involved zone Ⅰ and zone Ⅱ, and 5 cases involved zone Ⅱ and zone Ⅲ. The disease duration ranged from 1 to 24 months, with an average of 9.5 months. The patients were followed up to observe the recurrence and metastasis of the tumor, and the imaging examination was performed to observe the status of implant in place, fracture, bone resorption, bone nonunion, and so on. The improvement of hip pain was evaluated by visual analogue scale (VAS) score before operation and at 1 week after operation, and the recovery of hip function was evaluated according to the Musculoskeletal Tumor Society (MSTS) scoring system after operation. The operation time was 4-7 hours, with an average of 4.6 hours; the intraoperative blood loss ranged from 800 to 1 600 mL, with an average of 1 200.0 mL. There was no reoperation or death after operation. All patients were followed up 9-60 months (mean, 33.5 months). No tumor metastasis was found in 4 patients receiving chemotherapy during follow-up. Postoperative wound infection occurred in 1 case, and prosthesis dislocation occurred in 1 case at 1 month after prosthesis replacement. One case of giant cell tumor recurred at 12 months after operation, and the puncture biopsy showed malignant transformation of giant cell tumor, and hemipelvic amputation was performed. The postoperative hip pain significantly relieved, and the VAS score was 6.1±0.9 at 1 week after operation, which was significantly different from the preoperative score (8.2±1.3) ( t=9.699, P<0.001). At 12 months after operation, the MSTS score was 23.0±2.1, including 22.8±2.1 for patients with allogenic pelvis reconstruction and 23.3±2.3 for patients with prosthsis reconstruction. There was no significant difference in the MSTS score between the two reconstruction methods ( t=0.450, P=0.516). At last follow-up, 5 patients could walk with cane assistance and 7 patients could walk without cane assistance. The resection and reconstruction of primary bone tumor in pelvic zone Ⅱ can obtain satisfactory hip function, and the interface of allogeneic pelvis and 3D printing prosthesis have better bone ingrowth, which is more in line with the requirements of biomechanics and biological reconstruction. However, pelvis reconstruction is difficult, the patient's condition should be evaluated comprehensively before operation, and the long-term effectiveness needs further follow-up.

Head slippage following displacement of a Mayfield head clamp leading to a unique complication of laryngeal edema in an intubated patient: case report

Introduction: The Mayfield head clamp (MHC) is a three-pin skull clamp that allows excellent cranial stabilization during head and neck surgery and is the most frequently used head clamp in neurosurgery. In many cases, surgery is performed with complete reliance on the safety of the MHC. However, potentially serious or life-threatening complications, such as scalp lacerations, depressed skull fractures, venous emboli, or extradural hematoma can rarely occur. We describe a case in which the MHC displaced downwards due to sudden loss of grip during postoperative removal with a brief review of the literature. Case report: The patient was a 60-year-old male who was scheduled to undergo tumor resection of a recurrent bilateral parasagittal parafalcine meningioma via a bicoronal approach. While removing the MHC, the lower screw stabilizing the arm of the MHC system displaced downwards (when force was applied from both directions) leading to an extension of flexed neck along with jerking of the cervical spine despite hand stabilization of the head in an intubated patient with slight upward displacement of a tightly fixed endotracheal tube. Conclusion: We emphasize the importance of properly managing and maintaining instruments to prevent fatal injury.

Neuro-oncological augmented reality planning for intracranial tumor resection.

Before starting surgery for the resection of an intracranial tumor, its outlines are typically marked on the skin of the patient. This allows for the planning of the optimal skin incision, craniotomy, and angle of approach. Conventionally, the surgeon determines tumor borders using neuronavigation with a tracked pointer. However, interpretation errors can lead to important deviations, especially for deep-seated tumors, potentially resulting in a suboptimal approach with incomplete exposure. Augmented reality (AR) allows displaying of the tumor and critical structures directly on the patient, which can simplify and improve surgical preparation. We developed an AR-based workflow for intracranial tumor resection planning deployed on the Microsoft HoloLens II, which exploits the built-in infrared-camera for tracking the patient. We initially performed a phantom study to assess the accuracy of the registration and tracking. Following this, we evaluated the AR-based planning step in a prospective clinical study for patients undergoing resection of a brain tumor. This planning step was performed by 12 surgeons and trainees with varying degrees of experience. After patient registration, tumor outlines were marked on the patient's skin by different investigators, consecutively using a conventional neuronavigation system and an AR-based system. Their performance in both registration and delineation was measured in terms of accuracy and duration and compared. During phantom testing, registration errors remained below 2.0 mm and 2.0° for both AR-based navigation and conventional neuronavigation, with no significant difference between both systems. In the prospective clinical trial, 20 patients underwent tumor resection planning. Registration accuracy was independent of user experience for both AR-based navigation and the commercial neuronavigation system. AR-guided tumor delineation was deemed superior in 65% of cases, equally good in 30% of cases, and inferior in 5% of cases when compared to the conventional navigation system. The overall planning time (AR = 119 ± 44 s, conventional = 187 ± 56 s) was significantly reduced through the adoption of the AR workflow (p < 0.001), with an average time reduction of 39%. By providing a more intuitive visualization of relevant data to the surgeon, AR navigation provides an accurate method for tumor resection planning that is quicker and more intuitive than conventional neuronavigation. Further research should focus on intraoperative implementations.

