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Handley T, Jorm C, Symington C, Christie L, Forbes E, Munro A, Cheney R. 'It sort of has the feel of being at home': Mixed-methods evaluation of a pilot community-based palliative end-of-life service in a regional setting. Aust J Rural Health 2022; 30:582-592. [PMID: 35749467 PMCID: PMC9796149 DOI: 10.1111/ajr.12897] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/11/2022] [Accepted: 05/26/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To evaluate the acceptability and effectiveness of a small community-based hospice on the end-of-life experiences of patients and families. METHODS Mixed-methods study. DESIGN Patient admission data were used to assess utilisation of the hospice. Open-ended interviews with hospice patients and their families/carers were used to understand the emotional effects of the service. SETTING A small palliative end-of-life hospice in a rural town in NSW, Australia, during a 12-month trial period that began in March 2019. Data were collected in October-November 2019. PARTICIPANTS Patients, families and carers who used the hospice during the trial period, as well as staff working at the hospice. MAIN OUTCOME MEASURE(S) Quantitative measures included the number of patients admitted to the hospice, the average length of stay and the overall occupancy rate of the hospice. Quantitative interviews were used to explore the experiences of patients and families who used the hospice, and whether the hospice met their end-of-life needs. RESULTS During the trial, 58 patients were admitted to the hospice. The majority of admissions were less than 7 days. Two patients and nine family members were interviewed about their experiences, and six staff completed interviews. Experiences were consistently positive, with the community setting of the hospice contributing to a peaceful and home-like end-of-life experience. Interviewees described meaningful relationships with staff, a pleasant physical environment and the comprehensive care provided were key elements of this experience. CONCLUSION This model, embedding end-of-life care within a residential aged care facility, facilitated a positive end-of-life experience for residents of this regional community. The development of local models to meet local needs is essential to enabling people nearing the end of life to remain in their location of choice, and ensure that their needs are met at this vulnerable time.
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Affiliation(s)
- Tonelle Handley
- School of Medicine and Public HealthUniversity of NewcastleCallaghanNSWAustralia
| | - Christine Jorm
- School of Medicine and Public HealthUniversity of NewcastleCallaghanNSWAustralia
| | | | | | - Erin Forbes
- School of Medicine and Public HealthUniversity of NewcastleCallaghanNSWAustralia
| | - Alice Munro
- Western NSW Local Health DistrictOrangeNSWAustralia
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Finn SP, Addeo A, Dafni U, Thunnissen E, Bubendorf L, Madsen LB, Biernat W, Verbeken E, Hernandez-Losa J, Marchetti A, Cheney R, Warth A, Speel EJM, Quinn AM, Monkhorst K, Jantus-Lewintre E, Tischler V, Marti N, Dimopoulou G, Molina-Vila MA, Kammler R, Kerr KM, Peters S, Stahel RA. Prognostic Impact of KRAS G12C Mutation in Patients With NSCLC: Results From the European Thoracic Oncology Platform Lungscape Project. J Thorac Oncol 2021; 16:990-1002. [PMID: 33647504 DOI: 10.1016/j.jtho.2021.02.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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: 07/28/2020] [Revised: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 01/18/2023]
Abstract
INTRODUCTION KRAS mutations, the most frequent gain-of-function alterations in NSCLC, are currently emerging as potential predictive therapeutic targets. The role of KRAS-G12C (Kr_G12C) is of special interest after the recent discovery and preclinical analyses of two different Kr_G12C covalent inhibitors (AMG-510, MRTX849). METHODS KRAS mutations were evaluated in formalin-fixed, paraffin-embedded tissue sections by a microfluidic-based multiplex polymerase chain reaction platform as a component of the previously published European Thoracic Oncology Platform Lungscape 003 Multiplex Mutation study, of clinically annotated, resected, stage I to III NSCLC. In this study, -Kr_G12C mutation prevalence and its association with clinicopathologic characteristics, molecular profiles, and postoperative patient outcome (overall survival, relapse-free survival, time-to-relapse) were explored. RESULTS KRAS gene was tested in 2055 Lungscape cases (adenocarcinomas: 1014 [49%]) with I or II or III stage respective distribution of 53% or 24% or 22% and median follow-up of 57 months. KRAS mutation prevalence in the adenocarcinoma cohort was 38.0% (95% confidence interval (CI): 35.0% to 41.0%), with Kr_G12C mutation representing 17.0% (95% CI: 14.7% to 19.4%). In the "histologic-subtype" cohort, Kr_G12C prevalence was 10.5% (95% CI: 9.2% to 11.9%). When adjusting for clinicopathologic characteristics, a significant negative prognostic effect of Kr_G12C presence versus other KRAS mutations or nonexistence of KRAS mutation was identified in the adenocarcinoma cohort alone and in the "histologic-subtype" cohort. For overall survival in adenocarcinomas, hazard ratio (HR)G12C versus other KRAS is equal to 1.39 (95% CI: 1.03 to 1.89, p = 0.031) and HRG12C versus no KRAS is equal to 1.32 (95% CI: 1.03 to 1.69, p = 0.028) (both also significant in the "histologic-subtype" cohort). For time-to-relapse, HRG12C versus other KRAS is equal to 1.41 (95% CI: 1.03 to 1.92, p = 0.030). In addition, among all patients, for relapse-free survival, HRG12C versus no KRAS is equal to 1.27 (95% CI: 1.04 to 1.54, p = 0.017). CONCLUSIONS In this large, clinically annotated stage I to III NSCLC cohort, the specific Kr_G12C mutation is significantly associated with poorer prognosis (adjusting for clinicopathologic characteristics) among adenocarcinomas and in unselected NSCLCs.
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Affiliation(s)
- Stephen P Finn
- Cancer Molecular Diagnostics Laboratory, Institute of Molecular Medicine, St. James Hospital, Dublin, Ireland.
| | - Alfredo Addeo
- Department of Oncology, University Hospital Geneva, Geneva, Switzerland
| | - Urania Dafni
- ETOP Statistics Center, Frontier Science Foundation-Hellas, Athens, Greece; Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Erik Thunnissen
- Department of Pathology, Free University Medical Center, Amsterdam, the Netherlands
| | - Lukas Bubendorf
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Line Bille Madsen
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Wojciech Biernat
- Department of Pathology, Medical University of Gdansk, Gdansk, Poland
| | - Eric Verbeken
- Department of Pathology, University Hospital KU Leuven, Leuven, Belgium
| | | | - Antonio Marchetti
- Department of Pathology, Ospedale Clinicizzato Chieti, Chieti, Italy
| | - Richard Cheney
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Arne Warth
- Department of Pathology, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Ernst-Jan M Speel
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Anne Marie Quinn
- Department of Histopathology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Kim Monkhorst
- Division of Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Eloisa Jantus-Lewintre
- Department of Biotechnology, Universitat Politècnica de València, Valencia, Spain; Mixed Unit TRIAL (General University Hospital Valencia Research Foundation and Píncipe Felipe Research Center), Valencia, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Valencia, Spain
| | - Verena Tischler
- Division of Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Nesa Marti
- European Thoracic Oncology Platform, Bern, Switzerland
| | - Georgia Dimopoulou
- ETOP Statistics Center, Frontier Science Foundation-Hellas, Athens, Greece
| | | | | | - Keith M Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Solange Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Rolf A Stahel
- European Thoracic Oncology Platform, Bern, Switzerland
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Lower T, Kinsman L, Dinh MM, Lyle D, Cheney R, Allan J, Munro A, Taylor B, Wiggers JH, Bailey A, Weller L, Jacob A, Stephens AS. Patterns of emergency department use in rural and metropolitan New South Wales from 2012 to 2018. Aust J Rural Health 2020; 28:490-499. [DOI: 10.1111/ajr.12668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/17/2020] [Indexed: 12/31/2022] Open
Affiliation(s)
- Tony Lower
- Mid North Coast Local Health District Port Macquarie NSW Australia
| | - Leigh Kinsman
- Mid North Coast Local Health District Port Macquarie NSW Australia
- Faculty of Medicine and Health School of Nursing and Midwifery University of Newcastle Newcastle NSW Australia
| | - Michael M. Dinh
- New South Wales Institute of Trauma and Injury Management Sydney NSW Australia
- Faculty of Medicine and Health Sydney Medical School The University of Sydney Sydney NSW Australia
| | - David Lyle
- Broken Hill University Department of Rural Health Faculty of Medicine and Health School of Medicine The University of Sydney Sydney NSW Australia
| | - Richard Cheney
- Western New South Wales Local Health District Orange NSW Australia
| | - Julaine Allan
- Western New South Wales Local Health District Orange NSW Australia
| | - Alice Munro
- Western New South Wales Local Health District Orange NSW Australia
| | - Barbara Taylor
- Murrumbidgee Local Health District Wagga Wagga NSW Australia
| | - John H. Wiggers
- Faculty of Medicine and Health School of Medicine, and Public Health University of Newcastle Newcastle NSW Australia
- Hunter New England Local Health District New Lambton NSW Australia
| | - Andrew Bailey
- Mid North Coast Local Health District Port Macquarie NSW Australia
| | - Lauren Weller
- New South Wales Rural Health Research Alliance Port Macquarie NSW Australia
| | - Alycia Jacob
- Faculty of Medicine and Health School of Nursing and Midwifery University of Newcastle Newcastle NSW Australia
| | - Alexandre S. Stephens
- Northern New South Wales Local Health District Lismore NSW Australia
- Faculty of Medicine and Health School of Public Health The University of Sydney Sydney NSW Australia
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Thunnissen E, Kerr KM, Dafni U, Bubendorf L, Finn SP, Soltermann A, Biernat W, Cheney R, Verbeken E, Warth A, Marchetti A, Speel EJM, Pokharel S, Quinn AM, Monkhorst K, Navarro A, Madsen LB, Tsourti Z, Geiger T, Kammler R, Peters S, Stahel RA. Programmed death-ligand 1 expression influenced by tissue sample size. Scoring based on tissue microarrays' and cross-validation with resections, in patients with, stage I-III, non-small cell lung carcinoma of the European Thoracic Oncology Platform Lungscape cohort. Mod Pathol 2020; 33:792-801. [PMID: 31740722 DOI: 10.1038/s41379-019-0383-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 11/08/2022]
Abstract
PD-L1, as assessed by immunohistochemistry, is a predictive biomarker for immuno-oncology treatment in lung cancer. Different scoring methods have been used to assess its status, resulting in a wide range of positivity rates. We use the European Thoracic Oncology Platform Lungscape non-small cell lung carcinoma cohort to explore this issue. PD-L1 expression was assessed via immunohistochemistry on tissue microarrays (up to four cores per case), using the DAKO 28-8 immunohistochemistry assay, following a two-round external quality assessment procedure. All samples were analyzed under the same protocol. Cross-validation of scoring between tissue microarray and whole sections was performed in 10% randomly selected samples. Cutoff points considered: ≥1, 50 (primarily), and 25%. At the two external quality assessment rounds, tissue microarray scoring agreement rates between pathologists were: 73% and 81%. There were 2008 cases with valid immunohistochemistry tissue microarray results (50% all cores evaluable). Concordant cases at 1, 25, and 50% were: 85, 91, and 93%. Tissue microarray core results were identical for 70% of cases. Sensitivity of the tissue microarray method for 1, 25, and 50% was: 80, 78, and 79% (specificity: 90, 95, 98%). Complete agreement between tissue microarrays and whole sections was achieved for 60% of the cases. Highest sensitivity rates for 1% and 50% cutoffs were detected for higher number of cores. Underestimation of PD-L1 expression on small samples is more common than overestimation. We demonstrated that classification of PD-L1 on small biopsy samples does not represent the overall expression of PD-L1 in all non-small cell cancer carcinoma cases, although the majority of cases are 'correctly' classified. In future studies, sampling more and larger biopsies, recording the biopsy size and tumor load may permit further refinement, increasing predictive accuracy.
