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Ologun GO, Jones CP, Landrum KR, Pham PV, Ismail S, Long PK, Sorah JD, Stitzenberg KB, Meyers MO, Ollila DW. Clinical and Histological Response to Talimogene Laherparepvec Therapy in Advanced Melanoma: Impact on Overall Survival. J Am Coll Surg 2024; 238:508-516. [PMID: 38224076 DOI: 10.1097/xcs.0000000000000969] [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] [Indexed: 01/16/2024]
Abstract
BACKGROUND Talimogene laherparepvec (T-VEC) is an FDA-approved oncolytic herpesvirus therapy used for unresectable stage IIIB through IV metastatic melanoma. However, the correlation between clinical complete response (cCR) and pathologic complete response (pCR) in patients treated with T-VEC is understudied. STUDY DESIGN We conducted a retrospective study from a prospectively maintained IRB-approved melanoma single-center database in patients treated with T-VEC from October 2015 to April 2022. Patients were categorized into 3 groups: cCR with pCR, cCR without pCR, and less than cCR. The primary endpoint was overall survival. We used descriptive statistics, chi-square tests, and Wilcoxon rank-sum tests to compare key covariates among exposure groups. We used survival analysis to compare survival curves and reported hazard ratio of death (95% CI) across exposure groups. RESULTS We included 116 patients with a median overall survival (interquartile range) of 22.7 (14.8-39.3) months. The majority were men (69%) and White (97.4%), with a median age of 74.5 years. More than half of patients (n = 60, 51.6%) achieved cCR. Distribution among the groups was as follows: cCR with pCR (35.3%), cCR without pCR (16.3%), and less than cCR (48.4%). Median overall survival time (interquartile range) was 26.5 (18.6-36.0) months for cCR with pCR, 22.7 (14.4-35.5) months for cCR without pCR, and 17.8 (9.2-47.0) months for less than cCR (log-rank p value = 0.0033). CONCLUSIONS Patients achieving cCR with pCR after T-VEC therapy have the most favorable overall survival outcomes, whereas those achieving cCR without pCR have inferior survival and those achieving less than cCR have the poorest overall survival outcomes. These findings emphasize the importance of histological confirmation and provide insights for optimizing T-VEC therapy in patients with advanced melanoma.
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Affiliation(s)
- Gabriel O Ologun
- From the Division of Surgical Oncology, Department of Surgery (Ologun, Jones, Pham, Long, Stitzenberg, Meyers, Ollila)
| | - C Paige Jones
- From the Division of Surgical Oncology, Department of Surgery (Ologun, Jones, Pham, Long, Stitzenberg, Meyers, Ollila)
| | - Kelsey R Landrum
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Public Health, Chapel Hill, NC (Landrum, Ismail)
| | - P Veronica Pham
- From the Division of Surgical Oncology, Department of Surgery (Ologun, Jones, Pham, Long, Stitzenberg, Meyers, Ollila)
| | - Sherin Ismail
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Public Health, Chapel Hill, NC (Landrum, Ismail)
| | - Patricia K Long
- From the Division of Surgical Oncology, Department of Surgery (Ologun, Jones, Pham, Long, Stitzenberg, Meyers, Ollila)
| | - Jonathan D Sorah
- Division of Oncology, Department of Medicine (Sorah), University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Karyn B Stitzenberg
- From the Division of Surgical Oncology, Department of Surgery (Ologun, Jones, Pham, Long, Stitzenberg, Meyers, Ollila)
| | - Michael O Meyers
- From the Division of Surgical Oncology, Department of Surgery (Ologun, Jones, Pham, Long, Stitzenberg, Meyers, Ollila)
| | - David W Ollila
- From the Division of Surgical Oncology, Department of Surgery (Ologun, Jones, Pham, Long, Stitzenberg, Meyers, Ollila)
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Fleming AM, Herb J, Stiles ZE, Burkbauer L, Dickson PV, Glazer ES, Shibata D, Murphy AJ, Davidoff AM, Gleeson E, Kim HJ, Meyers MO, Stitzenberg K, Ollila DW, Deneve JL. Lymph node metastases in young patients with gastrointestinal stromal tumor: A nationwide analysis. J Surg Oncol 2023; 128:1268-1277. [PMID: 37650827 DOI: 10.1002/jso.27431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/02/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Children, adolescents, and young adults (CAYA) (age ≤39 years) with GIST have high rates of LNM, but their clinical relevance is undefined. This study analyzed the impact of LNM on overall survival (OS) for CAYA with GIST. METHODS The National Cancer Database was queried for patients with resected GIST and pathologic nodal staging data from 2004-2019. Factors associated with LNM were identified. Survival was assessed stratified by presence of LNM. RESULTS Of 4420 patients with GIST, 238 were CAYA (5.4%). When compared to older adults, CAYA more often had small intestine primaries (51.8% vs. 36.6%, p < 0.0001), T4 tumors (30.7% vs. 24.5%, p = 0.0275) and pN1 disease (11.3% vs. 4.7%, p < 0.0001). Within a multivariable Cox proportional hazards regression model adjusting for age, comorbid disease, mitotic rate, tumor size, and primary site, LNM were associated with increased hazard of death for older adults (hazard ratio [HR]: 1.83; confidence interval [CI]: 1.35-2.42; p < 0.0001), but not CAYA (HR: 3.38; CI: 0.50-14.08; p = 0.13). For CAYA, only high mitotic rate predicted mortality (HR: 4.68; CI: 1.41-18.37: p = 0.02). CONCLUSIONS LNM are more commonly identified among CAYA with resected GIST who undergo lymph node evaluations, but do not appear to impact OS as observed in older adults. High mitotic rate remains a predictor of poor outcomes for CAYA with GIST.
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Affiliation(s)
- Andrew M Fleming
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Joshua Herb
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Zachary E Stiles
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Laura Burkbauer
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Paxton V Dickson
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Evan S Glazer
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - David Shibata
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Andrew J Murphy
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Andrew M Davidoff
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Elizabeth Gleeson
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Hong J Kim
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michael O Meyers
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Karyn Stitzenberg
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David W Ollila
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jeremiah L Deneve
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
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Seth R, Agarwala SS, Messersmith H, Alluri KC, Ascierto PA, Atkins MB, Bollin K, Chacon M, Davis N, Faries MB, Funchain P, Gold JS, Guild S, Gyorki DE, Kaur V, Khushalani NI, Kirkwood JM, McQuade JL, Meyers MO, Provenzano A, Robert C, Santinami M, Sehdev A, Sondak VK, Spurrier G, Swami U, Truong TG, Tsai KK, van Akkooi A, Weber J. Systemic Therapy for Melanoma: ASCO Guideline Update. J Clin Oncol 2023; 41:4794-4820. [PMID: 37579248 DOI: 10.1200/jco.23.01136] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 05/25/2023] [Accepted: 06/09/2023] [Indexed: 08/16/2023] Open
Abstract
PURPOSE To provide guidance to clinicians regarding the use of systemic therapy for melanoma. METHODS American Society of Clinical Oncology convened an Expert Panel and conducted an updated systematic review of the literature. RESULTS The updated review identified 21 additional randomized trials. UPDATED RECOMMENDATIONS Neoadjuvant pembrolizumab was newly recommended for patients with resectable stage IIIB to IV cutaneous melanoma. For patients with resected cutaneous melanoma, adjuvant nivolumab or pembrolizumab was newly recommended for stage IIB-C disease and adjuvant nivolumab plus ipilimumab was added as a potential option for stage IV disease. For patients with unresectable or metastatic cutaneous melanoma, nivolumab plus relatlimab was added as a potential option regardless of BRAF mutation status and nivolumab plus ipilimumab followed by nivolumab was preferred over BRAF/MEK inhibitor therapy. Talimogene laherparepvec is no longer recommended as an option for patients with BRAF wild-type disease who have progressed on anti-PD-1 therapy. Ipilimumab- and ipilimumab-containing regimens are no longer recommended for patients with BRAF-mutated disease after progression on other therapies.This full update incorporates the new recommendations for uveal melanoma published in the 2022 Rapid Recommendation Update.Additional information is available at www.asco.org/melanoma-guidelines.
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Affiliation(s)
- Rahul Seth
- SUNY Upstate Medical University, Syracuse, NY
| | - Sanjiv S Agarwala
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | | | | | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | | | | | - Matias Chacon
- Instituto Alexander Fleming, Buenos Aires, Argentina
| | - Nancy Davis
- Vanderbilt University Medical Center, Nashville, TN
| | - Mark B Faries
- The Angeles Clinic and Research Institute and Cedars Sinai Medical Center, Los Angeles, CA
| | | | | | | | | | | | | | - John M Kirkwood
- University of Pittsburgh School of Medicine and UPMC Hillman Cancer Institute, Pittsburgh, PA
| | | | - Michael O Meyers
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Caroline Robert
- Gustave Roussy Cancer Centre and Paris-Saclay University, Villejuif, France
| | - Mario Santinami
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Vernon K Sondak
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Umang Swami
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Katy K Tsai
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - Alexander van Akkooi
- Melanoma Institute Australia, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
| | - Jeffrey Weber
- Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, New York, NY
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Kratzke IM, Barnhill JL, Putnam KT, Rao S, Meyers MO, Meltzer-Brody S, Farrell TM, Bluth K. Self-compassion training to improve well-being for surgical residents. Explore (NY) 2023; 19:78-83. [PMID: 35534424 DOI: 10.1016/j.explore.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/13/2022] [Accepted: 04/30/2022] [Indexed: 01/25/2023]
Abstract
CONTEXT Burnout remains prevalent among surgical residents. Self-compassion training may serve to improve their well-being. OBJECTIVE To evaluate the impact on well-being of a self-compassion program modified for surgical residents. DESIGN This is a 3-year, mixed-methods study using pre-post surveys and focus groups to identify areas for programmatic improvement and the subsequent impact of the modifications. SETTING A single academic institution. PARTICIPANTS Surgical residents participating in a self-compassion program. INTERVENTIONS A self-compassion program adapted from a larger course to fit the needs of surgical residents. MAIN OUTCOME MEASURES Themes relating to the program's strengths and weaknesses were identified through participant focus groups. Well-being was assessed through validated measurement tools, including The Maslach Burnout Inventory (MBI), Patient Health Questionnaire-9, Perceived Stress Scale, and Spielberger State-Trait Anxiety Inventory-6. RESULTS 95 residents participated in the self-compassion program, of which 40 residents completed both surveys (total response rate: 42%). All participants demonstrated severe burnout pre-program, based on scores of at least one of the MBI subscales. Emotional exhaustion scores improved post-program, with larger improvements seen after program modifications (2018: 58% vs 2020: 71%). Focus group findings demonstrated that residents need a safe and distraction-free space to practice self-compassion, and program engagement improved following modifications.
