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Renehan AG, Tipping O, Wang M. Diabetes and cancer: Doubts of a causal link. Int J Cancer 2024; 154:1875-1876. [PMID: 38450768 DOI: 10.1002/ijc.34862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Andrew G Renehan
- Division of Cancer Sciences, School of Medical Science, University of Manchester, Manchester, UK
| | - Owen Tipping
- Division of Cancer Sciences, School of Medical Science, University of Manchester, Manchester, UK
| | - Mengying Wang
- Division of Cancer Sciences, School of Medical Science, University of Manchester, Manchester, UK
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Hawwash NK, Sperrin M, Martin GP, Joshu CE, Florido R, Platz EA, Renehan AG. Overweight-years and cancer risk: A prospective study of the association and comparison of predictive performance with body mass index (Atherosclerosis Risk in Communities Study). Int J Cancer 2024; 154:1556-1568. [PMID: 38143298 PMCID: PMC7615716 DOI: 10.1002/ijc.34821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/12/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023]
Abstract
Excess body mass index (BMI) is associated with a higher risk of at least 13 cancers, but it is usually measured at a single time point. We tested whether the overweight-years metric, which incorporates exposure time to BMI ≥25 kg/m2 , is associated with cancer risk and compared this with a single BMI measure. We used adulthood BMI readings in the Atherosclerosis Risk in Communities (ARIC) study to derive the overweight-years metric. We calculated associations between the metric and BMI and the risk of cancers using Cox proportional hazards models. Models that either included the metric or BMI were compared using Harrell's C-statistic. We included 13,463 participants, with 3,876 first primary cancers over a mean of 19 years (SD 7) of cancer follow-up. Hazard ratios for obesity-related cancers per standard deviation overweight-years were 1.15 (95% CI: 1.05-1.25) in men and 1.14 (95% CI: 1.08-1.20) in women. The difference in the C-statistic between models that incorporated BMI, or the overweight-years metric was non-significant in men and women. Overweight-years was associated with the risk of obesity-related cancers but did not outperform a single BMI measure in association performance characteristics.
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Affiliation(s)
- Nadin K. Hawwash
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Cancer Research UK, Manchester Cancer Research Centre, Manchester, UK
| | - Matthew Sperrin
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Glen P. Martin
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Corinne E. Joshu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | - Roberta Florido
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elizabeth A. Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | - Andrew G. Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester, UK
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Fernandez LM, São Julião GP, Renehan AG, Beets GL, Papoila AL, Vailati BB, Kranenbarg EMK, Roodvoets AGH, Figueiredo NL, Van De Velde CJH, Habr-Gama A, Perez RO. Rectal Cancer and Organ-Preservation: Safety First, Then the King. Dis Colon Rectum 2023; 66:e1054-e1055. [PMID: 37493212 DOI: 10.1097/dcr.0000000000003020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
- Laura M Fernandez
- Colorectal Surgery, Digestive Department, Champalimaud Foundation, Lisbon, Portugal
| | - Guilherme P São Julião
- Angelita and Joaquim Gama Institute, São Paulo, Brazil, Department of Surgical Oncology, Hospital Beneficencia Portuguesa, São Paulo, Brazil, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Andrew G Renehan
- Manchester Cancer Research Centre, National Institute of Health and Research Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom, Colorectal and Peritoneal Oncology Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer institute, Amsterdam, The Netherlands, GROW School for Oncology and Developmental Biology, Maastricht University, The Netherlands
| | - Ana L Papoila
- NOVA Medical School, Faculdade de Ciências Médicas (NMS|FCM), Lisbon, Portugal
| | - Bruna B Vailati
- Angelita and Joaquim Gama Institute, São Paulo, Brazil, Department of Surgical Oncology, Hospital Beneficencia Portuguesa, São Paulo, Brazil, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | - Annet G H Roodvoets
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Nuno L Figueiredo
- Colorectal Surgery, Digestive Department, Champalimaud Foundation, Lisbon, Portugal, Colorectal Surgery, Hospital Lusiadas, Lisbon, Portugal
| | - Cornelis J H Van De Velde
- Department of Surgery, Netherlands Cancer institute, Amsterdam, The Netherlands, Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Angelita Habr-Gama
- Angelita and Joaquim Gama Institute, São Paulo, Brazil, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rodrigo O Perez
- Colorectal Surgery Division, Angelita and Joaquim Gama Institute, São Paulo, Brazil, Department of Surgical Oncology, Hospital Beneficencia Portuguesa, São Paulo, Brazil, Colorectal Surgery Division, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil, Ludwig Institute for Cancer Research, São Paulo Branch, Brazil
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Domzaridou E, Van Staa T, Renehan AG, Cook N, Welfare W, Ashcroft DM, Palin V. The Impact of Oral Antibiotics Prior to Cancer Diagnosis on Overall Patient Survival: Findings from an English Population-Based Cohort Study. Curr Oncol 2023; 30:8434-8443. [PMID: 37754529 PMCID: PMC10528751 DOI: 10.3390/curroncol30090614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND There is limited evidence in humans as to whether antibiotics impact the effectiveness of cancer treatments. Rodent studies have shown that disruption in gut microbiota due to antibiotics decreases cancer therapy effectiveness. We evaluated the associations between the antibiotic treatment of different time periods before cancer diagnoses and long-term mortality. METHODS Using the Clinical Practice Research Datalink GOLD, linked to the Cancer Registry's and the Office for National Statistics' mortality records, we delineated a study cohort that involved cancer patients who were prescribed antibiotics 0-3 months; 3-24 months; or more than 24 months before cancer diagnosis. Patients' exposure to antibiotics was compared according to the recency of prescriptions and time-to-event (all-cause mortality) by applying Cox models. RESULTS 111,260 cancer patients from England were included in the analysis. Compared with antibiotic prescriptions that were issued in the past, patients who had been prescribed antibiotics shortly before cancer diagnosis presented an increased hazard ratio (HR) for mortality. For leukaemia, the HR in the Cancer Registry was 1.32 (95% CI 1.16-1.51), for lymphoma it was 1.22 (1.08-1.36), for melanoma it was 1.28 (1.10-1.49), and for myeloma it was 1.19 (1.04-1.36). Increased HRs were observed for cancer of the uterus, bladder, and breast and ovarian and colorectal cancer. CONCLUSIONS Antibiotics that had been issued within the three months prior to cancer diagnosis may reduce the effectiveness of chemotherapy and immunotherapy. Judicious antibiotic prescribing is needed among cancer patients.
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Affiliation(s)
- Eleni Domzaridou
- National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
| | - Tjeerd Van Staa
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (T.V.S.); (V.P.)
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Andrew G. Renehan
- Centre for Health Informatics, Manchester Cancer Research Centre, University of Manchester, Manchester M13 9PL, UK;
| | - Natalie Cook
- Division of Cancer Science, School of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
- Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - William Welfare
- Public Health England Northwest, 3 Piccadilly Place, London Road, Manchester M1 3BN, UK;
| | - Darren M. Ashcroft
- National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Victoria Palin
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (T.V.S.); (V.P.)
- Maternal and Fetal Research Centre, Division of Developmental Biology and Medicine, University of Manchester, St Marys Hospital, Oxford Road, Manchester M13 9WL, UK
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Temmink SJD, Peeters KCMJ, Renehan AG, Pares O, Perez RO, Nilsson PJ. Author response to: Comment on: Outcomes following watch and wait of a clinical complete response in rectal cancer after neoadjuvant treatment: comparison of patients with and without complete response at first reassessment in the International Watch & Wait Database (IWWD). Br J Surg 2023; 110:1242. [PMID: 37348060 PMCID: PMC10416698 DOI: 10.1093/bjs/znad186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/28/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Sofieke J D Temmink
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew G Renehan
- Manchester Cancer Research Centre, National Institute of Health Research Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
- Colorectal and Peritoneal Oncology Centre, The Christie National Health Service Foundation Trust, Manchester, UK
| | - Oriol Pares
- Department of Radiation Oncology, Champalimaud Foundation, Lisboa, Portugal
| | - Rodrigo O Perez
- Department of Colorectal Surgery, Angelita and Joaquim Gama Institute, São Paulo, Brazil
- Department of Surgical Oncology, Hospital Beneficencia Portuguesa, São Paulo, Brazil; Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
- Ludwig Institute for Cancer Research, São Paulo Branch, São Paulo, Brazil
| | - Per J Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Wang M, Sperrin M, Rutter MK, Renehan AG. Cancer is becoming the leading cause of death in diabetes. Lancet 2023; 401:1849. [PMID: 37270233 DOI: 10.1016/s0140-6736(23)00445-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/27/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Mengying Wang
- Division of Cancer Sciences, School of Medical Sciences, University of Manchester, Manchester M20 4BX, UK; Manchester Cancer Research Centre, National Institute for Health Research, Manchester Biomedical Research Centre, Manchester, UK
| | - Matthew Sperrin
- Faculty of Biology, Medicine and Health, and Centre for Health Informatics, and Division of Informatics, Imaging and Data Science, School of Medical Sciences, University of Manchester, Manchester M20 4BX, UK
| | - Martin K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester M20 4BX, UK; Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, University of Manchester, Manchester M20 4BX, UK; Manchester Cancer Research Centre, National Institute for Health Research, Manchester Biomedical Research Centre, Manchester, UK.
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Temmink SJD, Peeters KCMJ, Bahadoer RR, Kranenbarg EMK, Roodvoets AGH, Melenhorst J, Burger JWA, Wolthuis A, Renehan AG, Figueiredo NL, Pares O, Martling A, Perez RO, Beets GL, van de Velde CJH, Nilsson PJ. Watch and wait after neoadjuvant treatment in rectal cancer: comparison of outcomes in patients with and without a complete response at first reassessment in the International Watch & Wait Database (IWWD). Br J Surg 2023; 110:676-684. [PMID: 36972213 PMCID: PMC10364523 DOI: 10.1093/bjs/znad051] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/13/2023] [Accepted: 02/05/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND In rectal cancer, watch and wait for patients with a cCR after neoadjuvant treatment has an established evidence base. However, there is a lack of consensus on the definition and management of a near-cCR. This study aimed to compare outcomes in patients who achieved a cCR at first reassessment versus later reassessment. METHODS This registry study included patients from the International Watch & Wait Database. Patients were categorized as having a cCR at first reassessment or at later reassessment (that is near-cCR at first reassessment) based on MRI and endoscopy. Organ preservation, distant metastasis-free survival, and overall survival rates were calculated. Subgroup analyses were done for near-cCR groups based on the response evaluation according to modality. RESULTS A total of 1010 patients were identified. At first reassessment, 608 patients had a cCR; 402 had a cCR at later reassessment. Median follow-up was 2.6 years for patients with a cCR at first reassessment and 2.9 years for those with a cCR at later reassessment. The 2-year organ preservation rate was 77.8 (95 per cent c.i. 74.2 to 81.5) and 79.3 (75.1 to 83.7) per cent respectively (P = 0.499). Similarly, no differences were found between groups in distant metastasis-free survival or overall survival rate. Subgroup analyses showed a higher organ preservation rate in the group with a near-cCR categorized exclusively by MRI. CONCLUSION Oncological outcomes for patients with a cCR at later reassessment are no worse than those of patients with a cCR at first reassessment.
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Affiliation(s)
- Sofieke J D Temmink
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Renu R Bahadoer
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Annet G H Roodvoets
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht Universitair Medisch Centrum+, Maastricht, the Netherlands
| | | | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Andrew G Renehan
- Manchester Cancer Research Centre, National Institute for Health Research Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
- Colorectal and Peritoneal Oncology Centre, Christie National Health Service Foundation Trust, Manchester, UK
| | | | - Oriol Pares
- Department of Radiation Oncology, Champalimaud Foundation, Lisbon, Portugal
| | - Anna Martling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Rodrigo O Perez
- Department of Colorectal Surgery, Angelita and Joaquim Gama Institute, São Paulo, Brazil
- Department of Surgical Oncology, Hospital Beneficencia Portuguesa, São Paulo, Brazil
- Colorectal Surgery Division, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
- Ludwig Institute for Cancer Research, São Paulo Branch, São Paulo, Brazil
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, the Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | | | - Per J Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Hawwash N, Sperrin M, Martin GP, Cook M, Matthews CE, Neuhouser ML, Joshu CE, Platz EA, Freisling H, Gunter M, Bristow R, Renehan AG. Abstract 3034: Excess weight by degree and duration and cancer risk: an individual participant data (IPD) meta - analyses of over 1.4 million participants (ABACus2 consortium). Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-3034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Background: Excess body fatness, approximated by body mass index (BMI), is associated with higher risk of at least 13 cancer types and is the second-largest avoidable cause of cancer in many populations. Current epidemiologic evidence linking body fatness with cancer risk is largely based on a ‘once-only’ BMI measure which may fail to capture the life-course exposure to body fatness. Here, we test whether a novel metric that combines repeated BMI measures over an individual’s adult lifetime, the overweight-years metric, improves the performance characteristics for associations with cancer compared with a ‘once-only’ BMI measure.
Methods: Within the ABACus 2 Consortium (4 US cohorts; 1 European cohort), we derived the overweight-years metric - a product of the degree of overweight (BMI minus 24.9 kg/m2) and the duration of overweight (in years). Using a random effects two-stage meta-analysis, we calculated the association between the overweight-years metric, and separately the cumulative degree and cumulative duration of overweight exposure with incident cancer by fitting multivariable-adjusted Cox proportional hazards models and comparing each metrics performance with BMI measured at a single time using Harrell’s C-statistic.
