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Balch CM. Ernst Bertner: A Surgeon with Prescient Vision for the Largest Medical Center in the World. Ann Surg Oncol 2024; 31:2833-2855. [PMID: 38324237 DOI: 10.1245/s10434-024-14894-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/29/2023] [Indexed: 02/08/2024]
Abstract
More than 75 years ago, surgeon Ernst Bertner envisioned the Texas Medical Center (TMC) as "breathtaking in the scope and breadth of its conception," that would be "one of the largest in the world"; a gigantic medical enterprise that would "attract the greatest scientists of the world" and would combine patient care, research, and education, on a scale that was "second to none." During the next 3 years, Bertner accomplished important pieces of the Herculean task to bring onto the campus 11 major buildings, including the University of Texas MD Anderson Hospital for Cancer Research, for which he was the interim director. This was an extraordinary accomplishment because at the outset he had only a strategic plan, the deed to 134 acres of forest, and financial support from the MD Anderson Foundation! Bertner further forecasted world-class clinical and educational programs in the TMC, stating: "We envision the time when the Medical Center will become a great magnet, drawing leaders in education, medicine, and dental professions. It will provide the physical facilities and the environment in which research will flourish and bring forth for all of us new discoveries in the field of medicine." So how did his bold vision and passionate leadership culminate in the TMC today? By any criteria of scale and program excellence, the TMC today can be regarded as the largest medical center in the world. Occupying a contiguous campus of 1345 acres (2.1 square miles), it comprises 162 buildings, 60+ member institutions, 21 hospitals (> 9200 beds), 21 academic institutions, 4 medical schools, 7 nursing schools, 3 public health schools, 2 pharmacy schools, and a dental school. More than 106,000 patients and visitors come daily to the TMC, which has more than 120,000 employees, including 5000 physicians, 5700 researchers, and 11,000 registered nurses. Ernst Bertner is credited for transforming the original vision of the TMC into a workable program, and whose dynamic devotion to the idea captured the devotion of others to accomplish this extraordinary feat. Thus, during this short interval from 1946 to 1950, Bertner transitioned the leadership of the MD Anderson Cancer Hospital to Dr. R. Lee Clark, conducted a busy general surgery and gynecologic practice, facilitated the monumental transfer of the Baylor Medical School from Dallas to Houston, helped to recruit Dr. Michael DeBakey from New Orleans, and fought a heroic battle against rhabdomyosarcoma, a very rare and aggressive cancer.
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Affiliation(s)
- Charles M Balch
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Wagner P, Levine EA, Kim AC, Shen P, Fleming ND, Westin SN, Berry LK, Karakousis GC, Tanyi JL, Olson MT, Madajewski B, Ostrander B, Krishnan K, Balch CM, Bartlett DL. Detection of Residual Peritoneal Metastases Following Cytoreductive Surgery Using Pegsitacianine, a pH-Sensitive Imaging Agent: Final Results from a Phase II Study. Ann Surg Oncol 2024:10.1245/s10434-024-15165-4. [PMID: 38622456 DOI: 10.1245/s10434-024-15165-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/25/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND For patients with peritoneal carcinomatosis, extent of disease and completeness of cytoreductive surgery (CRS) are major prognostic factors for long-term survival. Assessment of these factors could be improved using imaging agents. Pegsitacianine is a pH-sensitive polymeric micelle conjugated to the fluorophore indocyanine green. The micelle disassembles in acidic microenvironments, such as tumors, resulting in localized fluorescence unmasking. We assessed the utility of pegsitacianine in detecting residual disease following CRS. PATIENTS AND METHODS NCT04950166 was a phase II, non-randomized, open-label, multicenter US study. Patients eligible for CRS were administered an intravenous dose of pegsitacianine at 1 mg/kg 24-72 h before surgery. Following CRS, the peritoneal cavity was reexamined under near-infrared (NIR) illumination to evaluate for fluorescent tissue. Fluorescent tissue identified was excised and evaluated by histopathology. The primary outcome was the rate of clinically significant events (CSE), defined as detection of histologically confirmed residual disease excised with pegsitacianine or a revision in the assessment of completeness of CRS. Secondary outcomes included acceptable safety and pegsitacianine performance. RESULTS A total of 53 patients were screened, 50 enrolled, and 40 were evaluable for CSE across six primary tumor types. Residual disease was detected with pegsitacianine in 20 of 40 (50%) patients. Pegsitacianine showed high sensitivity and was well tolerated with no serious adverse events (SAEs). Transient treatment-related, non-anaphylactic infusion reactions occurred in 28% of patients. CONCLUSIONS Pegsitacianine was well tolerated and facilitated the recognition of occult residual disease following CRS. The high rate of residual disease detected suggests that the use of pegsitacianine augmented surgeon assessment and performance during CRS.
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Affiliation(s)
- Patrick Wagner
- Department of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Edward A Levine
- Department of Surgical Oncology, Atrium Health Wake Forest Baptist, Wake Forest University, Winston-Salem, NC, USA
| | - Alex C Kim
- Division of Surgical Oncology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Perry Shen
- Department of Surgical Oncology, Atrium Health Wake Forest Baptist, Wake Forest University, Winston-Salem, NC, USA
| | - Nicole D Fleming
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Shannon N Westin
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Laurel K Berry
- Department of Gynecologic Oncology, Atrium Health Wake Forest Baptist, Wake Forest University, Winston-Salem, NC, USA
| | - Giorgos C Karakousis
- Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Janos L Tanyi
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | - Charles M Balch
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - David L Bartlett
- Department of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
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Hunt KK, Balch CM. Surgical Oncology Heroes and Legends: Charles M. Balch, MD, as Interviewed by Kelly K. Hunt, MD. Ann Surg Oncol 2024; 31:722-723. [PMID: 38062294 DOI: 10.1245/s10434-023-14628-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Kelly K Hunt
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Charles M Balch
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Lin X, Sun W, Ren M, Xu Y, Wang C, Yan W, Kong Y, Balch CM, Chen Y. Prediction of nonsentinel lymph node metastasis in acral melanoma with positive sentinel lymph nodes. J Surg Oncol 2023; 128:1407-1415. [PMID: 37689989 DOI: 10.1002/jso.27438] [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: 02/05/2023] [Revised: 07/25/2023] [Accepted: 08/27/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Metastasis in a nonsentinel lymph node (non-SLN) is an unfavorable independent prognostic factor in cutaneous melanoma (CM). Recent data did suggest potential value of completion lymph node dissection (CLND) in CM patients with non-SLN metastasis. Prediction of non-SLN metastasis assists clinicians in deciding on adjuvant therapy without CLND. We analyzed risk factors and developed a prediction model for non-SLN status in acral melanoma (AM). METHODS This retrospective study enrolled 656 cases of melanoma who underwent sentinel lymph node biopsy at Fudan University Shanghai Cancer Center from 2009 to 2017. We identified 81 SLN + AM patients who underwent CLND. Clinicopathologic data, including SLN tumor burden and non-SLN status were examined with Cox and Logistics regression models. RESULTS Ulceration, Clark level, number of deposits in the SLN (NumDep) and maximum size of deposits (MaxSize) are independent risk factors associated with non-SLN metastases. We developed a scoring system that combines ulceration, the cutoff values of Clark level V, MaxSize of 2 mm, and NumDep of 5 to predict non-SLN metastasis with an efficiency of 85.2% and 100% positive predictive value in the high-rank group (scores of 17-24). CONCLUSIONS A scoring system that included ulceration, Clark level, MaxSize, and NumDep is reliable and effective for predicting non-SLN metastasis in SLN-positive AM.
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Affiliation(s)
- XinYi Lin
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Sun
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Min Ren
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yu Xu
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - ChunMeng Wang
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - WangJun Yan
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - YunYi Kong
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Charles M Balch
- Department of Surgical Oncology, University of Texas MD Anderson Cancer center, Houston, Texas, USA
| | - Yong Chen
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Liao N, Li C, Cao L, Chen Y, Ren C, Chen X, Mok H, Wen L, Li K, Wang Y, Zhang Y, Li Y, Lv J, Cao F, Luo Y, Li H, Wu W, Balch CM, Giuliano AE. Abstract P5-01-06: Single cell profile of tumor and immune cells in primary triple-negative breast cancer and different sites in the axillary lymph nodes. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p5-01-06] [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: 03/06/2023]
Abstract
Abstract
Purpose: Little is known about the host-tumor interaction in the lymph node basin at a single cell level. This study examines single cell sequences in breast cancer nodal metastasis of a patient with triple negative breast cancer. Methods: The primary breast tumor, sentinel lymph node, an adjacent lymph node with metastatic involvement and a clinically normal-appearing lymph node were collected during operation. Single-cell sequencing was performed on all specimens. Results: 14,016 cells were clustered as 6 cell populations. Cancer cells demonstrated the molecular characteristics of TNBC basal B subtype and highly expressed genes in the MAPK signaling cascade. Tumor associated macrophages regulated antigen processing and presentation and other immune-related pathways to promote tumor invasion. CD8+ and CD4+ T lymphocytes concentrated more in sentinel lymph node and mainly stratified as two transcriptional states. The immune cell amount variation among primary tumor, sentinel and normal lymph nodes showed the similar tendency between the scRNA-seq profile of TNBC samples and a previous reported bulk RNA-seq profile of a breast cancer cohort including all four breast cancer subtype samples. Discussion: Single-cell sequencing analysis suggested that the sentinel lymph node was the initial meeting site of tumor infiltration and immune response, where partial T lymphocytes perform anti-tumor activity while other T cells exhibit an exhaustion state. We proposed a molecular explanation to the well-established clinical principle that the 5-year and 10-year survival outcomes were noninferior between SLND and ALND.
Citation Format: Ning Liao, Cheukfai Li, Li Cao, Yanhua Chen, Chongyang Ren, Xiaoqing Chen, Hsiaopei Mok, Lingzhu Wen, Kai Li, Yulei Wang, Yuchen Zhang, Yingzi Li, Jiaoyi Lv, Fangrong Cao, Yuting Luo, Hongrui Li, Wendy Wu, Charles M. Balch, Armando E. Giuliano. Single cell profile of tumor and immune cells in primary triple-negative breast cancer and different sites in the axillary lymph nodes [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-01-06.
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Affiliation(s)
- Ning Liao
- 1Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences
| | - Cheukfai Li
- 2Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences
| | - Li Cao
- 3Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences
| | | | - Chongyang Ren
- 5Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences
| | - Xiaoqing Chen
- 6Foshan Maternity and Children’s Healthcare Hospital Affiliated to Southern Medical University
| | - Hsiaopei Mok
- 7Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences
| | - Lingzhu Wen
- 8Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences
| | - Kai Li
- 9Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences
| | - Yulei Wang
- 10Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences
| | - Yuchen Zhang
- 11Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences
| | - Yingzi Li
- 12Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences
| | - Jiaoyi Lv
- 13Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences
| | - Fangrong Cao
- 14Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences
| | - Yuting Luo
- 15Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences
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Liao N, Li C, Cao L, Chen Y, Ren C, Chen X, Mok H, Wen L, Li K, Wang Y, Zhang Y, Li Y, Lv J, Cao F, Luo Y, Li H, Wu W, Balch CM, Giuliano AE. Single-cell profile of tumor and immune cells in primary breast cancer, sentinel lymph node, and metastatic lymph node. Breast Cancer 2023; 30:77-87. [PMID: 36129636 DOI: 10.1007/s12282-022-01400-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/24/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Little is known about the host-tumor interaction in the lymph-node basin at a single cell level. This study examines single cell sequences in breast cancer nodal metastases of a patient with triple-negative breast cancer. METHODS The primary breast tumor, sentinel lymph node, an adjacent lymph node with metastatic involvement and a clinically normal-appearing lymph node were collected during surgery. Single-cell sequencing was performed on all four specimens. RESULTS 14,016 cells were clustered into 6 cell subpopulations. Cancer cells demonstrated the molecular characteristics of TNBC basal B subtype and highly expressed genes in the MAPK signaling cascade. Tumor-associated macrophages regulated antigen processing and presentation and other immune-related pathways to promote tumor invasion. CD8 + and CD4 + T lymphocytes concentrated more in sentinel lymph node and mainly stratified into two transcriptional states. The immune-cell amount variation among primary tumor, sentinel and normal lymph nodes showed a similar tendency between the sc-RNA-seq profile of TNBC samples and a previous reported bulk RNA-seq profile of a breast cancer cohort, including all four breast cancer subtype samples. DISCUSSION Single-cell sequencing analysis suggested that the sentinel lymph node was the initial meeting site of tumor infiltration and immune response, where partial T lymphocytes perform anti-tumor activity, while other T cells exhibit an exhausted state. We proposed a molecular explanation to the well-established clinical principle that the 5-year and 10-year survival outcomes were noninferior between SLND and ALND.