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Affiliation(s)
- Ian M Kratzke
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC 27599-7050, USA.
| | - Jessica L Barnhill
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, 101 Manning Drive, CB #7200, Chapel Hill, NC 27599-7200, USA
| | - Karen T Putnam
- Department of Psychiatry, University of North Carolina at Chapel Hill, 333 S. Columbia Street, Suite 304, MacNider Hall, Chapel Hill, NC 27514, USA
| | - Sanjana Rao
- Physiology Graduate School, North Carolina State University, 1020 Main Campus Drive, Room 2300A, Raleigh, NC 27695-7102, USA
| | - Michael O Meyers
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC 27599-7050, USA
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill, 333 S. Columbia Street, Suite 304, MacNider Hall, Chapel Hill, NC 27514, USA
| | - Timothy M Farrell
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC 27599-7050, USA
| | - Karen Bluth
- Department of Psychiatry, University of North Carolina at Chapel Hill, 333 S. Columbia Street, Suite 304, MacNider Hall, Chapel Hill, NC 27514, USA
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Oldan JD, Giglio BC, Smith E, Zhao W, Bouchard DM, Ivanovic M, Lee YZ, Collichio FA, Meyers MO, Wallack DE, Abernethy-Leinwand A, Long PK, Trembath DG, Googe PB, Kowalski MH, Ivanova A, Ezzell JA, Nikolaishvili-Feinberg N, Thomas NE, Wong TZ, Ollila DW, Li Z, Moschos SJ. Increased tryptophan, but not increased glucose metabolism, predict resistance of pembrolizumab in stage III/IV melanoma. Oncoimmunology 2023; 12:2204753. [PMID: 37123046 PMCID: PMC10142396 DOI: 10.1080/2162402x.2023.2204753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Clinical trials of combined IDO/PD1 blockade in metastatic melanoma (MM) failed to show additional clinical benefit compared to PD1-alone inhibition. We reasoned that a tryptophan-metabolizing pathway other than the kynurenine one is essential. We immunohistochemically stained tissues along the nevus-to-MM progression pathway for tryptophan-metabolizing enzymes (TMEs; TPH1, TPH2, TDO2, IDO1) and the tryptophan transporter, LAT1. We assessed tryptophan and glucose metabolism by performing baseline C11-labeled α-methyl tryptophan (C11-AMT) and fluorodeoxyglucose (FDG) PET imaging of tumor lesions in a prospective clinical trial of pembrolizumab in MM (clinicaltrials.gov, NCT03089606). We found higher protein expression of all TMEs and LAT1 in melanoma cells than tumor-infiltrating lymphocytes (TILs) within MM tumors (n = 68). Melanoma cell-specific TPH1 and LAT1 expressions were significantly anti-correlated with TIL presence in MM. High melanoma cell-specific LAT1 and low IDO1 expression were associated with worse overall survival (OS) in MM. Exploratory optimal cutpoint survival analysis of pretreatment 'high' vs. 'low' C11-AMT SUVmax of the hottest tumor lesion per patient revealed that the 'low' C11-AMT SUVmax was associated with longer progression-free survival in our clinical trial (n = 26). We saw no such trends with pretreatment FDG PET SUVmax. Treatment of melanoma cell lines with telotristat, a TPH1 inhibitor, increased IDO expression and kynurenine production in addition to suppression of serotonin production. High melanoma tryptophan metabolism is a poor predictor of pembrolizumab response and an adverse prognostic factor. Serotoninergic but not kynurenine pathway activation may be significant. Melanoma cells outcompete adjacent TILs, eventually depriving the latter of an essential amino acid.
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Affiliation(s)
- Jorge D. Oldan
- Departments of Radiology, The University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
- Biomedical Research Imaging Center, UNC-CH,Chapel Hill, NC, USA
| | | | - Eric Smith
- Departments of Radiology, The University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
- Biomedical Research Imaging Center, UNC-CH,Chapel Hill, NC, USA
| | - Weiling Zhao
- Biomedical Research Imaging Center, UNC-CH,Chapel Hill, NC, USA
| | | | - Marija Ivanovic
- Departments of Radiology, The University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
- Biomedical Research Imaging Center, UNC-CH,Chapel Hill, NC, USA
| | - Yueh Z. Lee
- Departments of Radiology, The University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
- Biomedical Research Imaging Center, UNC-CH,Chapel Hill, NC, USA
| | - Frances A. Collichio
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC, USA
- Departments of Medicine, The University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
| | - Michael O. Meyers
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC, USA
- Departmant of Surgery, The University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
| | - Diana E. Wallack
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC, USA
| | | | - Patricia K. Long
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC, USA
- Departmant of Surgery, The University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
| | - Dimitri G. Trembath
- Departments of Pathology And Laboratory Medicine, The University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
| | - Paul B. Googe
- Departments of Dermatology, The University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
| | - Madeline H. Kowalski
- Department of Biostatistics, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Anastasia Ivanova
- Department of Biostatistics, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Jennifer A. Ezzell
- Departments of Cell Biology and Physiology, The University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
| | | | - Nancy E. Thomas
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC, USA
- Departments of Dermatology, The University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
| | - Terence Z. Wong
- Departments of Radiology, The University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
- Biomedical Research Imaging Center, UNC-CH,Chapel Hill, NC, USA
| | - David W. Ollila
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC, USA
- Departmant of Surgery, The University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
| | - Zibo Li
- Departments of Radiology, The University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
- Biomedical Research Imaging Center, UNC-CH,Chapel Hill, NC, USA
| | - Stergios J. Moschos
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC, USA
- Departments of Medicine, The University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
- CONTACT Stergios J. Moschos Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC27599, USA
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Goodman KA, Ou FS, Hall NC, Bekaii-Saab T, Fruth B, Twohy E, Meyers MO, Boffa DJ, Mitchell K, Frankel WL, Niedzwiecki D, Noonan A, Janjigian YY, Thurmes PJ, Venook AP, Meyerhardt JA, O'Reilly EM, Ilson DH. Randomized Phase II Study of PET Response-Adapted Combined Modality Therapy for Esophageal Cancer: Mature Results of the CALGB 80803 (Alliance) Trial. J Clin Oncol 2021; 39:2803-2815. [PMID: 34077237 PMCID: PMC8407649 DOI: 10.1200/jco.20.03611] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/01/2021] [Accepted: 04/01/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate the use of early assessment of chemotherapy responsiveness by positron emission tomography (PET) imaging to tailor therapy in patients with esophageal and esophagogastric junction adenocarcinoma. METHODS After baseline PET, patients were randomly assigned to an induction chemotherapy regimen: modified oxaliplatin, leucovorin, and fluorouracil (FOLFOX) or carboplatin-paclitaxel (CP). Repeat PET was performed after induction; change in maximum standardized uptake value (SUV) from baseline was assessed. PET nonresponders (< 35% decrease in SUV) crossed over to the alternative chemotherapy during chemoradiation (50.4 Gy/28 fractions). PET responders (≥ 35% decrease in SUV) continued on the same chemotherapy during chemoradiation. Patients underwent surgery at 6 weeks postchemoradiation. Primary end point was pathologic complete response (pCR) rate in nonresponders after switching chemotherapy. RESULTS Two hundred forty-one eligible patients received Protocol treatment, of whom 225 had an evaluable repeat PET. The pCR rates for PET nonresponders after induction FOLFOX who crossed over to CP (n = 39) or after induction CP who changed to FOLFOX (n = 50) was 18.0% (95% CI, 7.5 to 33.5) and 20% (95% CI, 10 to 33.7), respectively. The pCR rate in responders who received induction FOLFOX was 40.3% (95% CI, 28.9 to 52.5) and 14.1% (95% CI, 6.6 to 25.0) in responders to CP. With a median follow-up of 5.2 years, median overall survival was 48.8 months (95% CI, 33.2 months to not estimable) for PET responders and 27.4 months (95% CI, 19.4 months to not estimable) for nonresponders. For induction FOLFOX patients who were PET responders, median survival was not reached. CONCLUSION Early response assessment using PET imaging as a biomarker to individualize therapy for patients with esophageal and esophagogastric junction adenocarcinoma was effective, improving pCR rates in PET nonresponders. PET responders to induction FOLFOX who continued on FOLFOX during chemoradiation achieved a promising 5-year overall survival of 53%.
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Affiliation(s)
| | - Fang-Shu Ou
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Nathan C. Hall
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - Briant Fruth
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Erin Twohy
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Anne Noonan
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Paul J. Thurmes
- Metro Minnesota Community Oncology Research Consortium, Minneapolis, MN
| | - Alan P. Venook
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
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Chen KA, Strassle PD, Meyers MO. Socioeconomic factors in timing of esophagectomy and association with outcomes. J Surg Oncol 2021; 124:1014-1021. [PMID: 34254329 PMCID: PMC10151060 DOI: 10.1002/jso.26606] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Disparities in esophageal cancer are well-established. The standard treatment for locally advanced esophageal cancer is chemoradiation followed by surgery. We sought to evaluate the association between socioeconomic factors, time to surgery, and patient outcomes. METHODS All patients ≥18 years old diagnosed with T2/3/4 or node-positive esophageal cancer between 2004 and 2016 and who underwent chemoradiation and esophagectomy in the National Cancer Database were included. Multivariable regression was used to assess the association between socioeconomic variables and time to surgery (grouped into <56, 56-84, and 85-112 days). RESULTS A total of 12 157 patients were included. Five-year overall survival was 39%, 35%, and 35% for the three groups examined. Postoperative 30- and 90-day mortality was increased in both the 56-84 days to surgery group (odds ratio [OR]: 1.30 and 1.20, respectively) and the 85-112 days group (OR: 1.37 and 1.56, respectively) when compared to <56 days. Patients of a minority race, public insurance, or lower income were more likely to have a longer time to surgery. CONCLUSION Longer time to surgery is associated with increased postoperative mortality and is more common in patients with lower socioeconomic status. Further research exploring reasons for delays to esophagectomy among disadvantaged patients could help target interventions to reduce disparities.