Results: Out of 1,419,850 participants in the ABACus 2 consortium, 716,909 participants were included. Per standard deviation overweight-years, the multivariable-adjusted hazard ratio for obesity-related cancers in men was 1.15 (95% CI: 1.13, 1.17, I2: 0) and for women was 1.11 (95% CI: 1.04, 1.18, I2: 0.94). For ‘once-only’ BMI, the per standard deviation multivariable-adjusted hazard ratio for obesity-related cancers in men was 1.16 (95% CI: 1.15,1.18, I2: 0) and for women was 1.13 (95% CI: 1.09,1.18, I2: 0.82). For most obesity-related cancers, both degree and duration of overweight were significantly associated with risk. The overweight-years metric had a C-statistic of 0.610 (95% CI: 0.569, 0.649) and once-only BMI had a C-statistic of 0.608 (95% CI: 0.566, 0.648) for combined obesity-related cancers in men. In
women, the C-statistic for overweight-years was 0.562 (95% CI: 0.537, 0.587) and once-only BMI had a C-statistic of 0.566 (95% CI: 0.544, 0.588) for combined obesity-related cancers. The C-statistic of the overweight-years metric and BMI measured at a single time combined was 0.609 (95% CI: 0.567, 0.650) in men and 0.573 (95% CI: 0.546, 0.600) in women for combined obesity-related cancers.
Conclusion: Overall, there were marginal differences in the predictive performance between the overweight-years metric and a ‘once-only’ baseline-BMI measure. These findings show that excess weight throughout adulthood is important in cancer development.
Funding: CRUK, NIHR, NHLBI, NCI, NPCR.
Citation Format: Nadin Hawwash, Matthew Sperrin, Glen P. Martin, Michael Cook, Charles E. Matthews, Marian L. Neuhouser, Corinne E. Joshu, Elizabeth A. Platz, Heinz Freisling, Marc Gunter, Rob Bristow, Andrew G. Renehan. Excess weight by degree and duration and cancer risk: an individual participant data (IPD) meta - analyses of over 1.4 million participants (ABACus2 consortium) [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 3034.
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Affiliation(s)
- Nadin Hawwash
- 1University of Manchester, Manchester, United Kingdom
| | | | | | | | | | | | | | | | - Heinz Freisling
- 4International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Marc Gunter
- 4International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Rob Bristow
- 5Cancer Research UK Manchester Cancer Research Centre, Manchester, United Kingdom
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Parmar KL, O'Reilly D, Valle J, Braun M, Malcomson L, Jones RP, Balaa F, Rees M, Welsh FKS, Filobbos R, Renehan AG. Protocol for the CoNoR Study: A prospective multi-step study of the potential added benefit of two novel assessment tools in colorectal liver metastases technical resectability decision-making. BMJ Open 2023; 13:e059369. [PMID: 36997247 PMCID: PMC10069542 DOI: 10.1136/bmjopen-2021-059369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Liver resection is the only curative treatment for colorectal liver metastases (CLM). Resectability decision-making is therefore a key determinant of outcomes. Wide variation has been demonstrated in resectability decision-making, despite the existence of criteria. This paper summarises a study protocol to evaluate the potential added value of two novel assessment tools in assessing CLM technical resectability: the Hepatica preoperative MR scan (MR-based volumetry, Couinaud segmentation, liver tissue characteristics and operative planning tool) and the LiMAx test (hepatic functional capacity). METHODS AND ANALYSIS This study uses a systematic multistep approach, whereby three preparatory workstreams aid the design of the final international case-based scenario survey:Workstream 1: systematic literature review of published resectability criteria.Workstream 2: international hepatopancreatobiliary (HPB) interviews.Workstream 3: international HPB questionnaire.Workstream 4: international HPB case-based scenario survey.The primary outcome measures are change in resectability decision-making and change in planned operative strategy, resulting from the novel test results. Secondary outcome measures are variability in CLM resectability decision-making and opinions on the role for novel tools. ETHICS AND DISSEMINATION The study protocol has been approved by a National Health Service Research Ethics Committee and registered with the Health Research Authority. Dissemination will be via international and national conferences. Manuscripts will be published. REGISTRATION DETAILS The CoNoR Study is registered with ClinicalTrials.gov (registration number NCT04270851). The systematic review is registered on the PROSPERO database (registration number CRD42019136748).
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Affiliation(s)
- Kat L Parmar
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester Cancer Research Centre, Manchester, UK
| | - Derek O'Reilly
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Department of Hepatobiliary Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Juan Valle
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Michael Braun
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Lee Malcomson
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester Cancer Research Centre, Manchester, UK
| | - Robert P Jones
- Department of Hepatobiliary Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Fady Balaa
- Department of Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Myrddin Rees
- Department of Surgery, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Fenella K S Welsh
- Department of Surgery, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Rafik Filobbos
- Department of Radiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Andrew G Renehan
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester Cancer Research Centre, Manchester, UK
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Jensen BW, Aarestrup J, Blond K, Jørgensen ME, Renehan AG, Vistisen D, Baker JL. Childhood body mass index trajectories, adult-onset type 2 diabetes, and obesity-related cancers. J Natl Cancer Inst 2023; 115:43-51. [PMID: 36214627 PMCID: PMC9830482 DOI: 10.1093/jnci/djac192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/04/2022] [Accepted: 08/31/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Elevated childhood body mass index (BMI), commonly examined as a "once-only" value, increases the risk of cancer and type 2 diabetes (T2D) in adulthood. Continuous exposure to adiposity during childhood may further increase cancer risk. We examined whether longitudinal childhood BMI trajectories were associated with adult obesity-related cancer and the role of adult-onset T2D in these associations. METHODS Five sex-specific latent class BMI trajectories were generated for 301 927 children (149 325 girls) aged 6-15 years from the Copenhagen School Health Records Register. Information on obesity-related cancers and T2D was obtained from national health registers. Incidence rate ratios (IRR), cumulative incidences, and confidence intervals (CI) were estimated using Poisson regressions. RESULTS Compared with the average childhood BMI trajectory (containing approximately 40% of individuals), the rate of obesity-related cancer (excluding breast cancer) increased with higher childhood BMI trajectories among women. The highest rates occurred in the overweight (IRR = 1.27, 95% CI = 1.17 to 1.38) and obesity (IRR = 1.79, 95% CI = 1.53 to 2.08) BMI trajectories. Similar patterns were observed among men. In contrast, women with the obesity childhood BMI trajectory had the lowest rate of pre- and postmenopausal breast cancer (IRR = 0.59, 95% CI = 0.43 to 0.80, and IRR = 0.41, 95% CI = 0.30 to 0.57, respectively). For all trajectories, the cumulative risk of obesity-related cancer increased with adult-onset T2D. CONCLUSION Consistent childhood overweight or obesity may increase the rates of adult obesity-related cancer and decrease the rates of breast cancer. Adult-onset T2D conferred additional risk for obesity-related cancer, but the effect did not differ across childhood BMI trajectories.
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Affiliation(s)
- Britt W Jensen
- Center for Clinical Research and Prevention, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Julie Aarestrup
- Center for Clinical Research and Prevention, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kim Blond
- Center for Clinical Research and Prevention, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Marit E Jørgensen
- Clinical Epidemiological Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Steno Diabetes Center Greenland, Nuuk, Greenland
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Dorte Vistisen
- Clinical Epidemiological Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jennifer L Baker
- Center for Clinical Research and Prevention, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Fernandez LM, São Julião GP, Renehan AG, Beets GL, Papoila AL, Vailati BB, Bahadoer RR, Kranenbarg EMK, Roodvoets AGH, Figueiredo NL, Van De Velde CJH, Habr-Gama A, Perez RO. The Risk of Distant Metastases in Patients With Clinical Complete Response Managed by Watch and Wait After Neoadjuvant Therapy for Rectal Cancer: The Influence of Local Regrowth in the International Watch and Wait Database. Dis Colon Rectum 2023; 66:41-49. [PMID: 36515514 DOI: 10.1097/dcr.0000000000002494] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Nearly 30% of patients with rectal cancer develop local regrowth after initial clinical complete response managed by watch and wait. These patients might be at higher risk for distant metastases. OBJECTIVE This study aimed to investigate risk factors for distant metastases using time-dependent analyses. DESIGN Data from an international watch and wait database were retrospectively reviewed. Cox regression analysis was used to determine risk factors for worse distant metastases-free survival. Conditional survival modeling was used to investigate the impact of risk factors on the development of distant metastases. SETTING Retrospective, multicenter database. PATIENTS A total of 793 patients (47 institutions) with rectal cancer and clinical complete response to neoadjuvant treatment from the International Watch & Wait Database were included. MAIN OUTCOME MEASURES Distant metastases-free survival. RESULTS Of the 793 patients managed with watch and wait (median follow-up 55.2 mo)' 85 patients (10.7%) had distant metastases. Fifty-one of 85 patients (60%) had local regrowth at any time. Local regrowth was an independent factor associated with worse distant metastases-free survival in the multivariable model. Using conditional estimates, patients with local regrowth without distant metastases for 5 years (from decision to watch and wait) remained at higher risk for development of distant metastases for 1 subsequent year compared to patients without local regrowth (5-year conditional distant metastases-free survival 94.9% vs 98.4%). LIMITATIONS Lack of information on adjuvant chemotherapy, salvage surgery for local regrowth, and heterogeneity of individual surveillance/follow-up strategies used may have affected results. CONCLUSIONS In patients with clinical complete response managed by watch and wait, development of local regrowth at any time is a risk factor for distant metastases. The risk of distant metastases remains higher for 5 years after development of local regrowth. See Video Abstract at http://links.lww.com/DCR/C53. EL RIESGO DE METSTASIS A DISTANCIA EN PACIENTES CON RESPUESTA CLNICA COMPLETA MANEJADA POR WATCH AND WAIT DESPUS DE LA TERAPIA NEOADYUVANTE PARA EL CNCER DE RECTO LA INFLUENCIA DEL NUEVO CRECIMIENTO LOCAL EN LA BASE DE DATOS INTERNACIONAL WATCH AND WAIT ANTECEDENTES:Casi el 30 % de los pacientes con cáncer de recto desarrollan un nuevo crecimiento local después de la respuesta clínica completa inicial manejada por watch and wait. Estos pacientes podrían tener un mayor riesgo de metástasis a distancia.OBJETIVO:Investigar los factores de riesgo de metástasis a distancia mediante análisis dependientes del tiempo.DISEÑO:Se revisó retrospectivamente los datos de la base de datos internacional de Watch and Wait. Se utilizó el análisis de regresión de Cox para determinar los factores de riesgo de peor sobrevida libre de metástasis a distancia. Se utilizó un modelo de sobrevida condicional para investigar el impacto de los factores de riesgo en el desarrollo de metástasis a distancia. El tiempo transcurrido hasta el evento se calculó utilizando la fecha de decisión para watch and wait y la fecha del nuevo crecimiento local para el diagnóstico de metástasis a distancia.ESCENARIOBase de datos multicéntrica retrospectiva.PACIENTES:Se incluyeron un total de 793 pacientes (47 instituciones) con cáncer de recto y respuesta clínica completa al tratamiento neoadyuvante de la base de datos internacional de Watch and Wait.PRINCIPALES MEDIDAS DE RESULTADO:Desarrollo de metástasis a distancia.RESULTADOS:De los 793 pacientes tratados con watch and wait (mediana de seguimiento de 55,2 meses), 85 (10,7%) tenían metástasis a distancia. 51 de 85 (60%) tuvieron recrecimiento local en algún momento. El recrecimiento local fue un factor independiente asociado a una peor supervivencia libre de metástasis a distancia en el modelo multivariable. Además, al usar estimaciones condicionales, los pacientes con recrecimiento local sin metástasis a distancia durante 5 años (desde la decisión de watch and wait) permanecieron en mayor riesgo de desarrollar metástasis a distancia durante un año subsiguiente en comparación con los pacientes sin recrecimiento local (sobrevida libre de metástasis a distancia a 5 años: recrecimiento local 94,9% frente a no recrecimiento local 98,4%).LIMITACIONES:La falta de información relacionada con el uso de quimioterapia adyuvante, las características específicas de la cirugía de rescate para el nuevo crecimient o local y la heterogeneidad de las estrategias individuales de vigilancia/seguimiento utilizadas pueden haber afectado los resultados observados.CONCLUSIONES:En pacientes con respuesta clínica completa manejados por Watch and Wait, el desarrollo de recrecimiento local en cualquier momento es un factor de riesgo para metástasis a distancia. El riesgo de metástasis a distancia sigue siendo mayor durante 5 años después del desarrollo de un nuevo crecimiento local. Consulte Video Resumen en http://links.lww.com/DCR/C53. (Traducción-Dr. Felipe Bellolio).
