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Metser U, Zukotynski K, Mak V, Langer D, MacCrostie P, Finelli A, Kapoor A, Chin J, Lavallée L, Klotz LH, Hagerty M, Hildebrand C, Bauman G. Effect of 18F-DCFPyL PET/CT on the Management of Patients with Recurrent Prostate Cancer: Results of a Prospective Multicenter Registry Trial. Radiology 2022; 303:414-422. [PMID: 35076300 DOI: 10.1148/radiol.211824] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The high positivity rate of prostate-specific membrane antigen (PSMA) PET in the setting of biochemical failure (BCF), even when conventional imaging is negative, is promising. Purpose To assess the disease detection rate of PSMA-based PET/CT with fluorine 18-DCFPyL as a radiotracer and the PET-directed management change in men with suspected limited recurrent prostate cancer. Materials and Methods This prospective multicenter registry (Ontario PSMA-PET Registry for Recurrent Prostate Cancer, or PREP) enrolled men with BCF after primary therapy (radical prostatectomy plus or minus salvage radiation therapy or primary radiation therapy) and zero to four disease sites at conventional imaging (CT and bone scintigraphy). The positivity rate of PSMA PET according to serum prostate-specific antigen (PSA) level; frequency of local-egional, oligometastatic, and extensive metastatic recurrence; and rate of change in management after PET findings were recorded. The nonparametric Mood median test was used to assess the association between serum PSA level and change in management. Results A total of 1289 men (median age, 71 years [interquartile range, 65-75 years]) were evaluated. PSMA PET helped detect disease in 841 of 1289 men (65%) and in 615 of 999 men (62%) with negative conventional imaging. The recurrence detection rates according to serum PSA level at enrollment were 38% (160 of 424 men), 63% (107 of 171 men), and 83% (573 of 692 men) for PSA under 0.5 ng/mL, 0.5-1.0 ng/mL, and above 1.0 ng/mL, respectively. At PSMA PET, 399 of 1289 men (31%) had local-regional recurrence, 314 (24%) had oligometastatic disease, and 128 (10%) had extensive metastases. Following PET examination, a change in planned management was recorded in 748 of 1289 men (58%), and in 371 of 1250 men (30%), there was a change in management intent, more commonly from palliative to potentially curative intent (255 of 1289 men [20%]). Conclusion Prostate-specific membrane antigen PET helped detect additional sites of disease compared with conventional imaging in approximately 60% of men with biochemical failure and suspected low-volume metastatic disease, resulting in frequent change in management, including a change from palliative to curative or radical intent therapy in 20% of men. Long-term follow-up is needed to determine whether this impacts disease control. Clinical trial registration no. NCT03718260 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Civelek in this issue.
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Affiliation(s)
- Ur Metser
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Katherine Zukotynski
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Victor Mak
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Deanna Langer
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Pamela MacCrostie
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Antonio Finelli
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Anil Kapoor
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Joseph Chin
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Luke Lavallée
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Laurence H Klotz
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Marlon Hagerty
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Catherine Hildebrand
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Glenn Bauman
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
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Glicksman RM, Metser U, Valliant J, Chung PW, Fleshner NE, Bristow RG, Green D, Finelli A, Hamilton R, Stanescu T, Hussey D, Catton C, Gospodarowicz M, Warde P, Bayley A, Breen S, Vines D, Jaffray DA, Berlin A. [ 18F]DCFPyL PET-MRI/CT for unveiling a molecularly defined oligorecurrent prostate cancer state amenable for curative-intent ablative therapy: study protocol for a phase II trial. BMJ Open 2020; 10:e035959. [PMID: 32327479 PMCID: PMC7204865 DOI: 10.1136/bmjopen-2019-035959] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The oligometastatic (OM) disease hypothesis of an intermediate metastatic state with limited distant disease deposits amenable for curative therapies remains debatable. Over a third of prostate cancer (PCa) patients treated with radical prostatectomy and postoperative radiotherapy experience disease recurrence; these patients are considered incurable by current standards. Often the recurrence cannot be localised by conventional imaging (CT and bone scan). Combined anatomical imaging with CT and/or MR with positron emission tomography (PET) using a novel second-generation prostate-specific membrane antigen (PSMA) probe, [18F]DCFPyL, is a promising imaging modality to unveil disease deposits in these patients. A new and earlier molecularly defined oligorecurrent (OR) state may be amenable to focal-targeted ablative curative-intent therapies, such as stereotactic ablative radiotherapy (SABR) or surgery, thereby significantly delaying or completely avoiding the need for palliative therapies in men with recurrent PCa after maximal local treatments. METHODS AND ANALYSIS This ongoing single-institution phase II study will enrol up to 75 patients total, to include up to 37 patients with response-evaluable disease, who have rising prostate-specific antigen (range 0.4-3.0 ng/mL) following maximal local therapies with no evidence of disease on conventional imaging. These patients will undergo [18F]DCFPyL PET-MR/CT imaging to detect disease deposits, which will then be treated with SABR or surgery. The primary endpoints are performance of [18F]DCFPyL PET-MR/CT, and treatment response rates following SABR or surgery. Demographics and disease characteristics will be summarised and analysed descriptively. Response rates will be described with waterfall plots and proportions. ETHICS AND DISSEMINATION Ethics approval was obtained from the institutional Research Ethics Board. All patients will provide written informed consent. [18F]DCFPyL has approval from Health Canada. The results of the study will be disseminated by the principal investigator. Patients will not be identifiable as individuals in any publication or presentation of this study. TRIAL REGISTRATION NUMBERS NCT03160794.