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Affiliation(s)
- Kevin A Chen
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Paula D Strassle
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael O Meyers
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Herb JN, Ollila DW, Stitzenberg KB, Meyers MO. ASO Visual Abstract: Use and Costs of Sentinel Lymph Node Biopsy in Nonulcerated T1b Melanoma: Analysis of a Population-Based Registry. Ann Surg Oncol 2021. [PMID: 33988792 DOI: 10.1245/s10434-021-10061-7] [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)
- Joshua N Herb
- Department of Surgery, Division of Surgical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - David W Ollila
- Department of Surgery, Division of Surgical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karyn B Stitzenberg
- Department of Surgery, Division of Surgical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael O Meyers
- Department of Surgery, Division of Surgical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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9
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Grova MM, Jenkins FG, Filippou P, Strassle PD, Jin Kim H, Ollila DW, Meyers MO. Gender Bias in Surgical Oncology Fellowship Recommendation Letters: Gaining Progress. J Surg Educ 2021; 78:866-874. [PMID: 33317986 DOI: 10.1016/j.jsurg.2020.08.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/24/2020] [Accepted: 08/29/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Gender bias has been identified in letters of recommendation (LOR) in many different surgical training fields. Among surgeons, women comprise over 30% of the full-time faculty positions nationally and surgical oncology is one of the most gender diverse surgical subspecialties. We sought to determine if bias existed in LOR submitted to a Complex General Surgical Oncology (CGSO) fellowship. DESIGN LOR for the CGSO fellowship were retrospectively analyzed from applicants at a single institution over an 8-year period (2013-2020). The linguistic content of the letters was analyzed using Linguistic Inquiry and Word Count (LIWC2015), a validated text analysis program. Using multivariable analysis, LOR were compared by gender of both applicant and letter writer to explore the association between gender and the characteristics of the applicants and letter writers. SETTING University of North Carolina at Chapel Hill (UNC), Division of Surgical Oncology and Endocrine Surgery. PARTICIPANTS Applicants interviewed for the CSGO fellowship program at the UNC from 2013 to 2020 as well as all applicants from the 2018 application cycle, regardless of interview status. RESULTS About 841 letters from 219 interviewed applicants throughout the 2013 to 2020 surgical oncology fellowship application cycles were included. No difference in authenticity, clout, analytic thinking, or emotional tone of the letters was seen when comparing men and women applicants. Of the 41 word categories analyzed, only "references to achievement" in LOR written for women was significantly higher when compared to LOR written for men (p = 0.01). Interestingly, significantly more women applicants had at least 1 LOR written by a woman (p = 0.04). A subset analysis of all applicants regardless of interview status from the 2018 cycle included 294 LOR from 77 applicants. With the inclusion of noninterviewed applicants, LOR for men had more analytic tone than LOR for women (p = 0.02), otherwise there were no significant differences between the groups. CONCLUSIONS Very few differences in LOR were found for applicants at a CGSO fellowship program based on applicant or letter writer gender. The lack of gender bias demonstrates progress within the field of surgical oncology, likely a result of recent work and educational effort in this area. Efforts to expand this progress into other surgical sub-specialties are necessary.
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Affiliation(s)
- Monica M Grova
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Frances G Jenkins
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Pauline Filippou
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Paula D Strassle
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hong Jin Kim
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - David W Ollila
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael O Meyers
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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10
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Herb JN, Ollila DW, Stitzenberg KB, Meyers MO. Use and Costs of Sentinel Lymph Node Biopsy in Non-Ulcerated T1b Melanoma: Analysis of a Population-Based Registry. Ann Surg Oncol 2021; 28:3470-3478. [PMID: 33900501 DOI: 10.1245/s10434-021-09998-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/25/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND The utility of sentinel lymph node biopsy (SLNB) for non-ulcerated T1b melanoma is debated and associated costs are poorly characterized. Prior work using institutional registries may overestimate the incidence of nodal positivity in this population. OBJECTIVE The aim of this study was to estimate the use of SLNB, positivity prevalence, and procedural costs in patients with non-ulcerated T1b melanoma using a population-based registry. METHODS We identified patients with clinically node-negative, non-ulcerated melanoma 0.8-1.0 mm thick (T1b according to the 8th edition standard of the American Joint Committee on Cancer) in the Surveillance, Epidemiology, and End Results database from 2010 to 2016. The prevalence of SLNB procedures and positive sentinel nodes were calculated. Factors associated with SLNB and sentinel node positivity were assessed using logistic regression. Medicare reimbursement costs and patient out-of-pocket expenses for SLNB and wide local excision (WLE) versus WLE alone were estimated. RESULTS Among 7245 included patients, 3835(53%) underwent SLNB, 156 (4.1%, 95% confidence interval 3.5-4.7) of whom had a positive SLNB. Younger age, >1 mitosis per mm2, female sex, and truncal tumor location were associated with higher odds of positivity. The estimated SLNB cost to identify one patient with stage III disease was $71,700 (range $54,648-$83,172). Out-of-pocket expenses for a Medicare patient were estimated to be $652 for a WLE and SLNB and $79 for a WLE alone. CONCLUSIONS In this population-based study, only 4% of selected non-ulcerated T1b patients had a positive SLNB, which is lower than prior reports. At the population level, SLNB is associated with high costs per prognostic information gained.
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Affiliation(s)
- Joshua N Herb
- Department of Surgery, Division of Surgical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - David W Ollila
- Department of Surgery, Division of Surgical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karyn B Stitzenberg
- Department of Surgery, Division of Surgical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael O Meyers
- Department of Surgery, Division of Surgical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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11
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Carter TM, Strassle PD, Ollila DW, Stitzenberg KB, Meyers MO, Maduekwe UN. Does acral lentiginous melanoma subtype account for differences in patterns of care in Black patients? Am J Surg 2021; 221:706-711. [PMID: 33461732 PMCID: PMC8376182 DOI: 10.1016/j.amjsurg.2020.12.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/11/2020] [Accepted: 12/21/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Melanoma-specific outcomes for Black patients are worse when compared to non-Hispanic white (NHW) patients. We sought to evaluate whether acral lentiginous melanoma, seen more commonly in Black patients, was associated with racial disparities in outcomes METHODS: The National Cancer Database was analyzed for major subtypes of stage I-IV melanoma diagnosed from 2004 to 2016. The association between Black race and (Siegel et al., Jan) 1 acral melanoma diagnosis and (Bradford et al., Apr) 2 receipt of major amputation for surgical management of melanoma was evaluated using multivariable logistic regression. RESULTS 251,864 patients were included (1453 Black). Black patients had increased odds of acral melanoma (odds ratio [OR] = 27.6, 95% CI]: 24.4, 31.2) compared to NHW patients. Black patients still had higher odds ratios of major amputation across all stages after adjusting for acral histology and other potential confounders CONCLUSIONS: Increased prevalence of acral melanoma in Black patients does not fully account for increased receipt of major amputation.
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Affiliation(s)
- Taylor M Carter
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Paula D Strassle
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - David W Ollila
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Karyn B Stitzenberg
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Michael O Meyers
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Ugwuji N Maduekwe
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
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12
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Meyers MO. Reply to B. P. L. Wijnhoven et al and F. Nuytens et al. J Clin Oncol 2021; 39:93-94. [PMID: 32946358 DOI: 10.1200/jco.20.02390] [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: 11/20/2022] Open
Affiliation(s)
- Michael O Meyers
- Michael O. Meyers, MD, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
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Grova MM, Donohue SJ, Bahnson M, Meyers MO, Bahnson EM. Allyship in Surgical Residents: Evidence for LGBTQ Competency Training in Surgical Education. J Surg Res 2020; 260:169-176. [PMID: 33341680 DOI: 10.1016/j.jss.2020.11.072] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/06/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Studies have shown poorer health outcomes for people who identify as sexual and/or gender minority (LGBTQ+) compared to heterosexual peers. Our goal was to establish baseline levels of LGBTQ Ally Identity Measure (AIM) scores: (1) Knowledge and Skills, (2) Openness and Support, and (3) Awareness of Oppression of the LGBTQ+ in surgical trainees, and implement a pilot training in LGBTQ + cultural competency. MATERIALS AND METHODS General surgery residents from a single academic medical center participated in a 2-h educational training developed from the existing Health Care Safe Zone training at our institution. Utilizing the previously validated LGBTQ Ally Identity Measure (AIM), residents responded to 19 items on Likert-type scales from 1 to 5 pretraining and 6 wk posttraining. The residents' perceptions of the utility of the training were also assessed. Data were analyzed by MANOVA, repeated measures MANOVA, and subsequent univariate analysis. RESULTS 27 residents responded to the pretraining survey (52%), 22 residents participated in the training, and 10 responded at 6 wk posttraining (19%). The average baseline scores were Knowledge and Skills 19.38 ± 4.64, Openness and Support 25.96 ± 4.31, and Awareness of Oppression 17.15 ± 2.20. Participants who identified as women scored 4.46 (95% CI 0.77-8.15) points higher in Openness and Support compared to males. Of those respondents who completed pretraining and posttraining surveys (n = 10), training had a significant effect on AIM scores with an improvement in Knowledge and Skills (P = 0.024) and Openness and Support (P = 0.042). Residents found the training relevant to surgery patient care (71%), increased their competency in LGBTQ + patient care (86%), and all participants indicated they were better LGBTQ allies following the training. CONCLUSIONS Assessing LGBTQ + allyship in surgical residents, we found that training improved AIM scores over time with significant improvement in the Knowledge and Skills, and Openness and Support scales, suggesting a viable and valuable curriculum focused on sexual and gender identity-related competencies within the graduate medical education for surgical trainees.
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Affiliation(s)
- Monica M Grova
- Department of Surgery, UNC Chapel Hill, Chapel Hill, North Carolina
| | - Sean J Donohue
- School of Medicine, UNC Chapel Hill, Chapel Hill, North Carolina
| | - Matthew Bahnson
- Department of Psychology, North Carolina State University, Raleigh, North Carolina
| | - Michael O Meyers
- Department of Surgery, UNC Chapel Hill, Chapel Hill, North Carolina
| | - Edward M Bahnson
- Division of Vascular Surgery, Department of Surgery, and Center of Nanotechnology in Drug Delivery, UNC Chapel Hill, Chapel Hill, North Carolina.
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14
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Grova MM, Donohue SJ, Meyers MO, Kim HJ, Ollila DW. Direct Comparison of In-Person Versus Virtual Interviews for Complex General Surgical Oncology Fellowship in the COVID-19 Era. Ann Surg Oncol 2020; 28:1908-1915. [PMID: 33244739 PMCID: PMC7690846 DOI: 10.1245/s10434-020-09398-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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: 10/15/2020] [Accepted: 11/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In the era of coronavirus disease 2019 (COVID-19), many Complex General Surgical Oncology (CGSO) fellowship programs implemented virtual interviews (VI) during the 2020 interview season. At our institution, we had the unique opportunity to conduct an in-person interview (IPI) prior to the pandemic-related travel restrictions, and a VI after the restrictions were in place. OBJECTIVE The goal of this study was to understand how the VI model compares with the traditional IPI approach. METHODS Online surveys were distributed to both groups, collecting feedback on their interview experience. Responses were evaluated using a two-sample t test assuming equal variances. RESULTS Twenty-three of 26 (88%) applicants completed the survey. Most applicants reported that the interview gave them a satisfactory understanding of the CGSO fellowship (100% IPI, 92% VI) and the majority in both groups felt that the interview experience allowed them to accurately represent themselves (92% and 82%, respectively). All participants in the IPI group felt they were able to get an adequate understanding of the culture of the program, while only 64% in the VI group agreed with that statement (p = 0.02). IPI applicants were more likely to agree that the interview experience was sufficient to allow them to make a ranking decision (92% vs. 54%; p = 0.04). CONCLUSIONS While the VI modality offers several advantages over the IPI, it still falls short in conveying some of the more subjective aspects of the programs, including program culture. Strategies to provide applicants with better insight into these areas during the VI will be important moving forward.