Successful Treatment of Fibro-Adipose Vascular Anomaly with Sirolimus

BackgroundThe purpose of this study was to present our initial experience in using sirolimus therapy to treat fibro-adipose vascular anomaly (FAVA). MethodsWe retrospectively reviewed the medical records of eight patients with FAVA who were treated with sirolimus at our hospital between July 2017 and October 2020. ResultsSix girls (75%) and two boys (25%) were included in the cohort; the average age was 8 years (range, 1–13 years). Vascular tumors developed mainly on the extremities, including the forearm (n = 2; 25.0%), calf (n = 4; 50.0%), and thigh (n = 2; 25.0%). The predominant symptoms included swelling of the lesion (n = 8; 100%), pain (n = 7; 87.5%), contracture (n = 3; 37.5%), and phlebectasia (n = 3; 37.5%). Magnetic resonance imaging was the primary method used for FAVA diagnosis, and all patients underwent enhanced MRI. All lesions were heterogeneous with hyperintense T1 signals. The fat-suppressed T2-weighted images also revealed heterogeneous hyperintense masses, thus indicating fibrofatty infiltration. All eight patients received a sirolimus treatment regimen after FAVA diagnosis. One patient underwent tumor resection but experienced recurrence, whereas the other six patients underwent biopsy. Histological examination revealed that the lesions consisted of fibrofatty tissue with abnormal venous channels and anomalous lymphatic vascular components. Sirolimus softened the masses and caused tumor shrinkage within 5.25 ± 2.6 weeks (range, 2–10 weeks) after treatment initiation. The tumors also involuted rapidly and became stable within 7.75 ± 2.25 months after treatment initiation (range, 6–12 months). All seven patients experiencing pain reported relief within 3.8 ± 1.8 weeks (range, 2–7 weeks) after initiation of sirolimus therapy. Sirolimus alleviated but did not fully resolve the contracture in three patients. Remarkably, five patients exhibited a complete response, and three patients exhibited a partial response. At the time of the last follow-up, three patients had begun to gradually taper off sirolimus after 24 months of treatment and maintained a low blood sirolimus concentration. No serious adverse effects were observed during treatment. ConclusionFAVA is a complex vascular malformation that appears to respond well to sirolimus treatment. Thus, sirolimus may be an effective and safe treatment for FAVA. Level of evidenceLEVEL IV.

Prognostic Value of CXCL12 in Non-Small Cell Lung Cancer Patients Undergoing Tumor Resection

Adjuvant chemotherapy is commonly indicated in lung cancer patients undergoing surgical therapy because tumor recurrence is frequent. A biomarker that can predict tumor recurrence in the postoperative period is currently unavailable. CXCR4 receptor and its ligand CXCL12 play important roles in metastasis. This study investigated the value of tumor CXCL12 expression to predict prognosis and indicate adjuvant chemotherapy in non-small cell lung cancer patients. This study enrolled 82 non-small cell lung cancer patients. The expression of CXCL12 was evaluated by immunohistochemistry. The degree of CXCL12 expression was assessed using the Allred score system. Among all subjects, the progression-free survival and overall survival were significantly prolonged in cancer patients with low tumor expression of CXCL12 compared to patients with high tumor expression. Multivariate analysis showed that the increased level of CXCL12 is a significant predictor of progression-free survival and overall survival in NSCLC patients. Among subjects with high tumor CXCL12 expression, progression-free survival and overall survival were significantly improved in patients treated with adjuvant chemotherapy compared to untreated patients. These results suggest the potential value of tumor CXCL12 expression as a marker to predict prognosis and to indicate adjuvant chemotherapy after surgical tumor resection in non-small cell lung cancer patients.

