Nationwide comprehensive gastro-intestinal cancer cohorts: the 3P initiative

BACKGROUND

The increasing sub-classification of cancer patients due to more detailed molecular classification of tumors, and limitations of current trial designs, require innovative research designs. We present the design, governance and current standing of three comprehensive nationwide cohorts including pancreatic, esophageal/gastric, and colorectal cancer patients (NCT02070146). Multidisciplinary collection of clinical data, tumor tissue, blood samples, and patient-reported outcome (PRO) measures with a nationwide coverage, provides the infrastructure for future and novel trial designs and facilitates research to improve outcomes of gastrointestinal cancer patients.

MATERIAL AND METHODS

All patients aged ≥18 years with pancreatic, esophageal/gastric or colorectal cancer are eligible. Patients provide informed consent for: (1) reuse of clinical data; (2) biobanking of primary tumor tissue; (3) collection of blood samples; (4) to be informed about relevant newly identified genomic aberrations; (5) collection of longitudinal PROs; and (6) to receive information on new interventional studies and possible participation in cohort multiple randomized controlled trials (cmRCT) in the future.

RESULTS

In 2015, clinical data of 21,758 newly diagnosed patients were collected in the Netherlands Cancer Registry. Additional clinical data on the surgical procedures were registered in surgical audits for 13,845 patients. Within the first two years, tumor tissue and blood samples were obtained from 1507 patients; during this period, 1180 patients were included in the PRO registry. Response rate for PROs was 90%. The consent rate to receive information on new interventional studies and possible participation in cmRCTs in the future was >85%. The number of hospitals participating in the cohorts is steadily increasing.

CONCLUSION

A comprehensive nationwide multidisciplinary gastrointestinal cancer cohort is feasible and surpasses the limitations of classical study designs. With this initiative, novel and innovative studies can be performed in an efficient, safe, and comprehensive setting.

[Evaluation of the density of acetylcholinesterase-positive and intrinsic adrenergic innervation of the uterus in rats]

According to the Karnovsky and Roots modified by E1 Badawi and Schenk's technique for the acetylcholinesterase-positive innervation and according to the Lindvall and Björklund modified by de la Torre and Surgeon's method for the adrenergic one, we have demonstrated the nervous fibers in the different tissues of the cervix, the corpus and the cornu of the she-rat in pro-oestrus. A statistic evaluation of the density of these nervous networks has been established for the different regions. The study of the histograms demonstrates the predominance of acetylcholinesterase-positive innervation versus the adrenergic one. The evolution of the nervous densities is similar for each tissue in the corpus and the cornu, these of the myometrium are the highest. In the cervix, the acetylcholinesterase-positive fibers dominate over the mucosal and submucosal ones, on the other hand, the adrenergic ones are richest in the muscle. Our morphometric studies confirm statistically the optic observations of the others authors.