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Affiliation(s)
- Ning Liao
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China.
| | - Cheukfai Li
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Li Cao
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Yanhua Chen
- Berry Oncology Corporation, No.2 Road Donghu, Fuzhou, 350200, China
| | - Chongyang Ren
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Xiaoqing Chen
- Foshan Maternity and Children's Healthcare Hospital, Affiliated to Southern Medical University, Foshan, China
| | - Hsiaopei Mok
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Lingzhu Wen
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Kai Li
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Yulei Wang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Yuchen Zhang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Yingzi Li
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Jiaoyi Lv
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Fangrong Cao
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Yuting Luo
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Hongrui Li
- Berry Oncology Corporation, No.2 Road Donghu, Fuzhou, 350200, China
| | - Wendy Wu
- Berry Oncology Corporation, No.2 Road Donghu, Fuzhou, 350200, China.
| | - Charles M Balch
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Wei X, Chen Y, Yao H, Wu D, Li H, Zhang R, Chi Z, Cui C, Bai X, Mao L, Qi Z, Li K, Lan S, Chen L, Guo R, Yao X, Lian B, Kong Y, Dai J, Tang B, Wang X, Gershenwald JE, Balch CM, Guo J, Si L. Prognostic impact of Breslow thickness in acral melanoma: A retrospective analysis. J Am Acad Dermatol 2022; 87:1287-1294. [PMID: 36075285 DOI: 10.1016/j.jaad.2022.08.052] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/19/2022] [Accepted: 08/28/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Evidence for the prognostic importance of tumor thickness in acral melanoma (AM) patients is limited. OBJECTIVE The objective of the study was to determine the prognostic impact of Breslow thickness in AM. METHODS This multicenter study enrolled patients diagnosed with localized AM between January 1, 2000 and December 31, 2017. Melanoma-specific survival (MSS) in different tumor thickness strata (T1-T4: ≤1, >1-2, >2-4, >4 mm, respectively) was estimated by the Kaplan-Meier method. Comparisons were performed by the log-rank test and multivariable Cox regression. RESULTS A total of 853 patients with clinical N0 (cN0) AM were included in the analysis. The median follow-up time was 60.1 months. The median MSS in patients with T1-T4 disease was not reached, 111.0, 92.8, and 67.1 months, respectively. MSS differed significantly among cN0 patients with T1-T3 AM (log-rank P = .004, .012, <0.001 for T1 vs T2, T2 vs T3, and T1 vs T3, respectively); however, there was no significant difference between T3 and T4 AM (hazard ratio = 0.82, 95% CI, 0.62-1.09). Six-subgroup analyses confirmed that survival outcomes were similar between different subgroups with tumor thickness >2 mm. LIMITATIONS The limitations were retrospective design and some missing variables. CONCLUSIONS There was no association between tumor thickness and survival in AM patients with a Breslow thickness >2 mm.
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Affiliation(s)
- Xiaoting Wei
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Yu Chen
- Department of Medical Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fujian, China
| | - Hong Yao
- Department of Cancer Biotherapy Center, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Yunnan, China; Guo Jun Expert Workstation of Yun Nan Province, The Third Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Di Wu
- Cancer Center, The First Hospital of Jilin University, Jilin, China
| | - Hang Li
- Department of Dermatology, Peking University First Hospital, National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Rui Zhang
- Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Liaoning, China
| | - Zhihong Chi
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Chuanliang Cui
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Xue Bai
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Lili Mao
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhonghui Qi
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Ke Li
- Department of Cancer Biotherapy Center, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Yunnan, China; Guo Jun Expert Workstation of Yun Nan Province, The Third Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Shijie Lan
- Cancer Center, The First Hospital of Jilin University, Jilin, China
| | - Lizhu Chen
- Department of Medical Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fujian, China
| | - Rui Guo
- Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Liaoning, China
| | - Xinyu Yao
- Department of Dermatology, Peking University First Hospital, National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Bin Lian
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Yan Kong
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Jie Dai
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Bixia Tang
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Xuan Wang
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charles M Balch
- Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jun Guo
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China; Guo Jun Expert Workstation of Yun Nan Province, The Third Affiliated Hospital of Kunming Medical University, Yunnan, China.
| | - Lu Si
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China.
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Guo J, Balch CM. Letter to the Editor Concerning "An Evidence-Based Staging System for Mucosal Melanoma: A Proposal," by Smith, Henry et al. Ann Surg Oncol 2022; 29:626-627. [PMID: 36255514 DOI: 10.1245/s10434-022-12635-5] [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] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Jun Guo
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China.
| | - Charles M Balch
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China.,Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Schachner B, Fanfan D, Zippi Z, Moore J, Balch CM, Klimberg VS. Trends in leadership at breast surgical oncology fellowships. Global Surg Educ 2022; 1:49. [PMID: 38013714 PMCID: PMC9555692 DOI: 10.1007/s44186-022-00046-9] [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] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/24/2022] [Accepted: 09/10/2022] [Indexed: 11/26/2022]
Abstract
Introduction Breast surgical oncology is a defined sub-specialty of general surgery that focuses on the surgical management of breast disease and malignancy within a multidisciplinary context. The fellowship directors (FD) that lead these programs have been selected for their abilities. As programs do research to ensure proper training for the next generation of breast surgical oncologists, we wanted to look into the FDs responsible for their training. Methods The Breast Surgical Oncology care program list was compiled via the Society of Surgical Oncology and American Society of Breast Surgeons Accredited programs (n = 60). The demographic information that was of interest included, but was not limited to, gender, age, ethnicity/background, past residency training, past fellowship training, year graduated from residency and fellowship, year since graduation to FD appointment, time at institution till FD appointment, and Hirsch index (h-index). Results Data were collected on all 60 FDs. The average age of FDs was 52 years old, 27% of FDs are men and 73% of FDs are women. The average H-index, number of publications, and number of citations were 19, 67, and 2648, respectively. The mean graduation year from residency was 2003, and from fellowship was 2006; with a mean of 9 years post fellowship graduation until becoming an FD. The most frequently attended residency was Rush (n = 4), and the most common fellowships were Memorial Sloan Kettering (n = 8), MD Anderson Cancer Center (n = 7), and John Wayne Cancer Institute (n = 4). Nine of the FDs stayed at the same institution after doing both residency and fellowship there (15%). Conclusion This is the first study to examine the demographics of those in FD positions in Surgical Breast Oncology, which is a relatively young fellowship. We found that FDs in Breast Surgical Oncology are defined by their high output of research. This qualification may be why the average age, and the number of years to FD are higher compared to other specialties where this research has been undertaken. Initial evaluation of FDs suggest more diversity in this field is needed. Further insight into the leaders training our next generation of surgeons is warranted.
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Affiliation(s)
- Benjamin Schachner
- University of Miami Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL 33136 USA
| | - Dino Fanfan
- Florida International University Herbert Wertheim College of Medicine, 11200 SW 8th St, Miami, FL 33199 USA
| | - Zachary Zippi
- Florida International University Herbert Wertheim College of Medicine, 11200 SW 8th St, Miami, FL 33199 USA
| | - Jessica Moore
- University of Miami/Jackson Health System, 1611 NW 12th Ave, Miami, Fl 33136 USA
| | - Charles M. Balch
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler Street FCT 17.6043, Houston, TX 77030 USA
- Department of Surgery, University of Texas Medical Branch, Galveston, TX USA
| | - V. Suzanne Klimberg
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler Street FCT 17.6043, Houston, TX 77030 USA
- Department of Surgery, University of Texas Medical Branch, Galveston, TX USA
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Balch CM, Winchester DP, Copeland EM. The Pivotal Leadership of Doctors R. Lee Clark and Murray M. Copeland in Transforming the Commission on Cancer (1955–1965). Ann Surg Oncol 2022; 29:5401-5421. [DOI: 10.1245/s10434-022-11923-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/18/2022]
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11
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Liao N, Li C, Cao L, Chen Y, Ren C, Chen X, Mok H, Wen LZ, Li K, Wang Y, Zhang Y, Li Y, Lv J, Cao F, Luo Y, Li H, Wu W, Balch CM, Giuliano AE. Single cell profile of tumor and immune cells in primary triple-negative breast cancer and different sites in the axillary lymph nodes. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e12570] [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: 11/20/2022] Open
Abstract
e12570 Background: Little is known about the host-tumor interaction in the lymph node basin at a single cell level. This study examines single cell sequences in breast cancer nodal metastasis of a patient with triple negative breast cancer. Methods: The primary breast tumor, sentinel lymph node, an adjacent lymph node with metastatic involvement and a clinically normal-appearing lymph node were collected during operation. Single-cell sequencing was performed on all specimens. Results: 14,016 cells were clustered as 6 cell populations. Cancer cells demonstrated the molecular characteristics of TNBC basal B subtype and highly expressed genes in the MAPK signaling cascade. Tumor associated macrophages regulated antigen processing and presentation and other immune-related pathways to promote tumor invasion. CD8+ and CD4+ T lymphocytes concentrated more in sentinel lymph node and mainly stratified as two transcriptional states. Conclusions: The first single cell report investigates the host-tumor interaction in the lymph node basin of triple-negative breast cancer. Single-cell sequencing analysis suggested that the sentinel lymph node was the initial meeting site of tumor infiltration and immune response, where partial T lymphocytes perform anti-tumor activity while other T cells exhibit an exhaustion state. We proposed a molecular explanation to the well-established clinical principle that the 5-year and 10-year survival outcomes were noninferior between sentinel lymph node dissection (SLND) and axillary lymph node dissection (ALND).
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Affiliation(s)
- Ning Liao
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Cheukfai Li
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Li Cao
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | | | - Chongyang Ren
- Department of Breast Cancer, Cancer Centre, Guangdong General Hospital, Guangzhou, China
| | - Xiaoqing Chen
- Foshan Maternity and Children’s Healthcare Hospital Affiliated to Southern Medical University, Foshan, China
| | - Hsiaopei Mok
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ling-Zhu Wen
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kai Li
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yulei Wang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuchen Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yingzi Li
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiaoyi Lv
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Fangrong Cao
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuting Luo
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hongrui Li
- Berry Oncology Corporation, Fuzhou, China
| | - Wendy Wu
- Berry Oncology Corporation, Beijing, China
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12
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Cui C, Lian B, Zhang X, Wu D, Li K, Si L, Yang Y, Tian H, Zhou L, Chi Z, Sheng X, Kong Y, Mao L, Wang X, Bai X, Yan X, Li S, Dai J, Tang B, Wei X, Gershenwald JE, Balch CM, Guo J. ASO Visual Abstract: An Evidence-Based Staging System for Mucosal Melanoma: a Proposal. Ann Surg Oncol 2022. [PMID: 35579763 DOI: 10.1245/s10434-022-11786-9] [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] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- ChuanLiang Cui
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Bin Lian
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - XiaoShi Zhang
- Biotherapy Center, Melanoma and Sarcoma Medical oncology Unit, SUN YAT-SEN University Cancer Center, Guangzhou, China
| | - Di Wu
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Ke Li
- Department of Cancer Biotherapy Center, Yunnan Cancer Hospital, Kunming, China
| | - Lu Si
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Yue Yang
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Hui Tian
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Li Zhou
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - ZhiHong Chi
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - XiNan Sheng
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Yan Kong
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - LiLi Mao
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Xuan Wang
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Xue Bai
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - XieQiao Yan
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - SiMing Li
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Jie Dai
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - BiXia Tang
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Xiaoting Wei
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas M. D.␣Anderson Cancer Center, Houston, TX, USA
| | - Charles M Balch
- Department of Surgical Oncology, The University of Texas M. D.␣Anderson Cancer Center, Houston, TX, USA
| | - Jun Guo
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China.
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13
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Zhang G, Ren C, Li C, Wang Y, Chen B, Wen L, Jia M, Li K, Mok H, Cao L, Chen X, Lin J, Wei G, Li Y, Zhang Y, Balch CM, Liao N. Distinct clinical and somatic mutational features of breast tumors with high-, low-, or non-expressing human epidermal growth factor receptor 2 status. BMC Med 2022; 20:142. [PMID: 35484593 PMCID: PMC9052533 DOI: 10.1186/s12916-022-02346-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [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: 08/26/2021] [Accepted: 03/16/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND HER2-low breast cancers were reported to have distinct clinicopathological characteristics from HER2-zero; however, the difference in their genetic features remains unclear. This study investigated the clinical and molecular features of breast tumors according to HER2 status. METHODS We analyzed the clinicopathological and genomic data of 523 Chinese women with breast cancer. Genomic data was generated by targeted next-generation sequencing (NGS) of breast tumor samples using a commercial 520 gene panel. The cohort was stratified according to HER2 status as HER2-zero (n = 90), HER2-low (n = 231), and HER2-positive (n = 202) according to their immunohistochemistry and fluorescence in situ hybridization results. RESULTS HER2-low breast tumors were enriched with hormone receptor-positive tumors, and who had lower Ki67 expression levels. Genes were differentially mutated across HER2 subgroups. HER2-low tumors had significantly more mutations involved in PI3K-Akt signaling than HER2-positive (p < 0.001) and HER2-zero breast tumors (p < 0.01). HER2-zero tumors had more mutations in checkpoint factors (p < 0.01), Fanconi anemia (p < 0.05), and p53 signaling and cell cycle pathway (p < 0.05) compared to HER2-low breast tumors. Compared with HER2-zero tumors, HER2-low tumors had significantly lower pathological complete response rates after neoadjuvant therapy (15.9% vs. 37.5%, p = 0.042) and proportion of relapsed/progressed patients across follow-up time points (p = 0.031), but had comparable disease-free survival (p = 0.271). CONCLUSION Our results demonstrate the distinct clinical and molecular features and clinical outcomes of HER2-low breast tumors.