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Affiliation(s)
- Monica M Grova
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sean J Donohue
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael O Meyers
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hong Jin Kim
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David W Ollila
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Seth R, Messersmith H, Kaur V, Kirkwood JM, Kudchadkar R, McQuade JL, Provenzano A, Swami U, Weber J, Alluri KC, Agarwala S, Ascierto PA, Atkins MB, Davis N, Ernstoff MS, Faries MB, Gold JS, Guild S, Gyorki DE, Khushalani NI, Meyers MO, Robert C, Santinami M, Sehdev A, Sondak VK, Spurrier G, Tsai KK, van Akkooi A, Funchain P. Systemic Therapy for Melanoma: ASCO Guideline. J Clin Oncol 2020; 38:3947-3970. [PMID: 32228358 DOI: 10.1200/jco.20.00198] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To provide guidance to clinicians regarding the use of systemic therapy for melanoma. METHODS ASCO convened an Expert Panel and conducted a systematic review of the literature. RESULTS A systematic review, one meta-analysis, and 34 additional randomized trials were identified. The published studies included a wide range of systemic therapies in cutaneous and noncutaneous melanoma. RECOMMENDATIONS In the adjuvant setting, nivolumab or pembrolizumab should be offered to patients with resected stage IIIA/B/C/D BRAF wild-type cutaneous melanoma, while either of those two agents or the combination of dabrafenib and trametinib should be offered in BRAF-mutant disease. No recommendation could be made for or against the use of neoadjuvant therapy in cutaneous melanoma. In the unresectable/metastatic setting, ipilimumab plus nivolumab, nivolumab alone, or pembrolizumab alone should be offered to patients with BRAF wild-type cutaneous melanoma, while those three regimens or combination BRAF/MEK inhibitor therapy with dabrafenib/trametinib, encorafenib/binimetinib, or vemurafenib/cobimetinib should be offered in BRAF-mutant disease. Patients with mucosal melanoma may be offered the same therapies recommended for cutaneous melanoma. No recommendation could be made for or against specific therapy for uveal melanoma. Additional information is available at www.asco.org/melanoma-guidelines.
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Affiliation(s)
- Rahul Seth
- State University of New York Upstate Medical University, Syracuse, NY
| | | | | | - John M Kirkwood
- University of Pittsburgh School of Medicine, Pittsburgh, PA
- University of Pittsburgh Medical Center, Hillman Cancer Institute, Pittsburgh, PA
| | | | | | | | - Umang Swami
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Jeffrey Weber
- Laura and Isaac Perlmutter Cancer Center at New York University, Langone Health, New York, NY
| | | | - Sanjiv Agarwala
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | | | - Nancy Davis
- Vanderbilt University Medical Center, Nashville, TN
| | | | - Mark B Faries
- The Angeles Clinic and Research Institute, Los Angeles, CA
- Cedars Sinai Medical Center, Los Angeles, CA
| | - Jason S Gold
- Veterans Administration Boston Healthcare System, West Roxbury, MA
| | | | - David E Gyorki
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Michael O Meyers
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Caroline Robert
- Gustave Roussy Cancer Centre, Villejuif, France
- Paris-Saclay University, Villejuif, France
| | - Mario Santinami
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Amikar Sehdev
- Indiana University School of Medicine, Indianapolis, IN
| | - Vernon K Sondak
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Katy K Tsai
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
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Carter T, Meyers MO. Importance of Medical School When Considering Applicants to Surgery Residency. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.08.520] [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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17
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Jadi J, Jin Kim H, O Meyers M, Maduekwe U. Change in Utilization of Radiation as an Adjunct to Gastrectomy in Distal Gastric Cancers. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.08.547] [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: 10/23/2022]
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18
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Meyers MO. Innovations in Surgical Technique and Translation to Broad Clinical Practice. J Clin Oncol 2020; 38:2119-2121. [PMID: 32421441 DOI: 10.1200/jco.20.00885] [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: 11/20/2022] Open
Affiliation(s)
- Michael O Meyers
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
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19
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Oldan JD, Ollila DW, Giglio BC, Smith E, Bouchard DM, Ivanovic M, Lee YZ, Collichio FA, Meyers MO, Wallack DE, Khandani AH, Abernathy-Leinwand A, Long PK, Ezzell JA, Trembath DG, Li Z, Wong TZ, Moschos SJ. High intratumoral tryptophan metabolism is a poor predictor of response to pembrolizumab (pembro) in metastatic melanoma (MM): Results from a prospective trial using baseline C11-labeled alpha-methyl tryptophan (C11-AMT) PET imaging for response prediction. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.3556] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3556 Background: Molecular imaging of metabolic pathways critical for effector T cell response other than glucose could predict response to PD1 inhibitors. We have previously shown that high expression of tryptophan metabolic pathway enzymes in stage III/IV melanoma correlates with reduced abundance of tumor-infiltrating lymphocytes (TILs, ASCO 2019, e21014). Here we investigated C11-AMT, a PET tracer that images tryptophan metabolism, as a predictor of response to pembro in patients (pts) with PD1 inhibitor-naïve MM. Methods: In this trial (NCT03089606) pts must have had measurable MM by RECIST, have undergone IV contrast CT, FDG-PET, and C11-AMT PET scan (30-40 min dynamic imaging), plus a mandatory tumor biopsy prior to pembro treatment. Results: 21 pts (16 males; 15 stage IV; median age 61) had all 3 baseline scans and evaluable research biopsies. 13 pts were non-progressors (CR = 4, PR = 6, and SD = 3). At a median f/u of 13.7 mons (2.8-25.1+), 6 pts are dead from MM, 11 are alive without MM and 4 are alive with MM. 46 tumor lesions were assessed by all 3 scans. Of the pts with tumor lesion, C11-AMT PET SUVmax < 7 and skewness < +0.3 of the tumor lesion with the highest C11-AMT SUVmax was associated with non-progression by RECIST (SUVmax < 7/skewness < +0.3 in progressors vs. non-progressors; Fisher’s 2-tail test p= 0.055). The corresponding association between baseline FDG-PET (SUVmax < 14 and skewness < +0.3) with treatment response was insignificant ( p= 0.08). There was a weak (Spearman ρ= 0.33) but significant correlation ( p= 0.001) in SUVmax between FDG-PET and C11-AMT among the 46 tumors analyzed. There was no significant correlation between melanoma-specific expression of the tryptophan- (TPH1, TPH2, IDO1, TDO2, LAT1) and glucose-metabolizing enzymes (GLUT1, HK1, HK3) by immunohistochemistry. Response to pembro trends to associate with present TILs (Fisher’s p= 0.087). Conclusions: Baseline C11-AMT PET imaging using simple radiomics measures (highest metabolic activity, SUVmax, and tumor heterogeneity, skewness) may better predict clinical benefit from pembro in MM than FDG PET. Variability in C11-AMT’s SUVmax cannot be solely explained by FDG-PET’s SUVmax, suggesting that these two imaging modalities may provide complementary information about intratumoral metabolic dysregulation that may relate with pembro response. Texture analysis using LifeX v4.0 will be presented at the meeting. Clinical trial information: NCT03089606 .
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Affiliation(s)
- Jorge D. Oldan
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David W. Ollila
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ben C. Giglio
- Biomedical Research Imaging Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Eric Smith
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Deeanna M. Bouchard
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Marija Ivanovic
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yueh Z. Lee
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Frances A. Collichio
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael O. Meyers
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Diana E. Wallack
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chape Hill, Chapel Hill, NC
| | - Amir H. Khandani
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Amber Abernathy-Leinwand
- Biomedical Research Imaging Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Patricia K. Long
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer Ashley Ezzell
- Department of Cell Biology and Physiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Dimitri G. Trembath
- Department of Pathology & Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Zibo Li
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Terence Z. Wong
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stergios J. Moschos
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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Herb JN, Ollila DW, Stitzenberg KB, Meyers MO. Completion Lymph Node Dissection for Select Patients with Sentinel Node-Positive Melanoma: In Reply to Bartlett and Coit. J Am Coll Surg 2020; 230:1122-1123. [PMID: 32178941 DOI: 10.1016/j.jamcollsurg.2020.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 11/18/2022]
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Abstract
There are multiple transitions in surgical education. Among the most significant are those from medical student to intern, from junior resident to senior resident, and from senior resident/fellow to independent practice. While there are new expectations and responsibilities associated with each of these roles, a surgeon's development should be thought of as more of a continuum with distinct points of greatest change and challenge. There are common themes at these various transitions that may be highlighted for both trainees and educators.