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Affiliation(s)
- Laura M Fernandez
- Colorectal Surgery, Digestive Department, Champalimaud Foundation, Lisbon, Portugal
| | - Guilherme P São Julião
- Colorectal Surgery Division, Angelita and Joaquim Gama Institute, São Paulo, Brazil
- Department of Surgical Oncology, Colorectal Surgery Division, Hospital Beneficencia Portuguesa, São Paulo, Brazil
- Colorectal Surgery Division, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Andrew G Renehan
- Manchester Cancer Research Centre, National Institute of Health and Research Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
- Colorectal and Peritoneal Oncology Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands
| | - Ana L Papoila
- NOVA Medical School, Faculdade de Ciências Médicas (NMS|FCM), Lisbon, Portugal
| | - Bruna B Vailati
- Colorectal Surgery Division, Angelita and Joaquim Gama Institute, São Paulo, Brazil
- Department of Surgical Oncology, Colorectal Surgery Division, Hospital Beneficencia Portuguesa, São Paulo, Brazil
- Colorectal Surgery Division, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Renu R Bahadoer
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Annet G H Roodvoets
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Nuno L Figueiredo
- Colorectal Surgery, Digestive Department, Champalimaud Foundation, Lisbon, Portugal
- Colorectal Surgery, Hospital Lusiadas, Lisbon, Portugal
| | - Cornelis J H Van De Velde
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Angelita Habr-Gama
- Colorectal Surgery Division, Angelita and Joaquim Gama Institute, São Paulo, Brazil
- Colorectal Surgery Division, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
- University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rodrigo O Perez
- Colorectal Surgery Division, Angelita and Joaquim Gama Institute, São Paulo, Brazil
- Department of Surgical Oncology, Colorectal Surgery Division, Hospital Beneficencia Portuguesa, São Paulo, Brazil
- Colorectal Surgery Division, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
- Ludwig Institute for Cancer Research, São Paulo Branch, Brazil
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Watson C, Geifman N, Renehan AG. Latent class trajectory modelling: impact of changes in model specification. Am J Transl Res 2022; 14:7593-7606. [PMID: 36398215 PMCID: PMC9641469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/13/2022] [Indexed: 06/16/2023]
Abstract
Latent class trajectory models (LCTMs) are often used to identify subgroups of patients that are clinically meaningful in terms of longitudinal exposure and outcome, e.g. drug response patterns. These models are increasingly applied in medicine and epidemiology. However, in many published studies, it is not clear whether the chosen models, where subgroups of patients are identified, represent real heterogeneity in the population, or whether any associations with clinically meaningful characteristics are accidental. In particular, we note an apparent over-reliance on lowest AIC or BIC values. While these are objective measures of goodness of fit, and can help identify the optimal number of subgroups, they are not sufficient on their own to fully evaluate a given trajectory model. Here we demonstrate how longitudinal latent class models can substantially change by making small modifications in model specification, and the impact of this on the relationship to clinical outcomes. We show that the predicted trajectory patterns and outcome probabilities differ when pre-specified cubic versus linear shapes are tested on the same data. However, both could be interpreted to be the "correct" model. We emphasise that LCTMs, like all unsupervised approaches, are hypotheses generating, and should not be directly implemented in clinical practice without significant testing and validation.
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Affiliation(s)
- Charlotte Watson
- Manchester Cancer Research Centre and NIHR Manchester Biomedical Research CentreManchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchester, UK
| | - Nophar Geifman
- School of Health Sciences, Faculty of Health and Medical Sciences, University of SurryGuildford, Surrey, UK
| | - Andrew G Renehan
- Manchester Cancer Research Centre and NIHR Manchester Biomedical Research CentreManchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchester, UK
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13
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Mbanu P, Saunders MP, Mistry H, Mercer J, Malcomson L, Yousif S, Price G, Kochhar R, Renehan AG, van Herk M, Osorio EV. Clinical and radiomics prediction of complete response in rectal cancer pre-chemoradiotherapy. Phys Imaging Radiat Oncol 2022; 23:48-53. [PMID: 35800297 PMCID: PMC9253904 DOI: 10.1016/j.phro.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 11/11/2022] Open
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Hawwash N, Martin GP, Sperrin M, Renehan AG. Link Between Obesity and Early-Onset Colorectal Cancers (EOCRC): Importance of Accounting for BMI Trajectories in Early Life. Am J Gastroenterol 2022; 117:812. [PMID: 35191409 DOI: 10.14309/ajg.0000000000001661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Nadin Hawwash
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Cancer Research UK Manchester Cancer Research Centre, Manchester, United Kingdom
| | - Glen P Martin
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Matthew Sperrin
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Cancer Research UK Manchester Cancer Research Centre, Manchester, United Kingdom
- National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester, United Kingdom
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15
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Alam NN, Wright AK, Rutter MK, Buchan I, Ashcroft DM, Sperrin M, Renehan AG. Body mass index and cancer mortality in patients with incident type 2 diabetes: A population-based study of adults in England. Diabetes Obes Metab 2022; 24:620-630. [PMID: 34866302 DOI: 10.1111/dom.14614] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 11/14/2021] [Accepted: 12/01/2021] [Indexed: 01/08/2023]
Abstract
AIMS We evaluated the relationship between body mass index (BMI) and cancer mortality in incident type 2 diabetes. METHODS We used the Clinical Practice Research Datalink GOLD (1998-2015), linked with the Office of National Statistics mortalities, and derived an incident type 2 diabetes cohort (N = 176 886; aged 30-85 years). We determined BMI ±12 months diabetes diagnosis. The primary outcome was cancer mortality, categorized into deaths from obesity-related cancers (ORCs) and non-ORCs. Secondary outcomes were site-specific cancer mortality and main causes of deaths [cancer, cardiovascular disease (CVD), non-cancer non-CVD]. We developed gender-specific Cox models and expressed risk as hazard ratios and 95% confidence intervals, stratified by smoking status. RESULTS With 886 850 person-years follow-up, 7593 cancer deaths occurred. Among women who never smoked, there were positive associations between BMI and deaths from endometrial (hazard ratios per 5 kg/m2 : 1.43; 95% confidence interval 1.26-1.61). Among men, associations between BMI and ORC mortality were inverse but attenuated towards null among never smokers and excluding deaths in the first 2 years. In men, the proportion of CVD deaths increased from 36.8% in BMI category 22.5 to 24.9 kg/m2 to 43.6% in BMI category ≥40 kg/m2 (p < .001). CONCLUSIONS We found some relationships between BMI and cancer mortality in patients with type 2 diabetes, but interpretations need to account for smoking status, reverse causality and deaths from CVD.
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Affiliation(s)
- Nasra N Alam
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alison K Wright
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Martin K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Iain Buchan
- Department of Public Health and Policy, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Matthew Sperrin
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
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16
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Mbanu P, Osorio EV, Mistry H, Malcomson L, Yousif S, Aznar M, Kochhar R, Van Herk M, Renehan AG, Saunders MP. Clinico-pathological predictors of clinical complete response in rectal cancer. Cancer Treat Res Commun 2022; 31:100540. [PMID: 35231874 DOI: 10.1016/j.ctarc.2022.100540] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Prediction of clinical complete response in rectal cancer before neoadjuvant chemo-radiotherapy treatment enables treatment selection. Patients predicted to have complete response could have chemo-radiotherapy, and others could have additional doublet chemotherapy at this stage of their treatment to improve their overall outcome. This work investigates the role of clinical variables in predicting clinical complete response. METHOD Using the UK-based OnCoRe database (2008 to 2019), we performed a propensity-score matched study of 322 patients who received neoadjuvant chemoradiotherapy. We collected pre-treatment clinic-pathological, inflammatory and radiotherapy-related characteristics. We determined the odds for the occurrence of cCR using conditional logistic regression models. We derived the post-model Area under the Curve (AUC) as an indicator of discrimination performance and stated a priori that an AUC of 0.75 or greater was required for potential clinical utility. RESULTS Pre-treatment tumour diameter, mrT-stage, haemoglobin, alkaline phosphate and total radiotherapy depths were associated with cCR on univariable and multivariable analysis. Additionally, neutrophil to lymphocyte ratio (NLR), neutrophil-monocyte to lymphocyte ratio (NMLR), lymphocyte count and albumin were all significantly associated with cCR on multivariable analysis. A nomogram using the above parameters was developed with a resulting ROC AUC of 0.75. CONCLUSION We identified routine clinic-pathological, inflammatory and radiotherapy-related variables which are independently associated with cCR. A nomogram was developed to predict cCR. The performance characteristics from this model were on the prior clinical utility threshold. Additional research is required to develop more associated variables to better select patients with rectal cancer undergoing chemoradiotherapy who may benefit from pursuing a W&W strategy.
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Affiliation(s)
- P Mbanu
- Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, United Kingdom.
| | - E Vasquez Osorio
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - H Mistry
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom; Division of Pharmacy, University of Manchester, Manchester, United Kingdom
| | - L Malcomson
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom; Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, United Kingdom
| | - S Yousif
- Department of Clinical Oncology, Lancashire Teaching Hospital, Preston, United Kingdom
| | - M Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - R Kochhar
- Department of Radiological Oncology, Christie NHS Foundation Trust, Manchester, United Kingdom
| | - M Van Herk
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - A G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom; Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, United Kingdom
| | - M P Saunders
- Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, United Kingdom
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Morgan RD, Ferreras C, Peset I, Avizienyte E, Renehan AG, Edmondson RJ, Murphy AD, Nicum S, Van Brussel T, Clamp AR, Lambrechts D, Zhou C, Jayson GC. c-MET/VEGFR-2 co-localisation impacts on survival following bevacizumab therapy in epithelial ovarian cancer: an exploratory biomarker study of the phase 3 ICON7 trial. BMC Med 2022; 20:59. [PMID: 35144591 PMCID: PMC8832801 DOI: 10.1186/s12916-022-02270-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Bevacizumab improves survival outcomes in women diagnosed with epithelial ovarian cancer (EOC). Pre-clinical data showed that the c-MET/VEGFR-2 heterocomplex negates VEGF inhibition through activation of c-MET signalling, leading to a more invasive and metastatic phenotype. We evaluated the clinical significance of c-MET and VEGFR-2 co-localisation and its association with VEGF pathway-related single nucleotide polymorphisms (SNPs) in women participating in the phase 3 trial, ICON7 (ClinicalTrials.gov identifier: NCT00262847). MATERIALS AND METHODS Patients had FIGO stage I-IIA grade 3/poorly differentiated or clear cell carcinoma or stage IIB-IV epithelial ovarian, primary peritoneal or fallopian tube cancer. Immunofluorescence staining for co-localised c-MET and VEGFR-2 on tissue microarrays and genotyping of germline DNA from peripheral blood leukocytes for VEGFA and VEGFR-2 SNPs was performed. The significance of these biomarkers was assessed against survival. RESULTS Tissue microarrays from 178 women underwent immunofluorescence staining. Multivariable analysis showed that greater c-MET/VEGFR-2 co-localisation predicted worse OS in patients treated with bevacizumab after adjusting for FIGO stage and debulking surgery outcome (hazard ratio [HR] 1.034, 95% confidence interval [95%CI] 1.010-1.059). Women in the c-MET/VEGFR-2HIGH group treated with bevacizumab demonstrated significantly reduced OS (39.3 versus > 60 months; HR 2.00, 95%CI 1.08-3.72). Germline DNA from 449 women underwent genotyping. In the bevacizumab group, those women with the VEGFR-2 rs2305945 G/G variant had a trend towards shorter PFS compared with G/T or T/T variants (18.3 versus 23.0 months; HR 0.74, 95%CI 0.53-1.03). CONCLUSIONS In bevacizumab-treated women diagnosed with EOC, high c-MET/VEGFR-2 co-localisation on tumour tissue and the VEGFR-2 rs2305945 G/G variant, which may be biologically related, were associated with worse survival outcomes.
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Affiliation(s)
- Robert D Morgan
- Division of Cancer Sciences, Faculty of Biology, Health and Medicine, University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, M20 4BX, UK
| | - Cristina Ferreras
- Division of Cancer Sciences, Faculty of Biology, Health and Medicine, University of Manchester, Manchester, UK
| | - Isabel Peset
- Medicines Discovery Catapult, Alderley Park, Cheshire, UK
| | | | - Andrew G Renehan
- Division of Cancer Sciences, Faculty of Biology, Health and Medicine, University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, M20 4BX, UK
| | - Richard J Edmondson
- Division of Cancer Sciences, Faculty of Biology, Health and Medicine, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Shibani Nicum
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Andrew R Clamp
- Division of Cancer Sciences, Faculty of Biology, Health and Medicine, University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, M20 4BX, UK
| | | | - Cong Zhou
- Cancer Biomarker Centre, Cancer Research UK Manchester Institute, Manchester, UK
| | - Gordon C Jayson
- Division of Cancer Sciences, Faculty of Biology, Health and Medicine, University of Manchester, Manchester, UK.
- The Christie NHS Foundation Trust, Manchester, M20 4BX, UK.
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Jensen BW, Watson C, Geifman N, Baker JL, Badrick E, Renehan AG. Weight Changes in Type 2 Diabetes and Cancer Risk: A Latent Class Trajectory Model Study. Obes Facts 2022; 15:150-159. [PMID: 34903697 PMCID: PMC9021620 DOI: 10.1159/000520200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 09/30/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Body mass index (BMI) is often elevated at type 2 diabetes (T2D) diagnosis. Using latent class trajectory modelling (LCTM) of BMI, we examined whether weight loss after diagnosis influenced cancer incidence and all-cause mortality. METHODS From 1995 to 2010, we identified 7,708 patients with T2D from the Salford Integrated Record database (UK) and linked to the cancer registry for information on obesity-related cancer (ORC), non-ORC; and all-cause mortality. Repeated BMIs were used to construct sex-specific latent class trajectories. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression models. RESULTS Four sex-specific BMI classes were identified; stable-overweight, stable-obese, obese-slightly-decreasing, and obese-steeply-decreasing; comprising 41%, 45%, 13%, and 1% of women, and 45%, 37%, 17%, and 1% of men, respectively. In women, the stable-obese class had similar ORC risks as the obese-slightly-decreasing class, whereas the stable-overweight class had lower risks. In men, the obese-slightly-decreasing class had higher risks of ORC (HR = 1.86, 95% CI: 1.05-3.32) than the stable-obese class, while the stable-overweight class had similar risks No associations were observed for non-ORC. Compared to the stable-obese class, women (HR = 1.60, 95% CI: 0.99-2.58) and men (HR = 2.37, 95% CI: 1.66-3.39) in the obese-slightly-decreasing class had elevated mortality. No associations were observed for the stable-overweight classes. CONCLUSION Patients who lost weight after T2D diagnosis had higher risks for ORC (in men) and higher all-cause mortality (both genders) than patients with stable obesity.