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Affiliation(s)
- Erik Thunnissen
- Department of Pathology, Amsterdam University Medical Center, location VU University Medical Center, Amsterdam, Netherlands.
| | - Keith M Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Urania Dafni
- Froniter Science Foundation-Hellas & National and Kapodistrian University of Athens, Athens, Greece
| | - Lukas Bubendorf
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Stephen P Finn
- Department of Histopathology, St James's Hospital and Trinity College, Dublin, Ireland
| | - Alex Soltermann
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Wojciech Biernat
- Department of Pathomorphology, Medical University of Gdansk, Gdansk, Poland
| | - Richard Cheney
- Department of Pathology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Erik Verbeken
- Department of Pathology, University Hospital KU Leuven, Leuven, Belgium
| | - Arne Warth
- Department of Pathology, Universitätsklinikum Heidelberg, Heidelberg, Germany
- Institute of Pathology, Cytopathology, and Molecular Pathology MVZ UEGP Giessen, Wetzlar, Limburg, Germany
| | - Antonio Marchetti
- Center of Predicitve Predictive Molecular Medicine, CeSI, University of Chieti-Pescara, Chieti, Italy
| | - Ernst-Jan M Speel
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Saraswati Pokharel
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Anne Marie Quinn
- Wythenshawe Hospital, Department of Histopathology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kim Monkhorst
- Division of Pathology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Atilio Navarro
- Department of Pathology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Line Bille Madsen
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Zoi Tsourti
- Frontier Science Foundation-Hellas & University of Athens, Athens, Greece
| | - Thomas Geiger
- Translational Research Coordination, European Thoracic Oncology Platform Coordinating Office, Bern, Switzerland
| | - Roswitha Kammler
- Translational Research Coordination, European Thoracic Oncology Platform Coordinating Office, Bern, Switzerland
| | - Solange Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Rolf A Stahel
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
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Kerr KM, Thunnissen E, Dafni U, Finn SP, Bubendorf L, Soltermann A, Verbeken E, Biernat W, Warth A, Marchetti A, Speel EJM, Pokharel S, Quinn AM, Monkhorst K, Navarro A, Madsen LB, Radonic T, Wilson J, De Luca G, Gray SG, Cheney R, Savic S, Martorell M, Muley T, Baas P, Meldgaard P, Blackhall F, Dingemans AM, Dziadziuszko R, Vansteenkiste J, Weder W, Polydoropoulou V, Geiger T, Kammler R, Peters S, Stahel R. A retrospective cohort study of PD-L1 prevalence, molecular associations and clinical outcomes in patients with NSCLC: Results from the European Thoracic Oncology Platform (ETOP) Lungscape Project. Lung Cancer 2019; 131:95-103. [PMID: 31027705 DOI: 10.1016/j.lungcan.2019.03.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 07/16/2018] [Revised: 01/10/2019] [Accepted: 03/14/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The PD-L1 biomarker is an important factor in selecting patients with non-small cell lung cancer for immunotherapy. While several reports suggest that PD-L1 positivity is linked to a poor prognosis, others suggest that PD-L1 positive status portends a good prognosis. METHODS PD-L1 positivity prevalence, assessed via immunohistochemistry (IHC) on tissue microarrays (TMAs), and its association with clinicopathological characteristics, molecular profiles and patient outcome- Relapse-free Survival (RFS), Time-to-Relapse (TTR) and Overall Survival (OS)- is explored in the ETOP Lungscape cohort of stage I-III non-small cell lung cancer (NSCLC). Tumors are considered positive if they have ≥1/5/25/50% neoplastic cell membrane staining. RESULTS PD-L1 expression was assessed in 2182 NSCLC cases (2008 evaluable, median follow-up 4.8 years, 54.6% still alive), from 15 ETOP centers. Adenocarcinomas represent 50.9% of the cohort (squamous cell: 42.4%). Former smokers are 53.7% (current: 31.6%, never: 10.5%). PD-L1 positivity prevalence is present in more than one third of the Lungscape cohort (1%/5% cut-offs). It doesn't differ between adenocarcinomas and squamous cell histologies, but is more frequently detected in higher stages, never smokers, larger tumors (1/5/25% cut-offs). With ≥1% cut-off it is significantly associated with IHC MET overexpression, expression of PTEN, EGFR and KRAS mutation (only for adenocarcinoma). Results for 5%, 25% and 50% cut-offs were similar, with MET being significantly associated with PD-L1 positivity both for AC (p < 0.001, 5%/25%/50% cut-offs) and SCC (p < 0.001, 5% & 50% cut-offs and p = 0.0017 for 25%). When adjusting for clinicopathological characteristics, a significant prognostic effect was identified in adenocarcinomas (adjusted p-values: 0.024/0.064/0.063 for RFS/TTR/OS 1% cut-off, analogous for 5%/25%, but not for 50%). Similar results obtained for the model including all histologies, but no effect was found for the squamous cell carcinomas. CONCLUSION PD-L1 positivity, when adjusted for clinicopathological characteristics, is associated with a better prognosis for non-metastatic adenocarcinoma patients.
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Affiliation(s)
- Keith M Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom.
| | - Erik Thunnissen
- Department of Pathology, VU University Medical Center, Amsterdam, Netherlands
| | - Urania Dafni
- Froniter Science Foundation-Hellas & University of Athens, Athens, Greece
| | - Stephen P Finn
- Department of Histopathology, St James's Hospital and Trinity College, Dublin, Ireland
| | - Lukas Bubendorf
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Alex Soltermann
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Eric Verbeken
- Department of Pathology, University Hospital KU Leuven, Leuven, Belgium
| | - Wojciech Biernat
- Department of Pathomorphology, Medical University of Gdansk, Gdansk, Poland
| | - Arne Warth
- Department of Pathology, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Antonio Marchetti
- Center of Predicitve Predictive Molecular Medicine, CeSI, University of Chieti-Pescara, Chieti, Italy
| | - Ernst-Jan M Speel
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Sarawati Pokharel
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Anne Marie Quinn
- Wythenshawe Hospital, Department of Histopathology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Kim Monkhorst
- Division of Pathology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Atilio Navarro
- Department of Pathology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Line Bille Madsen
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Teodora Radonic
- Department of Pathology, VU University Medical Center, Amsterdam, Netherlands
| | - Joan Wilson
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Graziano De Luca
- Center of Predicitve Predictive Molecular Medicine, CeSI, University of Chieti-Pescara, Chieti, Italy
| | - Steven G Gray
- Department of Clinical Medicine, St James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Richard Cheney
- Department of Pathology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Spasenija Savic
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Miguel Martorell
- Department of Pathology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Thomas Muley
- Translational Research Unit, Thoraxklinik, University Hospital of Heidelberg, and Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Paul Baas
- Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Peter Meldgaard
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Fiona Blackhall
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Anne-Marie Dingemans
- Department of Pulmonology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Rafal Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Johan Vansteenkiste
- Department of Respiratory Oncology, University Hospital KU Leuven, Leuven, Belgium
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Thomas Geiger
- Translational Research Coordination, ETOP Coordinating Office, Bern, Switzerland
| | - Roswitha Kammler
- Translational Research Coordination, ETOP Coordinating Office, Bern, Switzerland
| | - Solange Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Rolf Stahel
- Clinic of Oncology, University Hospital Zurich, Zurich, Switzerland
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Rulle U, Tsourti Z, Casanova R, Deml KF, Verbeken E, Thunnissen E, Warth A, Cheney R, Sejda A, Speel EJ, Madsen LB, Nonaka D, Navarro A, Sansano I, Marchetti A, Finn SP, Monkhorst K, Kerr KM, Haberecker M, Wu C, Zygoura P, Kammler R, Geiger T, Gendreau S, Schulze K, Vrugt B, Wild P, Moch H, Weder W, Ciftlik AT, Dafni U, Peters S, Bubendorf L, Stahel RA, Soltermann A. Computer-Based Intensity Measurement Assists Pathologists in Scoring Phosphatase and Tensin Homolog Immunohistochemistry — Clinical Associations in NSCLC Patients of the European Thoracic Oncology Platform Lungscape Cohort. J Thorac Oncol 2018; 13:1851-1863. [DOI: 10.1016/j.jtho.2018.08.2034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 07/16/2018] [Accepted: 08/02/2018] [Indexed: 12/31/2022]
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Letovanec I, Finn S, Zygoura P, Smyth P, Soltermann A, Bubendorf L, Speel EJ, Marchetti A, Nonaka D, Monkhorst K, Hager H, Martorell M, Sejda A, Cheney R, Hernandez-Losa J, Verbeken E, Weder W, Savic S, Di Lorito A, Navarro A, Felip E, Warth A, Baas P, Meldgaard P, Blackhall F, Dingemans AM, Dienemann H, Dziadziuszko R, Vansteenkiste J, O'Brien C, Geiger T, Sherlock J, Schageman J, Dafni U, Kammler R, Kerr K, Thunnissen E, Stahel R, Peters S. Evaluation of NGS and RT-PCR Methods for ALK Rearrangement in European NSCLC Patients: Results from the European Thoracic Oncology Platform Lungscape Project. J Thorac Oncol 2018; 13:413-425. [PMID: 29191776 DOI: 10.1016/j.jtho.2017.11.117] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [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: 09/08/2017] [Revised: 11/14/2017] [Accepted: 11/19/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The reported prevalence of ALK receptor tyrosine kinase gene (ALK) rearrangement in NSCLC ranges from 2% to 7%. The primary standard diagnostic method is fluorescence in situ hybridization (FISH). Recently, immunohistochemistry (IHC) has also proved to be a reproducible and sensitive technique. Reverse-transcriptase polymerase chain reaction (RT-PCR) has also been advocated, and most recently, the advent of targeted next-generation sequencing (NGS) for ALK and other fusions has become possible. This study compares anaplastic lymphoma kinase (ALK) evaluation with all four techniques in resected NSCLC from the large European Thoracic Oncology Platform Lungscape cohort. METHODS A total of 96 cases from the European Thoracic Oncology Platform Lungscape iBiobank, with any ALK immunoreactivity were examined by FISH, central RT-PCR, and NGS. An H-score higher than 120 defines IHC positivity. RNA was extracted from the same formalin-fixed, paraffin-embedded tissues. For RT-PCR, primers covered the most frequent ALK translocations. For NGS, the Oncomine Solid Tumour Fusion Transcript Kit (Thermo Fisher Scientific, Waltham, MA) was used. The concordance was assessed using the Cohen κ coefficient (two-sided α ≤ 5%). RESULTS NGS provided results for 77 of the 95 cases tested (81.1%), whereas RT-PCR provided results for 77 of 96 (80.2%). Concordance occurred in 55 cases of the 60 cases tested with all four methods (43 ALK negative and 12 ALK positive). Using ALK copositivity for IHC and FISH as the criterion standard, we derived a sensitivity for RT-PCR/NGS of 70.0%/85.0%, with a specificity of 87.1%/79.0%. When either RT-PCR or NGS was combined with IHC, the sensitivity remained the same, whereas the specificity increased to 88.7% and 83.9% respectively. CONCLUSION NGS evaluation with the Oncomine Solid Tumour Fusion transcript kit and RT-PCR proved to have high sensitivity and specificity, advocating their use in routine practice. For maximal sensitivity and specificity, ALK status should be assessed by using two techniques and a third one in discordant cases. We therefore propose a customizable testing algorithm. These findings significantly influence existing testing paradigms and have clear clinical and economic impact.