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Affiliation(s)
- Michael O Meyers
- Department of Surgery, The University of North Carolina at Chapel Hill School of Medicine, NC.
| | - Anthony G Charles
- Department of Surgery, The University of North Carolina at Chapel Hill School of Medicine, NC
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Williford ML, Scarlet S, Meyers MO, Luckett DJ, Fine JP, Goettler CE, Green JM, Clancy TV, Hildreth AN, Meltzer-Brody SE, Farrell TM. Multiple-Institution Comparison of Resident and Faculty Perceptions of Burnout and Depression During Surgical Training. JAMA Surg 2019; 153:705-711. [PMID: 29800976 DOI: 10.1001/jamasurg.2018.0974] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Prior studies demonstrate a high prevalence of burnout and depression among surgeons. Limited data exist regarding how these conditions are perceived by the surgical community. Objectives To measure prevalence of burnout and depression among general surgery trainees and to characterize how residents and attendings perceive these conditions. Design, Setting, and Participants This cross-sectional study used unique, anonymous surveys for residents and attendings that were administered via a web-based platform from November 1, 2016, through March 31, 2017. All residents and attendings in the 6 general surgery training programs in North Carolina were invited to participate. Main Outcomes and Measures The prevalence of burnout and depression among residents was assessed using validated tools. Burnout was defined by high emotional exhaustion or depersonalization on the Maslach Burnout Inventory. Depression was defined by a score of 10 or greater on the Patient Health Questionnaire-9. Linear and logistic regression models were used to assess predictive factors for burnout and depression. Residents' and attendings' perceptions of these conditions were analyzed for significant similarities and differences. Results In this study, a total of 92 residents and 55 attendings responded. Fifty-eight of 77 residents with complete responses (75%) met criteria for burnout, and 30 of 76 (39%) met criteria for depression. Of those with burnout, 28 of 58 (48%) were at elevated risk of depression (P = .03). Nine of 77 residents (12%) had suicidal ideation in the past 2 weeks. Most residents (40 of 76 [53%]) correctly estimated that more than 50% of residents had burnout, whereas only 13 of 56 attendings (23%) correctly estimated this prevalence (P < .001). Forty-two of 83 residents (51%) and 42 of 56 attendings (75%) underestimated the true prevalence of depression (P = .002). Sixty-six of 73 residents (90%) and 40 of 51 attendings (78%) identified the same top 3 barriers to seeking care for burnout: inability to take time off to seek treatment, avoidance or denial of the problem, and negative stigma toward those seeking care. Conclusions and Relevance The prevalence of burnout and depression was high among general surgery residents in this study. Attendings and residents underestimated the prevalence of these conditions but acknowledged common barriers to seeking care. Discrepancies in actual and perceived levels of burnout and depression may hinder wellness interventions. Increasing understanding of these perceptions offers an opportunity to develop practical solutions.
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Affiliation(s)
| | - Sara Scarlet
- Department of Surgery, University of North Carolina at Chapel Hill
| | - Michael O Meyers
- Department of Surgery, University of North Carolina at Chapel Hill
| | - Daniel J Luckett
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Jason P Fine
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Claudia E Goettler
- Department of Surgery, East Carolina Brody School of Medicine, Greenville, North Carolina
| | - John M Green
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Thomas V Clancy
- Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina
| | - Amy N Hildreth
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Affiliation(s)
- David W Ollila
- Department of Surgery, Division of Surgical Oncology, University of North Carolina, Chapel Hill, NC, USA.
| | - Michael O Meyers
- Department of Surgery, Division of Surgical Oncology, University of North Carolina, Chapel Hill, NC, USA
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Goodman KA, Hall N, Bekaii-Saab TS, Ou FS, Twohy E, Meyers MO, Boffa DJ, Mitchell K, Perry K, Frankel WL, Venook AP, O'Reilly EM, Ilson DH. Survival outcomes from CALGB 80803 (Alliance): A randomized phase II trial of PET scan-directed combined modality therapy for esophageal cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.4012] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Nathan Hall
- University of Pennsylvania, Philadelphia, PA
| | | | | | - Erin Twohy
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | | | - Daniel J. Boffa
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | | | - Kyle Perry
- The Ohio State University Comprehensive Cancer Center, James Cancer Hospital, Solove Research Institute, Columbus, OH
| | - Wendy L Frankel
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | - Alan P. Venook
- University of California San Francisco, San Francisco, CA
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25
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Affiliation(s)
- Jayson Miedema
- Department of Dermatology, University of North Carolina, Chapel Hill, North Carolina
| | - Michael O Meyers
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Daniel Zedek
- Coastal Carolina Pathology, Wilmington, North Carolina
| | - Michelle C Roughton
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Puneet S Jolly
- Department of Dermatology, University of North Carolina, Chapel Hill, North Carolina
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26
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Meyers MO, Sarosi GA, Brasel KJ. Perspective of Residency Program Directors on Accreditation Council for Graduate Medical Education Changes in Resident Work Environment and Duty Hours. JAMA Surg 2017; 152:905-906. [DOI: 10.1001/jamasurg.2017.2206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - George A. Sarosi
- Department of Surgery, North Florida/South Georgia Veterans Health System, Gainesville3University of Florida, Gainesville
| | - Karen J. Brasel
- Department of Surgery, Oregon Health and Science University, Portland
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27
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Grudziak J, Herndon B, Dancel RD, Arora H, Tignanelli CJ, Phillips MR, Crowner JR, True NA, Kiser AC, Brown RF, Goodell HP, Murty N, Meyers MO, Montgomery SP. Standardized, Interdepartmental, Simulation-Based Central Line Insertion Course Closes an Educational Gap and Improves Intern Comfort with the Procedure. Am Surg 2017. [DOI: 10.1177/000313481708300941] [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: 11/15/2022]
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28
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Laks S, Meyers MO, Deal AM, Frank JS, Stitzenberg KB, Yeh JJ, Thomas NE, Ollila DW. Tumor Mitotic Rate and Association with Recurrence in Sentinel Lymph Node Negative Stage II Melanoma Patients. Am Surg 2017. [DOI: 10.1177/000313481708300934] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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
Tumor mitotic rate (TMR) is a known prognostic variable in thin melanoma patients. Its significance in stage II melanoma patients is yet to be demonstrated. Retrospective analysis of a prospective melanoma database from 9/1997 to 7/2015 was performed. All stage II melanoma, with documented TMR, and six months of follow-up were included. We evaluated the association of clinicopathologic variables, TMR, as a continuous and categorical variable with recurrence-free survival (RFS) and overall survival (OS) using Cox proportional hazards modeling. We used a statistical model, X-tile, to develop optimal categorizations of TMR. A total of 265 patient characteristics are included in this study. Recurrences occurred in 82 (30.9%) patients, including 5 local, 41 regional, and 36 distant patients. In multivariate model, ulceration, Breslow, and continuous TMR were associated with worse RFS\OS. Continuous TMR demonstrated worse RFS (hazards ratio [HR] 1.02 (1.00–1.05)) and OS (HR 1.02 (1.00–1.04)), whereas dichotomized TMR (≥1 vs <1) was not significant. TMR >10.4 mitoses/mm2 has a 5-year RFS\OS of 27.2 and 44.3 per cent, respectively, compared with 57.4 and 71.4 per cent, respectively, for TMR <3.2 mitoses/mm2. Continuous TMR predicts incidence of recurrence in stage II melanoma. We propose a new categorization method developed by statistical modeling for optimal stratification that may guide surveillance for this disparate patient population.
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Affiliation(s)
- Shachar Laks
- Department of Surgery, Division of Surgical Oncology
| | | | | | | | | | - Jen Jen Yeh
- Department of Surgery, Division of Surgical Oncology
- Lineberger Comprehensive Cancer Center, and
| | - Nancy E. Thomas
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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29
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Laks S, Meyers MO, Deal AM, Frank JS, Stitzenberg KB, Yeh JJ, Thomas NE, Ollila DW. Tumor Mitotic Rate and Association with Recurrence in Sentinel Lymph Node Negative Stage II Melanoma Patients. Am Surg 2017; 83:972-978. [PMID: 28958277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Tumor mitotic rate (TMR) is a known prognostic variable in thin melanoma patients. Its significance in stage II melanoma patients is yet to be demonstrated. Retrospective analysis of a prospective melanoma database from 9/1997 to 7/2015 was performed. All stage II melanoma, with documented TMR, and six months of follow-up were included. We evaluated the association of clinicopathologic variables, TMR, as a continuous and categorical variable with recurrence-free survival (RFS) and overall survival (OS) using Cox proportional hazards modeling. We used a statistical model, X-tile, to develop optimal categorizations of TMR. A total of 265 patient characteristics are included in this study. Recurrences occurred in 82 (30.9%) patients, including 5 local, 41 regional, and 36 distant patients. In multivariate model, ulceration, Breslow, and continuous TMR were associated with worse RFS\OS. Continuous TMR demonstrated worse RFS (hazards ratio [HR] 1.02 (1.00-1.05)) and OS (HR 1.02 (1.00-1.04)), whereas dichotomized TMR (≥1 vs <1) was not significant. TMR >10.4 mitoses/mm2 has a 5-year RFS\OS of 27.2 and 44.3 per cent, respectively, compared with 57.4 and 71.4 per cent, respectively, for TMR <3.2 mitoses/mm2. Continuous TMR predicts incidence of recurrence in stage II melanoma. We propose a new categorization method developed by statistical modeling for optimal stratification that may guide surveillance for this disparate patient population.
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30
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Grudziak J, Herndon B, Dancel RD, Arora H, Tignanelli CJ, Phillips MR, Crowner JR, True NA, Kiser AC, Brown RF, Goodell HP, Murty N, Meyers MO, Montgomery SP. Standardized, Interdepartmental, Simulation-Based Central Line Insertion Course Closes an Educational Gap and Improves Intern Comfort with the Procedure. Am Surg 2017. [DOI: 10.1177/000313481708300615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Central line placement is a common procedure, routinely performed by junior residents in medical and surgical departments. Before this project, no standardized instructional course on the insertion of central lines existed at our institution, and few interns had received formal ultrasound training. Interns from five departments participated in a simulation-based central line insertion course. Intern familiarity with the procedure and with ultrasound, as well as their prior experience with line placement and their level of comfort, was assessed. Of the 99 interns in participating departments, 45 per cent had been trained as ofOctober 2015. Forty-one per cent were female. The majority (59.5%) had no prior formal ultrasound training, and 46.0 per cent had never placed a line as primary operator. Scores increased significantly, from a precourse score mean of 13.7 to a postcourse score mean of 16.1, P < 0.001. All three of the self-reported measures of comfort with ultrasound also improved significantly. All interns reported the course was “very much” helpful, and 100 per cent reported they felt “somewhat” or “much” more comfortable with the procedure after attendance. To our knowledge, this is the first hospital-wide, standardized, simulation-based central line insertion course in the United States. Preliminary results indicate overwhelming satisfaction with the course, better ultrasound preparedness, and improved comfort with central line insertion.
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Affiliation(s)
| | | | | | | | | | | | | | - Nicholas A. True
- Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Andy C. Kiser
- CLEAR Lab, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Cardiovascular Sciences, The Brody School of Medicine at East Carolina University, Greenville, NC
| | - Rebecca F. Brown
- Departments of General Surgery
- CLEAR Lab, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Harry P. Goodell
- CLEAR Lab, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Neil Murty
- CLEAR Lab, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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31
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Abstract
This article discusses the current National Comprehensive Cancer Network guidelines and other available Western and Eastern guidelines for the surveillance of gastric cancer following surgical resection. It reviews the literature assessing the utility of intensive surveillance strategies for gastric cancer, which fails to show an improvement in survival. The unique issues relating to follow-up of early gastric cancer and after endoscopic resection of early gastric cancer are discussed. This article also reviews the available modalities for follow-up. In addition, it briefly discusses the advancements in treatment of recurrent and metastatic disease and the implications for gastric cancer survival and surveillance strategies.