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Affiliation(s)
- Britt W. Jensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- *Britt W. Jensen,
| | - Charlotte Watson
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Nophar Geifman
- Centre for Health Informatics, University of Manchester, Manchester, United Kingdom
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Jennifer L. Baker
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Ellena Badrick
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Andrew G. Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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Cao J, van Veen EM, Peek N, Renehan AG, Ananiadou S. A Novel Automated Approach to Mutation-Cancer Relation Extraction by Incorporating Heterogeneous Knowledge. IEEE J Biomed Health Inform 2022; 27:1096-1105. [PMID: 36395134 DOI: 10.1109/jbhi.2022.3220924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Automatic extraction of relations between gene mutations and cancer entities occurring in the cancer literature using text mining can rapidly provide vital information to support precision cancer medicine. However, mutation-cancer relation extraction is more challenging than general relation extraction from free text, since it is often not possible without cancer-specific background knowledge and thus the model replies on a deeper understanding of complex surrounding tokens. We propose a deep learning model that jointly extracts mutations and their associated cancers. Background knowledge comes from two different knowledge bases which store different types of information about mutations. Given the different ways in which knowledge is stored in these two resources, we propose two separate methods for embedding knowledge, namely sentence-based knowledge integration and attribute-aware knowledge integration. The evaluation demonstrated that our model outperforms a number of baseline models and gains 96.00%, 92.57% and 94.57% F1 scores on three public datasets, EMU BCa, EMU PCa, and BRONCO, thus illustrating the effectiveness of our knowledge integration approach. The auxiliary experiments show that our models can utilize more informative text from the KBs and link the mutations to their corresponding cancer disease although the input text provides insufficient context.
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Affiliation(s)
- Jiarun Cao
- National Centre for Text Mining, Department of Computer Science, The University of Manchester, Manchester, U.K
| | - Elke M van Veen
- Manchester Centre for Genomic Medicine St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, U.K
| | - Niels Peek
- Centre for Health Informatics, Division of Informatics, Imaging, Data Science, School of Health Sciences, Faculty of Biology, Medicine, Health, The University of Manchester, Manchester, U.K
| | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine, Health, The University of Manchester, Manchester, U.K
| | - Sophia Ananiadou
- National Centre for Text Mining, Department of Computer Science, The University of Manchester, Manchester, U.K
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20
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Fokas E, Appelt A, Glynne-Jones R, Beets G, Perez R, Garcia-Aguilar J, Rullier E, Smith JJ, Marijnen C, Peters FP, van der Valk M, Beets-Tan R, Myint AS, Gerard JP, Bach SP, Ghadimi M, Hofheinz RD, Bujko K, Gani C, Haustermans K, Minsky BD, Ludmir E, West NP, Gambacorta MA, Valentini V, Buyse M, Renehan AG, Gilbert A, Sebag-Montefiore D, Rödel C. International consensus recommendations on key outcome measures for organ preservation after (chemo)radiotherapy in patients with rectal cancer. Nat Rev Clin Oncol 2021; 18:805-816. [PMID: 34349247 DOI: 10.1038/s41571-021-00538-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 02/07/2023]
Abstract
Multimodal treatment strategies for patients with rectal cancer are increasingly including the possibility of organ preservation, through nonoperative management or local excision. Organ preservation strategies can enable patients with a complete response or near-complete clinical responses after radiotherapy with or without concomitant chemotherapy to safely avoid the morbidities associated with radical surgery, and thus to maintain anorectal function and quality of life. However, standardization of the key outcome measures of organ preservation strategies is currently lacking; this includes a lack of consensus of the optimal definitions and selection of primary end points according to the trial phase and design; the optimal time points for response assessment; response-based decision-making; follow-up schedules; use of specific anorectal function tests; and quality of life and patient-reported outcomes. Thus, a consensus statement on outcome measures is necessary to ensure consistency and facilitate more accurate comparisons of data from ongoing and future trials. Here, we have convened an international group of experts with extensive experience in the management of patients with rectal cancer, including organ preservation approaches, and used a Delphi process to establish the first international consensus recommendations for key outcome measures of organ preservation, in an attempt to standardize the reporting of data from both trials and routine practice in this emerging area.
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Affiliation(s)
- Emmanouil Fokas
- Department of Radiotherapy of Oncology, University of Frankfurt, Frankfurt, Germany.
- German Cancer Research Center (DKFZ), Heidelberg, Germany.
- German Cancer Consortium (DKTK), Frankfurt, Germany.
- Frankfurt Cancer Institute (FCI), Frankfurt, Germany.
| | - Ane Appelt
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Robert Glynne-Jones
- Department of Radiotherapy, Mount Vernon Centre for Cancer Treatment, Northwood, UK
| | - Geerard Beets
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
- Department of Surgery, Netherlands Cancer Institute Amsterdam, Amsterdam, Netherlands
| | - Rodrigo Perez
- Department of Surgery, Angelita & Joaquim Institute, São Paulo, Brazil
| | - Julio Garcia-Aguilar
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Rullier
- Department of Colorectal Surgery, Haut-Lévèque Hospital, Centre Hospitalier Universitaire (CHU) Bordeaux, Bordeaux, France
| | - J Joshua Smith
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Corrie Marijnen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Femke P Peters
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Maxine van der Valk
- Department of Surgery, Netherlands Cancer Institute Amsterdam, Amsterdam, Netherlands
| | - Regina Beets-Tan
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Arthur S Myint
- The Clatterbridge Cancer Centre, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Simon P Bach
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - Michael Ghadimi
- Department of General, Visceral, and Paediatric Surgery, University Medical Center, Göttingen, Germany
| | - Ralf D Hofheinz
- Department of Medical Oncology, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Krzysztof Bujko
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Cihan Gani
- Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- German Cancer Research Center (DKFZ) Heidelberg and German Consortium for Translational Cancer Research (DKTK) Partner Site Tübingen, Tübingen, Germany
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Bruce D Minsky
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ethan Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicholas P West
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St. James's, School of Medicine, University of Leeds, Leeds, UK
| | - Maria A Gambacorta
- Department of Radiation Oncology and Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- Department of Radiation Oncology and Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marc Buyse
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
- International Drug Development Institute, San Francisco, CA, USA
| | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK
| | - Alexandra Gilbert
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | | | - Claus Rödel
- Department of Radiotherapy of Oncology, University of Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), Frankfurt, Germany
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21
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Rao S, Guren MG, Khan K, Brown G, Renehan AG, Steigen SE, Deutsch E, Martinelli E, Arnold D. Anal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up ☆. Ann Oncol 2021; 32:1087-1100. [PMID: 34175386 DOI: 10.1016/j.annonc.2021.06.015] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- S Rao
- GI Unit, Royal Marsden Hospital, London, UK
| | - M G Guren
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - K Khan
- University College London Hospitals NHS Foundation Trust/UCL Cancer Institute, London, UK; Royal Marsden Hospital, London, UK
| | - G Brown
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, UK
| | - A G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
| | - S E Steigen
- University Hospital of North Norway, Tromsø, Norway
| | - E Deutsch
- INSERM 1030, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - E Martinelli
- Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - D Arnold
- Department of Hematology, Oncology, Palliative Care Medicine and Rheumatology, Asklepios Hospital Altona, Hamburg, Germany
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22
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Watson C, Renehan AG, Geifman N. Associations of specific-age and decade recall body mass index trajectories with obesity-related cancer. BMC Cancer 2021; 21:502. [PMID: 33952200 PMCID: PMC8097878 DOI: 10.1186/s12885-021-08226-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/20/2021] [Indexed: 11/26/2022] Open
Abstract
Background Excess body fatness, commonly approximated by a one-off determination of body mass index (BMI), is associated with increased risk of at least 13 cancers. Modelling of longitudinal BMI data may be more informative for incident cancer associations, e.g. using latent class trajectory modelling (LCTM) may offer advantages in capturing changes in patterns with time. Here, we evaluated the variation in cancer risk with LCTMs using specific age recall versus decade recall BMI. Methods We obtained BMI profiles for participants from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. We developed gender-specific LCTMs using recall data from specific ages 20 and 50 years (72,513 M; 74,837 W); decade data from 30s to 70s (42,113 M; 47,352 W) and a combination of both (74,106 M, 76,245 W). Using an established methodological framework, we tested 1:7 classes for linear, quadratic, cubic and natural spline shapes, and modelled associations for obesity-related cancer (ORC) incidence using LCTM class membership. Results Different models were selected depending on the data type used. In specific age recall trajectories, only the two heaviest classes were associated with increased risk of ORC. For the decade recall data, the shapes appeared skewed by outliers in the heavier classes but an increase in ORC risk was observed. In the combined models, at older ages the BMI values were more extreme. Conclusions Specific age recall models supported the existing literature changes in BMI over time are associated with increased ORC risk. Modelling of decade recall data might yield spurious associations. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08226-4.
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Affiliation(s)
- Charlotte Watson
- Manchester Cancer Research Centre and NIHR Manchester Biomedical Research Centre, Manchester, UK. .,Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. .,Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Andrew G Renehan
- Manchester Cancer Research Centre and NIHR Manchester Biomedical Research Centre, Manchester, UK.,Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Nophar Geifman
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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23
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Parmar KL, Slawinski C, Malcomson L, OReilly D, Valle JW, Braun M, Naish JH, Williams SR, Renehan AG. O5: THE CLIFF AND CONOR STUDIES NOVEL ASSESSMENT TOOLS IN COLORECTAL LIVER METASTASES (CLIFF STUDY - CHANGE IN LIVER FUNCTION AND FAT IN PRE-OPERATIVE CHEMOTHERAPY FOR COLORECTAL LIVER METASTASES, CONOR STUDY. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Hepatic resection is the only potentially curative treatment for patients with colorectal liver metastases (CLM). Patient selection is key, but there is wide variation in practice. Pre-operative chemotherapy can improve oncological outcomes, however chemotherapy-associated liver injury (CALI) may hinder liver regenerative capacity. Standard pre-operative assessments fail to accurately capture factors such as CALI and future liver remnant (FLR) function. The CLiFF and CoNoR studies utilise two novel assessment techniques, aiming to improve patient outcomes.
Method
The CLiFF study prospectively assesses two primary outcomes in 35 patients undergoing pre-operative chemotherapy for CLM: 1) change in liver function (via LiMAx test: direct assessment of hepatic functional capacity), and 2) change in liver fat (via advanced MR imaging (in-house spectroscopy and modified Dixon technique, scaled up via Perspectum LiverMultiScan)). The CoNoR study assesses potential added benefit of these novel tools in CLM resectability decision-making via sequential workstreams: a systematic review and international hepatobiliary expert interviews inform the online survey, assessing added benefit via online MDT scenarios.
Result
Preliminary CLiFF analysis suggests that CALI changes in liver fat and function are unrelated. Liver fat analysis techniques are compared and correlated with digital histological analysis. The CoNoR systematic review identifies key factors influencing CLM resectability decision-making and informs the international expert interviews, scheduled to occur during a February 2020 international hepatobiliary conference.
Conclusion
These studies are the first to assess where these novel tools might be utilised to maximal patient benefit within the Hepatobiliary MDT, and the first systematic review in CLM resectability decision-making.
Take-home message
These two linked studies evaluate the use of two novel assessment tools in the treatment of colorectal liver metastases, with the potential to improve patient selection for curative resection and patient outcomes.
PATEY PRIZE SESSION
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Affiliation(s)
- KL Parmar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester
- Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Manchester
- The Christie NHS Foundation Trust, Manchester
| | - C Slawinski
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester
- Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Manchester
- The Christie NHS Foundation Trust, Manchester
| | - L Malcomson
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester
- Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Manchester
- The Christie NHS Foundation Trust, Manchester
| | - D OReilly
- Department of Hepatobiliary Surgery, Manchester University Foundation Hospitals, Manchester
| | - JW Valle
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester
- The Christie NHS Foundation Trust, Manchester
| | - M Braun
- The Christie NHS Foundation Trust, Manchester
| | - JH Naish
- Division of Cardiovascular Sciences, School of Medical Science, Faculty of Biology, Medicine and Health, University of Manchester
| | - SR Williams
- Centre for Imaging Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester
| | - AG Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester
- Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Manchester
- The Christie NHS Foundation Trust, Manchester
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24
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Sutton PA, O'Dwyer ST, Barriuso J, Aziz O, Selvasekar CR, Renehan AG, Wilson MS. Indications and outcomes for repeat cytoreductive surgery and heated intra-peritoneal chemotherapy in peritoneal surface malignancy. Surg Oncol 2021; 38:101572. [PMID: 33915487 DOI: 10.1016/j.suronc.2021.101572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/16/2020] [Accepted: 03/29/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is offered in specialist centres as a treatment for peritoneal surface tumours. Despite its demonstrated efficacy, intra-abdominal recurrence occurs in 31-57% of patients. The aim of this study is to review the early and long-term outcomes in patients who undergo repeat CRS/HIPEC. MATERIALS AND METHODS A retrospective review of a prospectively maintained database of patients who had undergone repeat CRS/HIPEC for appendiceal neoplasms and colorectal peritoneal metastases (CRPM) from 2003 to 2019 was performed at a single specialist centre. Data pertaining to both short term outcomes and survival were evaluated. RESULTS Of 1259 patients who had undergone CRS/HIPEC, 84(6.7%) underwent repeat surgery: 45(53.6%) had pseudomyxoma peritonei (PMP) secondary to low grade appendiceal mucinous neoplasms (LAMN), 21(25.0%) had appendix carcinoma and 18(21.4%) had CRPM. Demographics, intra-operative findings and short-term outcomes were comparable across tumour types and between procedures. Median (95% CI) interval between procedures was 22.7(18.9-26.6) months and was comparable between tumour types. Median (95%CI) overall survival was not reached for the cohort overall or for those with PMP, but was 61.0(32.6-89.4) months for those with appendix cancer and 76.9(47.4-106.4) months for CRPM (p=<0.001). Survival was favourable in the PMP group (HR [95%CI] 0.044 [0.008-0.262]; p = 0.000) and unfavourable in the CC2-3 at index CRS procedure group (HR [95%CI] 25.612 [2.703-242.703]; p = 0.005). CONCLUSION Our findings demonstrate that repeat cytoredutive surgery with HIPEC can result in favourable survival, especially for patients with PMP when complete cytoreduction is achieved at index operation. We recommend that detailed patient assessment is performed through an expert multidisciplinary team meeting (MDT).