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Affiliation(s)
- Igor Letovanec
- Institute of Pathology, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland.
| | - Stephen Finn
- Department of Histopathology, St James's Hospital and Trinity College, Dublin, Ireland
| | | | - Paul Smyth
- Department of Histopathology, St James's Hospital and Trinity College, Dublin, Ireland
| | - Alex Soltermann
- Institute of Pathology and Molecular Pathology, University Hospital Zürich, Zürich, Switzerland
| | - Lukas Bubendorf
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Ernst-Jan Speel
- Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Antonio Marchetti
- Center of Predicitve Molecular Medicine, CeSI, University of Chieti-Pescara, Chieti, Italy
| | - Daisuke Nonaka
- Department of Histopathology, The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Kim Monkhorst
- Division of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Henrik Hager
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Miguel Martorell
- Department of Pathology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Aleksandra Sejda
- Department of Pathomorphology, Medical University of Gdansk, Gdansk, Poland
| | - Richard Cheney
- Department of Pathology, State University of New York at Buffalo, Buffalo, New York
| | | | - Eric Verbeken
- Department of Pathology, University Hospital KU Leuven, Leuven, Belgium
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Spasenija Savic
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Alessia Di Lorito
- Center of Predicitve Molecular Medicine, CeSI, University of Chieti-Pescara, Chieti, Italy
| | - Atilio Navarro
- Department of Pathology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Enriqueta Felip
- Medical Oncology Department, Vall d'Hebrone University Hospital, Barcelona, Spain
| | - Arne Warth
- Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Paul Baas
- Department of Thoracic Oncology, The Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Peter Meldgaard
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Fiona Blackhall
- Deparment of Medical Oncology, The Chrisite NHS Foundation Trust, Manchester, United Kingdom
| | - Anne-Marie Dingemans
- Department of Pulmonology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hendrik Dienemann
- Department of Surgery, Thoraxklinik at Heidelberg University, Heidelberg, Germany
| | - Rafal Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Poland
| | - Johan Vansteenkiste
- Department of Respiratory Oncology, University Hospital KU Leuven, Leuven, Belgium
| | - Cathal O'Brien
- Department of Histopathology, St James's Hospital and Trinity College, Dublin, Ireland
| | - Thomas Geiger
- European Thoracic Oncology Platform, Bern, Switzerland
| | - Jon Sherlock
- Thermo Fisher Scientific, Paisley, United Kingdom
| | | | - Urania Dafni
- Frontier Science Foundation-Hellas & University of Athens, Athens, Greece
| | | | - Keith Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Erik Thunnissen
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Rolf Stahel
- Clinic of Oncology, University Hospital Zürich, Zürich, Switzerland
| | - Solange Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland
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8
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Kerr K, Dafni U, Schulze K, Thunnissen E, Bubendorf L, Hager H, Finn S, Biernat W, Vliegen L, Losa J, Marchetti A, Cheney R, Warth A, Speel EJ, Blackhall F, Monkhorst K, Jantus Lewintre E, Tischler V, Clark C, Bertran-Alamillo J, Meldgaard P, Gately K, Wrona A, Vandenberghe P, Felip E, De Luca G, Savic S, Muley T, Smit E, Dingemans AM, Priest L, Baas P, Camps C, Weder W, Polydoropoulou V, Geiger T, Kammler R, Sumiyoshi T, Molina M, Shames D, Stahel R, Peters S. Prevalence and clinical association of gene mutations through multiplex mutation testing in patients with NSCLC: results from the ETOP Lungscape Project. Ann Oncol 2018; 29:200-208. [DOI: 10.1093/annonc/mdx629] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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9
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Ammannagari N, Attwood K, Cheney R, Young JS, Kane JM, Salerno KE, Opyrchal M. Abstract P6-09-41: Factors predicting treatment outcomes of angiosarcoma of breast: A 25 year single institution experience. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-09-41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Primary (PAS) and secondary angiosarcoma (SAS) of breast account for < 1% of all breast neoplasms. SAS develops following radiation therapy (RT) to the breast or chest wall for treatment of breast cancer. The rarity of this tumor type makes it challenging to determine prognostic factors and develop optimal treatment strategies. Historically, large NCI cancer centers have reported a median overall survival ranging from 28 – 100 months with recurrence rate of 55%. Methods: We reviewed demographic, tumor, and treatment characteristics of breast AS patients diagnosed and treated at our institution between 1990 and 2015. Overall (OS) and recurrence free (RFS) survival were compared using standard statistical methods at a significance level of 0.05. Results: Of 12155 breast cancers, 22 patients (0.008%) with AS (PAS in 34%, SAS in 66%) were identified. Median age of PAS patients was significantly lower than SAS – 45 vs 71 years (p < 0.001). Median tumor size was 6.9 cm (7.3 cm vs 6.9 cm, p = 0.93) with multifocal disease seen in 22.7%. Tumor was high grade in 14 (50% vs 83.3%, p = 0.34). Median time from RT to SAS diagnosis was 7.8 years. Treatment included: mastectomy in 17 (77.3%), wide excision in 4 (18.2%), adjuvant RT in 4 (18.2%), taxane based chemotherapy in 11 (50%) and chemo-RT in 1 (4.5%). No significant differences were noted in tumor (p = 0.9) or treatment characteristics (p = 0.4) between PAS and SAS. Recurrence rate (mainly distant) was 36% (8 pts). The 5-year OS and RFS rates were 51% (95% CI 27–72%) and 36% (95% CI 14–58%) with estimated medians of 64.2 and 55.5 months, respectively with no significant difference between the two groups. Black ethnicity (11.6 vs 64.2 months, p = 0.015), multifocal disease (15.5 vs 64.2 months, p = 0.004) and tumor size of > 6.9 cm (8.3 vs 64.2 months, p = 0.03) were associated with poorer outcomes. Tumor grade was not related to OS. Adjuvant treatment (RT p = 0.49, chemotherapy p = 0.36) conferred no RFS or OS benefit. Conclusions: Patients with PAS were younger than SAS. Black race, multifocal presentation and larger tumor size predict worse clinical outcomes. Our institutional experience confirms the poor prognosis of angiosarcoma, and highlights the need for further research.
Citation Format: Ammannagari N, Attwood K, Cheney R, Young JS, Kane JM, Salerno KE, Opyrchal M. Factors predicting treatment outcomes of angiosarcoma of breast: A 25 year single institution experience [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-41.