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Affiliation(s)
- Guochun Zhang
- Department of Breast Surgery, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Chongyang Ren
- Department of Breast Surgery, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Cheukfai Li
- Department of Breast Surgery, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Yulei Wang
- Department of Breast Surgery, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Bo Chen
- Department of Breast Surgery, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Lingzhu Wen
- Department of Breast Surgery, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Minghan Jia
- Department of Breast Surgery, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Kai Li
- Department of Breast Surgery, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Hsiaopei Mok
- Department of Breast Surgery, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Li Cao
- Department of Breast Surgery, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | | | - Jiali Lin
- Department of Breast Surgery, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
- Department of Breast Surgery, Nanhai Second People's Hospital, Foshan, China
| | - Guangnan Wei
- Department of Breast Surgery, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Yingzhi Li
- Department of Breast Surgery, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
- Shantou University Medical College, Shantou, China
| | - Yuchen Zhang
- Department of Breast Surgery, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Charles M Balch
- Department of Surgical Oncology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Ning Liao
- Department of Breast Surgery, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China.
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14
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Cui C, Lian B, Zhang X, Wu D, Li K, Si L, Yang Y, Tian H, Zhou L, Chi Z, Sheng X, Kong Y, Mao L, Wang X, Bai X, Yan X, Li S, Dai J, Tang B, Wei X, Gershenwald JE, Balch CM, Guo J. An Evidence-Based Staging System for Mucosal Melanoma: A Proposal. Ann Surg Oncol 2022; 29:5221-5234. [DOI: 10.1245/s10434-022-11670-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/11/2022] [Indexed: 12/14/2022]
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Balch CM. The Politics of Recruiting Dr. R Lee Clark Jr. as the First Permanent Director of The University of Texas MD Anderson Hospital for Cancer Research : Part II: The Process and Politics of Recruiting Lt. Colonel R. Lee Clark Jr. to The University of Texas MD Anderson Hospital. Ann Surg Oncol 2021; 29:733-749. [PMID: 34635973 DOI: 10.1245/s10434-021-10736-1] [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] [Received: 07/30/2021] [Accepted: 08/13/2021] [Indexed: 11/18/2022]
Abstract
Dr. R. Lee Clark Jr. was a man of bold and extraordinary vision. He was truly a surgical oncology leader of the twentieth century. His leadership had a significant impact on the cancer community nationally and internationally. Historically, it is intriguing that Dr. Clark almost did not become President of the UT MD Anderson Cancer Center, since five other candidates were first offered the position and turned it down, and then Clark himself almost withdrew during the search process because of the political stalemate among the UT Regents to select a candidate. The saga began in 1945, when the Acting Director of MD Anderson Hospital for Cancer Research, Dr. Ernst Bertner, pressed the UT Regents to recruit a permanent Director, since he had just been appointed as the first President of the Texas Medical Center. Bertner was a major figure in recruiting Dr. R. Lee Clark, who was then a Lt. Colonel in the Army Air Force. Dr. Clark's vision for this unique cancer facility was first drafted on Randolph Army Airfield stationary in February 1946. An interesting twist to the story is that Dr. Clark almost did not get the job because of an alternative candidate, and because of the political vicissitudes among the University of Texas Board of Regents. Many of these political barriers were eventually overcome, and Dr. Clark was unanimously approved as the first permanent Director on 13 July 1946, and his leadership over the next 32 years changed the course of history.
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Affiliation(s)
- Charles M Balch
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler Street FCT 17.6043, Houston, TX, 77030, USA.
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Balch CM. The Politics of Recruiting Dr. R. Lee Clark Jr as the First Permanent Director of the University of Texas MD Anderson Hospital for Cancer Research : Part I: Creating the Texas Cancer Hospital and Events that Might Have Changed the Course of History (1941-1945). Ann Surg Oncol 2021; 29:719-732. [PMID: 34581922 DOI: 10.1245/s10434-021-10735-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/13/2021] [Indexed: 11/18/2022]
Abstract
The MD Anderson Cancer Center is one of the world's largest programs in cancer patient care, research, and education; yet, there were many historical twists and turns that almost led the cancer hospital to be located in a different place, under a different authority, and under different leadership. Although it was finally located in Houston, Texas, historical events could possibly have resulted in the cancer hospital being located in Dallas, Galveston, or Austin, Texas. Although Dr. R. Lee Clark Jr eventually became the first permanent Director, five other physicians were offered the position before him. After the war ended, Dr. Bertner, as acting director, urged the university Regents to press their search for a permanent director, but the selection process was snafued and prolonged because Regent D. Frank Strickland filibustered for his own candidate for the permanent job. And it was not Dr. R. Lee Clark Jr, who was favored by the other eight Regents.
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Affiliation(s)
- Charles M Balch
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
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17
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Chen B, Zhang G, Lai J, Xiao W, Li X, Li C, Mok H, Li K, Wang Y, Cao L, Jia M, Ren C, Wen L, Wei G, Lin J, Li Y, Zhang Y, Chen X, Wu X, Zhang H, Li M, Liu J, Balch CM, Liao N. Genetic and immune characteristics of sentinel lymph node metastases and multiple lymph node metastases compared to their matched primary breast tumours. EBioMedicine 2021; 71:103542. [PMID: 34454403 PMCID: PMC8399410 DOI: 10.1016/j.ebiom.2021.103542] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patients with breast cancer presenting with single lymph node metastasis (from a sentinel node) experience prolonged survival compared to patients with multiple lymph node metastases (≥3). However, little information is available on the genetic and immunological characteristics of breast cancer metastases within the regional lymph nodes as they progress from the sentinel lymph node (SLN) downstream to multiple regional lymph nodes (MLNs). METHODS Genomic profiling was performed using a next-generation sequencing panel covering 520 cancer-related genes in the primary tumour and metastatic lymph nodes of 157 female patients with breast cancer. We included primary tumours, metastatic lymph nodes and adjacent clinically normal lymph nodes (20 patients from the SLN group and 28 patients from the MLNs group) in the whole transcriptome analysis. FINDINGS The downstream metastatic lymph nodes (P = 0.029) and the primary breast tumours (P = 0.011) had a higher frequency of PIK3CA mutations compared to the SLN metastasis. We identified a distinct group of 14 mutations from single sentinel node metastasis and a different group of 15 mutations from multiple nodal metastases. Only 4 distinct mutations (PIK3CA, CDK4, NFKBIA and CDKN1B) were conserved in metastases from both lymph node settings. The tumour mutational burden (TMB) was significantly lower in single nodal metastasis compared to the paired primary breast cancer (P = 0.0021), while the decline in TMB did not reach statistical significance in the MLNs group (P = 0.083). In the gene set enrichment analysis, we identified 4 upregulated signatures in both primary tumour and nodal metastases from the MLNs group, including 3 Epithelial-mesenchymal transition(EMT) signatures and 1 angiogenesis signature. Both the CD8/Treg ratio and the CD8/EMT ratio were significantly higher in adjacent normal lymph nodes from patients with a single metastasis in the SLN compared with samples from the MLNs group (P = 0.045 and P = 0.023, respectively). This suggests that the immune defence from the MLNs patients might have a less favourable microenvironment, thus permitting multiple lymph nodes metastasis. INTERPRETATION Single lymph node metastases and multiple lymph node metastases have significant differences in their molecular profiles and immune profiles. The findings are associated with more aggressive tumour characteristics and less favourable immune charactoristics in patients with multiple nodal metastases compared to those with a single metastasis in the sentinel node. FUNDING This work was supported by funds from High-level Hospital Construction Project (DFJH201921), the National Natural Science Foundation of China (81902828 and 82002928), the Fundamental Research Funds for the Central Universities (y2syD2192230), and the Medical Scientific Research Foundation of Guangdong Province (B2019039).
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Affiliation(s)
- Bo Chen
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; School of Medicine, South China University of Technology, 106 Zhongshan Er Road, Guangzhou 510080, Guangdong, China
| | - Guochun Zhang
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; School of Medicine, South China University of Technology, 106 Zhongshan Er Road, Guangzhou 510080, Guangdong, China;; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China;; Shantou University Medical College, Shantou, Guangdong, China
| | - Jianguo Lai
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Weikai Xiao
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xuerui Li
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Cheukfai Li
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Hsiaopei Mok
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Kai Li
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yulei Wang
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Li Cao
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Minghan Jia
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Chongyang Ren
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Lingzhu Wen
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Guangnan Wei
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; School of Medicine, South China University of Technology, 106 Zhongshan Er Road, Guangzhou 510080, Guangdong, China
| | - Jiali Lin
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Yingzi Li
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Shantou University Medical College, Shantou, Guangdong, China
| | - Yuchen Zhang
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; School of Medicine, South China University of Technology, 106 Zhongshan Er Road, Guangzhou 510080, Guangdong, China
| | - Xiaoqing Chen
- Department of Breast Surgical Oncology, Foshan Maternity and Children's Healthcare Hospital Affiliated to Southern Medical University, Foshan, Guangdong, China
| | - Xueying Wu
- Genecast Biotechnology Co., Ltd; Beijing, China
| | - Henghui Zhang
- Genecast Biotechnology Co., Ltd; Beijing, China;; Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Min Li
- Burning Rock Biotech, Guangzhou, Guangdong, China
| | - Jing Liu
- Burning Rock Biotech, Guangzhou, Guangdong, China
| | - Charles M Balch
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Ning Liao
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; School of Medicine, South China University of Technology, 106 Zhongshan Er Road, Guangzhou 510080, Guangdong, China;; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China;; Shantou University Medical College, Shantou, Guangdong, China.
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Abstract
The MD Anderson Hospital for Cancer Research (as it was named in 1946) incorporated pioneering changes that set new standards in hospital design, construction, and function. It is remarkable that surgeon R. Lee Clark, the new Director of the MD Anderson Hospital, and with no previous experience in hospital construction, personally led the design and supervision of a world class medical care and research facility. This is the untold story of his leadership and his diligence visiting hospitals and cancer facilities in America and Europe, his clever hiring, his supervision of the architectural firms (through 23 versions of architectural plans), his adaptability to the market when building costs were skyrocketing, and his extraordinary ability in raising enormous funds from private, state, and federal sources. He was such a creative genius in his inaugural building project that the new MD Anderson "cancer station" was described by national magazines as totally unique in its design that set new standards in cancer care delivery. With his typical determination, enthusiasm, and creative approach to problem-solving, Clark embarked on this building project in 1946 with a budget of $1,750,000, expecting to complete this project in 2 to 3 years. In fact, the entire project took 8 years and cost five times more than the original estimate, at almost $9,000,000! The process took 2 years for Dr. Clark to visit more than 30 cancer facilities and many academic hospitals in America and in Europe, 2 years of architectural planning, and 4 years of construction. When MD Anderson opened its doors in 1954, it was described by national magazines as "one of the most modern hospitals in the nation."
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Affiliation(s)
- Charles M Balch
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Elghazaly H, Rugo HS, Azim HA, Swain SM, Arun B, Aapro M, Perez EA, Anderson BO, Penault-Llorca F, Conte P, El Saghir NS, Yip CH, Ghosn M, Poortmans P, Shehata MA, Giuliano AE, Leung JWT, Guarneri V, Gligorov J, Gulluoglu BM, Abdel Aziz H, Frolova M, Sabry M, Balch CM, Orecchia R, El-Zawahry HM, Al-Sukhun S, Abdel Karim K, Kandil A, Paltuev RM, Foheidi M, El-Shinawi M, ElMahdy M, Abulkhair O, Yang W, Aref AT, Bakkach J, Bahie Eldin N, Elghazawy H. Breast-Gynaecological & Immuno-Oncology International Cancer Conference (BGICC) Consensus and Recommendations for the Management of Triple-Negative Breast Cancer. Cancers (Basel) 2021; 13:2262. [PMID: 34066769 PMCID: PMC8125909 DOI: 10.3390/cancers13092262] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/07/2021] [Revised: 05/01/2021] [Accepted: 05/05/2021] [Indexed: 02/07/2023] Open
Abstract
Background: The management of patients with triple-negative breast cancer (TNBC) is challenging with several controversies and unmet needs. During the 12th Breast-Gynaecological & Immuno-oncology International Cancer Conference (BGICC) Egypt, 2020, a panel of 35 breast cancer experts from 13 countries voted on consensus guidelines for the clinical management of TNBC. The consensus was subsequently updated based on the most recent data evolved lately. Methods: A consensus conference approach adapted from the American Society of Clinical Oncology (ASCO) was utilized. The panellists voted anonymously on each question, and a consensus was achieved when ≥75% of voters selected an answer. The final consensus was later circulated to the panellists for critical revision of important intellectual content. Results and conclusion: These recommendations represent the available clinical evidence and expert opinion when evidence is scarce. The percentage of the consensus votes, levels of evidence and grades of recommendation are presented for each statement. The consensus covered all the aspects of TNBC management starting from defining TNBC to the management of metastatic disease and highlighted the rapidly evolving landscape in this field. Consensus was reached in 70% of the statements (35/50). In addition, areas of warranted research were identified to guide future prospective clinical trials.