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Affiliation(s)
- Rachel M Glicksman
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Ur Metser
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John Valliant
- Centre for Probe Development and Commercialization, McMaster University, Hamilton, Ontario, Canada
| | - Peter W Chung
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Neil E Fleshner
- Department of Surgical Oncology, Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert G Bristow
- Division of Cancer Sciences, Faculty of Biology, Health and Medicine, University of Manchester; Cancer Research UK Manchester Institute and Manchester Cancer Research Centre; The Christie NHS Foundation Trust, Manchester, UK
| | - David Green
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Antonio Finelli
- Department of Surgical Oncology, Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert Hamilton
- Department of Surgical Oncology, Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Teodor Stanescu
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Douglas Hussey
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Charles Catton
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Mary Gospodarowicz
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Padraig Warde
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Stephen Breen
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Doug Vines
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - David A Jaffray
- Office of the Chief Technology and Digital Officer; Department of Radiation Physics; Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alejando Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Zhao Y, Li J, Li D, Wang Z, Zhao J, Wu X, Sun Q, Lin PP, Plum P, Damanakis A, Gebauer F, Zhou M, Zhang Z, Schlösser H, Jauch KW, Nelson PJ, Bruns CJ. Tumor biology and multidisciplinary strategies of oligometastasis in gastrointestinal cancers. Semin Cancer Biol 2019; 60:334-343. [PMID: 31445220 DOI: 10.1016/j.semcancer.2019.08.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/20/2019] [Indexed: 12/11/2022]
Abstract
More than 70% of gastrointestinal (GI) cancers are diagnosed with metastases, leading to poor prognosis. For some cancer patients with limited sites of metastatic tumors, the term oligometastatic disease (OMD) has been coined as opposed to systemic polymetastasis (PMD) disease. Stephan Paget first described an organ-specific pattern of metastasis in 1889, now known as the "seed and soil" theory where distinct cancer types are found to metastasize to different tumor-specific sites. Our understanding of the biology of tumor metastasis and specifically the molecular mechanisms driving their formation are still limited, in particular, as it relates to the genesis of oligometastasis. In the following review, we discuss recent advances in general understanding of this metastatic behavior including the role of specific signaling pathways, various molecular features and biomarkers, as well as the interaction of carcinoma cells with their tissue microenvironments (both primary and metastatic niches). The unique features that underlie OMD provide potential targets for localized therapy. As it relates to clinical practice, OMD is emerging as treatable with surgical resection and/or other local therapy options. Strategies currently being applied in the clinical management of OMD will be discussed including surgical, radiation-based therapy, ablation procedures, and the results of emerging clinical trials involving immunotherapy.
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Affiliation(s)
- Yue Zhao
- Department of General, Visceral und Tumor Surgery, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany; Department of General, Visceral und Vascular Surgery, Otto von Guericke University, Magdeburg, Germany.
| | - Jiahui Li
- Department of General, Visceral und Tumor Surgery, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Dai Li
- Department of General, Visceral und Tumor Surgery, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany; Department of Anethesiology, Changhai Hospital, Naval Medical University, Shanghai, PR China
| | - Zhefang Wang
- Department of General, Visceral und Tumor Surgery, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Jiangang Zhao
- Department of General, Visceral und Tumor Surgery, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany; Department of General, Visceral und Vascular Surgery, Ludwig-Maximilian-University (LMU), Munich, Germany
| | - Xiaolin Wu
- Department of General, Visceral und Tumor Surgery, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Qiye Sun
- Department of General, Visceral und Tumor Surgery, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | | | - Patrick Plum
- Department of General, Visceral und Tumor Surgery, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany; Institute for Pathology, University Hospital Cologne, Cologne, Germany
| | - Alexander Damanakis
- Department of General, Visceral und Tumor Surgery, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Florian Gebauer
- Department of General, Visceral und Tumor Surgery, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Menglong Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Hans Schlösser
- Department of General, Visceral und Tumor Surgery, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany; Center for Integrated Oncology (CIO) Achen, Bonn, Cologne and Düsseldorf, Cologne, Germany
| | - Karl-Walter Jauch
- Department of General, Visceral und Vascular Surgery, Ludwig-Maximilian-University (LMU), Munich, Germany
| | - Peter J Nelson
- Department of Internal Medicine IV, University Hospital of Munich, Ludwig-Maximilians-University Munich, Germany
| | - Christiane J Bruns
- Department of General, Visceral und Tumor Surgery, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany; Center for Integrated Oncology (CIO) Achen, Bonn, Cologne and Düsseldorf, Cologne, Germany.
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