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Affiliation(s)
| | - K Attwood
- Roswell Park Cancer Institute, Buffalo, NY
| | - R Cheney
- Roswell Park Cancer Institute, Buffalo, NY
| | - JS Young
- Roswell Park Cancer Institute, Buffalo, NY
| | - JM Kane
- Roswell Park Cancer Institute, Buffalo, NY
| | - KE Salerno
- Roswell Park Cancer Institute, Buffalo, NY
| | - M Opyrchal
- Roswell Park Cancer Institute, Buffalo, NY
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10
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Finn S, Letovanec I, Zygoura P, Smyth P, Soltermann A, Bubendorf L, Speel EJ, Marchetti A, Nonaka D, Monkhorst K, Hager H, Martorell M, Sejda A, Cheney R, Hernandez-Losa J, Verbeken E, Weder W, Savic S, Di Lorito A, Navarro A, Felip E, Warth A, Baas P, Meldgaard P, Blackhall F, Dingemans AM, Dienemann H, Dziadziuszko R, Vansteenkiste J, Geiger T, Sherlock J, Schageman J, Dafni U, Kammler R, Kerr K, Thunnissen E, Peters S, Stahel R. P1.02-025 Evaluation of NGS and RT-PCR Methods for ALK Assessment in European NSCLC Patients: Results from the ETOP Lungscape Project. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.608] [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: 10/20/2022]
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11
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Ammannagari N, Attwood K, Cheney R, Young JS, Kane JM, Salerno KE, Opyrchal M. Treatment, outcomes and prognostic factors of angiosarcoma of breast: A 25 year single institution experience. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e22540] [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
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12
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Wei L, Liu S, Conroy J, Wang J, Papanicolau-Sengos A, Glenn ST, Murakami M, Liu L, Hu Q, Conroy J, Miles KM, Nowak DE, Liu B, Qin M, Bshara W, Omilian AR, Head K, Bianchi M, Burgher B, Darlak C, Kane J, Merzianu M, Cheney R, Fabiano A, Salerno K, Talati C, Khushalani NI, Trump DL, Johnson CS, Morrison CD. Whole-genome sequencing of a malignant granular cell tumor with metabolic response to pazopanib. Cold Spring Harb Mol Case Stud 2016; 1:a000380. [PMID: 27148567 PMCID: PMC4850888 DOI: 10.1101/mcs.a000380] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Granular cell tumors are an uncommon soft tissue neoplasm. Malignant granular cell tumors comprise <2% of all granular cell tumors, are associated with aggressive behavior and poor clinical outcome, and are poorly understood in terms of tumor etiology and systematic treatment. Because of its rarity, the genetic basis of malignant granular cell tumor remains unknown. We performed whole-genome sequencing of one malignant granular cell tumor with metabolic response to pazopanib. This tumor exhibited a very low mutation rate and an overall stable genome with local complex rearrangements. The mutation signature was dominated by C>T transitions, particularly when immediately preceded by a 5' G. A loss-of-function mutation was detected in a newly recognized tumor suppressor candidate, BRD7. No mutations were found in known targets of pazopanib. However, we identified a receptor tyrosine kinase pathway mutation in GFRA2 that warrants further evaluation. To the best of our knowledge, this is only the second reported case of a malignant granular cell tumor exhibiting a response to pazopanib, and the first whole-genome sequencing of this uncommon tumor type. The findings provide insight into the genetic basis of malignant granular cell tumors and identify potential targets for further investigation.
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Affiliation(s)
- Lei Wei
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Song Liu
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Jeffrey Conroy
- Center for Personalized Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Jianmin Wang
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | | | - Sean T Glenn
- Department of Cancer Genetics, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Mitsuko Murakami
- Center for Personalized Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Lu Liu
- Center for Personalized Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Qiang Hu
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Jacob Conroy
- Center for Personalized Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Kiersten Marie Miles
- Center for Personalized Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - David E Nowak
- Center for Personalized Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Biao Liu
- Center for Personalized Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Maochun Qin
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Wiam Bshara
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Angela R Omilian
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Karen Head
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Michael Bianchi
- Center for Personalized Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Blake Burgher
- Center for Personalized Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Christopher Darlak
- Center for Personalized Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - John Kane
- Department of Radiation Oncology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Mihai Merzianu
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Richard Cheney
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Andrew Fabiano
- Department of Surgery, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Kilian Salerno
- Department of Radiation Oncology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Chetasi Talati
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Nikhil I Khushalani
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Donald L Trump
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA;; Inova Dwight and Martha Schar Cancer Institute, Falls Church, Virginia 22042, USA
| | - Candace S Johnson
- Department of Pharmacology and Therapeutics, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | - Carl D Morrison
- Center for Personalized Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
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13
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Middleton LP, Mayo TL, Spinks TE, Cheney R, Chu P, Cooper HS, Dintzis S, Ehya H, Fletcher CD, Gerwirtz A, Magliocco AM, Martin SE, Rosenberg AE, Sherrod A, Tan LK, Wood BL, Walters RS. The value of secondary pathology review. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.7_suppl.7] [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
6 Background: Improving the value of cancer care is a major focus for the Alliance of Dedicated Cancer Centers (ADCC). Looking to align with the Institute of Medicine’s (IOM) initiative to “Develop and deploy approaches to identify, learn from, and reduce diagnostic errors and near misses in clinical practice,” the ADCC implemented a study to examine the clinical impact of expert secondary pathology review. The goal of this project was to: 1) demonstrate the value of secondary review of outside pathological specimens by ADCC subspecialty pathologists in identifying significant errors that can potentially impact treatment; and 2) create an opportunity to improve patient cancer care. Methods: All consult slides from patients referred to each ADCC center were reviewed by designated pathologists. Patient-level data for original and revised diagnoses were collected for two months in 2014. Discrepancies were classified as: 1) major - diagnosis changes treatment or surveillance; or, 2) minor - diagnosis does not change affect treatment or surveillance. To verify these assessments, disease-specific, multi-center teams of clinical experts reviewed each discrepant case and provided treatment recommendations for the original and revised diagnoses. Results: A total of 13,109 cases were collected across all ADCC centers and the discrepancy rate was 11% (1,488/1309); 3% (359/13,109) were major and 9% (1,129/13,109) were minor. The most common discrepancy was reclassification of the neoplasm cell type. The highest discrepancy rate was shown in the neuro-oncology and head and neck cases, with a 7% and 4% major discrepancy rate respectively. Conclusions: We identified an overall discrepancy rate of 11%, with 3% of cases leading to a change in treatment or surveillance. This demonstrates the importance of expert pathology review and that secondary pathology review can significantly improve clinical outcomes through precise and accurate pathological diagnoses. As indicated in the recent IOM report, this project further demonstrates that “diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions.”
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Affiliation(s)
| | - Tinisha L. Mayo
- Office of the Senior Vice President (SVP), Hospital and Clinics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tracy E. Spinks
- Office of the Senior Vice President (SVP), Hospital and Clinics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | | | - Sue Ellen Martin
- University of Southern California Medical Center, Los Angeles, CA
| | | | - Andy Sherrod
- University of Southern California, Los Angeles, CA
| | - Lee K Tan
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brent L. Wood
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Ronald Stewart Walters
- Office of the Executive Vice President (EVP) and Physician-in-Chief, The University of Texas MD Anderson Cancer Center, Houston, TX
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14
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Nakanishi Y, LeVea C, Dibaj S, Habib F, Cheney R, Kanehira K. Reappraisal of Serosal Invasion in Patients With T3 Colorectal Cancer by Elastic Stain: Clinicopathologic Study of 139 Surgical Cases With Special Reference to Peritoneal Elastic Lamina Invasion. Arch Pathol Lab Med 2016; 140:81-5. [DOI: 10.5858/arpa.2014-0647-oa] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context
Peritoneal elastic lamina invasion (PELI) has been reported to be an important adverse prognostic factor in pT3 colorectal cancer (CRC). However, the data supporting this contention are limited.
Objective
To clarify the associations between PELI of pT3 CRC and prognostic significance, 139 consecutive surgical cases of pT3 CRC were examined.
Design
One hundred thirty-nine consecutive in-house surgical cases of pT3 CRC between 1993 and 2011 were examined. Thirty consecutive surgical cases of pT4a CRC resected during the same period were examined for comparison. Case selections were restricted to pT3 CRCs with the sections containing the deepest adenocarcinoma invasion partially or entirely covered with the peritoneum. Elastic staining was performed on one section containing the deepest tumor invasion partially or entirely covered with the peritoneum. The associations between the presence of PELI and clinicopathologic factors including prognosis of the patients were examined.
Results
Peritoneal elastic lamina invasion was identified in 23.0% (32 of 139) of the pT3 CRCs. PELI was associated with primary site (P = .006), lymph node metastasis (P < .001), lymphovascular invasion (P < .001), recurrence (P = .007), and patient's age (P = .002). The proportions of patients with a 4-year recurrence-free period in those with negative PELI, positive PELI, and pT4a tumor were 90.3%, 66.7%, and 28.9%, respectively (P < .001).
Conclusions
Elastic staining is useful to evaluate the serosal invasion of CRC. Positive PELI is a significant predictive factor for lymph node metastasis and recurrence-free survival in patients with pT3 CRC. This indicates that pT3 tumors with PELI should be treated like pT4a tumors.
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Affiliation(s)
- Yukihiro Nakanishi
- From the Departments of Pathology (Drs Nakanishi, LeVea, Habib, Cheney, and Kanehira) and Biostatistics and Bioinformatics (Ms Dibaj), Roswell Park Cancer Institute, Buffalo, New York; and the Department of Pathology and Laboratory Medicine, Tulane University School of Medicine, New Orleans, Louisiana (Dr Nakanishi)
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15
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Mitsis D, Opyrchal M, Zhao Y, Kane Iii JM, Cheney R, Salerno KE. Exceptional Clinical Response to BRAF-Targeted Therapy in a Patient with Metastatic Sarcoma. Cureus 2015; 7:e439. [PMID: 26858920 PMCID: PMC4731329 DOI: 10.7759/cureus.439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Soft tissue sarcomas (STS) are a rare and heterogeneous group of tumors arising from mesenchymal tissue comprising 1% of all adult cancers. The prognosis of metastatic STS is dismal. As there are few active drugs, there is a critical need to find new therapeutic alternatives in order to improve outcomes. Most sarcoma subtypes are fairly resistant to standard chemotherapy regimens and/or have a short duration of response. The era of molecular targeted therapy may present new treatment options for metastatic STS and an opportunity to drive biomarker discovery and personalized medicine. This case report describes a patient with a synchronous metastatic high-grade sarcoma who was treated with BRAF-targeted therapy with resolution of his metastatic lesions. To our knowledge, this exceptional response has not been described in sarcoma literature. The patient presented with a large anterior abdominopelvic wall mass. Biopsy showed a high-grade spindle cell sarcoma. Staging scans confirmed two pulmonary metastases. He was initiated on combination chemotherapy with mixed results. He received 50 Gy of radiation to the primary tumor followed by two additional cycles of combination chemotherapy, with an interval increase in the size of the pulmonary metastases. Molecular testing revealed a BRAF V600E mutation in the primary tumor. The patient was initiated on dabrafenib/trametinib with a dramatic response and resolution of his pulmonary metastases. The patient underwent surgical resection of his primary mass, and pathology confirmed no evidence of residual disease. Detailed genetic characterization of STS coupled with novel therapeutic strategies, including molecular targeted therapy, may have the potential to transform the care of patients diagnosed with sarcoma.