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Affiliation(s)
- Hesham Elghazaly
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt; (H.A.A.); (M.S.); (K.A.K.); (N.B.E.); (H.E.)
| | - Hope S. Rugo
- Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco, CA 94158, USA
| | - Hamdy A. Azim
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Giza 12613, Egypt; (H.A.A.); (H.M.E.-Z.)
| | - Sandra M. Swain
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, MedStar Health, Washington, DC 20007, USA;
| | - Banu Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Matti Aapro
- Breast Center, Clinique de Genolier, 1272 Genolier, Switzerland;
| | - Edith A. Perez
- Department of Hematology & Oncology, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Benjamin O. Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA 98195, USA;
| | - Frederique Penault-Llorca
- Department of Pathology, Clermont Auvergne University, INSERM U1240 “Molecular Imaging and Theranostic Strategies”, Center Jean Perrin, Montalembert, 63000 Clermont-Ferrand, France;
| | - Pierfranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Istituto Oncologico Veneto IOV IRCCS, 35128 Padova, Italy; (P.C.); (V.G.)
| | - Nagi S. El Saghir
- Department of Internal Medicine, Division of Hematology Oncology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon;
| | - Cheng-Har Yip
- Subang Jaya Medical Centre, Kuala Lumpur 47500, Malaysia;
| | - Marwan Ghosn
- Hematology and Oncology Department, Saint Joseph University, Beirut 1104 2020, Lebanon;
| | - Philip Poortmans
- Iridium Kankernetwerk and Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk-Antwerp, Belgium;
| | - Mohamed A. Shehata
- Clinical oncology Department, Menoufia University, Shebin Elkom 51132, Egypt;
| | - Armando E. Giuliano
- Department of Surgery, Surgical Oncology Division, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Jessica W. T. Leung
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Istituto Oncologico Veneto IOV IRCCS, 35128 Padova, Italy; (P.C.); (V.G.)
| | - Joseph Gligorov
- Institut Universitaire de Cancérologie AP-HP. Sorbonne Université, INSERM U938, 75013 Paris, France;
| | - Bahadir M. Gulluoglu
- Breast & Endocrine Surgery Unit, Marmara University School of Medicine, University Hospital, Istanbul 34722, Turkey;
| | - Hany Abdel Aziz
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt; (H.A.A.); (M.S.); (K.A.K.); (N.B.E.); (H.E.)
| | - Mona Frolova
- Federal State Budgetary Institution “NN Blokhin National Medical Research Center of Oncology” of the Ministry of Health of the Russian Federation, 127994 Moscow, Russia;
| | - Mohamed Sabry
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt; (H.A.A.); (M.S.); (K.A.K.); (N.B.E.); (H.E.)
| | - Charles M. Balch
- Surgical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Roberto Orecchia
- Scientific Directorate, IRCCS European Institute of Oncology (IEO), and University of Milan, 20122 Milan, Italy;
| | - Heba M. El-Zawahry
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Giza 12613, Egypt; (H.A.A.); (H.M.E.-Z.)
| | | | - Khaled Abdel Karim
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt; (H.A.A.); (M.S.); (K.A.K.); (N.B.E.); (H.E.)
| | - Alaa Kandil
- Department of Clinical Oncology, Alexandria School of Medicine, Alexandria 21131, Egypt;
| | - Ruslan M. Paltuev
- Russian Association of Oncological Mammology, Department of Breast Tumours of Federal State Budgetary Institution “Petrov Research Institute of Oncology”, 197758 Saint Petersburg, Russia;
| | - Meteb Foheidi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Adult Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah 22384, Saudi Arabia;
| | - Mohamed El-Shinawi
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt;
- Vice President of Galala University, Galala University, Suez 435611, Egypt
| | - Manal ElMahdy
- Department of Pathology, Ain shams University, Cairo 11566, Egypt;
| | - Omalkhair Abulkhair
- Oncology Department, Alfaisal university, Alhabib Hospital, Riyad 11533, Saudi Arabia;
| | - Wentao Yang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China;
| | - Adel T. Aref
- The School of Public Health, University of Adelaide, Adelaide 5005, Australia;
| | - Joaira Bakkach
- Biomedical Genomics & Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, Abdel Malek Essaadi University, Tangier 90000, Morocco;
| | - Nermean Bahie Eldin
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt; (H.A.A.); (M.S.); (K.A.K.); (N.B.E.); (H.E.)
| | - Hagar Elghazawy
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt; (H.A.A.); (M.S.); (K.A.K.); (N.B.E.); (H.E.)
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20
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Elghazaly H, Aref AT, Anderson BO, Arun B, Yip CH, Abdelaziz H, Ghosn M, Al-Foheidi M, Cardenosa G, Leung JWT, Gado N, Balch CM, Sabry M, Ezz Elarab L, Giuliano AE, El-Zawahry HM, Abdel Karim K, Nasr A, Maki H, Chung H, Saadeddin A, Abdelwahab MM, Al Tahan FM, Chalabi N, Frolova M, Kamal RM, Shehata MA, Bahie Eldin N, Elghazawy H. The first BGICC consensus and recommendations for breast cancer awareness, early detection and risk reduction in low- and middle-income countries and the MENA region. Int J Cancer 2021; 149:505-513. [PMID: 33559295 DOI: 10.1002/ijc.33506] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/14/2021] [Accepted: 01/22/2021] [Indexed: 01/31/2023]
Abstract
In low-middle income countries (LMICs) and the Middle East and North Africa (MENA) region, there is an unmet need to establish and improve breast cancer (BC) awareness, early diagnosis and risk reduction programs. During the 12th Breast, Gynecological & Immuno-oncology International Cancer Conference - Egypt 2020, 26 experts from 7 countries worldwide voted to establish the first consensus for BC awareness, early detection and risk reduction in LMICs/MENA region. The panel advised that there is an extreme necessity for a well-developed BC data registries and prospective clinical studies that address alternative modalities/modified BC screening programs in areas of limited resources. The most important recommendations of the panel were: (a) BC awareness campaigns should be promoted to public and all adult age groups; (b) early detection programs should combine geographically distributed mammographic facilities with clinical breast examination (CBE); (c) breast awareness should be encouraged; and (d) intensive surveillance and chemoprevention strategies should be fostered for high-risk women. The panel defined some areas for future clinical research, which included the role of CBE and breast self-examination as an alternative to radiological screening in areas of limited resources, the interval and methodology of BC surveillance in women with increased risk of BC and the use of low dose tamoxifen in BC risk reduction. In LMICs/MENA region, BC awareness and early detection campaigns should take into consideration the specific disease criteria and the socioeconomic status of the target population. The statements with no consensus reached should serve as potential catalyst for future clinical research.
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Affiliation(s)
- Hesham Elghazaly
- Clinical Oncology Department, Ain shams University, Cairo, Egypt
| | - Adel T Aref
- School of Public health, University of Adelaide, Adelaide, Australia
| | - Benjamin O Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA
| | - Banu Arun
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cheng-Har Yip
- Subang Jaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Hany Abdelaziz
- Clinical Oncology Department, Ain shams University, Cairo, Egypt
| | - Marwan Ghosn
- Hematology and Oncology Department, Saint Joseph University, Beirut, Lebanon
| | - Meteb Al-Foheidi
- Princess Noorah Oncology Center/College of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Gilda Cardenosa
- Wake Forest Baptist Medical Center, Winston Salem, North Carolina, USA
| | - Jessica W T Leung
- Breast Imaging Department, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nivine Gado
- Clinical Oncology Department, Ain shams University, Cairo, Egypt
| | - Charles M Balch
- Surgical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mohamed Sabry
- Clinical Oncology Department, Ain shams University, Cairo, Egypt
| | - Lobna Ezz Elarab
- Clinical Oncology Department, Ain shams University, Cairo, Egypt
| | - Armando E Giuliano
- Surgical Oncology Division, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Heba M El-Zawahry
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | | | - Azza Nasr
- Radiotherapy Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hussein Maki
- Khartoum Oncology Specialized Center, Khartoum, Sudan
| | - Hannah Chung
- Breast Imaging Department, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ahmed Saadeddin
- King Abdullah Specialized Children's Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | | | | | - Nivine Chalabi
- Radiology Department, Ain Shams University, Cairo, Egypt
| | - Mona Frolova
- NN Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - Rasha M Kamal
- Radiology Department, Cairo University, Cairo, Egypt
| | - Mohamed A Shehata
- Clinical Oncology Department, Menoufia University, Shebin Elkom, Egypt
| | | | - Hagar Elghazawy
- Clinical Oncology Department, Ain shams University, Cairo, Egypt
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21
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Balch CM. Correction to: The Surgical Legacy of Randolph Lee Clark Jr, MD: First Surgeon-in-Chief and Director of University of Texas MD Anderson Cancer Center I. Training and Surgical Practice Before Recruitment to University of Texas MD Anderson Hospital. Ann Surg Oncol 2021; 28:867. [PMID: 33532880 DOI: 10.1245/s10434-021-09666-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Charles M Balch
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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22
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Balch CM. The Surgical Legacy of Randolph Lee Clark, Jr, MD: First Director and Surgeon-in-Chief of University of Texas MD Anderson Cancer Center II. Surgical Practice and Leadership at University of Texas MD Anderson Cancer Center (1946-1978). Ann Surg Oncol 2021; 28:4794-4804. [PMID: 33515334 DOI: 10.1245/s10434-020-09514-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/07/2020] [Indexed: 11/18/2022]
Abstract
Dr. R. Lee Clark Jr brought a broad-based cancer surgery experience to MD Anderson Hospital for Cancer Research when he became its first Surgeon-in-Chief and full-time salaried physician in 1946. He performed major surgery until 1971 including major head and neck operations, thyroidectomy, mastectomy, radical melanoma and sarcoma surgery, gastric and abdominal-perineal resection, and even hemipelvectomy. He initiated major programs in radiation therapy and mammography breast screening, and organized teams of specialists in a group practice providing multidisciplinary cancer care. Dr. Clark was elected into membership by the James Ewing Society (currently the Society of Surgical Oncology), the Southern Surgical Association, and the American Surgical Association, and was a founding member of the Society of Head and Neck Surgery. The Society of Surgical Oncology honored him with the Lucy Wortham James Award in 1965 and the James Ewing Lecture Award in 1977. Dr. Clark also provided invaluable leadership in the American College of Surgeons, leading a fledgling Committee on Cancer into a robust organization that became the Commission on Cancer. The College of Surgeons honored him with their Distinguished Service Award in 1969. Dr. Clark recruited major surgical leaders and personally designed the new hospital that opened in 1954, described in Time magazine as "the most modern, most ingeniously designed hospital in the U.S." R. Lee Clark, Jr. was an accomplished and busy clinical surgeon, a visionary and charismatic leader, and an organizational genius. Indeed, he was one of the first pioneers in the specialty of surgical oncology.
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Affiliation(s)
- Charles M Balch
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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23
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Balch CM. The Surgical Legacy of Randolph Lee Clark Jr, MD: First Surgeon-in-Chief and Director of University of Texas MD Anderson Cancer Center I. Training and Surgical Practice Before Recruitment to University of Texas MD Anderson Hospital. Ann Surg Oncol 2021; 28:4782-4793. [PMID: 33469795 DOI: 10.1245/s10434-020-09511-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/18/2020] [Accepted: 11/28/2020] [Indexed: 11/18/2022]
Abstract
Dr R. Lee Clark Jr was the first Surgeon-in-Chief and permanent Director of the University of Texas MD Anderson Cancer Hospital, leading the institution from 1946 to 1978. He is known for his visionary leadership as President, but much less about his prodigious activity as a general surgeon and for his academic contributions as a clinical researcher and surgical educator. His general surgery training at the Mayo Clinic from 1935 to 1939 was extensive, having been involved in over 2000 operations. Dr Clark then began a prodigious surgery practice for 2 years in Jackson, MS. He described his clinical practice: "I have done more than 600 major operations a year, of all types-from the brain to the colon". He was commissioned into the Army Air Force in 1942, as Chief of Surgical Services, with 30 surgeons at a 1000-bed hospital in North Carolina. In 1944, he transferred to Wright Patterson Field in Dayton, OH, as Chief of the Experimental Surgical Unit. He published numerous articles about surgical problems in aviation medicine and edited the journal Air Surgeon's Bulletin. His final assignment in 1945 was Chairman of the Department of Surgery at Randolph Field in San Antonio, TX. On 12 July 1946, after a rather turbulent and vacillating recruitment process, Dr Clark received a unanimous vote by the University of Texas Board of Regents to become the first permanent Director and Surgeon-in-Chief, and so, Randolph Lee Clark Jr began the most productive and impactful phase of his career.
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Affiliation(s)
- Charles M Balch
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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24
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Jia M, Liao N, Chen B, Zhang G, Wang Y, Li X, Cao L, Mok H, Ren C, Li K, Li C, Wen L, Lin J, Wei G, Balch CM. PIK3CA somatic alterations in invasive breast cancers: different spectrum from Caucasians to Chinese detected by next generation sequencing. Breast Cancer 2021; 28:644-652. [PMID: 33386585 PMCID: PMC8065000 DOI: 10.1007/s12282-020-01199-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/15/2020] [Accepted: 11/27/2020] [Indexed: 12/31/2022]
Abstract
Purpose Somatic alteration of phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) is a crucial therapeutic target in breast cancer (BC) and PI3Kα-specific inhibitor Alpelisib has been used in clinics. This study investigates the PIK3CA alterations in Chinese and Caucasians BC patients for the purpose of selecting anti-PI3K therapy. Methods The molecular profile of the PIK3CA gene was analyzed in 412 Chinese patients with untreated invasive BC using a 540 gene next-generation sequencing panel. The results were compared with data of the Caucasian BC patients in The Cancer Genome Atlas (TCGA-white). Results PIK3CA alterations were frequently found in BC of estrogen receptor (ER) positive (49.3%, p = 0.024), low ki67 proliferation index (58.3%, p = 0.007) and low pathological grade (grade I/II/III 80%, 53.4%, 35.9%, p < 0.001). Compared to TCGA-white, Chinese BC patients had a higher alteration frequency (45.6% vs. 34.7%, p < 0.001) with larger proportion of p.H1047R mutation among three common mutation sites (p.E545K, p.E542K and p.H1047R) (66.1% vs. 43.7%, p = 0.01). Across four molecular subtypes, ER + /human epidermal growth factor receptor 2 positive (HER2 +) tumors harbored the most PIK3CA alterations (51.6%), while ER-/HER2- harbored the least alteration (30.0%) but the most copy number amplification (19.05%). Conclusion PIK3CA alterations prevail in Chinese BC patients and have different molecular features compared to that of Caucasians. The results provide precise annotations of PIK3CA genomic alterations of Chinese in the context of application of PIK3CA inhibitor.