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Affiliation(s)
- P A Sutton
- Colorectal and Peritoneal Oncology Centre, The Christie Hospital, UK.
| | - S T O'Dwyer
- Colorectal and Peritoneal Oncology Centre, The Christie Hospital, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - J Barriuso
- Colorectal and Peritoneal Oncology Centre, The Christie Hospital, UK
| | - O Aziz
- Colorectal and Peritoneal Oncology Centre, The Christie Hospital, UK
| | - C R Selvasekar
- Colorectal and Peritoneal Oncology Centre, The Christie Hospital, UK
| | - A G Renehan
- Colorectal and Peritoneal Oncology Centre, The Christie Hospital, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Cancer Research Centre and NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - M S Wilson
- Colorectal and Peritoneal Oncology Centre, The Christie Hospital, UK
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25
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Anderson AS, Renehan AG, Saxton JM, Bell J, Cade J, Cross AJ, King A, Riboli E, Sniehotta F, Treweek S, Martin RM. Cancer prevention through weight control-where are we in 2020? Br J Cancer 2021; 124:1049-1056. [PMID: 33235315 PMCID: PMC7960959 DOI: 10.1038/s41416-020-01154-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/07/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023] Open
Abstract
Growing data from epidemiological studies highlight the association between excess body fat and cancer incidence, but good indicative evidence demonstrates that intentional weight loss, as well as increasing physical activity, offers much promise as a cost-effective approach for reducing the cancer burden. However, clear gaps remain in our understanding of how changes in body fat or levels of physical activity are mechanistically linked to cancer, and the magnitude of their impact on cancer risk. It is important to investigate the causal link between programmes that successfully achieve short-term modest weight loss followed by weight-loss maintenance and cancer incidence. The longer-term impact of weight loss and duration of overweight and obesity on risk reduction also need to be fully considered in trial design. These gaps in knowledge need to be urgently addressed to expedite the development and implementation of future cancer-control strategies. Comprehensive approaches to trial design, Mendelian randomisation studies and data-linkage opportunities offer real possibilities to tackle current research gaps. In this paper, we set out the case for why non-pharmacological weight-management trials are urgently needed to support cancer-risk reduction and help control the growing global burden of cancer.
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Affiliation(s)
- Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Division of Population Health & Genomics. Level 7, Mailbox 7, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - Andrew G Renehan
- The Christie NHS Foundation Trust, Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health University of Manchester, Wilmslow Rd, Manchester, M20 4BX, UK
| | - John M Saxton
- Department of Sport, Exercise & Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Room 259, Northumberland Building, Newcastle Upon Tyne, NE1 8ST, UK
| | - Joshua Bell
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
| | - Janet Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, G11, Stead House, University of Leeds, Leeds, LS2 9JT, UK
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Angela King
- NIHR Cancer and Nutrition Collaboration, Level E and Pathology Block (mailpoint 123), Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Falko Sniehotta
- Policy Research Unit Behavioural Science, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Room 306, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Richard M Martin
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
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Anderson AS, Martin RM, Renehan AG, Cade J, Copson ER, Cross AJ, Grimmett C, Keaver L, King A, Riboli E, Shaw C, Saxton JM. Cancer survivorship, excess body fatness and weight-loss intervention-where are we in 2020? Br J Cancer 2021; 124:1057-1065. [PMID: 33235316 PMCID: PMC7961062 DOI: 10.1038/s41416-020-01155-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/24/2020] [Accepted: 10/22/2020] [Indexed: 01/29/2023] Open
Abstract
Earlier diagnosis and more effective treatments mean that the estimated number of cancer survivors in the United Kingdom is expected to reach 4 million by 2030. However, there is an increasing realisation that excess body fatness (EBF) is likely to influence the quality of cancer survivorship and disease-free survival. For decades, the discussion of weight management in patients with cancer has been dominated by concerns about unintentional weight loss, low body weight and interventions to increase weight, often re-enforced by the existence of the obesity paradox, which indicates that high body weight is associated with survival benefits for some types of cancer. However, observational evidence provides strong grounds for testing the hypothesis that interventions for promoting intentional loss of body fat and maintaining skeletal muscle in overweight and obese cancer survivors would bring important health benefits in terms of survival outcomes and long-term impact on treatment-related side effects. In this paper, we outline the need for studies to improve our understanding of the health benefits of weight-loss interventions, such as hypocaloric healthy-eating plans combined with physical activity. In particular, complex intervention trials that are pragmatically designed are urgently needed to develop effective, clinically practical, evidence-based strategies for reducing EBF and optimising body composition in people living with and beyond common cancers.
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Affiliation(s)
- Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Division of Population Health & Genomics, University of Dundee Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - Richard M Martin
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 2PS, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Andrew G Renehan
- The Christie NHS Foundation Trust, Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK
| | - Janet Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, G11, Stead House, University of Leeds, Leeds, LS2 9JT, UK
| | - Ellen R Copson
- Wessex Genomic Medicine Centre, Cancer Sciences Academic Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Chloe Grimmett
- School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Laura Keaver
- Department of Health and Nutritional Science, Institute of Technology Sligo, Sligo, F91 YW50, Ireland
| | - Angela King
- NIHR Cancer and Nutrition Collaboration, Level E and Pathology Block (mailpoint 123), Southampton General Hospital, Tremona Road, Southampton, SO 16 6YD, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Clare Shaw
- Biomedical Research Centre at The Royal Marsden and the Institute of Cancer Research, Fulham Road, London, SW3 6JJ, UK
| | - John M Saxton
- Department of Sport, Exercise & Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Northumberland Building, Newcastle upon Tyne, NE1 8ST, UK
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27
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Fernandez LM, São Julião GP, Figueiredo NL, Beets GL, van der Valk MJM, Bahadoer RR, Hilling DE, Meershoek-Klein Kranenbarg E, Roodvoets AGH, Renehan AG, van de Velde CJH, Habr-Gama A, Perez RO. Conditional recurrence-free survival of clinical complete responders managed by watch and wait after neoadjuvant chemoradiotherapy for rectal cancer in the International Watch & Wait Database: a retrospective, international, multicentre registry study. Lancet Oncol 2020; 22:43-50. [PMID: 33316218 DOI: 10.1016/s1470-2045(20)30557-x] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Watch and wait is a novel management strategy in patients with rectal cancer who have a clinical complete response after neoadjuvant chemoradiotherapy. Surveillance of these patients is generally intensive, because local regrowth (with the potential for salvage) occurs in 25% of patients, and distant metastases occur in 10% of patients. It is unclear for how long these patients should be followed up. To address this issue, we did conditional survival modelling using the International Watch & Wait Database (IWWD), which is a large-scale registry of patients with a clinical complete response after neoadjuvant chemotherapy who have been managed by a watch-and-wait strategy. METHODS We did a retrospective, multicentre registry study using a dataset from the IWWD, which includes data from 47 clinics across 15 countries. We selected patients (aged ≥18 years) with rectal cancer who had a clinical complete response after neoadjuvant chemotherapy, and who were subsequently managed by a watch-and-wait strategy between Nov 25, 1991, and Dec 31, 2015. Patients who had not achieved a clinical complete response or who had undergone any surgical procedure were excluded. The criteria used for defining a clinical complete response and the specific surveillance strategies were at the discretion of each participating centre. We used conditional survival modelling to estimate the probability of patients remaining free of local regrowth or distant metastasis for an additional 2 years after sustaining a clinical complete response or being distant metastasis-free for 1, 3, and 5 years from the date of the decision to commence watch and wait. The primary outcomes were conditional local regrowth-free survival at 3 years, and conditional distant metastasis-free survival at 5 years. FINDINGS We identified 793 patients in the IWWD with clinical complete response who had been managed by a watch-and-wait strategy. Median follow-up was 55·2 months (IQR 36·0-75·6). The probability of remaining free from local regrowth for an additional 2 years if a patient had a sustained clinical complete response for 1 year was 88·1% (95% CI 85·8-90·9), for 3 years was 97·3% (95·2-98·6), and for 5 years was 98·6% (97·6-100·0). The probably of remaining free from distant metastasis for a further 2 years in patients who had a clinical complete response without distant metastasis for 1 year was 93·8% (92·3-95·9), for 3 years was 97·8% (96·6-99·3), and for 5 years was 96·6% (94·0-98·9). INTERPRETATION These results suggest that the intensity of active surveillance in patients with rectal cancer managed by a watch-and-wait approach could be reduced if they achieve and maintain a clinical complete response within the first 3 years of starting this approach. FUNDING European Registration of Cancer Care, financed by the European Society of Surgical Oncology, the Champalimaud Foundation Lisbon, the Bas Mulder Award, granted by the Alpe d'HuZes Foundation and the Dutch Cancer Society, the European Research Council Advanced Grant, and the National Institute of Health and Research Manchester Biomedical Research Centre.
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Affiliation(s)
- Laura M Fernandez
- Colorectal Surgery, Digestive Department, Champalimaud Foundation, Lisbon, Portugal
| | - Guilherme P São Julião
- Department of Surgical Oncology, Hospital Beneficencia Portuguesa, São Paulo, Brazil; Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Nuno L Figueiredo
- Colorectal Surgery, Digestive Department, Champalimaud Foundation, Lisbon, Portugal
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | | | - Renu R Bahadoer
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Denise E Hilling
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands; Department of Surgery, Erasmus MC, Rotterdam, Netherlands
| | | | - Annet G H Roodvoets
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Andrew G Renehan
- Manchester Cancer Research Centre, National Institute of Health and Research, Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK; Colorectal and Peritoneal Oncology Centre, The Christie National Health Service Foundation Trust, Manchester, UK
| | | | - Angelita Habr-Gama
- Department of Colorectal Surgery, Angelita and Joaquim Gama Institute, São Paulo, Brazil; Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rodrigo O Perez
- Department of Colorectal Surgery, Angelita and Joaquim Gama Institute, São Paulo, Brazil; Department of Surgical Oncology, Hospital Beneficencia Portuguesa, São Paulo, Brazil; Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Ludwig Institute for Cancer Research, São Paulo Branch, São Paulo, Brazil.
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Sekhar H, Kochhar R, Carrington B, Kaye T, Tolan D, Saunders MP, Sperrin M, Sebag-Montefiore D, van Herk M, Renehan AG. Three-dimensional (3D) magnetic resonance volume assessment and loco-regional failure in anal cancer: early evaluation case-control study. BMC Cancer 2020; 20:1165. [PMID: 33256671 PMCID: PMC7706015 DOI: 10.1186/s12885-020-07613-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background The primary aim was to test the hypothesis that deriving pre-treatment 3D magnetic resonance tumour volume (mrTV) quantification improves performance characteristics for the prediction of loco-regional failure compared with standard maximal tumour diameter (1D) assessment in patients with squamous cell carcinoma of the anus undergoing chemoradiotherapy. Methods We performed an early evaluation case-control study at two UK centres (2007–2014) in 39 patients with loco-regional failure (cases), and 41 patients disease-free at 3 years (controls). mrTV was determined using the summation of areas method (Volsum). Reproducibility was assessed using intraclass concordance correlation (ICC) and Bland-Altman limits of agreements. We derived receiver operating curves using logistic regression models and expressed accuracy as area under the curve (ROCAUC). Results The median time per patient for Volsum quantification was 7.00 (inter-quartile range, IQR: 0.57–12.48) minutes. Intra and inter-observer reproducibilities were generally good (ICCs from 0.79 to 0.89) but with wide limits of agreement (intra-observer: − 28 to 31%; inter-observer: − 28 to 46%). Median mrTVs were greater for cases (32.6 IQR: 21.5–53.1 cm3) than controls (9.9 IQR: 5.7–18.1 cm3, p < 0.0001). The ROCAUC for mrT-size predicting loco-regional failure was 0.74 (95% CI: 0.63–0.85) improving to 0.82 (95% CI: 0.72–0.92) when replaced with mrTV (test for ROC differences, p = 0.024). Conclusion Preliminary results suggest that the replacement of mrTV for mrT-size improves prediction of loco-regional failure after chemoradiotherapy for squamous cell carcinoma of the anus. However, mrTV calculation is time consuming and variation in its reproducibility are drawbacks with the current technology. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-020-07613-7.