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Affiliation(s)
| | | | - Yujie Zhao
- Medical Oncology, Carle Foundation Hospital
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16
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Kerr K, Dafni U, Schulze K, Thunnissen E, Bubendorf L, Hager H, Gately K, Biernat W, Vliegen L, Hernandez Losa J, Marchetti A, Cheney R, Warth A, Speel E, Blackhall F, Molina M, Shames D, Peters S, Stahel R. 3001 Prevalence and clinical association of gene mutations through Multiplex Mutation Testing in patients with NSCLC: Results from the ETOP Lungscape Project. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31647-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Ku SY, Ramakrishnan S, Ciamporcero E, Xu B, Azabdaftari G, Cheney R, Pili R. Abstract 2546: HDAC and Hsp90 inhibition as therapeutic strategy for translocation renal cell carcinoma. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-2546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Xp11.2 translocation renal cell carcinoma (tRCC) is an aggressive subtype of kidney cancer, which mainly occurs in young patients. The prevalence of this disease is about 30% in pediatric RCC, but ∼1% in adult RCC cases. Patients with tRCC are refractory to standard therapies for clear cell RCC. Therefore, there is no efficient treatment for this type of kidney cancer. The tRCC harbors gene fusions involving the TFE3 transcription factor on chromosome X with several partner genes, leading to TFE3 elevation in the cell nucleus, but its function remains unclear. We have successfully established a cell line and patient-derived xenograft from a tRCC patient to develop rational therapeutic strategies and understand the tumor biology.
Methods: We have utilized a feeder layer containing a ROCK inhibitor to favorably generate a cell line, 277T, from a young tRCC patient. Also, we have implanted tumor samples from the patient subcutaneously into SCID mice to establish a patient-derived xenograft model, RP-R-07, and continuously maintain tumor growth in vivo. Cells were treated with different drugs, and then assessed by MTT assay and trypan blue staining for growth inhibition and cell death investigations. TFE3 expression in cells and tumors were detected by immunofluorescence and immunohistochemistry. The combined drug effects were determined by CalcuSyn analysis.
Results: Our preliminary results demonstrated that TFE3 is predominately expressing in the nucleus of 277T cells and RP-R-07 tumor model compared to other subtypes of RCC by immunofluorescence and immunohistochemistry, respectively. Further, we treated 277T cells with several cytotoxic drugs showing that the cells didn't respond to docetaxel, doxorubicin, rapamycin, or a PI3K-mTOR inhibitor, but were sensitive to the Hsp90 inhibitor AUY922, and the HDAC inhibitor LBH589. Moreover, combining both AUY922 and LBH589 induced greater cell death compared to each single treatment (73% vs 41% for LBH589; 73% vs 19% for AUY922). In addition, an in vivo experiment indicated that LBH589 did inhibit tumor growth.
Conclusions: Overall our results indicate that tRCC is sensitive to HSP90 and HDAC inhibitors both in vitro and in vivo. The combination of LBH589 and AUY922 represents a promising strategy for treating tRCC
Citation Format: Sheng-Yu Ku, Swathi Ramakrishnan, Eric Ciamporcero, Bo Xu, Gissou Azabdaftari, Richard Cheney, Roberto Pili. HDAC and Hsp90 inhibition as therapeutic strategy for translocation renal cell carcinoma. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2546. doi:10.1158/1538-7445.AM2015-2546
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Affiliation(s)
| | | | | | - Bo Xu
- Roswell Park Cancer Institute, Buffalo, NY
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18
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Sule N, Xu BO, El Zein D, Szigeti K, George S, Kane JM, Cheney R. Radiation-induced Chondrosarcoma of the Bladder. Case Report and Review of Literature. Anticancer Res 2015; 35:2857-2860. [PMID: 25964567] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Chondrosarcoma of the bladder is an extremely rare disease. Only five previously described cases are known in the medical literature. PATIENTS AND METHODS We present a chondrosarcoma developed 19 years after radiation treatment in a 73-year-old patient. A literature search of articles published from 1984 to 2014 was performed. RESULTS This is the first reported case of post-radiation bladder chondrosarcoma. We compared the clinicopathological features of the previously reported cases and reviewed the medical literature of the bladder sarcomas and post-radiation sarcomas. CONCLUSION The primary treatment for bladder mesenchymal neoplasms is surgical, preferably radical cystectomy with or without chemotherapy. Positive surgical margin is one of the most important factors negatively affecting disease-specific, recurrence-free and overall survival rates.
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Affiliation(s)
- Norbert Sule
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY, U.S.A.
| | - B O Xu
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY, U.S.A
| | - Dima El Zein
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, NY, U.S.A
| | - Kinga Szigeti
- Department of Neurology, University at Buffalo, Buffalo, NY, U.S.A
| | - Saby George
- Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, NY, U.S.A
| | - John M Kane
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, U.S.A
| | - Richard Cheney
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY, U.S.A
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19
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Blackhall FH, Peters S, Bubendorf L, Dafni U, Kerr KM, Hager H, Soltermann A, O'Byrne KJ, Dooms C, Sejda A, Hernández-Losa J, Marchetti A, Savic S, Tan Q, Thunnissen E, Speel EJM, Cheney R, Nonaka D, de Jong J, Martorell M, Letovanec I, Rosell R, Stahel RA. Prevalence and Clinical Outcomes for Patients With ALK-Positive Resected Stage I to III Adenocarcinoma: Results From the European Thoracic Oncology Platform Lungscape Project. J Clin Oncol 2014; 32:2780-7. [DOI: 10.1200/jco.2013.54.5921] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose The prevalence of anaplastic lymphoma kinase (ALK) gene fusion (ALK positivity) in early-stage non–small-cell lung cancer (NSCLC) varies by population examined and detection method used. The Lungscape ALK project was designed to address the prevalence and prognostic impact of ALK positivity in resected lung adenocarcinoma in a primarily European population. Methods Analysis of ALK status was performed by immunohistochemistry (IHC) and fluorescent in situ hybridization (FISH) in tissue sections of 1,281 patients with adenocarcinoma in the European Thoracic Oncology Platform Lungscape iBiobank. Positive patients were matched with negative patients in a 1:2 ratio, both for IHC and for FISH testing. Testing was performed in 16 participating centers, using the same protocol after passing external quality assessment. Results Positive ALK IHC staining was present in 80 patients (prevalence of 6.2%; 95% CI, 4.9% to 7.6%). Of these, 28 patients were ALK FISH positive, corresponding to a lower bound for the prevalence of FISH positivity of 2.2%. FISH specificity was 100%, and FISH sensitivity was 35.0% (95% CI, 24.7% to 46.5%), with a sensitivity value of 81.3% (95% CI, 63.6% to 92.8%) for IHC 2+/3+ patients. The hazard of death for FISH-positive patients was lower than for IHC-negative patients (P = .022). Multivariable models, adjusted for patient, tumor, and treatment characteristics, and matched cohort analysis confirmed that ALK FISH positivity is a predictor for better overall survival (OS). Conclusion In this large cohort of surgically resected lung adenocarcinomas, the prevalence of ALK positivity was 6.2% using IHC and at least 2.2% using FISH. A screening strategy based on IHC or H-score could be envisaged. ALK positivity (by either IHC or FISH) was related to better OS.
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Affiliation(s)
- Fiona H. Blackhall
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Solange Peters
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Lukas Bubendorf
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Urania Dafni
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Keith M. Kerr
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Henrik Hager
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Alex Soltermann
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Kenneth J. O'Byrne
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Dooms
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Aleksandra Sejda
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Javier Hernández-Losa
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Antonio Marchetti
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Spasenija Savic
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Qiang Tan
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Erik Thunnissen
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Ernst-Jan M. Speel
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Richard Cheney
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Daisuke Nonaka
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Jeroen de Jong
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Miguel Martorell
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Igor Letovanec
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Rafael Rosell
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
| | - Rolf A. Stahel
- Fiona H. Blackhall and Daisuke Nonaka, Manchester University and The Christie National Health Services Foundation Trust, Manchester; Keith M. Kerr, Aberdeen University Medical School, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; Solange Peters and Igor Letovanec, Centre Hospitalier Universitaire Vaudois, Lausanne; Lukas Bubendorf and Spasenija Savic, Institute for Pathology, University Hospital Basel, Basel; Alex Soltermann and Rolf A. Stahel, University Hospital Zurich, Zurich, Switzerland
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Nwogu CE, Yendamuri S, Tan W, Kannisto E, Bogner P, Morrison C, Cheney R, Dexter E, Picone A, Hennon M, Hutson A, Reid M, Adjei A, Demmy TL. Lung cancer lymph node micrometastasis detection using real-time polymerase chain reaction: correlation with vascular endothelial growth factor expression. J Thorac Cardiovasc Surg 2013; 145:702-7; discussion 707-8. [PMID: 23414988 DOI: 10.1016/j.jtcvs.2012.12.023] [Citation(s) in RCA: 15] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 08/17/2012] [Accepted: 12/10/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Lymph node staging provides critical information in patients with non-small cell lung cancer (NSCLC). Lymphangiogenesis may be an important contributor to the pathophysiology of lymphatic metastases. We hypothesized that the presence of lymph node micrometastases positively correlates with vascular endothelial growth factors (VEGFs) A, C, and D as well as VEGF-receptor-3 (lymphangiogenic factors) expression in lymph nodes. METHODS Forty patients with NSCLC underwent preoperative positron emission tomography-computed tomography and mediastinoscopy. Real-time polymerase chain reaction (RT-PCR) assays for messenger RNA expression of epithelial markers (ie, cytokeratin 7; carcinoembryonic antigen-related cell adhesion molecule 5; and palate, lung, and nasal epithelium carcinoma-associated protein) were performed in selected fluorodeoxyglucose-avid lymph nodes. VEGF-A, VEGF-C, VEGF-D, and VEGF receptor-3 expression levels were measured in primary tumors and lymph nodes. Wilcoxon rank sum test was run for the association between the RT-PCR epithelial marker levels and VEGF expression levels in the lymph nodes. RESULTS RT-PCR for cytokeratin 7; carcinoembryonic antigen-related cell adhesion molecule 5; or palate, lung, and nasal epithelium carcinoma-associated protein indicated lymph node micrometastatic disease in 19 of 35 patients (54%). There was a high correlation between detection of micrometastases and VEGF-A, VEGF-C, VEGF-D, or VEGF receptor-3 expression levels in lymph nodes. Median follow-up was 12.6 months. CONCLUSIONS RT-PCR analysis of fluorodeoxyglucose-avid lymph nodes results in up-staging a patient's cancer. Micrometastases correlate with the expression of VEGF in lymph nodes in patients with NSCLC. This may reflect the role of lymphangiogenesis in promoting metastases.