A phase II study of CAPOXIRI as a neoadjuvant chemotherapy in patients with locally advanced rectal cancer (Colorectal Cancer Treatment Group, MSCSGO).

109 Background: Addition of perioperative multi-agent chemotherapy to the treatment strategy for locally advanced rectal cancer (LARC) may be a promising option. We conducted a multicenter single-arm phase II study to evaluate the safety and efficacy of capecitabine combined with oxaliplatin and irinotecan (CAPOXIRI) as triplet neoadjuvant chemotherapy in patients with LARC. Methods: The key eligibility criteria were as follows: (1) age over 20 years; (2) Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1; (3) resectable clinical stage II (T3 or T4 with N0) or III (any T and N1–3), with the primary tumor located within 12 cm of the anal verge. Patients received intravenous oxaliplatin (85 mg/m2) and intravenous irinotecan (150 mg/m2) on day 1 and oral capecitabine (1,000 mg/m2) twice daily on days 1–7 followed by 7 days of rest, repeated every 2 weeks for six cycles. Total mesothelial resection was performed 4–8 weeks after chemotherapy ended. In addition to the treatment protocol, patients received adjuvant chemotherapy for four cycles. The primary study endpoint was the pathological complete response (pCR) rate. We based the sample size of the study described herein on an expected pCR rate of 18% and a threshold pCR rate of 5% to detect differences at a two-sided alpha error of 0.05 and a statistical power of 0.2. Results: Between June 2013 and December 2016, 55 patients were enrolled in the study. Forty-five (83.3%) of the 54 patients who underwent NAC received the full six courses. Fifty-two (94.5%) patients underwent tumor resection. Laparoscopic surgery was performed in 47 (90.4%) patients, and lateral lymph node dissection was performed in 35 (67.3%) patients. Forty-nine (94.2%) patients underwent R0 resection. The pCR rate was 7.7% (95% CI 3.0% to 18.2%). The 3-year local recurrence rate was 3.9%, the 3-year disease-free survival (DFS) rate was 77.3, and the 3-year overall survival rate was 96.0%. NAC-related grade 3/4 adverse event rates were as follows: neutropenia (25.9%), anorexia (13.0%), diarrhea (11.1%) and anemia (7.4%). Conclusions: CAPOXIRI neoadjuvant chemotherapy appears to be feasible and efficacious for patients with LARC. Although neoadjuvant XELOXIRI alone did not yield our expected pCR rate, the local recurrence rate, 3-year DFS and measures of safety met current standards. Clinical trial information: UMIN000009974 .

Use of Mixed Reality in Neuro-Oncology: A Single Centre Experience

(1) Background: Intra-operative neuronavigation is currently an essential component to most neurosurgical operations. Recent progress in mixed reality (MR) technology has attempted to overcome the disadvantages of the neuronavigation systems. We present our experience using the HoloLens 2 in neuro-oncology for both intra- and extra-axial tumours. (2) Results: We describe our experience with three patients who underwent tumour resection. We evaluated surgeon experience, accuracy of superimposed 3D image in tumour localisation with standard neuronavigation both pre- and intra-operatively. Surgeon training and usage for HoloLens 2 was short and easy. The process of image overlay was relatively straightforward for the three cases. Registration in prone position with a conventional neuronavigation system is often difficult, which was easily overcome during use of HoloLens 2. (3) Conclusion: Although certain limitations were identified, the authors feel that this system is a feasible alternative device for intra-operative visualization of neurosurgical pathology. Further studies are being planned to assess its accuracy and suitability across various surgical disciplines.

Surgeon experience in glioblastoma surgery of the elderly—a multicenter, retrospective cohort study