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Affiliation(s)
- Hema Sekhar
- Division of Molecular & Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK.
| | - Rohit Kochhar
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Thomas Kaye
- Department of Clinical Radiology, St James' University Hospital, Leeds, UK
| | - Damian Tolan
- Department of Clinical Radiology, St James' University Hospital, Leeds, UK
| | - Mark P Saunders
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Matthew Sperrin
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - David Sebag-Montefiore
- Leeds Institute of Cancer & Pathology, University of Leeds, St James' University Hospital, Leeds, UK
| | - Marcel van Herk
- Division of Molecular & Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK
| | - Andrew G Renehan
- Division of Molecular & Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK
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29
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Parmar KL, O'Reilly D, Valle JW, Braun M, Naish JH, Williams SR, Lloyd WK, Malcomson L, Cresswell K, Bamford C, Renehan AG. Prospective study of change in liver function and fat in patients with colorectal liver metastases undergoing preoperative chemotherapy: protocol for the CLiFF Study. BMJ Open 2020; 10:e027630. [PMID: 32967864 PMCID: PMC7513559 DOI: 10.1136/bmjopen-2018-027630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Preoperative chemotherapy in patients undergoing resection for colorectal liver metastases (CLM) improves oncological outcomes. However, chemotherapy-associated liver injury (occurring in two patterns: vascular and fat deposition) is a real clinical concern prior to hepatic resection. After major liver resection, regeneration of the residual liver is a prerequisite for recovery and avoidance of liver failure, but this regenerative capacity may be hindered by chemotherapy. Thus, there is a need to predict for this serious complication. Over the past two decades, several tests and derived indices have been developed, which have failed to achieve clinical utility, mainly as they were indirect measurements of liver function. Here, we will use a novel test of liver function (the liver maximum capacity (LiMAx) test), and measure liver fat using MRI. METHODS AND ANALYSIS This prospective study will assess changes in liver function longitudinally, measured by the LiMAx test, and liver fat, measured by advanced MRI using both MR spectroscopy and the modified Dixon method, in up to 35 patients undergoing preoperative chemotherapy for CLM. The primary outcomes will be the changes in liver function and fat compared with baseline prechemotherapy measurements. Secondary outcome measures include: routinely measured liver function blood tests, anthropometric measurements, postoperative histology and digital quantification of fat, postoperative complications and mortality and quality of life. ETHICS AND DISSEMINATION The study was approved by a National Health Service Research Ethics Committee and registered with the Health Research Authority. Dissemination will be via international and national conferences and the National Institute for Health Research network. Manuscripts will be published. TRIAL REGISTRATION NUMBER This study is registered online at www.clinicaltrials.gov (registration number NCT03562234).
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Affiliation(s)
- Kat L Parmar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Cancer Research Centre, Manchester, UK
| | - Derek O'Reilly
- Hepatobiliary Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Juan W Valle
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Oncology, Christie NHS Foundation Trust, Manchester, UK
| | - Michael Braun
- Oncology, Christie NHS Foundation Trust, Manchester, UK
| | - Jo H Naish
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Steve R Williams
- Centre for Imaging Sciences, University of Manchester, Manchester, UK
| | - William K Lloyd
- Centre for Imaging Sciences, University of Manchester, Manchester, UK
| | - Lee Malcomson
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Surgery, Christie NHS Foundation Trust, Manchester, UK
| | - Katharine Cresswell
- Public Programmes Team, Research and Innovation Division, Manchester University NHS Foundation Trust, Manchester, UK
| | - Colin Bamford
- Cancer Patient and Public Advisory Group, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Surgery, Christie NHS Foundation Trust, Manchester, UK
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30
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Parmar KL, Malcomson L, Renehan AG. Watch and wait or surgery for clinical complete response in rectal cancer: a need to study both sides. Colorectal Dis 2020; 22:839-840. [PMID: 31755201 DOI: 10.1111/codi.14912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/12/2019] [Indexed: 02/08/2023]
Affiliation(s)
- K L Parmar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK.,Manchester Cancer Research Centre, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester, UK
| | - L Malcomson
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK.,Manchester Cancer Research Centre, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester, UK
| | - A G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK.,Manchester Cancer Research Centre, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester, UK
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31
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Slawinski CGV, Barriuso J, Guo H, Renehan AG. Obesity and Cancer Treatment Outcomes: Interpreting the Complex Evidence. Clin Oncol (R Coll Radiol) 2020; 32:591-608. [PMID: 32595101 DOI: 10.1016/j.clon.2020.05.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/17/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
A wealth of epidemiological evidence, combined with plausible biological mechanisms, present a convincing argument for a causal relationship between excess adiposity, commonly approximated as body mass index (BMI, kg/m2), and incident cancer risk. Beyond this relationship, there are a number of challenges posed in the context of interpreting whether being overweight (BMI 25.0-29.9 kg/m2) or obese (BMI ≥ 30.0 kg/m2) adversely influences disease progression, cancer mortality and survival. Elevated BMI (≥ 25.0 kg/m2) may influence treatment selection of, for example, the approach to surgery; the choice of chemotherapy dosing; the inclusion of patients into randomised clinical trials. Furthermore, the technical challenges posed by an elevated BMI may adversely affect surgical outcomes, for example, morbidity (increasing the risk of surgical site infections), reduced lymph node harvest (and subsequent risk of under-staging and under-treatment) and increased risk of margin positivity. Suboptimal chemotherapy dosing, associated with capping chemotherapy in obese patients as an attempt to avoid excess toxicity, might be a driver of poor prognostic outcomes. By contrast, the efficacy of immune checkpoint inhibition may be enhanced in patients who are obese, although in turn, this observation might be due to reverse causality. So, a central research question is whether being overweight or obese adversely affects outcomes either directly through effects of cancer biology or whether adverse outcomes are mediated through indirect pathways. A further dimension to this complex relationship is the obesity paradox, a phenomenon where being overweight or obese is associated with improved survival where the reverse is expected. In this overview, we describe a framework for evaluating methodological problems such as selection bias, confounding and reverse causality, which may contribute to spurious interpretations. Future studies will need to focus on prospective studies with well-considered methodology in order to improve the interpretation of causality.
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Affiliation(s)
- C G V Slawinski
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - J Barriuso
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - H Guo
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - A G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK
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32
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Affiliation(s)
- Nasra Alam
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alison K Wright
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK
| | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Cancer Research Centre, National Institute for Health Research, Manchester Biomedical Research Centre, Manchester, M20 4BX, UK.
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Renehan AG, Pegington M, Harvie MN, Sperrin M, Astley SM, Brentnall AR, Howell A, Cuzick J, Gareth Evans D. Young adulthood body mass index, adult weight gain and breast cancer risk: the PROCAS Study (United Kingdom). Br J Cancer 2020; 122:1552-1561. [PMID: 32203222 PMCID: PMC7217761 DOI: 10.1038/s41416-020-0807-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/15/2020] [Accepted: 03/03/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND We tested the hypothesis that body mass index (BMI) aged 20 years modifies the association of adult weight gain and breast cancer risk. METHODS We recruited women (aged 47-73 years) into the PROCAS (Predicting Risk Of Cancer At Screening; Manchester, UK: 2009-2013) Study. In 47,042 women, we determined BMI at baseline and (by recall) at age 20 years, and derived weight changes. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for new breast cancer using Cox models and explored relationships between BMI aged 20 years, subsequent weight changes and breast cancer risk. RESULTS With median follow-up of 5.6 years, 1142 breast cancers (post-menopausal at entry: 829) occurred. Among post-menopausal women at entry, BMI aged 20 years was inversely associated [HR per SD: 0.87 (95% CI: 0.79-0.95)], while absolute weight gain was associated with breast cancer [HR per SD:1.23 (95% CI: 1.14-1.32)]. For post-menopausal women who had a recall BMI aged 20 years <23.4 kg/m2 (75th percentile), absolute weight gain was associated with breast cancer [HR per SD: 1.31 (95% CIs: 1.21-1.42)], but there were no associations for women with a recall BMI aged 20 years of >23.4 kg/m2 (Pinteraction values <0.05). CONCLUSIONS Adult weight gain increased post-menopausal breast cancer risk only among women who were <23.4 kg/m2 aged 20 years.
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Affiliation(s)
- Andrew G Renehan
- Manchester Cancer Research Centre and NIHR Manchester Biomedical Research Centre, Manchester, UK.
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Mary Pegington
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Prevent Breast Cancer, Nightingale Breast Screening Centre, University Hospital of South Manchester, Manchester, UK
| | - Michelle N Harvie
- Prevent Breast Cancer, Nightingale Breast Screening Centre, University Hospital of South Manchester, Manchester, UK
| | - Matthew Sperrin
- MRC Health eResearch Centre (HeRC), Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Susan M Astley
- Centre for Imaging Science, Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, UK
- The University of Manchester, Manchester Academic Health Science Centre, University Hospital of South Manchester, Manchester, UK
| | - Adam R Brentnall
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Anthony Howell
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Prevent Breast Cancer, Nightingale Breast Screening Centre, University Hospital of South Manchester, Manchester, UK
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - D Gareth Evans
- Manchester Cancer Research Centre and NIHR Manchester Biomedical Research Centre, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Prevent Breast Cancer, Nightingale Breast Screening Centre, University Hospital of South Manchester, Manchester, UK
- Genomic Medicine, Manchester Academic Health Sciences Centre, University of Manchester and Central Manchester Foundation Trust, Manchester, UK
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34
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Sekhar H, Malcomson L, Kochhar R, Sperrin M, Alam N, Chakrbarty B, Fulford PE, Wilson MS, O'Dwyer ST, Saunders MP, Renehan AG. Temporal improvements in loco-regional failure and survival in patients with anal cancer treated with chemo-radiotherapy: treatment cohort study (1990-2014). Br J Cancer 2020; 122:749-758. [PMID: 31932755 PMCID: PMC7078229 DOI: 10.1038/s41416-019-0689-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 01/20/2023] Open
Abstract
Background We evaluated oncological changes in patients with squamous cell carcinoma of the anus (SCCA) treated by chemoradiotherapy (CRT) from a large UK institute, to derive estimates of contemporary outcomes. Methods We performed a treatment-cohort analysis in 560 patients with non-metastatic SCCA treated with CRT over 25 years. The primary outcomes were 3-year loco-regional failure (LRF), 5-year overall survival (OS), and 5-year cancer-specific survival (CSS). We developed prediction models; and overlaid estimates on published results from historic trials. Results Age distributions, proportions by gender and cT stage remained stable over time. The median follow-up was 61 (IQR: 36–79) months. Comparing the first period (1990–1994) with the last period (2010–2014), 3-year LRF declined from 33 to 16% (Ptrends < 0.001); 5-year OS increased from 60% to 76% (Ptrends = 0.001); and 5-year CCS increased from 62% in to 80% (Ptrends = 0.001). For 2020, the models predicted a 3-year LRF of 14.7% (95% CIs: 0–31.3); 5-year OS of 74.7% (95% CIs: 54.6–94.9); and 5-year CSS of 85.7% (95% CIs: 75.3–96.0). Reported oncological outcomes from historic trials generally underestimated contemporary outcomes. Conclusions Current and predicted rates for 3-year LRF and 5-year survivals are considerably improved compared with those in historic trials.
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Affiliation(s)
- Hema Sekhar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biological, Medicine and Health, University of Manchester, Manchester, UK
| | - Lee Malcomson
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biological, Medicine and Health, University of Manchester, Manchester, UK
| | - Rohit Kochhar
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Matthew Sperrin
- Health eResearch Centre, Farr Institute, University of Manchester, Manchester, UK
| | - Nooreen Alam
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Bipasha Chakrbarty
- Department of Pathology, The Christie NHS Foundation Trust, Manchester, UK
| | - Paul E Fulford
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - Malcolm S Wilson
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - Sarah T O'Dwyer
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - Mark P Saunders
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biological, Medicine and Health, University of Manchester, Manchester, UK. .,Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK.
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Florio AA, Campbell PT, Zhang X, Zeleniuch-Jacquotte A, Wactawski-Wende J, Smith-Warner SA, Sinha R, Simon TG, Sesso HD, Schairer C, Rosenberg L, Rohan TE, Robien K, Renehan AG, Purdue MP, Poynter JN, Palmer JR, Newton CC, Lu Y, Linet MS, Liao LM, Lee IM, Koshiol J, Kitahara CM, Kirsh VA, Hofmann JN, Graubard BI, Giovannucci E, Gaziano JM, Gapstur SM, Freedman ND, Demuth J, Chong DQ, Chan AT, Buring JE, Bradshaw PT, Beane Freeman LE, McGlynn KA, Petrick JL. Abdominal and gluteofemoral size and risk of liver cancer: The liver cancer pooling project. Int J Cancer 2019; 147:675-685. [PMID: 31677159 DOI: 10.1002/ijc.32760] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 12/16/2022]
Abstract
Obesity is known to be associated with primary liver cancer (PLC), but the separate effects of excess abdominal and gluteofemoral size are unclear. Thus, we examined the association between waist and hip circumference with risk of PLC overall and by histologic type-hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). The Liver Cancer Pooling Project is a consortium of prospective cohort studies that include data from 1,167,244 individuals (PLC n = 2,208, HCC n = 1,154, ICC n = 335). Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CI) were estimated using proportional hazards regression. Waist circumference, per 5 cm increase, was associated with an 11% increased PLC risk (HR = 1.11, 95%CI: 1.09-1.14), including when adjusted for hip circumference (HR = 1.12, 95%CI: 1.08-1.17) and also when restricted to individuals in a normal body mass index (BMI) range (18.5 to <25 kg/m2 ; HR = 1.14, 95%CI: 1.07-1.21). Hip circumference, per 5 cm increase, was associated with a 9% increased PLC risk (HR = 1.09, 95%CI: 1.06-1.12), but no association remained after adjustment for waist circumference (HR = 0.99, 95%CI: 0.94-1.03). HCC and ICC results were similar. These findings suggest that excess abdominal size is associated with an increased risk of liver cancer, even among individuals considered to have a normal BMI. However, excess gluteofemoral size alone confers no increased risk. Our findings extend prior analyses, which found an association between excess adiposity and risk of liver cancer, by disentangling the separate effects of excess abdominal and gluteofemoral size through utilization of both waist and hip circumference measurements.