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Affiliation(s)
- Chukwumere E Nwogu
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Nwogu C, Demmy T, Yendamuri S, Tan W, Bogner P, Dexter E, Picone A, Hennon M, Hutson A, Reid M, Cheney R, Adjei A. Abstract 4671: Radioguided detection of lymph node metastasis in non-small cell lung cancer. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-4671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Lymph node staging provides the most important prognostic information in patients with loco-regional non-small cell lung cancer. We hypothesized that gamma radiation detection using an intra-operative hand-held gamma probe following intravenous 18F-fluorodeoxyglucose (FDG) injection would identify lymph nodes containing metastases in a much more sensitive manner than standard pathological practices. We compared the accuracy of detecting thoracic lymph node metastases using positron emission tomography- computed tomography (PET-CT) versus the gamma probe.
Methods:
One hundred patients with resectable lung cancers had pre-operative positron emission tomography-computed tomography (PET-CT) and mediastinoscopy. 10mCi of FDG was injected on the day of surgery. A handheld gamma probe detected increased FDG uptake within thoracic lymph nodes during pulmonary resection procedures. The lymph nodes that demonstrated increased FDG uptake, but were non-malignant by conventional H&E staining underwent further serial sectioning, immunohistochemistry (IHC) and RT-PCR (reverse transcriptase - polymerase chain reaction). Sensitivity and specificity for lymph node metastasis detection by PET-CT and the gamma probe were calculated.
Results:
Three patients had metastatic lymphadenopathy detected at mediastinoscopy, so their procedures were aborted, while the others proceeded to lung resection and complete lymphadenectomy. Fifteen additional patients had lymph node involvement on routine pathologic analysis. IHC and RT-PCR detected micrometastatic lymph node disease in 4 and 29 patients, respectively. Using RT-PCR as the gold standard, the sensitivity and specificity of PET-CT for detection of lymph node metastasis were 11% and 98% respectively, in contrast to 38% and 50% respectively for the gamma probe.
Conclusion:
The intra-operative hand held gamma probe is more sensitive but less specific than PET-CT in detecting lymph node metastasis from lung cancer. Its overall accuracy was low, resulting in limited up-staging of patients. RT-PCR analysis of FDG-avid lymph nodes for epithelial markers increased the clinical utility of this probe in detecting micrometastasis. Such up-staged patients could derive a survival benefit from adjuvant chemotherapy. More specific radioisotopes are being developed to improve the clinical utility of this technique.
Citation Format: Chukwumere Nwogu, Todd Demmy, Sai Yendamuri, Wei Tan, Paul Bogner, Elisabeth Dexter, Anthony Picone, Mark Hennon, Alan Hutson, Mary Reid, Richard Cheney, Alex Adjei. Radioguided detection of lymph node metastasis in non-small cell lung cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4671. doi:10.1158/1538-7445.AM2013-4671
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Affiliation(s)
| | - Todd Demmy
- Roswell Park Cancer Institute, Buffalo, NY
| | | | - Wei Tan
- Roswell Park Cancer Institute, Buffalo, NY
| | | | | | | | | | | | - Mary Reid
- Roswell Park Cancer Institute, Buffalo, NY
| | | | - Alex Adjei
- Roswell Park Cancer Institute, Buffalo, NY
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Sant V, Cheney R, Holena D, Braslow B, Pascual J, Reilly P, Allen S. Trauma Recidivism: Short Time to Reinjury Calls for Early and Aggressive Violence Prevention and Intervention. J Surg Res 2013. [DOI: 10.1016/j.jss.2012.10.874] [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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Carr BG, Wiebe DJ, Richmond TS, Cheney R, Branas CC. A randomised controlled feasibility trial of alcohol consumption and the ability to appropriately use a firearm. Inj Prev 2010; 15:409-12. [PMID: 19959734 DOI: 10.1136/ip.2008.020768] [Citation(s) in RCA: 8] [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: 12/18/2022]
Abstract
OBJECTIVE To show the feasibility of using a controlled trial to investigate the effect of alcohol on firearm use. METHODS Randomised, blinded, placebo-controlled trial in the Firearm Usage and Safety Experiments (FUSE) Lab. Treatment subjects (male, 21-40-year-old, non-habitual drinkers, with no professional firearms training) received alcohol; control subjects received placebo alcohol. The AIS PRISim Firearm Simulator, including real pistols retrofitted to discharge compressed air cartridges that simulate firearm recoil and sound, was used to measure firearm performance. Accuracy and speed for target shooting, reaction time scenarios, and scenarios requiring judgement about when to use a gun were measured. RESULTS 12 subjects enrolled in the trial, completing 160 training scenarios. All subjects in the alcohol arm reached target alcohol level. 33% of placebo subjects reported alcohol consumption. Mechanical malfunction of the simulator occurred in 9 of 160 (5.6%) scenarios. Intoxicated subjects were less accurate, slower to fire in reaction time scenarios, and quicker to fire in scenarios requiring judgement relative to controls. CONCLUSIONS The feasibility of a randomised, controlled trial exploring the relationship between alcohol consumption and firearm use was shown. The hypothesis that alcohol consumption worsens accuracy and retards judgement about when to use a gun should be tested. Larger trials could inform policies regarding firearm use while intoxicated.
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Affiliation(s)
- B G Carr
- Department of Emergency Medicine, University of Pennsylvania, School of Medicine, 929 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA.
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Ali L, Helm T, Cheney R, Conroy J, Sait S, Guitart J, Gerami P. Correlating array comparative genomic hybridization findings with histology and outcome in spitzoid melanocytic neoplasms. Int J Clin Exp Pathol 2010; 3:593-599. [PMID: 20661407 PMCID: PMC2907121] [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] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Accepted: 06/25/2010] [Indexed: 05/29/2023]
Abstract
Melanocytic neoplasms with spitzoid features including spitz nevi, spitz tumors and spitzoid melanomas are commonly encountered in the practice of dermatopathology. Although many cases can be accurately diagnosed on the basis of morphology and histology, a significant number of cases may be difficult to accurately classify. Several studies have now shown that chromosomal copy number aberrations are typical of melanoma while present in only a small percent and to a limited degree in spitz nevi. In this study, we correlated the clinical, histologic and array CGH findings of 10 spiztoid melanocytic neoplasms. Our study shows that the clinical and histologic changes correlate well with the molecular findings by array CGH. Further that array CGH can be used to help classify and predict behavior of spitzoid melanocytic neoplasms. A limited variety of copy number aberrations including gains of 11p and much more rarely 7q may be seen in spitz nevi. Additionally in this report we present the first case of a typical spitz nevus with copy number gains involving both 7q and 11p. Conversely, melanomas with spitzoid features typically have multiple chromsomal copy number aberrations involving a variety of loci. A smaller number of chromosomal aberrations, possibly a single aberrant locus, may be present in spitz tumors, but their presence may predict more aggressive behavior.
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Affiliation(s)
- Liaqat Ali
- Department of Pathology, SUNY Buffalo State University of New York at BuffaloNew York, USA
- Department of Pathology: Roswell Park Cancer InstituteBuffalo, New York, USA
| | - Thomas Helm
- Department of Pathology, SUNY Buffalo State University of New York at BuffaloNew York, USA
| | - Richard Cheney
- Department of Pathology: Roswell Park Cancer InstituteBuffalo, New York, USA
| | - Jeffrey Conroy
- Department of Genomic Resources: Roswell Park Cancer InstituteBuffalo, New York, USA
| | - Sheilla Sait
- Department of Pathology: Roswell Park Cancer InstituteBuffalo, New York, USA
| | - Joan Guitart
- Department of Dermatology and the Northwestern Lurie Cancer Center: Northwestern UniversityChicago, Illinois, USA
| | - Pedram Gerami
- Department of Dermatology and the Northwestern Lurie Cancer Center: Northwestern UniversityChicago, Illinois, USA
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Najarian DJ, Morrison C, Sait SNJ, Meguerditchian AN, Kane J, Cheney R, Zeitouni NC. Recurrent giant cell fibroblastoma treated with Mohs micrographic surgery. Dermatol Surg 2010; 36:417-21. [PMID: 20100251 DOI: 10.1111/j.1524-4725.2009.01459.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- David J Najarian
- Department of Dermatology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
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Qian F, Villella J, Wallace PK, Mhawech-Fauceglia P, Tario JD, Andrews C, Matsuzaki J, Valmori D, Ayyoub M, Frederick PJ, Beck A, Liao J, Cheney R, Moysich K, Lele S, Shrikant P, Old LJ, Odunsi K. Efficacy of levo-1-methyl tryptophan and dextro-1-methyl tryptophan in reversing indoleamine-2,3-dioxygenase-mediated arrest of T-cell proliferation in human epithelial ovarian cancer. Cancer Res 2009; 69:5498-504. [PMID: 19491279 DOI: 10.1158/0008-5472.can-08-2106] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [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: 01/07/2023]
Abstract
It has been reported that levo-1-methyl tryptophan (L-1MT) can block indoleamine-2,3-dioxygenase (IDO) expressed by human dendritic cells (DC), whereas dextro-1-methyl tryptophan (D-1MT) is inefficient. However, whether L-1MT or D-1MT can efficiently reverse IDO-induced arrest of human T-cell proliferation has not been clarified. Here, we show a marked immunosuppressive effect of IDO derived from INDO-transfected 293 cell, IDO+ ovarian cancer cells, and monocyte-derived DCs on CD4+ Th1 cells, CD8+ T cells, and natural killer cells derived from peripheral blood, ascites, and tumors of ovarian cancer patients. We found that, whereas L-1MT and D/L-1MT can restore proliferation of tumor-derived and peripheral blood T-cell subsets, D-1MT does not effectively restore IDO-induced arrest of T-cell proliferation. Although D-1MT inhibited kynurenine production at high concentrations, L-1MT was more effective in abrogating kynurenine generation and tryptophan depletion, whereas tryptophan was completely depleted by IDO even in the presence of high amounts of D-1MT. Together, the results indicate that, whereas the generation of tryptophan metabolites (kynurenines) by IDO is important in mediating suppression of T-cell proliferation, the degree to which tryptophan depletion is restored by 1MT is also critical in overcoming IDO-induced arrest of T-cell proliferation.
