Dandi Huang

Beyond post-operative readmissions: analysis of the impact of unplanned readmissions during primary treatment of advanced-stage epithelial ovarian cancer on long-term oncology outcome

Multiple studies have assessed post-operative readmissions in advanced ovarian cancer. To evaluate all unplanned readmissions during the primary treatment period of advanced epithelial ovarian cancer, and the impact of readmission on progression-free survival. This was a single institution retrospective study from January 2008 to October 2018. Χ A total of 484 patients (279 primary cytoreductive surgery, 205 neoadjuvant chemotherapy) were analyzed. In total, 272 of 484 (56%; 37% primary cytoreductive surgery, 32% neoadjuvant chemotherapy, p=0.29) patients were readmitted during the primary treatment period. Overall, 42.3% of the readmissions were surgery related, 47.8% were chemotherapy related, and 59.6% were cancer related but not related to surgery or chemotherapy, and each readmission could qualify for more than one reason. Readmitted patients had a higher rate of chronic kidney disease (4.1% vs 1.0%, p=0.038). Post-operative, chemotherapy, and cancer-related readmissions were similar between the two groups. However, the percentage of inpatient treatment days due to unplanned readmission was twice as high for primary cytoreductive surgery at 2.2% vs 1.3% for neoadjuvant chemotherapy (p<0.001). Despite longer readmissions in the primary cytoreductive surgery group, Cox regression analysis demonstrated that readmissions did not affect progression-free survival (HR=1.22, 95% CI 0.98 to 1.51; p=0.08). Primary cytoreductive surgery, higher modified Frailty Index, grade 3 disease, and optimal cytoreduction were associated with longer progression-free survival. In this study, 35% of the women with advanced ovarian cancer had at least one unplanned readmission during the entire treatment time. Patients treated by primary cytoreductive surgery spent more days during readmission than those with neoadjuvant chemotherapy. Readmissions did not affect progression-free survival and may not be valuable as a quality metric.

The Impact of JAK1 Pathogenic Variants and MHC-I Expression on Response to Immune Checkpoint Inhibition in Endometrial Cancer

Abstract Purpose: Immune checkpoint inhibitors (ICI) have increasing application in endometrial cancer, underscoring the need for robust biomarkers for patient selection. JAK1 pathogenic variants (PV) have previously been implicated in immune evasion. In this study, we identify biomarkers predictive of ICI response in endometrial cancer and the implications of JAK1 PVs in this context. Experimental Design: This is a translational study of tumors from 84 patients with endometrial cancer treated with ICIs. High-throughput proteomic-based profiling was used to quantify 193 phosphoprotein/protein expression levels, including key JAK/STAT signaling pathway components. Associations with clinical outcomes were assessed using multivariate regression analysis. The functional consequences of JAK1 PVs were explored through in vitro signaling assays and analyses of The Cancer Genome Atlas database. Results: MHC-I expression correlated with improved progression-free survival (P = 0.035), validated in orthogonal approaches. Notably, a subset of patients harboring JAK1 PVs demonstrated exceptional survival on ICIs. In The Cancer Genome Atlas cohort of microsatellite instability–high and DNA polymerase epsilon–mutated tumors, homozygous loss of JAK1 trended toward decreased survival, whereas heterozygous loss of JAK1 was associated with significantly improved survival (P = 0.026), suggesting partial retention of antigen presentation pathways. Among our ICI-treated microsatellite instability–high tumor samples, NK cell marker NCAM1 was associated with improved survival (P = 0.02). Conclusions: These data support MHC-I as a potential predictive biomarker for ICI response in endometrial cancer. Additionally, we show that partial retention of JAK1 signaling in JAK1 tumors with heterozygous loss is associated with improved survival, potentially attributable to enhanced NK cell activity in tumors with low MHC-I expression.