PurposeTo assess the impact of individual surgeon experience on overall survival (OS), extent of resection (EOR) and surgery-related morbidity in elderly patients with glioblastoma (GBM), we performed a retrospective case-by-case analysis.MethodsGBM patients aged ≥ 65 years who underwent tumor resection at two academic centers were analyzed. The experience of each neurosurgeon was quantified in three ways: (1) total number of previously performed glioma surgeries (lifetime experience); (2) number of surgeries performed in the previous five years (medium-term experience) and (3) in the last two years (short-term experience). Surgeon experience data was correlated with survival (OS) and surrogate parameters for surgical quality (EOR, morbidity).Results198 GBM patients (median age 73.0 years, median preoperative KPS 80, IDH-wildtype status 96.5%) were included. Median OS was 10.0 months (95% CI 8.0–12.0); median EOR was 89.4%. Surgery-related morbidity affected 19.7% patients. No correlations of lifetime surgeon experience with OS (P = .693), EOR (P = .693), and surgery-related morbidity (P = .435) were identified. Adjuvant therapy was associated with improved OS (P < .001); patients with surgery-related morbidity were less likely to receive adjuvant treatment (P = .002). In multivariable testing, adjuvant therapy (P < .001; HR = 0.064, 95%CI 0.028–0.144) remained the only significant predictor for improved OS.ConclusionLess experienced neurosurgeons achieve similar surgical results and outcome in elderly GBM patients within the setting of academic teaching hospitals. Adjuvant treatment and avoidance of surgery-related morbidity are crucial for generating a treatment benefit for this cohort.

Doege-Potter Syndrome: A Rare Paraneoplastic Syndrome of Solid Fibrous Tumors Reported in Indonesia

Introduction: Solitary fibrous tumors (SFT) is a rare group of tumor. Even rarer, it is associated with Doege-Potter syndrome (DPS), which manifests as hypoglycemia due to paraneoplastic syndrome. From searching through national reports and articles, this was the first case of DPS in Indonesia. Case: A 60-year-old woman was admitted to the emergency department with dyspnea and unconscious. The patient’s glucose level showed 21mg/dL. A solid mass on the patient’s right lung was shown on the chest X-ray. A previous biopsy concluded that the patient had a solid fibrous tumor with a history of profound hypoglycemia. The patient underwent tumor resection and got a biopsy of the tumor. After resection, the patient showed no sign of hypoglycemia, and the blood glucose level was stable. We concluded that the patient had DPS, a paraneoplastic syndrome associated with the solid fibrous tumor. Conclusion: Performing an adequate examination and giving prompt treatments can increase the patient’s quality of life, even though it is a rare disease and hard to diagnose. The patient’s condition, evaluated from a clinical condition, chest X-ray, and blood glucose, was better than before getting radical resection.

Extent of resection and histopathology grading as a survival risk factor in a patient with medulloblastoma

Background: Medulloblastoma is a common neoplasm in the pediatric population with a poor prognosis. Incomplete resection has been reported to be related to second-look surgery and subsequent more malignant clinical course, while certain histopathological is said to have a more favorable prognosis. Methods: This study retrospectively analyzed data from patients with medulloblastoma who underwent tumor resection in our hospital between 2016 to 2020. Histopathologic information and the extent of resection were collected. Survival analysis was done with log-rank and Kaplan-Meier to determine the overall and progression-free survival. Results: There were 42 patients with medulloblastoma with mean overall survival of 16.5 months and a mean progression-free survival of 12.43 months. Patient with subtotal resection has the longest mean overall survival and progression-free survival compared with others. Patient with classical medulloblastoma has the longest mean overall survival and progression-free survival compared to other types of histopathology. Conclusion: The extent of resection and histopathology grading is statistically significantly related to the outcome of a patient with medulloblastoma

Preoperative Plasma miRNA Levels Predict Prognosis in Early-stage Malignant Melanoma.

Non-invasive circulating tumor biomarkers in liquid biopsy, such as microRNAs (miRNA), provide for better personalization of treatment strategies. The aim of our study was to assess the prognosis of patients with melanoma undergoing tumor resection with curative intent based on analysis of selected circulating miRNAs. A total of 22 patients with stage I to III melanoma were enrolled into this prospective study. Plasma samples were obtained pre-surgery and early post-surgery from peripheral blood draws. A panel of 23 candidate miRNAs was designed and expression of miRNAs were analyzed by reverse transcription-quantitative polymerase chain reaction with exogenous reference control cel-miR-39-3p. Higher preoperative expression levels of miR-99a (p=0.008), miR-320 (p=0.009), miR-1908 (p=0.001), miR-494 (p=0.018) and miR-4487 (p=0.048) were associated with a shorter disease-free interval. Similarly, higher preoperative plasma levels of miR-99a (p=0.017), miR-221 (p=0.026), miR-320 (p=0.016), miR-494 (p=0.009), miR-1260 (p=0.026) and miR-1908 (p=0.024) were associated with worse overall survival. No significant differences between pre- and postoperative plasma miRNA levels were observed. Liquid biopsy is a minimally-invasive approach which can lead to a better understanding of cancer behavior and offers the possibility of precise patient prognosis, allowing selection of the most appropriate treatment. Our study showed that preoperative plasma levels of miR-99a, miR-221, miR-320, miR-494, miR-1908 and miR-4487 were associated with disease-free interval and overall survival of patients with early-stage melanoma. This approach may help in decision-making about the appropriateness of modern adjuvant treatment administration in patients with resectable melanoma.