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Affiliation(s)
- Feng Qian
- Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
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Khubchandani S, Deeb G, Smiley SL, Battiwalla M, Paplham P, Brown K, Syta M, Hahn T, Cheney R, McCarthy PL, Hong F. Fatal hyperacute graft-versus-host disease following denileukin diftitox treatment for recurrent t cell lymphoma after allogeneic stem cell transplantation. Biol Blood Marrow Transplant 2009; 15:887-90. [PMID: 19539223 DOI: 10.1016/j.bbmt.2009.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2008] [Accepted: 03/09/2009] [Indexed: 11/29/2022]
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Abstract
Obtaining high quality fresh or frozen prostate tissue in gram amounts promotes the research of prostate cancer. Due to the inability to effectively recognize prostate cancer upon the cut section of a fresh prostate many pathology departments perform whole organ processing precluding the procurement of prostate tissue. Some sites randomly procure tissue, while others perform specialized procedures that can be difficult to duplicate. Neither of these types of procurement consistently results in gram quantities of tissue procured from each prostate with a high percentage of samples yielding tissue corresponding to cancer. In this study, we present a simplified model of prostate tissue procurement that has no impact on Gleason grade, tumor stage or margin status, requires minimal specialized processing, and obtains gram amounts of fresh tissue from each radical prostatectomy specimen with a high percentage yielding cancer tissue.
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Affiliation(s)
- Carl Morrison
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
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Ongchin M, Sharratt E, Dominguez I, LeVea C, Cheney R, Wang J, Brattain M, Rajput A. PL16. The Effects of Epidermal Growth Factor Receptor Activation and Attenuation of the TGFβ Pathway in an Orthotopic Model of Colon Cancer. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.290] [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: 10/21/2022]
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Tomar S, Stoll HL, Grassi MA, Cheney R. Treatment of cutaneous pseudolymphoma with interferon alfa-2b. J Am Acad Dermatol 2009; 60:172-4. [DOI: 10.1016/j.jaad.2008.07.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 07/17/2008] [Accepted: 07/31/2008] [Indexed: 11/30/2022]
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Fischer J, Rossetti S, Cheney R, Sacchi N. Abstract A19: Identification of epigenetic hits can predict breast cancer risk. Cancer Prev Res (Phila) 2008. [DOI: 10.1158/1940-6207.prev-08-a19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
A19
RARB2 is a master tumor suppressor that mediates the growth-inhibitory action of retinoic acid (RA). Homozygosis for epigenetically silent RARB2 alleles, which results into loss of RARB2 tumor suppressor activity, leads to RA-resistance, and apparently precedes the acquisition of morphological transformation of breast epithelial cells (Bistulfi et al., Cancer Research, 2006). RARB2 epigenetic silencing is marked by chromatin repressive changes, including DNA methylation of the RARB2 CpG island (Sirchia et al., Oncogene, 2000). In a mechanistic study, we demonstrated that methylation arises at a specific epicenter in the RARB2 CpG island, which we call the RARB2 methylation epicenter (RME) (Ren et al., MCB, 2005). Here we show that RME methylation is detectable in both benign and ductal carcinoma in situ within the same patient tissue sample. This finding implies sequential epigenetic silencing of RARB2 alleles. Timely identification of the first epigenetic hit in breast tissue of women at risk of breast cancer could prevent progression to RME methylation homozygosity, the consequent loss of RARB2-mediated tumor suppressor function, RA-resistance, and morphological epithelial cell transformation.
This work was supported by the Roswell Park Alliance Foundation Award (NS), the Breast Cancer Coalition of Rochester (NS), the Susan Komen Foundation (SR).
Citation Information: Cancer Prev Res 2008;1(7 Suppl):A19.
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Abstract
With the advent of endoscopy, the incidence of rectal carcinoid tumors has not only risen, but the majority are localized at presentation. This has led to excisional and/or ablative therapy in lieu of radical resections. A single institute's experience with rectal carcinoids was reviewed to determine the impact this approach has had on outcomes, and evaluate any selection criteria for optimizing patient survival. A single institute's tumor registry was retrospectively queried, identifying 14 patients with rectal carcinoid tumors over a 28-year period. The mean age at diagnosis was 52.1 +/- 14.4 years. Six of the 14 patients were female. Presenting symptoms included a change in bowel habits in six (38%), rectal bleeding in six (38%), and abdominal pain or distention in five (31%) patients. No patient had symptoms consistent with carcinoid syndrome. The rectal carcinoids were a mean 9.2 +/- 3.4 cm from the anal verge and a mean 9 +/- 6 mm in size. Endoscopic and/or transanal excision/fulguration techniques treated 11 (79%) patients, whereas two (14%) patients underwent a low anterior resection (LAR). Surveillance entailed periodic endoscopy for a median 65 months (range 8-281). No patient developed recurrent carcinoid disease for a 20-year overall survival of 70%.
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Affiliation(s)
- Anders Merg
- Department of Surgical Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
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Wongsena W, Ferrone S, Cheney R, Leelayuwat C, Sripa B. MHC Class I and MICA Expressions in Liver Fluke Associated Cholangiocarcinoma. Clin Immunol 2007. [DOI: 10.1016/j.clim.2007.03.498] [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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Abstract
OBJECTIVE Understanding global firearm mortality is hindered by data availability, quality, and comparability. This study assesses the adequacy of publicly available data, examines populations for whom firearm mortality data are not publicly available, and estimates the global burden of non-conflict related firearm mortality. DESIGN The design is a secondary analysis of existing data. A dataset of countries, populations, economic development, and geographic regions was created, using United Nations 2000 world population data and World Bank classifications of economic development and global regions. Firearm mortality data were obtained from governmental vital statistics reported by the World Health Organization and published survey data. A qualitative review of literature informed estimates for the 15 most populous countries without firearm death data. For countries without data, estimates of firearm deaths were made using quartiles of observed rates and peer reviewed literature. MAIN OUTCOME MEASURES Non-conflict related firearm deaths. RESULTS Global non-conflict related firearm deaths were estimated to fall between 196,000 and 229,000, adjusted to the year 2000. 162,800 firearm deaths adjusted for the year 2000 came from countries reporting data and represent 35% of the world's 186 countries. Public data are not available for 122 of these 186 countries, representing more than three billion (54%) of the world's population, predominately in lower and lower middle income countries. Estimates of firearm death for those countries without data range from 33,200 to 66,200. CONCLUSIONS This study provides evidence that the burden of firearm related mortality poses a substantial threat to local and global health.
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Affiliation(s)
- T S Richmond
- School of Nursing, Firearm and Injury Center at Penn, Senior Fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania, PA 19104, USA.
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Bene NI, Zeitouni NC, Cheney R. Unusual cutaneous manifestation of angiocentric T-cell lymphoma: a case report. Cutis 2006; 77:310-2. [PMID: 16776287] [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: 05/10/2023]
Abstract
Angiocentric T-cell lymphoma may clinically present with a broad variety of cutaneous manifestations, including papules, nodules, and ulcerated tumors, and may mimic cutaneous vasculitis and Wegener granulomatosis. Histologic diagnosis of angiocentric T-cell lymphoma also may present a challenge because of variations in the degree of cellular infiltrate and cellular atypia. The correct diagnosis is critical because of the importance of choosing the correct therapeutic modality-chemotherapy or x-ray radiation. We report a case of angiocentric T-cell lymphoma with extensive necrotic facial ulcers that responded to treatment with fludarabine, cyclophosphamide, and prednisone.
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Affiliation(s)
- Natalie I Bene
- Department of Dermatology, Roswell Park Cancer Insititute, Buffalo, New York, USA.
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Vaquerano J, Kraybill WG, Driscoll DL, Cheney R, Kane JM. American Joint Committee on Cancer Clinical Stage as a Selection Criterion for Sentinel Lymph Node Biopsy in Thin Melanoma. Ann Surg Oncol 2006; 13:198-204. [PMID: 16418885 DOI: 10.1245/aso.2006.03.092] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [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: 03/23/2004] [Accepted: 08/25/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND A significant proportion of newly diagnosed melanomas are thin lesions (< or = 1.00 mm). Because tumor thickness correlates with the risk for nodal metastases, sentinel lymph node (SLN) biopsy in this subset is controversial. Incorporating other prognostic factors (Clark level and ulceration), we evaluated the 6th edition American Joint Committee on Cancer (AJCC) clinical stage as a simple and widely applicable guideline for offering SLN biopsy for thin melanoma. METHODS This study was a review of a prospective melanoma SLN database from 1993 to 2003 with emphasis on SLN positivity rates based on the 6th edition AJCC primary tumor thickness intervals and clinical stage. RESULTS Three hundred five patients underwent SLN biopsy, with an overall positivity rate of 17.7%. By the 6th edition AJCC, lesions < or = 1.00 mm had an SLN positivity rate of 6.6%. By 6th edition clinical stage, SLN positivity rates were 4.9% for stage IA and 10.4% for stage IB. By using stage IA as the criterion for not offering SLN biopsy, this procedure would have been avoided in 46% (39 of 85) of < or = 1.00-mm melanoma patients with a negative SLN. CONCLUSIONS Sixth edition AJCC clinical stage IB as a selection criterion for performing SLN biopsy in thin melanoma identifies most patients with a positive SLN while also avoiding a negative SLN biopsy in many patients. Until additional widely accepted and validated selection criteria are available, SLN biopsy for clinical stage IB, but not stage IA, thin melanomas is a reasonable approach.