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Affiliation(s)
- Shachar Laks
- Division of Surgical Oncology, University of North Carolina, 170 Manning Drive, CB #7213, 1150 Physicians Office Building, Chapel Hill, NC 27599-7213, USA
| | - Michael O Meyers
- Division of Surgical Oncology, University of North Carolina, 170 Manning Drive, CB #7213, 1150 Physicians Office Building, Chapel Hill, NC 27599-7213, USA
| | - Hong Jin Kim
- Division of Surgical Oncology, University of North Carolina, 170 Manning Drive, CB #7213, 1150 Physicians Office Building, Chapel Hill, NC 27599-7213, USA.
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32
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Berger AC, Ollila DW, Christopher A, Kairys JC, Mastrangelo MJ, Feeney K, Dabbish N, Leiby B, Frank JA, Stitzenberg KB, Meyers MO. Patient Symptoms Are the Most Frequent Indicators of Recurrence in Patients with American Joint Committee on Cancer Stage II Melanoma. J Am Coll Surg 2017; 224:652-659. [PMID: 28189663 DOI: 10.1016/j.jamcollsurg.2016.12.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with stage II melanoma have a considerable risk for recurrence. Current guidelines are imprecise as to optimal follow-up. We hypothesized that by examining recurrence patterns, we could help to better inform guidelines. STUDY DESIGN We queried IRB-approved melanoma databases of Thomas Jefferson University and University of North Carolina, identifying 581 patients with stage II melanoma between 1996 and 2015 with at least 1 year of follow-up. Data included location of first recurrence and how recurrence was detected (ie patient symptom, physician examination, or routine surveillance imaging). Cox regression with backward elimination was used for multivariable analysis. RESULTS One hundred and seventy-one patients had a recurrence (29.4%), the incidence increased considerably by stage sub-group. Significant predictors of recurrence included male sex (p = 0.003), ulceration (p = 0.03), and stage (p < 0.001). On multivariable analysis, male sex and stage continued to be significant (p < 0.01). For overall survival, regression, ulceration, stage, and age were significant predictors of survival. Stage, regression, and age remained significant by multivariable analysis. Patient symptoms were the most frequent mode of detection (40%), followed by physician examination (30%) and surveillance imaging (26%)-this did not differ significantly by stage. Regional nodes were the most common site of recurrence (30%), followed by lung (27%) and in-transit (18%). CONCLUSIONS The majority of recurrences in stage II melanoma are detected by patients and their physicians and rarely by routine imaging. As such, clinical follow-up and patient education are critical factors in detection of recurrence. With the prevalence of regional nodal recurrences, ultrasound might prove to be an important strategy in early recurrence detection.
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Affiliation(s)
- Adam C Berger
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA.
| | - David W Ollila
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | | | - John C Kairys
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | | | - Kendra Feeney
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Nooreen Dabbish
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | - Benjamin Leiby
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | - Jill A Frank
- Department of Surgery, University of North Carolina, Chapel Hill, NC
| | | | - Michael O Meyers
- Department of Surgery, University of North Carolina, Chapel Hill, NC
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33
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Goodman KA, Niedzwiecki D, Hall N, Bekaii-Saab TS, Ye X, Meyers MO, Mitchell-Richards K, Boffa DJ, Frankel WL, Venook AP, Hochster HS, Crane CH, O'Reilly EM, Ilson DH. Initial results of CALGB 80803 (Alliance): A randomized phase II trial of PET scan-directed combined modality therapy for esophageal cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
1 Background: To determine whether changing chemotherapy (CT) during pre-op chemoradiation (CRT) based on response to induction CT by 18F-fluoro-deoxyglucose PET imaging can lead to improved pathologic complete response (pCR) in patients (pts) with resectable esophageal and gastroesophageal junction (GEJ) adenocarcinomas. Methods: 257 eligible pts were enrolled, underwent baseline PET scan, and were randomized to one of 2 induction CT arms: Modified FOLFOX-6 (oxaliplatin, leucovorin, 5-FU), days 1, 15, 29 or Carboplatin/Paclitaxel (CP), days 1, 8, 22, 29. Repeat PET was performed days 36-42; change in max standardized uptake value (SUV) from baseline was assessed. PET non-responders (≤35% decrease in SUV – PET-NR) crossed over to alternative CT regimen during CRT (50.4Gy/28 fractions). PET responders (>35% decrease in SUV – PET-R) continued on same CT during CRT. Pts underwent surgery 6 wks post-CRT. Pts evaluable if had surgery, disease progression (PD), death due to disease, were unresectable or had adverse event (AE). Primary endpoint was pCR in PET-NR who crossed over to alternative CT (expected 5% under H0 to 20% under Ha). Results: Pre-audit PET response data after induction CT and pCR rates after CRT and surgery are shown in the table. For PET-NR who crossed over to alternative CT during CRT, pCR was 15.6%; 95% CI (0.08, 0.26). Conclusions: Efficacy criteria were met for an improvement in pCR rates among pts who were PET-NR after induction CT and received alternative CT during CRT for esophageal and GEJ adenoca. Pts receiving induction and concurrent CP had an unexpectedly low pCR. Support: U10CA180821, U10CA180882 Clinical trial information: NCT01333033. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | - Wendy L Frankel
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | - Alan P. Venook
- University of California, San Francisco, San Francisco, CA
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34
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Lopez N, Strassle PD, Laks S, Meyers MO, Kim HJ, Yeh JJ. Take Only What You Need? A Nationwide Analysis Revealing the Cost of Splenectomy in Distal Pancreatectomy. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.06.154] [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: 11/27/2022]
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35
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Stitzenberg KB, Chang Y, Smith AB, Meyers MO, Nielsen ME. Impact of Location of Readmission on Outcomes After Major Cancer Surgery. Ann Surg Oncol 2016; 24:319-329. [PMID: 27613557 DOI: 10.1245/s10434-016-5528-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The burden of readmissions after major cancer surgery is high. Prior work suggests that one-third of readmitted patients are readmitted to a different hospital than where the surgery was performed. The impact of this location of readmission needs to be more thoroughly understood. METHODS This retrospective cohort study was performed on Surveillance, Epidemiology, and End Results (SEER)-Medicare patients with bladder, esophagus, lung, or pancreas cancer diagnosed from 2001 to 2007 who underwent extirpative surgery and were readmitted within 90 days. Readmission location was classified as 'index' if readmission was at the hospital where surgery was performed, or 'different' if readmission was elsewhere. Outcomes including complications, reoperations, in-hospital mortality, 90-day mortality, and 90-day total costs were compared based on the location of readmission using a propensity score inverse probability treatment weight analysis. RESULTS Overall, 7903 (28 %) patients were readmitted within 90 days of index hospitalization. Thirty-three percent were readmitted to a different hospital (bladder 30 %, esophagus 34 %, lung 34 %, pancreas 34 %). Ninety-day mortality and total costs of care were not significantly different between the readmission location groups (all p > 0.05); however, substantial differences in the types of patients, and timing of and reasons for readmission were observed between the two groups. CONCLUSIONS Patients readmitted to different hospitals after major cancer surgery are a different group of patients than those readmitted to the index hospital. Accounting for this, we did not find significant differences in short-term clinical outcomes or costs of care based on readmission location; however, differences in long-term outcomes were observed that should be further explored in future studies.
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Affiliation(s)
- Karyn B Stitzenberg
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA. .,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
| | - YunKyung Chang
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Angela B Smith
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.,Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | - Michael O Meyers
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Matthew E Nielsen
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.,Department of Urology, University of North Carolina, Chapel Hill, NC, USA
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36
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Treece AL, Duncan DL, Tang W, Elmore S, Morgan DR, Meyers MO, Dominguez RL, Speck O, Gulley ML. Gastric adenocarcinoma microRNA profiles in fixed tissue and in plasma reveal cancer-associated and Epstein-Barr virus-related expression patterns. J Transl Med 2016; 96:661-71. [PMID: 26950485 PMCID: PMC5767475 DOI: 10.1038/labinvest.2016.33] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/09/2015] [Accepted: 01/12/2016] [Indexed: 12/27/2022] Open
Abstract
MicroRNA expression in formalin-fixed paraffin-embedded tissue (FFPE) or plasma may add value for cancer management. The GastroGenus miR Panel was developed to measure 55 cancer-specific human microRNAs, Epstein-Barr virus (EBV)-encoded microRNAs, and controls. This Q-rtPCR panel was applied to 100 FFPEs enriched for adenocarcinoma or adjacent non-malignant mucosa, and to plasma of 31 patients. In FFPE, microRNAs upregulated in malignant versus adjacent benign gastric mucosa were hsa-miR-21, -155, -196a, -196b, -185, and -let-7i. Hsa-miR-18a, 34a, 187, -200a, -423-3p, -484, and -744 were downregulated. Plasma of cancer versus non-cancer controls had upregulated hsa-miR-23a, -103, and -221 and downregulated hsa-miR-378, -346, -486-5p, -200b, -196a, -141, and -484. EBV-infected versus uninfected cancers expressed multiple EBV-encoded microRNAs, and concomitant dysregulation of four human microRNAs suggests that viral infection may alter cellular biochemical pathways. Human microRNAs were dysregulated between malignant and benign gastric mucosa and between plasma of cancer patients and non-cancer controls. Strong association of EBV microRNA expression with known EBV status underscores the ability of microRNA technology to reflect disease biology. Expression of viral microRNAs in concert with unique human microRNAs provides novel insights into viral oncogenesis and reinforces the potential for microRNA profiles to aid in classifying gastric cancer subtypes. Pilot studies of plasma suggest the potential for a noninvasive addition to cancer diagnostics.
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Affiliation(s)
- Amanda L Treece
- Pathology and Laboratory Medicine,University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Daniel L Duncan
- Pathology and Laboratory Medicine,University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Weihua Tang
- Pathology and Laboratory Medicine,University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sandra Elmore
- Pathology and Laboratory Medicine,University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Douglas R Morgan
- Lineberger Comprehensive Cancer Center,Gastroenterology,Vanderbilt University, Nashville, TN,University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael O Meyers
- Lineberger Comprehensive Cancer Center,Surgical Oncology,University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Olga Speck
- Pathology and Laboratory Medicine,University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Margaret L Gulley
- Pathology and Laboratory Medicine,Lineberger Comprehensive Cancer Center,University of North Carolina at Chapel Hill, Chapel Hill, NC
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37
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Farrell TM, Ghaderi I, McPhail LE, Alger AR, Meyers MO, Meyer AA. Measuring Patterns of Surgeon Confidence Using a Novel Assessment Tool. Am Surg 2016; 82:28-35. [PMID: 26802851] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Confidence should increase during surgical training and practice. However, few data exist regarding confidence of surgeons across this continuum. Confidence may develop differently in clinical and personal domains, or may erode as specialization or age restricts practice. A reliable scale of confidence is needed to track this competency. A novel survey was distributed to surgeons in private and academic settings. One hundred and thirty-four respondents completed this cross-sectional survey. Surgeons reported anticipated reactions to clinical scenarios within three patient care domains (acute inpatient, nonacute inpatient, and outpatient) and in personal spheres. Confidence scores were plotted against years of experience. Curves of best fit were generated and trends assessed. A subgroup completed a second survey after four years to assess the survey's reliability over time. During residency, there is steep improvement in confidence reported by surgeons in all clinical domains, with further increase for inpatient domains during transition into practice. Confidence in personal spheres also increases quickly during residency and thereafter. The surgeon confidence scale captures the expected acquisition of confidence during early surgical experience, and will have value in following trends in surgeon confidence as training and practice patterns change.