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Affiliation(s)
- Minghan Jia
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
| | - Ning Liao
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China. .,School of Medicine, South China University of Technology, Guangzhou, China. .,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| | - Bo Chen
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
| | - Guochun Zhang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
| | - Yulei Wang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
| | - Xuerui Li
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
| | - Li Cao
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
| | - Hsiaopei Mok
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
| | - Chongyang Ren
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
| | - Kai Li
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
| | - Cheukfai Li
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
| | - Lingzhu Wen
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
| | - Jiali Lin
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Guangnan Wei
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China.,School of Medicine, South China University of Technology, Guangzhou, China
| | - Charles M Balch
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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25
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Li K, Liao N, Chen B, Zhang G, Wang Y, Guo L, Wei G, Jia M, Wen L, Ren C, Cao L, Mok H, Li C, Lin J, Chen X, Zhang Z, Hou T, Li M, Liu J, Balch CM, Liao N. Genetic mutation profile of Chinese HER2-positive breast cancers and genetic predictors of responses to Neoadjuvant anti-HER2 therapy. Breast Cancer Res Treat 2020; 183:321-332. [PMID: 32638235 PMCID: PMC7383038 DOI: 10.1007/s10549-020-05778-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/06/2020] [Accepted: 06/26/2020] [Indexed: 12/20/2022]
Abstract
Purpose Despite the therapeutic success of existing HER2-targeted therapies, tumors respond quite differently to them. This study aimed at figuring out genetic mutation profile of Chinese HER2-positive patients and investigating predictive factors of neoadjuvant anti-HER2 responses. Methods We employed two cohorts. The first cohort was comprised of 181 HER2-positive patients treated at Guangdong Provincial People’s Hospital from 2012 to 2018. The second cohort included 40 patients from the first cohort who underwent HER2-targeted neoadjuvant chemotherapy. Genetic mutations were characterized using next-generation sequencing. We employed the most commonly used definition of pathological complete response (pCR)-eradication of tumor from both breast and lymph nodes (ypT0/is ypN0). Results In Chinese HER2-positive breast cancer patients, TP53 (74.6%), CDK12 (64.6%) and PIK3CA (46.4%) have the highest mutation frequencies. In cohort 2, significant differences were found between pCR and non-pCR groups in terms of the initial Ki67 status, TP53 missense mutations, TP53 LOF mutations, PIK3CA mutations and ROS1 mutations (p = 0.028, 0.019, 0.005, 0.013, 0.049, respectively). Furthermore, TP53 LOF mutations and initial Ki67 status (OR 7.086, 95% CI 1.366–36.749, p = 0.020 and OR 6.007, 95% CI 1.120–32.210, p = 0.036, respectively) were found to be predictive of pCR status. Conclusion TP53 LOF mutations and initial Ki67 status in HER2-positive breast cancer are predictive of pCR status after HER2-targeted NACT.
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Affiliation(s)
- Kai Li
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Ning Liao
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China.,School of Medicine, South China University of Technology, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Bo Chen
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Guochun Zhang
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Yulei Wang
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Liping Guo
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Guangnan Wei
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China.,School of Medicine, South China University of Technology, Guangzhou, China
| | - Minghan Jia
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Lingzhu Wen
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Chongyang Ren
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Li Cao
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Hsiaopei Mok
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Cheukfai Li
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Jiali Lin
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaoqing Chen
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | | | - Ting Hou
- Burning Rock Biotech, Guangzhou, China
| | - Min Li
- Burning Rock Biotech, Guangzhou, China
| | - Jing Liu
- Burning Rock Biotech, Guangzhou, China
| | - Charles M Balch
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ning Liao
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China. .,School of Medicine, South China University of Technology, Guangzhou, China. .,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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Hwang ES, Balch CM, Balch GC, Feldman SM, Golshan M, Grobmyer SR, Libutti SK, Margenthaler JA, Sasidhar M, Turaga KK, Wong SL, McMasters KM, Tanabe KK. Surgical Oncologists and the COVID-19 Pandemic: Guiding Cancer Patients Effectively through Turbulence and Change. Ann Surg Oncol 2020; 27:2600-2613. [PMID: 32535870 PMCID: PMC7293588 DOI: 10.1245/s10434-020-08673-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 05/17/2020] [Indexed: 12/27/2022]
Abstract
Background The COVID-19 pandemic has posed extraordinary demands from patients, providers, and health care systems. Despite this, surgical oncologists must maintain focus on providing high-quality, empathetic care for the almost 2 million patients nationally who will be diagnosed with operable cancer this year. The focus of hospitals is transitioning from initial COVID-19 preparedness activities to a more sustained approach to cancer care. Methods Editorial Board members provided observations of the implications of the pandemic on providing care to surgical oncology patients. Results Strategies are presented that have allowed institutions to successfully prepare for cancer care during COVID-19, as well as other strategies that will help hospitals and surgical oncologists manage anticipated challenges in the near term. Perspectives are provided on: (1) maintaining a safe environment for surgical oncology care; (2) redirecting the multidisciplinary model to guide surgical decisions; (3) harnessing telemedicine to accommodate requisite physical distancing; (4) understanding interactions between SARS CoV-2 and cancer therapy; (5) considering the ethical impact of professional guidelines for surgery prioritization; and (6) advocating for our patients who require oncologic surgery in the midst of the COVID-19 pandemic. Conclusions Until an effective vaccine becomes available for widespread use, it is imperative that surgical oncologists remain focused on providing optimal care for our cancer patients while managing the demands that the COVID-19 pandemic will continue to impose on all of us.
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Affiliation(s)
- E Shelley Hwang
- Department of Surgery, Duke University and Duke Cancer Institute, Durham, NC, USA
| | - Charles M Balch
- Division of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Glen C Balch
- Department of Surgery, Emory University, Atlanta, GA, USA
| | - Sheldon M Feldman
- Department of Surgery, Montefiore Einstein Center for Cancer Care, Bronx, NY, USA
| | - Mehra Golshan
- Department of Surgery, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA, USA
| | - Stephen R Grobmyer
- Oncology Institute, and Pulmonary and Critical Care Medicine Institutes, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Julie A Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Madhu Sasidhar
- Oncology Institute, and Pulmonary and Critical Care Medicine Institutes, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Kiran K Turaga
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Sandra L Wong
- Department of Surgery, Geisel School of Medicine, Dartmouth, NH, USA
| | - Kelly M McMasters
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kenneth K Tanabe
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
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Balch CM, Harvey Sevier C. Origins of the National Comprehensive Cancer Network. J Natl Compr Canc Netw 2020; 18:499-502. [DOI: 10.6004/jnccn.2020.7555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wei X, Wu D, Li H, Zhang R, Chen Y, Yao H, Chi Z, Sheng X, Cui C, Bai X, Qi Z, Li K, Lan S, Chen L, Guo R, Yao X, Mao L, Lian B, Kong Y, Dai J, Tang B, Yan X, Wang X, Li S, Zhou L, Balch CM, Si L, Guo J. The Clinicopathological and Survival Profiles Comparison Across Primary Sites in Acral Melanoma. Ann Surg Oncol 2020; 27:3478-3485. [PMID: 32253677 PMCID: PMC7410855 DOI: 10.1245/s10434-020-08418-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 11/17/2019] [Indexed: 01/10/2023]
Abstract
Background The clinicopathological and survival profiles across primary sites in acral melanoma (AM) are still controversial and unclear. Methods This is a multi-center retrospective study. Clinicopathological data of AM patients diagnosed between 1 January 2000 and 31 December 2017 from 6 large tertiary hospitals in China were extracted. Chi square tests were used to compare basic characteristics between primary sites of sole, palm and nail bed. Melanoma-specific survival (MSS) differences based on primary sites were compared by log-rank tests and multivariate Cox regressions were used to identify prognostic factors for MSS. Results In total, 1157 AM patients were included. The sole group had a more advanced initial stage, deeper Breslow thickness, higher recurrence rate and distant metastases risk (all P < 0.05). The proportion of age < 65 years and ulceration were statistically lower in nail bed and palm groups, respectively. A total of 294 patients underwent sentinel lymph node biopsy and rates of positive SLN status had no statistical difference across primary sites. Among 701 patients with genetic profiles, the mutational frequency of BRAF, C-KIT, and PDGFRA were similar except for NRAS (higher in sole group, P = 0.0102). The median MSS of sole, nail bed and palm patients were 65.0 months, 112.0 months, and not reached, respectively (log-rank P = 0.0053). In multivariate analyses, primary site, initial stage, ulceration and recurrence were the prognostic factors for MSS in overall population, but the statistical significance varied over primary sites. Conclusions Substantial clinicopathological and survival heterogeneities exist across different primary sites in the AM population. Sole melanoma has worse prognosis compared with palm and nail bed subtypes.
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Affiliation(s)
- Xiaoting Wei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Di Wu
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Hang Li
- Department of Dermatology, National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, Beijing, China
| | - Rui Zhang
- Department of Colorectal Surgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China
| | - Yu Chen
- Department of Medical Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Hong Yao
- Department of Cancer Biotherapy Center, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhihong Chi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Xinan Sheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Chuanliang Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Xue Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Zhonghui Qi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Ke Li
- Department of Cancer Biotherapy Center, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shijie Lan
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Lizhu Chen
- Department of Medical Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Rui Guo
- Department of Colorectal Surgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China
| | - Xinyu Yao
- Department of Dermatology, National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, Beijing, China
| | - Lili Mao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Bin Lian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Yan Kong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Jie Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Bixia Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Xieqiao Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Xuan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Siming Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Li Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Charles M Balch
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lu Si
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China.
| | - Jun Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China.
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Balch CM. Special Article Celebrating SSO 80th Anniversary: William Stewart MacComb—The Father of the Society of Surgical Oncology (SSO) and a Pioneering Surgical Oncologist. Ann Surg Oncol 2020; 27:2141-2148. [DOI: 10.1245/s10434-020-08340-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Indexed: 11/18/2022]
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Chen B, Zhang G, Wei G, Wang Y, Guo L, Lin J, Li K, Mok H, Cao L, Ren C, Wen L, Jia M, Li C, Hou T, Han-Zhang H, Liu J, Balch CM, Liao N. Heterogeneity of genomic profile in patients with HER2-positive breast cancer. Endocr Relat Cancer 2020; 27:153-162. [PMID: 31905165 DOI: 10.1530/erc-19-0414] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 11/22/2019] [Accepted: 12/24/2019] [Indexed: 11/08/2022]
Abstract
HER2-positive breast cancer is a biologically and clinically heterogeneous disease. Based on the expression of hormone receptors (HR), breast tumors can be further categorized into HR positive and HR negative. Here, we elucidated the comprehensive somatic mutation profile of HR+ and HR- HER2-positive breast tumors to understand their molecular heterogeneity. In this study, 64 HR+/HER2+ and 43 HR-/HER2+ stage I-III breast cancer patients were included. Capture-based targeted sequencing was performed using a panel consisting of 520 cancer-related genes, spanning 1.64 megabases of the human genome. A total of 1119 mutations were detected among the 107 HER2-positive patients. TP53, CDK12 and PIK3CA were the most frequently mutated, with mutation rates of 76, 61 and 49, respectively. HR+/HER2+ tumors had more gene amplification, splice site and frameshift mutations and a smaller number of missense, nonsense and insertion-deletion mutations than HR-/HER2+ tumors. In KEGG analysis, HR+/HER2+ tumors had more mutations in genes involved in homologous recombination (P = 0.004), TGF-beta (P = 0.007) and WNT (P = 0.002) signaling pathways than HR-/HER2+ tumors. Moreover, comparative analysis of our cohort with datasets from The Cancer Genome Atlas and Molecular Taxonomy of Breast Cancer International Consortium revealed the distinct somatic mutation profile of Chinese HER2-positive breast cancer patients. Our study revealed the heterogeneity of somatic mutations between HR+/HER2+ and HR-/HER2+ in Chinese breast cancer patients. The distinct mutation profile and related pathways are potentially relevant in the development of optimal treatment strategies for this subset of patients.