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Affiliation(s)
- Andrea A Florio
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Peter T Campbell
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - Xuehong Zhang
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | | | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY
| | - Stephanie A Smith-Warner
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Rashmi Sinha
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Tracey G Simon
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Howard D Sesso
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Catherine Schairer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Lynn Rosenberg
- Slone Epidemiology Center, Boston University, Boston, MA
| | - Thomas E Rohan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Kim Robien
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Andrew G Renehan
- Faculty Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Mark P Purdue
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Jenny N Poynter
- Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Julie R Palmer
- Slone Epidemiology Center, Boston University, Boston, MA
| | - Christina C Newton
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - Yunxia Lu
- Department of Population Health and Disease Prevention, Program in Public Health, University of California Irvine, Irvine, CA
| | - Martha S Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Linda M Liao
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - I-Min Lee
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Jill Koshiol
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Cari M Kitahara
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Victoria A Kirsh
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan N Hofmann
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Barry I Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Edward Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - John M Gaziano
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- VA Boston Healthcare System, Boston, MA
| | - Susan M Gapstur
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Jane Demuth
- Information Management Services Inc, Silver Spring, MD
| | - Dawn Q Chong
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Andrew T Chan
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA
| | - Julie E Buring
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Patrick T Bradshaw
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA
| | - Laura E Beane Freeman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Jessica L Petrick
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
- Slone Epidemiology Center, Boston University, Boston, MA
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Larentzakis A, O'Dwyer ST, Becker J, Shuweihdi F, Aziz O, Selvasekar CR, Fulford P, Renehan AG, Wilson M. Referral pathways and outcome of patients with colorectal peritoneal metastasis (CRPM). Eur J Surg Oncol 2019; 45:2310-2315. [DOI: 10.1016/j.ejso.2019.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/27/2019] [Accepted: 07/03/2019] [Indexed: 12/25/2022] Open
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Badrick E, Cresswell K, Ellis P, Renehan AG, Crosbie EJ. Top ten research priorities for detecting cancer early. Lancet Public Health 2019; 4:e551. [PMID: 31562068 DOI: 10.1016/s2468-2667(19)30185-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/11/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Ellena Badrick
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Cancer Research Centre, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester M204BX, UK
| | - Katharine Cresswell
- Division on Evolution and Genomic Sciences, School of Biological, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Cancer Research Centre, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester M204BX, UK
| | | | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Cancer Research Centre, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester M204BX, UK; The Christie National Health Service Foundation Trust, Manchester, UK.
| | - Emma J Crosbie
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Cancer Research Centre, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester M204BX, UK; Manchester University National Health Service Foundation Trust, Manchester, UK
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Affiliation(s)
- Andrew G Renehan
- Division of Cancer Sciences, Manchester Academic Health Science Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
- Manchester Cancer Research Centre, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester, UK.
| | - Nasra N Alam
- Division of Cancer Sciences, Manchester Academic Health Science Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Cancer Research Centre, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester, UK
| | - Matthew Sperrin
- Health eResearch Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Marti FEM, Jayson GC, Manoharan P, O'Connor J, Renehan AG, Backen AC, Mistry H, Ortega F, Li K, Simpson KL, Allen J, Connell J, Underhill S, Misra V, Williams KJ, Stratford I, Jackson A, Dive C, Saunders MP. Novel phase I trial design to evaluate the addition of cediranib or selumetinib to preoperative chemoradiotherapy for locally advanced rectal cancer: the DREAMtherapy trial. Eur J Cancer 2019; 117:48-59. [PMID: 31229949 DOI: 10.1016/j.ejca.2019.04.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 04/21/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The DREAMtherapy (Dual REctal Angiogenesis MEK inhibition radiotherapy) trial is a novel intertwined design whereby two tyrosine kinase inhibitors (cediranib and selumetinib) were independently evaluated with rectal chemoradiotherapy (CRT) in an efficient manner to limit the extended follow-up period often required for radiotherapy studies. PATIENTS AND METHODS Cediranib or selumetinib was commenced 10 days before and then continued with RT (45 Gy/25#/5 wks) and capecitabine (825 mg/m2 twice a day (BID)). When three patients in the cediranib 15-mg once daily (OD) cohort were in the surveillance period, recruitment to the selumetinib cohort commenced. This alternating schedule was followed throughout. Three cediranib (15, 20 and 30 mg OD) and two selumetinib cohorts (50 and 75 mg BID) were planned. Circulating and imaging biomarkers of inflammation/angiogenesis were evaluated. RESULTS In case of cediranib, dose-limiting diarrhoea, fatigue and skin reactions were seen in the 30-mg OD cohort, and therefore, 20 mg OD was defined as the maximum tolerated dose. Forty-one percent patients achieved a clinical or pathological complete response (7/17), and 53% (9/17) had an excellent clinical or pathological response (ECPR). Significantly lower level of pre-treatment plasma tumour necrosis factor alpha (TNFα) was found in patients who had an ECPR. In case of selumetinib, the 50-mg BID cohort was poorly tolerated (fatigue and diarrhoea); a reduced dose cohort of 75-mg OD was opened which was also poorly tolerated, and further recruitment was abandoned. Of the 12 patients treated, two attained an ECPR (17%). CONCLUSIONS This novel intertwined trial design is an effective way to independently investigate multiple agents with radiotherapy. The combination of cediranib with CRT was well tolerated with encouraging efficacy. TNFα emerged as a potential predictive biomarker of response and warrants further evaluation.
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Affiliation(s)
| | - G C Jayson
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - P Manoharan
- The Christie NHS Foundation Trust, Manchester, UK; Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - J O'Connor
- The Christie NHS Foundation Trust, Manchester, UK; Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - A G Renehan
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - A C Backen
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - H Mistry
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PT, UK
| | - F Ortega
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PT, UK
| | - K Li
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - K L Simpson
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, Manchester, UK
| | - J Allen
- The Christie NHS Foundation Trust, Manchester, UK
| | - J Connell
- The Christie NHS Foundation Trust, Manchester, UK
| | - S Underhill
- The Christie NHS Foundation Trust, Manchester, UK
| | - V Misra
- The Christie NHS Foundation Trust, Manchester, UK
| | - K J Williams
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PT, UK; Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - I Stratford
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PT, UK
| | - A Jackson
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - C Dive
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, Manchester, UK
| | - M P Saunders
- The Christie NHS Foundation Trust, Manchester, UK.
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Affiliation(s)
- Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Manchester M20 4BX, UK.
| | - Kelly Lloyd
- Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Manchester M20 4BX, UK
| | - Isabella Renehan
- Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, UK
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Renehan AG, Muirhead R, Berkman L, McParland L, Sebag-Montefiore D. Early stage anal margin cancer: towards evidence-based management. Colorectal Dis 2019; 21:387-391. [PMID: 30687991 DOI: 10.1111/codi.14571] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/12/2019] [Indexed: 02/08/2023]
Affiliation(s)
- A G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - R Muirhead
- Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - L Berkman
- Patient and Public Involvement Trial Representative, London, UK
| | - L McParland
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - D Sebag-Montefiore
- Leeds Cancer Centre, St James University Hospital, University of Leeds, Leeds, UK
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Kelly SP, Lennon H, Sperrin M, Matthews C, Freedman ND, Albanes D, Leitzmann MF, Renehan AG, Cook MB. Body mass index trajectories across adulthood and smoking in relation to prostate cancer risks: the NIH-AARP Diet and Health Study. Int J Epidemiol 2019; 48:464-473. [PMID: 30376043 PMCID: PMC6469294 DOI: 10.1093/ije/dyy219] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Previously we showed that adulthood body mass index (BMI) trajectories that result in obesity were associated with elevated risks of fatal prostate cancer (PCA). To further explore this relationship, we conducted a study within the NIH-AARP Diet and Health Study. METHODS Among 153 730 eligible men enrolled in the NIH-AARP cohort from 1995 to 1996 (median follow-up = 15.1 years), we identified 630 fatal PCA cases and 16 896 incident cases. BMI was assessed for ages 18, 35 and 50 and at study entry, enabling examination of latent class-identified BMI trajectories. Hazard ratios (HRs) and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression. RESULTS BMI at study entry (mean age = 63, HR = 1.12; 95% CI = 1.01, 1.24, per 5-unit increase) and maximum BMI during adulthood (HR = 1.12; 95% CI = 1.02, 1.24, per 5-unit increase) shared modest associations with increased risk of fatal PCA. Smoking status likely modified the relationship between BMI trajectories and fatal PCA (Pinteraction = 0.035 via change-in-estimate variable section, P = 0.065 via full a priori model). Among never-smokers, BMI trajectory of normal weight to obesity was associated with increased risk of fatal disease (HR = 2.37; 95% CI = 1.38, 4.09), compared with the maintained normal weight trajectory, whereas there was no association among former or current-smokers. Total and non-aggressive PCA exhibited modest inverse associations with BMI at all ages, whereas no association was observed for aggressive PCA. CONCLUSIONS Increased BMI was positively associated with fatal PCA, especially among never-smokers. Future studies that examine PCA survival will provide additional insight as to whether these associations are the result of biology or confounding.
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Affiliation(s)
- Scott P Kelly
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Hannah Lennon
- Division of Cancer Sciences, School Faculty of Biology, Medicine and Health
| | - Matthew Sperrin
- Farr Institute, MRC Health eResearch Centre, University of Manchester, Manchester, UK
| | - Charles Matthews
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael F Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Andrew G Renehan
- Division of Cancer Sciences, School Faculty of Biology, Medicine and Health
- Farr Institute, MRC Health eResearch Centre, University of Manchester, Manchester, UK
| | - Michael B Cook
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Chadi SA, Beets GL, Perez RO, Renehan AG. Watch-and-wait strategy in rectal cancer – Authors' reply. Lancet Gastroenterol Hepatol 2019; 4:97. [DOI: 10.1016/s2468-1253(18)30418-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 01/18/2023]
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MacKintosh ML, Derbyshire AE, McVey RJ, Bolton J, Nickkho‐Amiry M, Higgins CL, Kamieniorz M, Pemberton PW, Kirmani BH, Ahmed B, Syed AA, Ammori BJ, Renehan AG, Kitchener HC, Crosbie EJ. The impact of obesity and bariatric surgery on circulating and tissue biomarkers of endometrial cancer risk. Int J Cancer 2019; 144:641-650. [PMID: 30289975 PMCID: PMC6519061 DOI: 10.1002/ijc.31913] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/21/2018] [Accepted: 09/19/2018] [Indexed: 02/03/2023]
Abstract
Obesity is the strongest risk factor for endometrial cancer (EC). To inform targeted screening and prevention strategies, we assessed the impact of obesity and subsequent bariatric surgery-induced weight loss on endometrial morphology and molecular pathways implicated in endometrial carcinogenesis. Blood and endometrial tissue were obtained from women with class III-IV obesity (body mass index ≥40 and ≥50 kg/m2 , respectively) immediately prior to gastric bypass or sleeve gastrectomy, and at two and 12 months' follow up. The endometrium underwent pathological examination and immunohistochemistry was used to quantify proliferation (Ki-67), oncogenic signaling (PTEN, pAKT, pERK) and hormone receptor (ER, PR) expression status. Circulating biomarkers of insulin resistance, reproductive function and inflammation were also measured at each time point. Seventy-two women underwent bariatric surgery. At 12 months, the mean change in total and excess body weight was -32.7 and -62.8%, respectively. Baseline endometrial biopsies revealed neoplastic change in 10 women (14%): four had EC, six had atypical hyperplasia (AH). After bariatric surgery, most cases of AH resolved (5/6) without intervention (3/6) or with intrauterine progestin (2/6). Biomarkers of endometrial proliferation (Ki-67), oncogenic signaling (pAKT) and hormone receptor status (ER, PR) were significantly reduced, with restoration of glandular PTEN expression, at 2 and 12 months. There were reductions in circulating biomarkers of insulin resistance (HbA1c, HOMA-IR) and inflammation (hsCRP, IL-6), and increases in reproductive biomarkers (LH, FSH, SHBG). We found an unexpectedly high prevalence of occult neoplastic changes in the endometrium of women undergoing bariatric surgery. Their spontaneous reversal and accompanying down-regulation of PI3K-AKT-mTOR signaling with weight loss may have implications for screening, prevention and treatment of this disease.