DUPAN-II normalisation as a biological indicator during preoperative chemoradiation therapy for resectable and borderline resectable pancreatic cancer

BackgroundDuke pancreatic mono-clonal antigen type 2 (DUPAN-II) is a famous tumour maker for pancreatic cancer (PC) as well as carbohydrate antigen 19–9 (CA19-9). We evaluated the clinical implications of DUPAN-II levels as a biological indicator for PC during preoperative chemoradiation therapy (CRT).MethodsThis retrospective analysis included data from 221 consecutive patients with resectable and borderline resectable PC at diagnosis who underwent preoperative CRT between 2008 and 2017. We focused on 73 patients with elevated pre-CRT DUPAN-II levels (> 230 U/mL; more than 1.5 times the cut-off value for the normal range). Pre- and post-CRT DUPAN-II levels and the changes in DUPAN-II ratio were measured.ResultsUnivariate analysis identified normalisation of DUPAN-II levels after CRT as a significant prognostic factor (hazard ratio [HR] = 2.06, confidence interval [CI] = 1.03–4.24, p = 0.042). Total normalisation ratio was 49% (n = 36). Overall survival (OS) in patients with normalised DUPAN-II levels was significantly longer than that in 73 patients with elevated levels (5-year survival, 55% vs. 21%, p = 0.032) and in 60 patients who underwent tumour resection (5-year survival, 59% vs. 26%, p = 0.039).ConclusionNormalisation of DUPAN-II levels during preoperative CRT was a significant prognostic factor and could be an indicator to monitor treatment efficacy and predict patient prognosis.

Isocitrate-dehydrogenase-mutant lower grade glioma in elderly patients: treatment and outcome in a molecularly characterized contemporary cohort

PurposeLower-grade glioma (LGG) is rare among patients above the age of 60 (“elderly”). Previous studies reported poor outcome, likely due to the inclusion of isocitrate dehydrogenase (IDH) wildtype astrocytomas and advocated defensive surgical and adjuvant treatment. This study set out to question this paradigm analyzing a contemporary cohort of patients with IDH mutant astrocytoma and oligodendroglioma WHO grade 2 and 3.MethodsElderly patients treated in our department for a supratentorial, hemispheric LGG between 2009 and 2019 were retrospectively analyzed for patient-, tumor- and treatment-related factors and progression-free survival (PFS) and compared to patients aged under 60. Inclusion required the availability of subtype-defining molecular data and pre- and post-operative tumor volumes.Results207 patients were included, among those 21 elderlies (10%). PFS was comparable between elderly and younger patients (46 vs. 54 months; p = 0.634). Oligodendroglioma was more common in the elderly (76% vs. 46%; p = 0.011). Most patients underwent tumor resection (elderly: 81% vs. younger: 91%; p = 0.246) yielding comparable residual tumor volumes (elderly: 7.8 cm3; younger: 4.1 cm3; p = 0.137). Adjuvant treatment was administered in 76% of elderly and 61% of younger patients (p = 0.163). Uni- and multi-variate survival analyses identified a tumor crossing the midline, surgical strategy, and pre- and post-operative tumor volumes as prognostic factors.ConclusionElderly patients constitute a small fraction of molecularly characterized LGGs. In contrast to previous reports, favorable surgical and survival outcomes were achieved in our series comparable to those of younger patients. Thus, intensified treatment including maximal safe resection should be advocated in elderly patients whenever feasible.