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Affiliation(s)
- Bo Chen
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Guochun Zhang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Guangnan Wei
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yulei Wang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Liping Guo
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiali Lin
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Kai Li
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Hsiaopei Mok
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Li Cao
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Chongyang Ren
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Lingzhu Wen
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Minghan Jia
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Cheukfai Li
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Ting Hou
- Burning Rock Biotech, Guangzhou, Guangdong, China
| | | | - Jing Liu
- Burning Rock Biotech, Guangzhou, Guangdong, China
| | - Charles M Balch
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ning Liao
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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Jia M, Liao N, Chen B, Zhang G, Wang Y, Chen X, Guo L, Cao L, Mok H, Ren C, Li K, Li C, Wen L, Lin J, Wei G, Zhang Z, Balch CM. Abstract P4-09-11: PIK3CA somatic alterations in 412 chinese invasive breast cancers: Higher frequency of mutant H1047R detected by next generation sequencing compared to breast cancer in caucasians. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p4-09-11] [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: 11/16/2022]
Abstract
Abstract
Purpose: Somatic alterations of PIK3CA gene is an important therapeutic target in breast cancer (BC). The PI3Kα-specific inhibitor alpelisib was remarkably active against PIK3CA-mutated, HR-positive/HER2-negative BC in the SOLAR-1 trial. We hypothesized that PIK3CA alterations in Chinese BC patients across different molecular subtypes might differ from other ethnic groups and this information would be useful for selecting anti-PI3K therapy. Methods: The molecular profile of the PIK3CA gene was analyzed in 412 Chinese untreated invasive BC patients with ER/HER2 molecular subtypes, using a 540 gene next-generation sequencing panel. The results were compared to the molecular profile of Caucasian breast cancer patients in The Cancer Genome Atlas(TCGA-white). Results: Compared to wild type, PIK3CA alterations were more frequent in the ER+ subtype (49.3%, p=0.024), and tumors with low ki67 proliferation (58.3%, p=0.007) and low histological grade (grade I/II/III 80%, 53.4%, 35.9%, p<0.001). Compared to TCGA Caucasian race (TCGA-white), Chinese BC patients had a higher alteration frequency (45.6% vs. 34.7%, p<0.001). The p.H1047R mutation predominantly occurred among three hot spots (p.E545K, p.E542K and p.H1047R) for Chinese BC compared to that of the TCGA-white cohort (66.1% vs 43.7%, p=0.01). Nine novel mutation sites of PIK3CA were observed in the Chinese cohort that was absent among Caucasian BC patients. Among the four ER/HER2 molecular subtypes, ER+/HER2+ tumors harbored the most PIK3CA alterations (51.6%), while ER-/HER2- harbored the least (30.0%). However the latter presented the highest frequency of copy number amplification (19.05%). Conclusion: PIK3CA alterations prevail in nearly half of Chinese BC patients and has some different molecular features compared to that of Caucasian BC patients. The PIK3CA distribution patterns differed among four ER/HER2 subtypes. The results provide more insights for evaluating the results of PIK3CA inhibitors.
Citation Format: Minghan Jia, Ning Liao, Bo Chen, Guochun Zhang, Yulei Wang, Xiaoqing Chen, Liping Guo, Li Cao, Hsiaopei Mok, Chongyang Ren, Kai Li, Cheukfai Li, Lingzhu Wen, Jiali Lin, Guangnan Wei, Zhou Zhang, Charles M Balch. PIK3CA somatic alterations in 412 chinese invasive breast cancers: Higher frequency of mutant H1047R detected by next generation sequencing compared to breast cancer in caucasians [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-09-11.
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Affiliation(s)
- Minghan Jia
- 1Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ning Liao
- 1Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bo Chen
- 1Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guochun Zhang
- 1Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yulei Wang
- 1Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaoqing Chen
- 1Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Liping Guo
- 1Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Li Cao
- 1Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hsiaopei Mok
- 1Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chongyang Ren
- 1Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kai Li
- 1Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Cheukfai Li
- 1Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lingzhu Wen
- 1Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiali Lin
- 1Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guangnan Wei
- 1Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences, Guangzhou, China
| | | | - Charles M Balch
- 3Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Abstract
Surgery remains a mainstay in the treatment of most solid cancers. Surgeons have always engaged in various forms of high-quality cancer research to optimize outcomes for their patients, for example, contributing to clinical research and outcomes research as well as health education and public health policy. Over the past decade, however, concerns have been raised about a global decline in the number of surgeons performing basic science research alongside clinical activity - so-called surgeon scientists. Herein, we describe some of the unique obstacles faced by contemporary trainee and practising surgeons engaged in research, as well as providing a perspective on the implications of the diminishing prominence of the surgeon scientist. Finally, we offer some thoughts on potential strategies and future directions for surgical engagement in oncology research to increase the number of research-active surgeons.
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Affiliation(s)
- Robert P Jones
- School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool, UK. .,North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK.
| | - Chandrakanth Are
- Division of Surgical Oncology, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Thomas J Hugh
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Jianmin Xu
- Department of Surgery, Shanghai Zhongshan Hospital, Shanghai, China
| | - Charles M Balch
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Graeme J Poston
- North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK
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Lillemoe HA, Scally CP, Adams CL, Bednarski BK, Balch CM, Aloia TA, Gershenwald JE, Lee JE, Grubbs EG. Complex General Surgical Oncology Fellowship Applicants: Trends over Time and the Impact of Board Certification Eligibility. Ann Surg Oncol 2019; 26:2667-2674. [DOI: 10.1245/s10434-019-07420-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Indexed: 11/18/2022]
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LIAN BIN, Cui C, Song X, Zhang X, Wu D, Si L, Chi Z, Sheng X, Zhou L, Mao L, Tang B, Wang X, Li SM, Yan X, Balch CM, Guo J. Mucosal melanoma staging and classification: Firstly established. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e21008] [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: 11/20/2022] Open
Abstract
e21008 Background: Mucosal melanomas (MM) have a significantly worse survival outcome than cutaneous melanoma. The current staging rules for cutaneous melanoma do not apply to mucosal melanoma. Our previous studies have demonstrated mucosal melanomas arising from different anatomic sites can be staged and treated as a single disease entity. We are recommending a new evidence-based staging system for mucosal melanoma. Methods: The mucosal melanoma staging recommendations were made on the basis of a multivariate analysis of 543 patients with stages I, II, and III melanoma and 547 patients with stage IV melanoma to clarify TNM classifications and stage grouping criteria. Results: New staging definitions include the following: (1) in patients with localized melanoma, the depth of tumor invasion of the primary melanomas is the most dominant prognostic factor: T1 for tumor invading mucosa or submucosa; T2 for tumor invading the muscularis propria; T3 for tumor invading adventitia; T4 for tumor invading adjacent structures; (2) The dominant prognostic factor for regional nodal metastases is the number of metastatic nodes: N1 for 1 regional metastatic node; N2 for 2 or more regional metastatic nodes; (3) On the basis of a multivariate analysis of patients with distant metastases, the dominant component in defining the M category is the site of distant metastases (M1:lung only vs. M2:liver only vs. M3:brain only vs. M4:all other visceral metastatic sites). An elevated serum lactate dehydrogenase level would be designated in parenthesis. The staging grouping of mucosal melanoma can be defined as follow: (1) stage I: T1N0M0; (2) Stage II:T2-4N0M0; (3) Stage IIIA: T1-4N1M0, Stage IIIB: T1-4N2M0; (4) Stage IV: anyTanyNM1-4. Conclusions: Using an evidence-based approach, the proposed staging system of mucosal melanoma is the first to be established that reflects our improved understanding of this disease.
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Affiliation(s)
- BIN LIAN
- Peking University Cancer Hospital, Beijing, China
| | | | - Xin Song
- Yunnan Cancer Hospital, Kunming, China
| | - Xiaoshi Zhang
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Di Wu
- The First Hospital of Jilin University, Jilin, China
| | - Lu Si
- Peking University Cancer Hospital, Beijing, China
| | - Zhihong Chi
- Peking University Cancer Hospital, Beijing, China
| | - Xinan Sheng
- Peking University Cancer Hospital, Beijing, China
| | - Li Zhou
- Peking University Cancer Hospital, Beijing, China
| | - Lili Mao
- Peking University Cancer Hospital, Beijing, China
| | - Bixia Tang
- Peking University Cancer Hospital, Beijing, China
| | - Xuan Wang
- Peking University Cancer Hospital, Beijing, China
| | - Si Ming Li
- Peking University Cancer Hospital, Beijing, China
| | - Xieqiao Yan
- Peking University Cancer Hospital, Beijing, China
| | | | - Jun Guo
- Peking University Cancer Hospital and Institute, Beijing Shi, China
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Chen B, Liao N, Zhang GC, Wang Y, Chen X, Guo L, Cao L, Mok H, Ren CY, Li K, Jia M, Li C, Wen LZ, Lin J, Wei G, Hou T, Lizaso A, Liu J, Balch CM. Distinct mutational landscape between HR+ and HR- HER2+ early-stage breast cancer patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.543] [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: 11/20/2022] Open
Abstract
543 Background: HER2 targeted therapy has revolutionized the survival outcomes of early and advanced HER2+ breast cancer (BC). However, among HER2+ patients, the therapeutic response to HER2 inhibitors vary. To understand the molecular mechanism of the variability in therapeutic efficacies, the mutational landscape of HER2+ tumors need to be elucidated. Methods: 107 HER2+ Chinese stage I-III BC patients were included in the study, including 64 HR+ and 43 HR- patients. A majority of the patients were diagnosed with infiltrating ductal carcinoma (99/107). Capture-based targeted sequencing was performed using a panel consisting of 520 cancer-related genes spanning 1.64 MB of the human genome. Results: 1,119 alterations were detected, including 478 single nucleotide variants (SNVs), 14 insertions or deletions, 29 fusions, 593 copy number amplifications (CNA), 2 large genomic rearrangements and 3 CN deletions in 267 genes. Alterations in 99 genes were shared between HR+/HER2+ and HR-/HER2+ tumors; while 123 and 45 genes were only detected in either HR+/HER2+ or HR-/HER2+ tumors, respectively. CNA, splice site and frameshift mutations were significantly more in HR+/HER2+ patients ( p= 0.017). Specifically, CNA in SPOP, CCND1, FGF19, FGF3, FGF4, RNF43, RAD51C, ADGRA4 and MDM4 and various alterations in GATA3 were significantly more among HR+/HER2+ tumors ( p< 0.05). In addition to HER2 amplifications, concurrent fusions in ERBB2 (67%, 4/6), SNVs in ERBB3 (100%, 3/3) and ERBB4 (100%, 1/1) were more likely to be detected in HR+/HER2+ tumors, while concurrent EGFR amplifications were exclusively detected in HR-/HER2+ tumors. The trend of concurrent mutations was consistent with mutation types detected in HER2- tumors based on HR status, wherein EGFR amplifications were more frequent in HR-/HER2- tumors, while SNVs in EGFR, ERBB2, ERBB3 and ERBB4 were more predominant in HR+/HER2- tumors. Based on KEGG pathway analysis, HR+/HER2+ tumors had more frequent alterations in TGFb ( p= 0.007), WNT ( p= 0.002) and homologous recombination ( p= 0.004) pathways than HR-/HER2+ tumors. Furthermore, our data revealed that HR+/HER2+ and HR-/HER2+ patients had comparable TMB ( p= 0.24), with a median TMB of 4.0 mutations/Mb for both. Conclusions: Our study revealed genetic heterogeneity between HR+ and HR- HER2+ tumors. The distinct genetic alterations are potentially relevant in the development of optimal treatment strategies for such patients.
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Affiliation(s)
- Bo Chen
- Guangdong General Hospital & Guangdong Academy of Medical Sciences, Department of Breast Cancer, Guangzhou, China
| | - Ning Liao
- Department of Breast Cancer, Cancer Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guo-Chun Zhang
- Department of Breast Cancer, Cancer Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yulei Wang
- Guangdong General Hospital & Guangdong Academy of Medical Sciences, Department of Breast Cancer, Guangzhou, China
| | - Xiaoqing Chen
- Department of Breast Cancer, Cancer Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Liping Guo
- Department of Breast Cancer, Cancer Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Li Cao
- Department of Breast Cancer, Cancer Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hsiaopei Mok
- Guangdong General Hospital & Guangdong Academy of Medical Sciences, Department of Breast Cancer, Guangzhou, China
| | - Chong-Yang Ren
- Guangdong Academy of Medical Sciences and Guangdong General Hospital, Guangzhou, China
| | - Kai Li
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Minghan Jia
- Department of Breast Cancer, Cancer Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Cheukfai Li
- Guangdong General Hospital & Guangdong Academy of Medical Sciences, Department of Breast Cancer, Guangzhou, China
| | - Ling-Zhu Wen
- Guangdong Academy of Medical Sciences and Guangdong General Hospital, Guangzhou, China
| | - Jiali Lin
- Guangdong General Hospital & Guangdong Academy of Medical Sciences, Department of Breast Cancer, Guangzhou, China
| | - Guangnan Wei
- Guangdong General Hospital & Guangdong Academy of Medical Sciences, Department of Breast Cancer, Guangzhou, China
| | - Ting Hou
- Burning Rock Biotech, Guangzhou, China
| | | | - Jing Liu
- Burning Rock Biotech, Guangzhou, China
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Zhang G, Wang Y, Chen B, Guo L, Cao L, Ren C, Wen L, Li K, Jia M, Li C, Mok H, Chen X, Wei G, Lin J, Zhang Z, Hou T, Han-Zhang H, Liu C, Liu H, Liu J, Balch CM, Meric-Bernstam F, Liao N. Characterization of frequently mutated cancer genes in Chinese breast tumors: a comparison of Chinese and TCGA cohorts. Ann Transl Med 2019; 7:179. [PMID: 31168460 DOI: 10.21037/atm.2019.04.23] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The complexity of breast cancer at the clinical, morphological and genomic levels has been extensively studied in the western population. However, the mutational genomic profiles in Chinese breast cancer patients have not been explored in any detail. Methods We performed targeted sequencing using a panel consisting of 33 breast cancer-related genes to investigate the genomic landscape of 304 consecutive treatment-naïve Chinese breast cancer patients at Guangdong Provincial People's Hospital (GDPH), and further compared the results to those in 453 of Caucasian breast cancer patients from The Cancer Genome Atlas (TCGA). Results The most frequently mutated gene was TP53 (45%), followed by PIK3CA (44%), GATA3 (18%), MAP3K1 (10%), whereas the copy-number amplifications were frequently observed in genes of ERBB2 (24%), MYC (23%), FGFR1 (13%) and CCND1 (10%). Among the 8 most frequently mutated or amplified genes, at least one driver was identifiable in 87.5% (n=267) of our GDPH cohort, revealing the significant contribution of these known driver genes in the development of Chinese breast cancer. Compared to TCGA data, the median age at diagnosis in our cohort was significantly younger (48 vs. 58 years; P<0.001), while the distribution of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2) statuses were similar. The largest difference occurred in HR+/HER2- subtype, where 8 of the 10 driver genes compared had statistically significant differences in their frequency, while there were differences in 2 of 10 driver genes among the TNBC and HR+/HER2+ group, but none in the HR-/HER2+ patients in our cohort compared to the TCGA data. Collectively, the most significant genomic difference was a significantly higher prevalence for TP53 and AKT1 in Chinese patients. Additionally, more than half of TP53-mutation HR+/HER2- Chinese patients (~60%) are likely to harbor more severe mutations in TP53, such as nonsense, indels, and splicing mutations. Conclusions We elucidated the mutational landscape of cancer genes in Chinese breast cancer and further identified significant genomic differences between Asian and Caucasian patients. These results should improve our understanding of pathogenesis and/or metastatic behavior of breast cancer across races/ethnicities, including a better selection of targeted therapies.