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Affiliation(s)
- Michelle L. MacKintosh
- Department of Obstetrics and GynaecologySt Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Abigail E. Derbyshire
- Department of Obstetrics and GynaecologySt Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Rhona J. McVey
- Department of HistopathologyManchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - James Bolton
- Department of HistopathologyManchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Mahshid Nickkho‐Amiry
- Department of Obstetrics and GynaecologySt Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Catherine L. Higgins
- Department of HistopathologyManchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Martyna Kamieniorz
- Department of HistopathologyManchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Philip W. Pemberton
- Department of Clinical BiochemistryManchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Bilal H. Kirmani
- Department of Cardiothoracic SurgeryLiverpool Heart and Chest HospitalLiverpoolUnited Kingdom
| | - Babur Ahmed
- Department of Obesity Medicine, Diabetes & EndocrinologySalford Royal NHS Foundation Trust, Manchester Academic Health Science CentreSalfordUnited Kingdom
| | - Akheel A. Syed
- Department of Obesity Medicine, Diabetes & EndocrinologySalford Royal NHS Foundation Trust, Manchester Academic Health Science CentreSalfordUnited Kingdom
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine & HealthUniversity of ManchesterManchesterUnited Kingdom
| | - Basil J. Ammori
- Department of Obesity Medicine, Diabetes & EndocrinologySalford Royal NHS Foundation Trust, Manchester Academic Health Science CentreSalfordUnited Kingdom
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine & HealthUniversity of ManchesterManchesterUnited Kingdom
| | - Andrew G. Renehan
- Obesity and Cancer Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and HealthManchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, University of ManchesterManchesterUnited Kingdom
| | - Henry C. Kitchener
- Gynaecological Oncology Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUnited Kingdom
| | - Emma J. Crosbie
- Department of Obstetrics and GynaecologySt Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
- Gynaecological Oncology Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUnited Kingdom
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Abstract
BACKGROUND To our knowledge, no publication providing overarching guidance on the conduct of systematic reviews of observational studies of etiology exists. METHODS AND FINDINGS Conducting Systematic Reviews and Meta-Analyses of Observational Studies of Etiology (COSMOS-E) provides guidance on all steps in systematic reviews of observational studies of etiology, from shaping the research question, defining exposure and outcomes, to assessing the risk of bias and statistical analysis. The writing group included researchers experienced in meta-analyses and observational studies of etiology. Standard peer-review was performed. While the structure of systematic reviews of observational studies on etiology may be similar to that for systematic reviews of randomised controlled trials, there are specific tasks within each component that differ. Examples include assessment for confounding, selection bias, and information bias. In systematic reviews of observational studies of etiology, combining studies in meta-analysis may lead to more precise estimates, but such greater precision does not automatically remedy potential bias. Thorough exploration of sources of heterogeneity is key when assessing the validity of estimates and causality. CONCLUSION As many reviews of observational studies on etiology are being performed, this document may provide researchers with guidance on how to conduct and analyse such reviews.
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Affiliation(s)
- Olaf M. Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Endocrinology and Metabolism, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jan P. Vandenbroucke
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Myriam Cevallos
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Andrew G. Renehan
- Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Douglas G. Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Centre for Infectious Diseases Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Fish R, Sanders C, Adams R, Brewer J, Brookes ST, DeNardo J, Kochhar R, Saunders MP, Sebag-Montefiore D, Williamson PR, Renehan AG. A core outcome set for clinical trials of chemoradiotherapy interventions for anal cancer (CORMAC): a patient and health-care professional consensus. Lancet Gastroenterol Hepatol 2018; 3:865-873. [PMID: 30507470 DOI: 10.1016/s2468-1253(18)30264-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/04/2018] [Accepted: 07/23/2018] [Indexed: 12/17/2022]
Abstract
Chemoradiotherapy is the primary treatment for patients with squamous cell carcinoma of the anus, but variations in the reported outcomes have restricted between-study comparisons. Treatment-related morbidity is considerable; however, no trial has comprehensively quantified long-term side-effects or quality of life. Therefore, we established the first international health-care professional and patient consensus to develop a core outcome set, using the Core Outcome Measures in Effectiveness Trials method. We used the results from our previous systematic review and combined them in this Review with patient interviews to derive a comprehensive list of outcomes, followed by a two-round Delphi survey completed by 149 participants (55 patients and 94 health-care professionals) from 11 countries. The Delphi results were discussed at a consensus meeting of health-care professionals and patients. Agreement was reached on 19 outcomes across four domains: disease activity, survival, toxicity, and life impact. Implementation of the Core Outcome Research Measures in Anal Cancer (CORMAC) set in future trials will serve as a framework to achieve standardisation, facilitate selection of health-area-specific evaluation tools, reduce redundancy of outcome lists, allow between-study comparisons, and ultimately enhance the relevance of trial findings to health-care professionals, trialists, and patients.
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Affiliation(s)
- Rebecca Fish
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Colorectal and Peritoneal Oncology Centre, Christie National Health Service Foundation Trust, Manchester, UK.
| | - Caroline Sanders
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Richard Adams
- Centre for Trials Research, Cardiff University School of Medicine, Cardiff, UK; Velindre Cancer Centre, Cardiff, UK
| | - Julie Brewer
- Colorectal and Peritoneal Oncology Centre, Christie National Health Service Foundation Trust, Manchester, UK
| | - Sara T Brookes
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Jill DeNardo
- Colorectal and Peritoneal Oncology Centre, Christie National Health Service Foundation Trust, Manchester, UK
| | - Rohit Kochhar
- Colorectal and Peritoneal Oncology Centre, Christie National Health Service Foundation Trust, Manchester, UK
| | - Mark P Saunders
- Colorectal and Peritoneal Oncology Centre, Christie National Health Service Foundation Trust, Manchester, UK
| | | | - Paula R Williamson
- Medical Research Council North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Cancer Research Centre and National Institute for Health Research, Manchester Biomedical Research Centre, University of Manchester, Manchester, UK; Colorectal and Peritoneal Oncology Centre, Christie National Health Service Foundation Trust, Manchester, UK
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Affiliation(s)
- Fraser M Smith
- Department of Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Katharine Cresswell
- NIHR Biomedical Research Centre Patient and Public Cancer Research Advisory Group, Public Programmes Team, Manchester University NHS Foundation Trust; and Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Arthur Sun Myint
- Clatterbridge Cancer Centre, Bebington, Wirral, UK
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Andrew G Renehan
- Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK
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Chadi SA, Malcomson L, Ensor J, Riley RD, Vaccaro CA, Rossi GL, Daniels IR, Smart NJ, Osborne ME, Beets GL, Maas M, Bitterman DS, Du K, Gollins S, Sun Myint A, Smith FM, Saunders MP, Scott N, O'Dwyer ST, de Castro Araujo RO, Valadao M, Lopes A, Hsiao CW, Lai CL, Smith RK, Paulson EC, Appelt A, Jakobsen A, Wexner SD, Habr-Gama A, Sao Julião G, Perez R, Renehan AG. Factors affecting local regrowth after watch and wait for patients with a clinical complete response following chemoradiotherapy in rectal cancer (InterCoRe consortium): an individual participant data meta-analysis. Lancet Gastroenterol Hepatol 2018; 3:825-836. [PMID: 30318451 DOI: 10.1016/s2468-1253(18)30301-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND In patients with rectal cancer who achieve clinical complete response after neoadjuvant chemoradiotherapy, watch and wait is a novel management strategy with potential to avoid major surgery. Study-level meta-analyses have reported wide variation in the proportion of patients with local regrowth. We did an individual participant data meta-analysis to investigate factors affecting occurrence of local regrowth. METHODS We updated search results of a recent systematic review by searching MEDLINE and Embase from Jan 1, 2016, to May 5, 2017, and used expert knowledge to identify published studies reporting on local regrowth in patients with rectal cancer managed by watch and wait after clinical complete response to neoadjuvant chemoradiotherapy. We restricted studies to those that defined clinical complete response using criteria equivalent to São Paulo benchmarks (ie, absence of residual ulceration, stenosis, or mass within the rectum on clinical and endoscopic examination). The primary outcome was 2-year cumulative incidence of local regrowth, estimated with a two-stage random-effects individual participant data meta-analysis. We assessed the effects of clinical and treatment factors using Cox frailty models, expressed as hazard ratios (HRs). From these models, we derived percentage differences in mean θ as an approximation of the effect of measured covariates on between-centre heterogeneity. This study is registered with PROSPERO, number CRD42017070934. FINDINGS We obtained individual participant data from 11 studies, including 602 patients enrolled between March 11, 1990, and Feb 13, 2017, with a median follow-up of 37·6 months (IQR 25·0-58·7). Ten of the 11 datasets were judged to be at low risk of bias. 2-year cumulative incidence of local regrowth was 21·4% (random-effects 95% CI 15·3-27·6), with high levels of between-study heterogeneity (I2=61%). We noted wide between-centre variation in patient, tumour, and treatment characteristics. We found some evidence that increasing cT stage was associated with increased risk of local regrowth (random-effects HR per cT stage 1·40, 95% CI 1·00-1·94; ptrend=0·048). In a subgroup of 459 patients managed after 2008 (when pretreatment staging by MRI became standard), 2-year cumulative incidence of local regrowth was 19% (95% CI 13-28) for stage cT1 and cT2 tumours, 31% (26-37) for cT3, and 37% (21-60) for cT4 (random-effects HR per cT stage 1·50, random-effects 95% CI 1·03-2·17; ptrend=0·0330). We estimated that measured factors contributed 4·8-45·3% of observed between-centre heterogeneity. INTERPRETATION In patients with rectal cancer and clinical complete response after chemoradiotherapy managed by watch and wait, we found some evidence that increasing cT stage predicts for local regrowth. These data will inform clinician-patient decision making in this setting. Research is needed to determine other predictors of a sustained clinical complete response. FUNDING None.
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Affiliation(s)
- Sami A Chadi
- Division of Surgical Oncology and General Surgery, Princess Margaret Hospital and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lee Malcomson
- Manchester Cancer Research Centre and NIHR Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - Joie Ensor
- Centre for Prognosis Research, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Richard D Riley
- Centre for Prognosis Research, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Carlos A Vaccaro
- Servicio Cirugia General, Sector de Coloproctologia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Gustavo L Rossi
- Servicio Cirugia General, Sector de Coloproctologia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ian R Daniels
- Exeter Colorectal Unit, and Exeter Surgical Health Sciences Research Unit (HESRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Neil J Smart
- Exeter Colorectal Unit, and Exeter Surgical Health Sciences Research Unit (HESRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Melanie E Osborne
- Exeter Colorectal Unit, and Exeter Surgical Health Sciences Research Unit (HESRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, Netherlands; GROW, School of Oncology and Developmental Biology, University of Maastricht, Maastricht, Netherlands
| | - Monique Maas
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Kevin Du
- Department of Radiation Oncology, New York University Langone Medical Center, New York, NY, USA
| | | | | | - Fraser M Smith
- Royal Liverpool Hospital NHS Foundation Trust, Liverpool, UK
| | - Mark P Saunders
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Nigel Scott
- Royal Preston NHS Foundation Trust, Preston, UK
| | - Sarah T O'Dwyer
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - Rodrigo Otavio de Castro Araujo
- Department of Abdominal and Pelvic Surgery, Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | - Marcus Valadao
- Department of Abdominal and Pelvic Surgery, Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | - Alberto Lopes
- Department of Abdominal and Pelvic Surgery, Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | - Cheng-Wen Hsiao
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, China
| | - Chien-Liang Lai
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, China
| | - Radhika K Smith
- Department of Surgery, Philadelphia VA Medical Center, and Division of Colon and Rectal Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Emily Carter Paulson
- Department of Surgery, Philadelphia VA Medical Center, and Division of Colon and Rectal Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ane Appelt
- Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark; Leeds Cancer Centre, St James's University Hospital, and Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Anders Jakobsen
- Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | | | - Guilherme Sao Julião
- Ludwig Institute for Cancer Research, Molecular Biology and Genomics Lab, São Paulo, Brazil
| | - Rodiguo Perez
- Instituto Angelita e Joaquim Gama, São Paulo, Brazil; Ludwig Institute for Cancer Research, Molecular Biology and Genomics Lab, São Paulo, Brazil
| | - Andrew G Renehan
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK; Centre for Prognosis Research, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK.
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Badrick E, Renehan I, Renehan AG. Linkage of the UK Clinical Practice Research Datalink with the national cancer registry. Eur J Epidemiol 2018; 34:101-102. [PMID: 30291528 PMCID: PMC6326001 DOI: 10.1007/s10654-018-0441-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 09/01/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Ellena Badrick
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, School of Medical Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Isabella Renehan
- Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, UK
| | - Andrew G Renehan
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, School of Medical Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK. .,Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK.
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Fish R, Renehan AG, Punnett G, Aziz O, Fulford P, Selvasekar C, Wilson M, Halstead R, O'Dwyer ST. Referral and treatment pathways for pseudomyxoma peritonei of appendiceal origin within a national treatment programme. Colorectal Dis 2018; 20:888-896. [PMID: 29920919 DOI: 10.1111/codi.14310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/06/2018] [Indexed: 02/08/2023]
Abstract
AIM Pseudomyxoma peritonei (PMP) is a rare neoplasm of the appendix, which if untreated disseminates throughout the abdominal cavity and generates considerable morbidity. Since 2002 in the UK, patients with PMP have been managed via two nationally commissioned centres. We evaluated referrals and treatment pathways over time at the Manchester centre. METHOD Data from all patients referred with suspected PMP were prospectively collected (2002-2015). Definitive treatment was cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy. Disease burden was quantified using the Peritoneal Cancer Index (PCI) (score 0-39) and complete cytoreduction (CC) defined by scores of 0/1. Novel treatment algorithms were developed for patients with low grade appendiceal mucinous neoplasm (LAMN) localized to the peri-appendiceal tissue. RESULTS In all, 817 patients with confirmed PMP were referred increasing from 11 in 2002 to 103 in 2015. Disease burden was high with a mean PCI of 31 in the first quartile (Q1), levelling off to 15, 15, 17 thereafter (P = 0.002). The proportion of CC0/1 increased from 67% in Q1 to 77% Q2 and 74% Q3/4. Where complete cytoreduction was achieved, 5- and 10-year overall survival was 77% and 66%. The proportion of patients referred with localized LAMN increased over time reaching 25% each year since 2010 (Ptrend < 0.0001). Two-thirds of localized LAMN now undergo laparoscopically assisted risk-reducing CRS. CONCLUSION The establishment of a national treatment centre was associated with an initial presentation of patients with advanced disease. The programme has demonstrated a clear trend over time towards earlier referral and adoption of minimally invasive techniques for localized disease.
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Affiliation(s)
- R Fish
- Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK.,Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - A G Renehan
- Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK.,Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
| | - G Punnett
- Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK
| | - O Aziz
- Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK.,Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - P Fulford
- Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK
| | - C Selvasekar
- Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK
| | - M Wilson
- Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK
| | - R Halstead
- Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK
| | - S T O'Dwyer
- Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK.,Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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