A Case Report of Brain Metastases Originating from Papillary Thyroid Carcinoma

Introduction: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. Brain metastases originating from PTC is extremely rare, presents only in 0.4-1.2% of all PTC cases. PTC presenting with distant metastasis has less favourable outcome. Case Presentation: A 67-years-old female patient presented with a painless and progressively enlarging lump on the forehead since 2 years before admitted. Patient also claimed to have a slow-growing neck swelling over 5 years. Physical examination revealed mass on forehead, and multiple nodules on thyroid. Fine Needle Aspiration Biopsy (FNAB) of neck mass was performed and PTC was confirmed. Head Multi Sliced Computed Tomography (MSCT) examination was performed to evaluate forehead mass and revealed heterogeneous extra axial mass (8.5 x 6.4 x 7.3 cm) in the left frontal lobe. Patient underwent tumor resection and the postoperative histopathologic examination confirmed metastases of PTC. Thyroidectomy was recommended but patient refused to undergo further intervention. Conclusions: Early detection and treatment of PTC is crucial as distant metastases may develop and reduce the survival rate.

Abstract B124: Food accessibility and its impact on clinical outcomes in patients undergoing surgery for pancreatic ductal adenocarcinoma

Abstract Accessing healthy food is paramount to one’s nutritional status, a known factor in postoperative morbidity and long-term mortality. The relationship between a patient’s food accessibility and outcomes following surgical resection in pancreatic ductal adenocarcinoma (PDAC) is unknown. The objective of this study was to compare postoperative outcomes and long-term survival of PDAC patients residing in low and high food accessibility areas who underwent surgical resection. Adult PDAC patients undergoing surgical resection at a single tertiary academic center from 2011 to 2021 were identified retrospectively. Patient addresses were mapped onto the United States Department of Agriculture (USDA) Food Access Research Atlas to determine food accessibility status. Those with residence in areas designated by the USDA as having limited access to healthy food were classified as having “low food accessibility” (LFA). Those not classified as having LFA were labeled as having “high food accessibility” (HFA). Demographics, comorbidities, neoadjuvant treatment status, tumor characteristics, postoperative complications, hospital stay characteristics, overall survival, and recurrence rates were collected. Data were evaluated using descriptive statistics and Cox-Proportional Hazard models for survival. In total, 89 patients met inclusion criteria, of which 23 (25.8%) patients resided in areas of LFA. No significant differences existed in patient age, sex, or other sociodemographics. Patient BMI was higher for LFA patients than HFA patients (28.3 vs 24.6, p = 0.0070). Major comorbidities were comparable except for an increased rate of diabetes in LFA patients (56.5% vs 29.2%, p = 0.0194). Both groups underwent neoadjuvant treatment at similar rates. Tumor grade was significantly different for the groups with LFA patients having higher rates of poor differentiation compared to HFA patients (39.1% G3 vs 9.4% G3, p = 0.0015). Lymphovascular invasion, perineural invasion, and number of positive lymph nodes were similar. Minor complications, readmission, and recurrence did not demonstrate differences between groups but LFA patients suffered from higher rates of major complication (52.2% vs 27.3%, p = 0.0296). Total hospital length of stay and ICU length of stay were also similar. Overall survival was 12.1 months in LFA patients and 15.2 months in HFA patients but was not significantly different (p = 0.16). Low food accessibility is associated with greater rates of major complications in PDAC patients undergoing tumor resection yet does not significantly impact overall survival in this deadly disease. Awareness of patient food accessibility status may be beneficial in recognizing those who might benefit the most from nutritional prehabilitation and those less able to act on nutritional recommendations. Citation Format: Christopher M. Liu, Devon C. Freudenberger, Salem Rustom, Vignesh Vudatha, Shreya Raman, Teja Devarakonda, Kelly M. Herremans, Andrea N. Riner, Luke Wolfe, Jose G. Trevino. Food accessibility and its impact on clinical outcomes in patients undergoing surgery for pancreatic ductal adenocarcinoma [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B124.

Aesthetic Approach for a Buccal Solitary Fibrous Tumor

Solitary fibrous tumors (SFTs) are caused by the proliferation of mesenchymal cells. Facial SFTs are rare. Resection scar (of a subcutaneous tumor in the buccal area) is distinctive if it is located at the center of the cheek. To avoid this complication, we resected the lesion using a preauricular incision to approach the superficial musculoaponeurotic system, an approach similar to that used during rhytidectomy (face-lift). A 42-year-old woman underwent tumor resection using this approach. Eight months after, no tumor recurrence was observed. Additionally, no scarring or facial nerve paralysis was observed. Immunostaining of the tumor cells revealed CD34-positive, Bcl-2-positive, STAT6-positive, and some SMA-positive cells, and SFT was diagnosed. This case falls into the low-risk SFT group. Therefore, careful follow-up is necessary for SFTs because they have a high risk of recurrence and local metastasis.