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Affiliation(s)
- Guochun Zhang
- Department of Breast Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yulei Wang
- Department of Breast Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Bo Chen
- Department of Breast Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Liping Guo
- Department of Breast Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510000, China
| | - Li Cao
- Department of Breast Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Chongyang Ren
- Department of Breast Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Lingzhu Wen
- Department of Breast Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Kai Li
- Department of Breast Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Minghan Jia
- Department of Breast Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Cheukfai Li
- Department of Breast Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Hsiaopei Mok
- Department of Breast Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xiaoqing Chen
- Department of Breast Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510000, China
| | - Guangnan Wei
- Department of Breast Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China.,School of Medicine, South China University of Technology, Guangzhou 510000, China
| | - Jiali Lin
- Department of Breast Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510000, China
| | - Zhou Zhang
- Burning Rock Biotech, Guangzhou 510000, China
| | - Ting Hou
- Burning Rock Biotech, Guangzhou 510000, China
| | | | | | - Hao Liu
- Burning Rock Biotech, Guangzhou 510000, China
| | - Jing Liu
- Burning Rock Biotech, Guangzhou 510000, China
| | - Charles M Balch
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Funda Meric-Bernstam
- Departments of Breast Surgical Oncology and Investigational Cancer Therapeutics, Institute of Personalized Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ning Liao
- Department of Breast Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510000, China.,School of Medicine, South China University of Technology, Guangzhou 510000, China
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Liao N, Zhang G, Wang Y, Guo L, Cao L, Zhang Z, Balch CM, Meric-Bernstam F. Abstract P4-04-08: Genomic profiling of 304 treatment-naïve Chinese breast cancer patients: A comparison of Chinese and TCGA cohorts. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-04-08] [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: 11/16/2022]
Abstract
Abstract
Background: The complexity of BC at the clinical, morphological and molecular level has been well recognized. Molecular profiling, which reveals the intrinsic biology among subtypes, has significantly advanced the management of this disease. However, previous studies have provided very limited molecular data on Chinese breast cancer patients.
Methods: We performed targeted sequencing using a panel consisting of 36 BC related genes to interrogate the genomic landscape of 304 consecutive treatment-naïve Chinese BC patients and compared our results to the TCGA data set.
Results: Comparing to TCGA, our cohort had significantly fewer patients with triple negative breast cancer (8.2% vs 15.5% p=0.002). The most prominent genomic difference was our cohort had significantly higher TP53mutation frequency in HR+/HER2- and HR+/HER2+ groups. The composition of TP53 mutations also differed significantly between two cohorts in HR+/HER2- group, with TCGA cohort having missense mutation as the predominant mutation; whereas, in our cohort, nonsense and frameshift mutations were predominant. We classified the most populated and diverse group of HR+/HER2- cancer into 4 subgroups based on molecular signature. The clinical significance of this proposed classification was confirmed by differences in overall survival using data from the TCGA.
Conclusions:We identified distinctive genomic patterns associated with Chinese breast cancer patients compared to TCGA data, suggesting the importance of mutation-based stratification according to ethnic status. To the best of our knowledge, this is one of the largest study of Chinese BC patients that interrogated the spectrum of mutational events and correlated these molecular signatures with clinical outcomes.
This study was supported by funding from National Natural Science Foundation of China (Grant No. 81602645), Guangdong Provincial Natural Science Foundation (Grant No. 2016A030313768) and Research Funds from Guangzhou Science and Technology Bureau (Grant No. 201707010418 and 201804010430).
Citation Format: Liao N, Zhang G, Wang Y, Guo L, Cao L, Zhang Z, Balch CM, Meric-Bernstam F. Genomic profiling of 304 treatment-naïve Chinese breast cancer patients: A comparison of Chinese and TCGA cohorts [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-04-08.
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Affiliation(s)
- N Liao
- Cancer Center Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Burning Rock Biotech, Guangzhou, Guangdong, China; University of Texas MD Anderson Cancer Center, Houston, TX; Institute of Personalized Cancer Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - G Zhang
- Cancer Center Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Burning Rock Biotech, Guangzhou, Guangdong, China; University of Texas MD Anderson Cancer Center, Houston, TX; Institute of Personalized Cancer Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Y Wang
- Cancer Center Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Burning Rock Biotech, Guangzhou, Guangdong, China; University of Texas MD Anderson Cancer Center, Houston, TX; Institute of Personalized Cancer Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - L Guo
- Cancer Center Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Burning Rock Biotech, Guangzhou, Guangdong, China; University of Texas MD Anderson Cancer Center, Houston, TX; Institute of Personalized Cancer Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - L Cao
- Cancer Center Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Burning Rock Biotech, Guangzhou, Guangdong, China; University of Texas MD Anderson Cancer Center, Houston, TX; Institute of Personalized Cancer Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Z Zhang
- Cancer Center Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Burning Rock Biotech, Guangzhou, Guangdong, China; University of Texas MD Anderson Cancer Center, Houston, TX; Institute of Personalized Cancer Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - CM Balch
- Cancer Center Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Burning Rock Biotech, Guangzhou, Guangdong, China; University of Texas MD Anderson Cancer Center, Houston, TX; Institute of Personalized Cancer Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - F Meric-Bernstam
- Cancer Center Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Burning Rock Biotech, Guangzhou, Guangdong, China; University of Texas MD Anderson Cancer Center, Houston, TX; Institute of Personalized Cancer Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX
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Hewitt DB, Merkow RP, DeLancey JO, Wayne JD, Hyngstrom JR, Russell MC, Gerami P, Balch CM, Bilimoria KY. National practice patterns of completion lymph node dissection for sentinel node-positive melanoma. J Surg Oncol 2018; 118:493-500. [DOI: 10.1002/jso.25160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/16/2018] [Indexed: 01/28/2023]
Affiliation(s)
- D. Brock Hewitt
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies; Feinberg School of Medicine, Northwestern University; Chicago Illinois
- Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER-Onc), Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Feinberg School of Medicine, Northwestern University; Chicago Illinois
- Department of Surgery; Thomas Jefferson University Hospital; Philadelphia Pennsylvania
| | - Ryan P. Merkow
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies; Feinberg School of Medicine, Northwestern University; Chicago Illinois
- Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER-Onc), Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Feinberg School of Medicine, Northwestern University; Chicago Illinois
| | - John Oliver DeLancey
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies; Feinberg School of Medicine, Northwestern University; Chicago Illinois
| | - Jeffrey D. Wayne
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies; Feinberg School of Medicine, Northwestern University; Chicago Illinois
| | - John R. Hyngstrom
- Division of General Surgery; Huntsman Cancer Institute, University of Utah Health Care; Salt Lake City Utah
| | - Maria C. Russell
- Division of Surgical Oncology, Department of Surgery; Emory University School of Medicine; Atlanta Georgia
| | - Pedram Gerami
- Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER-Onc), Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Feinberg School of Medicine, Northwestern University; Chicago Illinois
| | - Charles M. Balch
- Division of Surgery; University of Texas MD Anderson Cancer Center; Houston Texas
| | - Karl Y. Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies; Feinberg School of Medicine, Northwestern University; Chicago Illinois
- Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER-Onc), Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Feinberg School of Medicine, Northwestern University; Chicago Illinois
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Balch CM. Detection of melanoma metastases with the sentinel node biopsy: the legacy of Donald L. Morton, MD (1934-2014). Clin Exp Metastasis 2018; 35:425-429. [PMID: 29855858 DOI: 10.1007/s10585-018-9908-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/22/2018] [Accepted: 05/29/2018] [Indexed: 01/07/2023]
Abstract
Dr. Donald L. Morton was clearly the pioneer of the sentinel node biopsy, which was a major advance in oncology that has improved the management of cancer patients worldwide. He conducted a series of practice-changing clinical trials to validate the important staging role of the sentinel lymph node biopsy for melanoma, and also spawned other studies that demonstrated its staging value in multiple other cancer types, most notably in breast cancer, gastric cancer, and colorectal cancer. His many contributions in this field have provided a unique opportunity to study host/tumor relationships, since the sentinel lymph node is the first location were the host immune defenses are confronted with metastasis arising from the primary cancer.
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Affiliation(s)
- Charles M Balch
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Davis CH, Bass BL, Behrns KE, Lillemoe KD, Garden OJ, Roh MS, Lee JE, Balch CM, Aloia TA. Reviewing the review: a qualitative assessment of the peer review process in surgical journals. Res Integr Peer Rev 2018; 3:4. [PMID: 29850109 PMCID: PMC5964882 DOI: 10.1186/s41073-018-0048-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite rapid growth of the scientific literature, no consensus guidelines have emerged to define the optimal criteria for editors to grade submitted manuscripts. The purpose of this project was to assess the peer reviewer metrics currently used in the surgical literature to evaluate original manuscript submissions. METHODS Manuscript grading forms for 14 of the highest circulation general surgery-related journals were evaluated for content, including the type and number of quantitative and qualitative questions asked of peer reviewers. Reviewer grading forms for the seven surgical journals with the higher impact factors were compared to the seven surgical journals with lower impact factors using Fisher's exact tests. RESULTS Impact factors of the studied journals ranged from 1.73 to 8.57, with a median impact factor of 4.26 in the higher group and 2.81 in the lower group. The content of the grading forms was found to vary considerably. Relatively few journals asked reviewers to grade specific components of a manuscript. Higher impact factor journal manuscript grading forms more frequently addressed statistical analysis, ethical considerations, and conflict of interest. In contrast, lower impact factor journals more commonly requested reviewers to make qualitative assessments of novelty/originality, scientific validity, and scientific importance. CONCLUSION Substantial variation exists in the grading criteria used to evaluate original manuscripts submitted to the surgical literature for peer review, with differential emphasis placed on certain criteria correlated to journal impact factors.
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Affiliation(s)
- Catherine H. Davis
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Herman Pressler, Unit 1484, Houston, TX 77030 USA
- Department of Surgery, Houston Methodist Hospital, Houston, TX USA
| | - Barbara L. Bass
- Department of Surgery, Houston Methodist Hospital, Houston, TX USA
| | - Kevin E. Behrns
- Department of Surgery, Saint Louis University School of Medicine, Saint Louis, MO USA
| | - Keith D. Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | | | - Mark S. Roh
- Orlando Health, The University of Florida Health Cancer Center, Orlando, FL USA
| | - Jeffrey E. Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Herman Pressler, Unit 1484, Houston, TX 77030 USA
| | - Charles M. Balch
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Herman Pressler, Unit 1484, Houston, TX 77030 USA
| | - Thomas A. Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Herman Pressler, Unit 1484, Houston, TX 77030 USA
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Balch CM. Revolutionary Advances in Immunotherapy for Melanoma Are Coming into the Surgical Arena: Are We Ready? Ann Surg Oncol 2018; 25:1803-1806. [PMID: 29752603 DOI: 10.1245/s10434-018-6516-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Charles M Balch
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Cui C, Lian B, Zhou L, Song X, Zhang X, Wu D, Chi Z, Si L, Sheng X, Kong Y, Tang B, Mao L, Wang X, Li S, Dai J, Yan X, Bai X, Balch CM, Guo J. Multifactorial Analysis of Prognostic Factors and Survival Rates Among 706 Mucosal Melanoma Patients. Ann Surg Oncol 2018; 25:2184-2192. [PMID: 29748886 DOI: 10.1245/s10434-018-6503-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The hypothesis that mucosal melanomas from different anatomic sites would have different prognostic features and survival outcome was tested in a multifactorial analysis. METHODS Complete clinical and pathological information from 706 mucosal melanoma patients from different anatomical sites was compared for overall survival (OS) and prognostic factors. RESULTS Mucosal melanomas arising from different anatomical sites did not have any significant differences in OS in a multivariate analysis (p = 0.721). Among all 706 stage I-IV mucosal melanoma patients, depth of tumor invasion (p < 0.001), number of lymph node metastases (p < 0.001), and sites of distant metastases (p < 0.001) were independent prognostic factors for OS; among 543 stage I-III patients, depth of tumor invasion (p < 0.001) and number of lymph node metastases (p < 0.001) were independent prognostic factors for OS; and among 547 stage IV patients, depth of tumor invasion (p = 0.009), number of lymph node metastases (p < 0.001), and combined distant metastases and elevation of serum lactate dehydrogenase (LDH; p < 0.001) were independent prognostic factors for OS. The presence of c-KIT or BRAF mutations was not predictive of survival. CONCLUSIONS This is the first large-scale study comparing outcomes of mucosal melanomas from different anatomic sites in a multifactorial analysis. There were no significant survival differences among mucosal melanomas arising at different sites when matched for staging and prognostic and molecular factors, thus rejecting our hypothesis. We concluded that prognostic characteristics of mucosal melanomas can be staged as a single histological group, regardless of the anatomic site of the primary tumor.