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Affiliation(s)
- Timothy M Farrell
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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38
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Abstract
Confidence should increase during surgical training and practice. However, few data exist regarding confidence of surgeons across this continuum. Confidence may develop differently in clinical and personal domains, or may erode as specialization or age restricts practice. A reliable scale of confidence is needed to track this competency. A novel survey was distributed to surgeons in private and academic settings. One hundred and thirty-four respondents completed this cross-sectional survey. Surgeons reported anticipated reactions to clinical scenarios within three patient care domains (acute inpatient, nonacute inpatient, and outpatient) and in personal spheres. Confidence scores were plotted against years of experience. Curves of best fit were generated and trends assessed. A subgroup completed a second survey after four years to assess the survey's reliability over time. During residency, there is steep improvement in confidence reported by surgeons in all clinical domains, with further increase for inpatient domains during transition into practice. Confidence in personal spheres also increases quickly during residency and thereafter. The surgeon confidence scale captures the expected acquisition of confidence during early surgical experience, and will have value in following trends in surgeon confidence as training and practice patterns change.
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Affiliation(s)
- Timothy M. Farrell
- From the Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Iman Ghaderi
- From the Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lindsee E. Mcphail
- From the Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amy R. Alger
- From the Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael O. Meyers
- From the Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anthony A. Meyer
- From the Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Samples JE, Snavely AC, Meyers MO. Postoperative Morbidity in Curative Resection of Gastroesophageal Carcinoma Does Not Impact Long-term Survival. Am Surg 2015; 81:1228-1231. [PMID: 26736158] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Significant morbidity and mortality have historically been reported for surgical resection of gastric and gastroesophageal junction tumors. We evaluated our experience to determine morbidity and mortality and evaluated demographic and pathologic risk factors associated with postoperative outcome and long-term survival. A retrospective, Institutional Review Board-approved, single-institution database identified 102 patients who underwent resection with curative intent for gastroesophageal junction or gastric carcinoma from 2004 to 2012. The method of Kaplan and Meier was used to describe overall survival and estimate median survival. Of 102 patients, 74 were male and 28 were female. Of these, 24 patients were > 70 years of age at surgery (median = 62.9). Forty esophagectomies, 25 total gastrectomies, and 37 subtotal gastrectomies were performed. Two patients died (one esophagectomy and one gastrectomy). Forty-one developed a complication: 17 minor and 35 major, including six anastomotic leaks. Patients with low preoperative albumin (P = 0.01) and increased age (P = 0.05) were associated with having a postoperative complication; extent of nodal dissection (P = 0.48), jejunostomy (0.24), performance status (P = 0.77), type of surgery (P = 0.74), and neoadjuvant therapy (P = 0.24) were not associated. More extensive nodal dissection was associated with a decreased risk of death (P = 0.007). Having any complication (P = 0.20), an anastomotic leak (P = 0.17), worse grade of complication (P = 0.15), presence of feeding jejunostomy tube (P = 0.17), and neoadjuvant therapy (P = 0.30) were not associated with changes in overall survival. Thorough lymph node dissection improves survival without increasing postoperative morbidity. The data advocate for increased lymph node yield and close attention to nutritional support in gastroesophageal carcinoma patients.
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Affiliation(s)
- Jennifer E Samples
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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40
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Abstract
Significant morbidity and mortality have historically been reported for surgical resection of gastric and gastroesophageal junction tumors. We evaluated our experience to determine morbidity and mortality and evaluated demographic and pathologic risk factors associated with postoperative outcome and long-term survival. A retrospective, Institutional Review Board-approved, single-institution database identified 102 patients who underwent resection with curative intent for gastroesophageal junction or gastric carcinoma from 2004 to 2012. The method of Kaplan and Meier was used to describe overall survival and estimate median survival. Of 102 patients, 74 were male and 28 were female. Of these, 24 patients were > 70 years of age at surgery (median = 62.9). Forty esophagectomies, 25 total gastrectomies, and 37 subtotal gastrectomies were performed. Two patients died (one esophagectomy and one gastrectomy). Forty-one developed a complication: 17 minor and 35 major, including six anastomotic leaks. Patients with low preoperative albumin ( P = 0.01) and increased age ( P = 0.05) were associated with having a postoperative complication; extent of nodal dissection ( P = 0.48), jejunostomy (0.24), performance status ( P = 0.77), type of surgery ( P = 0.74), and neoadjuvant therapy ( P = 0.24) were not associated. More extensive nodal dissection was associated with a decreased risk of death ( P = 0.007). Having any complication ( P = 0.20), an anastomotic leak ( P = 0.17), worse grade of complication ( P = 0.15), presence of feeding jejunostomy tube ( P = 0.17), and neoadjuvant therapy ( P = 0.30) were not associated with changes in overall survival. Thorough lymph node dissection improves survival without increasing postoperative morbidity. The data advocate for increased lymph node yield and close attention to nutritional support in gastroesophageal carcinoma patients.
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Affiliation(s)
- Jennifer E. Samples
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anna C. Snavely
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael O. Meyers
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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41
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Henry NL, Patt DA, Meyers MO, Malik M, Bretsch J, Jackson C, Grupe A, Von Roenn J. Bridging the Medical Education and Quality Cancer Care Divide: A Call to Action. J Oncol Pract 2015; 11:424-6. [PMID: 26130819 DOI: 10.1200/jop.2015.004242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
ASCO Leadership Development Program members were tasked by the ASCO Board of Directors to explore how to optimize integration of key aspects of oncology care in order to facilitate continuous quality improvement for the practicing oncologist. This Perspective summarizes their findings.
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Affiliation(s)
- N Lynn Henry
- University of Michigan Medical School, Ann Arbor, MI; Texas Oncology, Austin, TX; University of North Carolina School of Medicine, Chapel Hill, NC; Nizam's Institute of Medical Sciences, Hyderabad, India; and American Society of Clinical Oncology, Alexandria, VA
| | - Debra A Patt
- University of Michigan Medical School, Ann Arbor, MI; Texas Oncology, Austin, TX; University of North Carolina School of Medicine, Chapel Hill, NC; Nizam's Institute of Medical Sciences, Hyderabad, India; and American Society of Clinical Oncology, Alexandria, VA
| | - Michael O Meyers
- University of Michigan Medical School, Ann Arbor, MI; Texas Oncology, Austin, TX; University of North Carolina School of Medicine, Chapel Hill, NC; Nizam's Institute of Medical Sciences, Hyderabad, India; and American Society of Clinical Oncology, Alexandria, VA
| | - Monica Malik
- University of Michigan Medical School, Ann Arbor, MI; Texas Oncology, Austin, TX; University of North Carolina School of Medicine, Chapel Hill, NC; Nizam's Institute of Medical Sciences, Hyderabad, India; and American Society of Clinical Oncology, Alexandria, VA
| | - Jennifer Bretsch
- University of Michigan Medical School, Ann Arbor, MI; Texas Oncology, Austin, TX; University of North Carolina School of Medicine, Chapel Hill, NC; Nizam's Institute of Medical Sciences, Hyderabad, India; and American Society of Clinical Oncology, Alexandria, VA
| | - Carmen Jackson
- University of Michigan Medical School, Ann Arbor, MI; Texas Oncology, Austin, TX; University of North Carolina School of Medicine, Chapel Hill, NC; Nizam's Institute of Medical Sciences, Hyderabad, India; and American Society of Clinical Oncology, Alexandria, VA
| | - Anne Grupe
- University of Michigan Medical School, Ann Arbor, MI; Texas Oncology, Austin, TX; University of North Carolina School of Medicine, Chapel Hill, NC; Nizam's Institute of Medical Sciences, Hyderabad, India; and American Society of Clinical Oncology, Alexandria, VA
| | - Jamie Von Roenn
- University of Michigan Medical School, Ann Arbor, MI; Texas Oncology, Austin, TX; University of North Carolina School of Medicine, Chapel Hill, NC; Nizam's Institute of Medical Sciences, Hyderabad, India; and American Society of Clinical Oncology, Alexandria, VA
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42
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Baker JJ, Meyers MO, Deal AM, Frank JF, Stitzenberg KB, Ollila DW. Prognostic significance of tumor mitotic rate in T2 melanoma staged with sentinel lymphadenectomy. J Surg Oncol 2015; 111:711-5. [DOI: 10.1002/jso.23880] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 12/06/2014] [Indexed: 12/29/2022]
Affiliation(s)
| | - Michael O. Meyers
- Division of Surgical Oncology; Department of Surgery; University of North Carolina-Chapel Hill; North Carolina
- Lineberger Comprehensive Cancer Center; University of North Carolina-Chapel Hill; North Carolina
| | - Allison M. Deal
- Lineberger Comprehensive Cancer Center; University of North Carolina-Chapel Hill; North Carolina
- Biostatistics Core Facility; University of North Carolina-Chapel Hill; North Carolina
| | - Jill F. Frank
- Lineberger Comprehensive Cancer Center; University of North Carolina-Chapel Hill; North Carolina
| | - Karyn B. Stitzenberg
- Division of Surgical Oncology; Department of Surgery; University of North Carolina-Chapel Hill; North Carolina
- Lineberger Comprehensive Cancer Center; University of North Carolina-Chapel Hill; North Carolina
| | - David W. Ollila
- Division of Surgical Oncology; Department of Surgery; University of North Carolina-Chapel Hill; North Carolina
- Lineberger Comprehensive Cancer Center; University of North Carolina-Chapel Hill; North Carolina
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Ollila DW, Meyers MO. Another brick in the wall: toward a better understanding of melanoma of unknown primary. Ann Surg Oncol 2014; 21:4054-5. [PMID: 25201497 DOI: 10.1245/s10434-014-4027-5] [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] [Indexed: 11/18/2022]
Affiliation(s)
- David W Ollila
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,
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Baker JJ, Stitzenberg KB, Collichio FA, Meyers MO, Ollila DW. Systematic review: surgery for patients with metastatic melanoma during active treatment with ipilimumab. Am Surg 2014; 80:805-810. [PMID: 25105403] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Studies of ipilimumab have shown improved overall survival in patients with metastatic cutaneous melanoma. As a result, use of ipilimumab in patients with Stage IV melanoma is rapidly increasing. Patients with Stage IV melanoma often require urgent operations for complications from metastases, but little is known about the safety of surgical intervention for patients receiving ipilimumab. We performed a systematic review of the literature using PubMed. Our search terms were melanoma and ipilimumab. We excluded foreign language articles, review articles, and those not addressing cutaneous melanoma. We identified 194 publications matching the search criteria. Only six of those met the inclusion criteria. In these six publications, seven patients who had undergone surgical intervention during treatment with ipilimumab were described. There were no documented surgical complications. We reviewed our institutional experience and identified an additional three patients. No postoperative complications could be attributed directly to ipilimumab. There are limited data on the safety of surgical intervention during treatment with ipilimumab. Preliminary reports suggest there is no reason to withhold or delay surgery for patients receiving ipilimumab therapy.