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Affiliation(s)
- ChuanLiang Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Bin Lian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Li Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xin Song
- Yunnan Cancer Hospital, Kunming, China
| | - XiaoShi Zhang
- SUN YAT-SEN University Cancer Center, Guangzhou, China
| | - Di Wu
- The First Hospital of Jilin University, Changchun, China
| | - ZhiHong Chi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lu Si
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - XiNan Sheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yan Kong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - BiXia Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - LiLi Mao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xuan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - SiMing Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jie Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - XieQiao Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xue Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Charles M Balch
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Jun Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.
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Balch CM, McMasters KM, Klimberg VS, Pawlik TM, Posner MC, Roh M, Tanabe KK, Whippen D, Ikoma N. Steps to Getting Your Manuscript Published in a High-Quality Medical Journal. Ann Surg Oncol 2018; 25:850-855. [PMID: 29349528 DOI: 10.1245/s10434-017-6320-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Indexed: 12/24/2022]
Abstract
Publication of your research represents the culmination of your scientific activities. The key to getting manuscripts accepted is to make them understandable and informative so that your colleagues will read and benefit from them. We describe key criteria for acceptance of manuscripts and outline a multi-step process for writing the manuscript. The likelihood that a manuscript will be accepted by a major journal is significantly increased if the manuscript is written in polished and fluent scientific English. Although scientific quality is the most important consideration, clear and concise writing often makes the difference between acceptance and rejection. As with any skill, efficient writing of high-quality manuscripts comes with experience and repetition. It is very uncommon for a manuscript to be accepted as submitted to a journal. Thoughtful and respectful responses to the journal reviewers' comments are critical. Success in scientific writing, as in surgery, is dependent on effort, repetition, and commitment. The transfer of knowledge through a well-written publication in a high-quality medical journal will have an impact not only in your own institution and country, but also throughout the world.
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Affiliation(s)
- Charles M Balch
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Kelly M McMasters
- Department of Surgery, University of Louisville, Louisville, KY, USA
| | - V Suzanne Klimberg
- Division of Surgical Oncology, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | | | | | - Mark Roh
- UF Health Cancer Center, Orlando Health, Orlando, FL, USA
| | - Kenneth K Tanabe
- Division of Surgical Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Deborah Whippen
- Editorial Office, Annals of Surgical Oncology, North Fort Myers, FL, USA
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Wong SL, Faries MB, Kennedy EB, Agarwala SS, Akhurst TJ, Ariyan C, Balch CM, Berman BS, Cochran A, Delman KA, Gorman M, Kirkwood JM, Moncrieff MD, Zager JS, Lyman GH. Sentinel Lymph Node Biopsy and Management of Regional Lymph Nodes in Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update. Ann Surg Oncol 2017; 25:356-377. [PMID: 29236202 DOI: 10.1245/s10434-017-6267-7] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE To update the American Society of Clinical Oncology (ASCO)-Society of Surgical Oncology (SSO) guideline for sentinel lymph node (SLN) biopsy in melanoma. METHODS An ASCO-SSO panel was formed, and a systematic review of the literature was conducted regarding SLN biopsy and completion lymph node dissection (CLND) after a positive sentinel node in patients with melanoma. RESULTS Nine new observational studies, two systematic reviews and an updated randomized controlled trial (RCT) of SLN biopsy, as well as two randomized controlled trials of CLND after positive SLN biopsy, were included. RECOMMENDATIONS Routine SLN biopsy is not recommended for patients with thin melanomas that are T1a (non-ulcerated lesions < 0.8 mm in Breslow thickness). SLN biopsy may be considered for thin melanomas that are T1b (0.8 to 1.0 mm Breslow thickness or <0.8 mm Breslow thickness with ulceration) after a thorough discussion with the patient of the potential benefits and risk of harms associated with the procedure. SLN biopsy is recommended for patients with intermediate-thickness melanomas (T2 or T3; Breslow thickness of >1.0 to 4.0 mm). SLN biopsy may be recommended for patients with thick melanomas (T4; > 4.0 mm in Breslow thickness), after a discussion of the potential benefits and risks of harm. In the case of a positive SLN biopsy, CLND or careful observation are options for patients with low-risk micrometastatic disease, with due consideration of clinicopathological factors. For higher risk patients, careful observation may be considered only after a thorough discussion with patients about the potential risks and benefits of foregoing CLND. Important qualifying statements outlining relevant clinicopathological factors, and details of the reference patient populations are included within the guideline.
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Affiliation(s)
- Sandra L Wong
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Mark B Faries
- The Angeles Clinic and Research Institute, Santa Monica, CA, USA
| | - Erin B Kennedy
- American Society of Clinical Oncology, Alexandria, VA, USA.
| | | | | | | | | | | | - Alistair Cochran
- Los Angeles Center for Health Services, University of California, Los Angeles, CA, USA
| | | | | | - John M Kirkwood
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | | | - Jonathan S Zager
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Wong SL, Faries MB, Kennedy EB, Agarwala SS, Akhurst TJ, Ariyan C, Balch CM, Berman BS, Cochran A, Delman KA, Gorman M, Kirkwood JM, Moncrieff MD, Zager JS, Lyman GH. Sentinel Lymph Node Biopsy and Management of Regional Lymph Nodes in Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update. J Clin Oncol 2017; 36:399-413. [PMID: 29232171 DOI: 10.1200/jco.2017.75.7724] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Purpose To update the American Society of Clinical Oncology (ASCO)-Society of Surgical Oncology (SSO) guideline for sentinel lymph node (SLN) biopsy in melanoma. Methods An ASCO-SSO panel was formed, and a systematic review of the literature was conducted regarding SLN biopsy and completion lymph node dissection (CLND) after a positive sentinel node in patients with melanoma. Results Nine new observational studies, two systematic reviews, and an updated randomized controlled trial of SLN biopsy, as well as two randomized controlled trials of CLND after positive SLN biopsy, were included. Recommendations Routine SLN biopsy is not recommended for patients with thin melanomas that are T1a (nonulcerated lesions < 0.8 mm in Breslow thickness). SLN biopsy may be considered for thin melanomas that are T1b (0.8 to 1.0 mm Breslow thickness or < 0.8 mm Breslow thickness with ulceration) after a thorough discussion with the patient of the potential benefits and risk of harms associated with the procedure. SLN biopsy is recommended for patients with intermediate-thickness melanomas (T2 or T3; Breslow thickness of > 1.0 to 4.0 mm). SLN biopsy may be recommended for patients with thick melanomas (T4; > 4.0 mm in Breslow thickness), after a discussion of the potential benefits and risks of harm. In the case of a positive SLN biopsy, CLND or careful observation are options for patients with low-risk micrometastatic disease, with due consideration of clinicopathological factors. For higher-risk patients, careful observation may be considered only after a thorough discussion with patients about the potential risks and benefits of foregoing CLND. Important qualifying statements outlining relevant clinicopathological factors and details of the reference patient populations are included within the guideline. Additional information is available at www.asco.org/melanoma-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Sandra L Wong
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mark B Faries
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Erin B Kennedy
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Sanjiv S Agarwala
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Timothy J Akhurst
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Charlotte Ariyan
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Charles M Balch
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Barry S Berman
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Alistair Cochran
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Keith A Delman
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mark Gorman
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - John M Kirkwood
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Marc D Moncrieff
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jonathan S Zager
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Gary H Lyman
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
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Balch CM, Roh M, McMasters KM, Whippen D. Celebrating the Annals of Surgical Oncology's 25-Year Anniversary: One of the Most Cited Surgical Journals in the World. Ann Surg Oncol 2017; 25:1-4. [PMID: 29214449 DOI: 10.1245/s10434-017-6261-0] [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] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Charles M Balch
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark Roh
- UF Health Cancer Center-Orlando Health, Orlando, USA
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Balch CM, Roh MS, Hubona CM. The Annals of Surgical Oncology: An Oncology Journal for Surgeons. Ann Surg Oncol 2017; 25:5-6. [DOI: 10.1245/s10434-017-6288-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Indexed: 11/18/2022]
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Gershenwald JE, Scolyer RA, Hess KR, Sondak VK, Long GV, Ross MI, Lazar AJ, Faries MB, Kirkwood JM, McArthur GA, Haydu LE, Eggermont AMM, Flaherty KT, Balch CM, Thompson JF. Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin 2017; 67:472-492. [PMID: 29028110 PMCID: PMC5978683 DOI: 10.3322/caac.21409] [Citation(s) in RCA: 1414] [Impact Index Per Article: 202.0] [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: 06/06/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 02/06/2023] Open
Abstract
Answer questions and earn CME/CNE To update the melanoma staging system of the American Joint Committee on Cancer (AJCC) a large database was assembled comprising >46,000 patients from 10 centers worldwide with stages I, II, and III melanoma diagnosed since 1998. Based on analyses of this new database, the existing seventh edition AJCC stage IV database, and contemporary clinical trial data, the AJCC Melanoma Expert Panel introduced several important changes to the Tumor, Nodes, Metastasis (TNM) classification and stage grouping criteria. Key changes in the eighth edition AJCC Cancer Staging Manual include: 1) tumor thickness measurements to be recorded to the nearest 0.1 mm, not 0.01 mm; 2) definitions of T1a and T1b are revised (T1a, <0.8 mm without ulceration; T1b, 0.8-1.0 mm with or without ulceration or <0.8 mm with ulceration), with mitotic rate no longer a T category criterion; 3) pathological (but not clinical) stage IA is revised to include T1b N0 M0 (formerly pathologic stage IB); 4) the N category descriptors "microscopic" and "macroscopic" for regional node metastasis are redefined as "clinically occult" and "clinically apparent"; 5) prognostic stage III groupings are based on N category criteria and T category criteria (ie, primary tumor thickness and ulceration) and increased from 3 to 4 subgroups (stages IIIA-IIID); 6) definitions of N subcategories are revised, with the presence of microsatellites, satellites, or in-transit metastases now categorized as N1c, N2c, or N3c based on the number of tumor-involved regional lymph nodes, if any; 7) descriptors are added to each M1 subcategory designation for lactate dehydrogenase (LDH) level (LDH elevation no longer upstages to M1c); and 8) a new M1d designation is added for central nervous system metastases. This evidence-based revision of the AJCC melanoma staging system will guide patient treatment, provide better prognostic estimates, and refine stratification of patients entering clinical trials. CA Cancer J Clin 2017;67:472-492. © 2017 American Cancer Society.
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Affiliation(s)
- Jeffrey E. Gershenwald
- Professor of Surgery and Cancer Biology, Department of Surgical Oncology; Medical Director, Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard A. Scolyer
- Conjoint Medical Director, Melanoma Institute Australia; Clinical Professor, The University of Sydney, Sydney, New South Wales, Australia
- Senior Staff Pathologist, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kenneth R. Hess
- Professor, Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vernon K. Sondak
- Chair, Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL
| | - Georgina V. Long
- Conjoint Medical Director and Chair of Melanoma Medical Oncology and Translational Research, Melanoma Institute Australia, The University of Sydney and Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Merrick I. Ross
- Professor of Surgery, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alexander J. Lazar
- Professor of Pathology, Dermatology, and Translational Molecular Pathology; Director, Melanoma Molecular Diagnostics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mark B. Faries
- Co-Director, Melanoma Program; Head, Surgical Oncology, The Angeles Clinic and Research Institute, Los Angeles, CA
| | - John M. Kirkwood
- Professor of Medicine, Dermatology, and Translational Science, The University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Grant A. McArthur
- Executive Director, Victorian Comprehensive Cancer Center, Melbourne, Victoria, Australia
| | - Lauren E. Haydu
- Manager, Clinical Data Management Systems, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Keith T. Flaherty
- Director, Termeer Center for Targeted Therapy, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Charles M. Balch
- Professor of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John F. Thompson
- Professor of Melanoma and Surgical Oncology, Melanoma Institute Australia, The University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Davis CH, Bass BL, Lillemoe KD, Lee JE, Balch CM, Aloia TA. Reviewing the Review: Assessment of the Peer-Review Process in Surgical Journals. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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