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Affiliation(s)
- Justin J Baker
- Division of Surgical Oncology, Department of Surgery, Maine Medical Center, Portland, Maine, USA
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45
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Baker JJ, Stitzenberg KB, Collichio FA, Meyers MO, Ollila DW. Systematic Review: Surgery for Patients with Metastatic Melanoma during Active Treatment with Ipilimumab. Am Surg 2014. [DOI: 10.1177/000313481408000833] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Studies of ipilimumab have shown improved overall survival in patients with metastatic cutaneous melanoma. As a result, use of ipilimumab in patients with Stage IV melanoma is rapidly increasing. Patients with Stage IV melanoma often require urgent operations for complications from metastases, but little is known about the safety of surgical intervention for patients receiving ipilimumab. We performed a systematic review of the literature using PubMed. Our search terms were melanoma and ipilimumab. We excluded foreign language articles, review articles, and those not addressing cutaneous melanoma. We identified 194 publications matching the search criteria. Only six of those met the inclusion criteria. In these six publications, seven patients who had undergone surgical intervention during treatment with ipilimumab were described. There were no documented surgical complications. We reviewed our institutional experience and identified an additional three patients. No postoperative complications could be attributed directly to ipilimumab. There are limited data on the safety of surgical intervention during treatment with ipilimumab. Preliminary reports suggest there is no reason to withhold or delay surgery for patients receiving ipilimumab therapy.
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Affiliation(s)
- Justin J. Baker
- Division of Surgical Oncology, Department of Surgery, Maine Medical Center, Portland, Maine
| | | | | | - Michael O. Meyers
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery
| | - David W. Ollila
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery
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Sargent DJ, Shi Q, Gill S, Louvet C, Everson RB, Kellner U, Clancy TE, Pipas JM, Resnick MB, Meyers MO, Wu TT, Huntsman D, Validire P, Farooq U, Pavey ES, Beaudry G, Haince JF, Fradet Y. Molecular testing for lymph node metastases as a determinant of colon cancer recurrence: results from a retrospective multicenter study. Clin Cancer Res 2014; 20:4361-9. [PMID: 24919572 DOI: 10.1158/1078-0432.ccr-13-2659] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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
PURPOSE Recurrence risk assessment to make treatment decisions for early-stage colon cancer patients is a major unmet medical need. The aim of this retrospective multicenter study was to evaluate the clinical utility of guanylyl cyclase C (GCC) mRNA levels in lymph nodes on colon cancer recurrence. METHODS The proportion of lymph nodes with GCC-positive mRNA (LNR) was evaluated in 463 untreated T3N0 patients, blinded to clinical outcomes. One site's (n = 97) tissue grossing method precluded appropriate lymph node assessment resulting in post hoc exclusion. Cox regression models tested the relationship between GCC and the primary endpoint of time to recurrence. Assay methods, primary analyses, and cut points were all prespecified. RESULTS Final dataset contained 366 patients, 38 (10%) of whom had recurrence. Presence of four or more GCC-positive lymph nodes was significantly associated with risk of recurrence [hazard ratio (HR) = 2.46, 95% confidence interval (CI), 1.07-5.69, P = 0.035], whereas binary GCC LNR risk class (HR = 1.87, 95% CI, 0.99-3.54, P = 0.054) and mismatch repair (MMR) status (HR = 0.77, 95% CI, 0.36-1.62, P = 0.49) were not. In a secondary analysis using a 3-level GCC LNR risk group classification of high (LNR > 0.20), intermediate (0.10 < LNR ≤ 0.20), and low (LNR ≤ 0.10), high-risk patients had a 2.5 times higher recurrence risk compared with low-risk patients (HR = 2.53, 95% CI, 1.24-5.17, P = 0.011). CONCLUSIONS GCC status is a promising prognostic factor independent of traditional histopathology risk factors in a contemporary population of patients with stage IIa colon cancer not treated with adjuvant therapy, but GCC determination must be performed with methodology adapted to the tissue procurement and fixation technique.
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Affiliation(s)
| | - Qian Shi
- Division of Biomedical Statistics and Informatics
| | - Sharlene Gill
- University of British Columbia, BC Cancer Agency, Vancouver, BC
| | | | | | - Udo Kellner
- Johannes Wessling Klinikum Minden, Minden, Germany
| | - Thomas E Clancy
- Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - J Marc Pipas
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Murray B Resnick
- Alpert Medical School, Brown University and Rhode Island Hospital, Providence, Rhode Island
| | - Michael O Meyers
- Division of Surgical Oncology, The University of North Carolina, Chapel Hill, North Carolina
| | - Tsung-Teh Wu
- Department of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | - David Huntsman
- University of British Columbia, BC Cancer Agency, Vancouver, BC
| | - Pierre Validire
- Pathology, Institut Mutualiste Montsouris, Paris, France; and
| | - Umar Farooq
- University of Connecticut Health Center, Farmington, Connecticut
| | | | | | | | - Yves Fradet
- DiagnoCure Inc., Québec, Canada; Departments of
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Affiliation(s)
| | - Karyn Beth Stitzenberg
- Division of Surgical Oncology and Endocrine Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Michael O. Meyers
- Division of Surgical Oncology and Endocrine Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
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Affiliation(s)
- Jeffrey J Dehmer
- Fellow, Pediatric Surgery, Children's Mercy, Kansas City, Missouri. Associate professor and program director, General Surgery Residency, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina;
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Abstract
PURPOSE Standard of care treatment for most stage I rectal cancers is total mesorectal excision (TME). Given the morbidity associated with TME, local excision (LE) for early-stage rectal cancer has been explored. This study examines practice patterns and overall survival (OS) for early-stage rectal cancer. METHODS All patients in the National Cancer Data Base diagnosed with rectal cancer from 1998 to 2010 were initially included. Use of LE versus proctectomy and use of adjuvant radiation therapy were compared over time. Adjusted Cox proportional hazards models were used to compare OS based on treatment. RESULTS LE was used to treat 46.5% of patients with T1 and 16.8% with T2 tumors. Use of LE increased steadily over time (P < .001). LE was most commonly used for women, black patients, very old patients, those without private health insurance, those with well-differentiated tumors, and those with T1 tumors. Proctectomy was associated with higher rates of tumor-free surgical margins compared with LE (95% v 76%; P < .001). Adjuvant radiation therapy use decreased over time independent of surgical procedure or T stage. For T2N0 disease, patients treated with LE alone had significantly poorer adjusted OS than those treated with proctectomy alone or multimodality therapy. CONCLUSION Guideline-concordant adoption of LE for treatment of low-risk stage I rectal cancer is increasing. However, use of LE is also increasing for higher-risk rectal cancers that do not meet guideline criteria for LE. Treatment with LE alone is associated with poorer long-term OS. Additional studies are warranted to understand the factors driving increased use of LE.
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Affiliation(s)
- Karyn B. Stitzenberg
- All authors: University of North Carolina at Chapel Hill; and Karyn B. Stitzenberg, Hanna K. Sanoff, Michael O. Meyers, and Joel E. Tepper, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Hanna K. Sanoff
- All authors: University of North Carolina at Chapel Hill; and Karyn B. Stitzenberg, Hanna K. Sanoff, Michael O. Meyers, and Joel E. Tepper, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Dolly C. Penn
- All authors: University of North Carolina at Chapel Hill; and Karyn B. Stitzenberg, Hanna K. Sanoff, Michael O. Meyers, and Joel E. Tepper, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Michael O. Meyers
- All authors: University of North Carolina at Chapel Hill; and Karyn B. Stitzenberg, Hanna K. Sanoff, Michael O. Meyers, and Joel E. Tepper, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Joel E. Tepper
- All authors: University of North Carolina at Chapel Hill; and Karyn B. Stitzenberg, Hanna K. Sanoff, Michael O. Meyers, and Joel E. Tepper, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Abstract
PURPOSE Standard of care treatment for most stage I rectal cancers is total mesorectal excision (TME). Given the morbidity associated with TME, local excision (LE) for early-stage rectal cancer has been explored. This study examines practice patterns and overall survival (OS) for early-stage rectal cancer. METHODS All patients in the National Cancer Data Base diagnosed with rectal cancer from 1998 to 2010 were initially included. Use of LE versus proctectomy and use of adjuvant radiation therapy were compared over time. Adjusted Cox proportional hazards models were used to compare OS based on treatment. RESULTS LE was used to treat 46.5% of patients with T1 and 16.8% with T2 tumors. Use of LE increased steadily over time (P < .001). LE was most commonly used for women, black patients, very old patients, those without private health insurance, those with well-differentiated tumors, and those with T1 tumors. Proctectomy was associated with higher rates of tumor-free surgical margins compared with LE (95% v 76%; P < .001). Adjuvant radiation therapy use decreased over time independent of surgical procedure or T stage. For T2N0 disease, patients treated with LE alone had significantly poorer adjusted OS than those treated with proctectomy alone or multimodality therapy. CONCLUSION Guideline-concordant adoption of LE for treatment of low-risk stage I rectal cancer is increasing. However, use of LE is also increasing for higher-risk rectal cancers that do not meet guideline criteria for LE. Treatment with LE alone is associated with poorer long-term OS. Additional studies are warranted to understand the factors driving increased use of LE.
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Affiliation(s)
- Karyn B Stitzenberg
- All authors: University of North Carolina at Chapel Hill; and Karyn B. Stitzenberg, Hanna K. Sanoff, Michael O. Meyers, and Joel E. Tepper, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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