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Affiliation(s)
- Julio Vaquerano
- Department of Surgical Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York 14263, USA
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Abstract
OBJECTIVES/HYPOTHESIS For oral cancer patients, the presence of neck nodal metastases is the most important disease prognosticator. However, a significant proportion of clinically N0 patients harbor occult microscopic nodal metastasis. Our objective was to determine the feasibility and accuracy of sentinel node biopsy (SNB) in the staging of T2N0 oral carcinoma patients. STUDY DESIGN Prospective analysis. METHODS Twenty patients with previously untreated N0 oral cavity squamous cell carcinoma were studied. Each patient had an SNB performed using preoperative technetium sulfur colloid lymphoscintigraphy, intraoperative gamma probe guidance, and intraoperative peritumoral injection of 1% isosulfan blue. All patients underwent neck dissection. The sentinel lymph nodes (SLNs) were sectioned in 2- to 3-mm intervals, formalin fixed, and sectioned at three levels. The non-SLNs were sectioned in a routine manner for histologic examination. RESULTS SLNs were identified in all patients (100%) and accurately predicted the pathologic nodal status in 18 of 20 patients (90%). Tumor was found exclusively in the SLNs in six patients (30%). Two patients had positive SLNs at multiple neck levels. Two patients had a negative SLN and a positive non-SLN (false-negative findings). Occult nodal metastases were present in 60% of the cohort. CONCLUSIONS SNB is a technically feasible and accurate procedure for staging the neck in oral carcinoma patients. However, SNB accuracy is lower for floor of the mouth lesions. The rate of occult nodal metastases identified in this cohort is higher than previously reported in the literature. These results suggest that SNB warrants further multi-institutional studies.
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Affiliation(s)
- Nestor Rigual
- Department of Head and Neck Surgery, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
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Said M, Wiseman S, Yang J, Alrawi S, Douglas W, Cheney R, Hicks W, Rigual N, Loree T, Spiegel G, Tan D. Tissue eosinophilia: a morphologic marker for assessing stromal invasion in laryngeal squamous neoplasms. BMC Clin Pathol 2005; 5:1. [PMID: 15638930 PMCID: PMC548265 DOI: 10.1186/1472-6890-5-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2004] [Accepted: 01/07/2005] [Indexed: 12/02/2022] Open
Abstract
Background The assessment of tumor invasion of underlying benign stroma in neoplastic squamous proliferation of the larynx may pose a diagnostic challenge, particularly in small biopsy specimens that are frequently tangentially sectioned. We studied whether thresholds of an eosinophilic response to laryngeal squamous neoplasms provides an adjunctive histologic criterion for determining the presence of invasion. Methods Eighty-seven(n = 87) cases of invasive squamous cell carcinoma and preinvasive squamous neoplasia were evaluated. In each case, the number of eosinophils per high power field(eosinophils/hpf), and per 10 hpf in the tissue adjacent to the neoplastic epithelium, were counted and tabulated. For statistical purposes, the elevated eosinophils were defined and categorized as: focally and moderately elevated (5–9 eos/hpf), focally and markedly increased(>10/hpf), diffusely and moderately elevated(5–19 eos/10hpf), and diffusely and markedly increased (>20/10hpf). Results In the invasive carcinoma, eosinophil counts were elevated focally and /or diffusely, more frequently seen than in non-invasive neoplastic lesions. The increased eosinophil counts, specifically >10hpf, and >20/10hpf, were all statistically significantly associated with stromal invasion. Greater than 10 eosinophils/hpf and/or >20 eosinophils/10hpf had highest predictive power, with a sensitivity, specificity and positive predictive value of 82%, 93%, 96% and 80%, 100% and 100%, respectively. Virtually, greater than 20 eosinophils/10 hpf was diagnostic for tumor invasion in our series. Conclusion Our study suggests for the first time that the elevated eosinophil count in squamous neoplasia of the larynx is a morphologic feature associated with tumor invasion. When the number of infiltrating eosinophils exceeds 10/hpf and or >20/10 hpf in a laryngeal biopsy with squamous neoplasia, it represents an indicator for the possibility of tumor invasion. Similarly, the presence of eosinophils meeting these thresholds in an excisional specimen should prompt a thorough evaluation for invasiveness, when evidence of invasion is absent, or when invasion is suspected by conventional criteria in the initial sections.
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Affiliation(s)
- Mahmoud Said
- Department of Pathology, AmeriPath, Orlando, USA
| | - Sam Wiseman
- Department of Surgery St. Paul's Hospital/University of British Columbia, Vancouver, BC, Canada
| | - Jun Yang
- Department of Cancer Prevention, Roswell Park Cancer Institute, Buffalo, USA
| | - Sadir Alrawi
- Department of Surgery, Roswell Park Cancer Institute, Buffalo, USA
| | - Wade Douglas
- Department of Surgery, Roswell Park Cancer Institute, Buffalo, USA
| | - Richard Cheney
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, USA
| | - Wesley Hicks
- Department of Surgery, Roswell Park Cancer Institute, Buffalo, USA
| | - Nestor Rigual
- Department of Surgery, Roswell Park Cancer Institute, Buffalo, USA
| | - Thom Loree
- Department of Surgery, Roswell Park Cancer Institute, Buffalo, USA
| | - Gregory Spiegel
- Department of Histopathology, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Dongfeng Tan
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, USA
- Department of Pathology and Laboratory Medicine, University of Texas Health Centre at Houston, 6431 Fannin, MSB 2.222, Houston, TX 77030, USA
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Oseroff AR, Shieh S, Frawley NP, Cheney R, Blumenson LE, Pivnick EK, Bellnier DA. Treatment of Diffuse Basal Cell Carcinomas and Basaloid Follicular Hamartomas in Nevoid Basal Cell Carcinoma Syndrome by Wide-Area 5-Aminolevulinic Acid Photodynamic Therapy. ACTA ACUST UNITED AC 2005; 141:60-7. [PMID: 15655143 DOI: 10.1001/archderm.141.1.60] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [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] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To report the use of wide-area 5-aminolevulinic acid photodynamic therapy to treat numerous basal cell carcinomas (BCCs) and basaloid follicular hamartomas (BFHs). DESIGN Report of cases. SETTING Roswell Park Cancer Institute. Patients Three children with BCCs and BFHs involving 12% to 25% of their body surface areas. Interventions Twenty percent 5-aminolevulinic acid was applied to up to 22% of the body surface for 24 hours under occlusion. A dye laser and a lamp illuminated fields up to 7 cm and 16 cm in diameter, respectively; up to 36 fields were treated per session. MAIN OUTCOME MEASURES Morbidity, patient response, and light dose-photodynamic therapy response relationship and durability. RESULTS Morbidity was minimal, with selective phototoxicity and rapid healing. After 4 to 7 sessions, with individual areas receiving 1 to 3 treatments, the patients had 85% to 98% overall clearance and excellent cosmetic outcomes without scarring. For laser treatments, a sigmoidal light dose-response relationship predicted more than 85% initial response rates for light doses 150 J/cm(2) or more. Responses were durable up to 6 years. Conclusion 5-Aminolevulinic acid photodynamic therapy is safe, well tolerated, and effective for extensive areas of diffuse BCCs and BFHs and appears to be the treatment of choice in children.
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Affiliation(s)
- Allan R Oseroff
- Department of Dermatology, Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY 14263, USA.
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Alrawi SJ, Deeb G, Cheney R, Wallace P, Loree T, Rigual N, Hicks W, Tan D. Lipomatous hemangiopericytoma of the head and neck: immunohistochemical and DNA ploidy analyses. Head Neck 2004; 26:544-9. [PMID: 15162357 DOI: 10.1002/hed.20054] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lipomatous hemangiopericytoma (LHPC) is a newly described rare soft tissue tumor with unpredictable biologic behavior and is difficult to diagnose by conventional histologic parameters. The molecular analyses of this entity to date are sparse. Only a few cases of LHPC have been reported. Although one case of LHPC in the sinonasal region was briefly reported, this is the first case in the head and neck region with detailed clinicopathologic features and molecular analysis of this entity. METHODS We reported a case of LHPC in a 55-year-old woman with a slowly growing lesion in the occipital area that was diagnosed by CT and MRI and removed surgically. Immunohistochemical and DNA ploidy analyses were performed. RESULTS A panel of 16 markers was included for immunohistochemical analysis. Diffuse immunopositivity of CD57 in our case provides supportive evidence that LHPC is linked with HPC because this marker is also present in approximately 50% of conventional HPCs. CD57 should be used in the immunohistochemical panel in any lesion suspected to be LHPC. Furthermore, CD57 along with CD34 and XIIIa is thought to stain for primitive mesenchymal stem cells, suggesting a bimodal/multimodal differentiation of LHPC. By flow cytometry, we found that tumor cells were 100% diploid with the S-phase fraction (SPF) being 3.21%. A significant positive correlation was detected between nuclear proliferating index and SPF (p < 0.001, by Spearman analysis). These findings provide molecular evidence indicating a benign nature of LHPC. CONCLUSIONS Contrary to the old belief that HPC has an aggressive nature, this variant of tumor looks less aggressive. The patient was followed for 1 year without any evidence of recurrence, supporting our pathologic hypothesis.
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Affiliation(s)
- Sadir J Alrawi
- Roswell Park Cancer Institute, State University of New York, Buffalo, New York 14263, USA
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Tan D, Li Q, Deeb G, Ramnath N, Slocum HK, Brooks J, Cheney R, Wiseman S, Anderson T, Loewen G. Thyroid transcription factor-1 expression prevalence and its clinical implications in non-small cell lung cancer: a high-throughput tissue microarray and immunohistochemistry study. Hum Pathol 2003; 34:597-604. [PMID: 12827614 DOI: 10.1016/s0046-8177(03)00180-1] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Thyroid transcription factor 1 (TTF-1), a homeodomain-containing transcription factor, plays a pivotal role in lung development, cell growth, and differentiation processes. The current literature reports considerable variation in frequency of TTF-1 protein expression in human non-small cell lung cancer (NSCLC). TTF-1 expression has not been extensively investigated as a prognostic marker in NSCLC. To assess the prevalence of TTF-1 expression, and to evaluate its potential role in disease prognosis, 140 stage I-IIIA NSCLCs with long-term follow-up were studied under uniform conditions using high-density tissue microarray (TMA) combined with immunohistochemistry. Patient survival and association of TTF-1 expression with clinicopathologic parameters were analyzed. One hundred twenty-six tumor samples were fully assessable after tissue processing. Sixty-four samples (50.8%) expressed TTF-1 and 62 (49.2%) displayed no expression. TTF-1 expression was significantly (P < 0.001) correlated with histological subtype: 51 adenocarcinomas (AdCs) (51 of 75; 68%) versus 9 squamous cell carcinomas (SCCs) (9 of 43; 21%) were TTF-1 positive. TTF-1 expression, performance status, nodal status, and tumor stage were significantly related to patient survival. In multivariate analysis, positive TTF-1 expression tended to favor a better patient outcome (P = 0.05). Overall, NSCLC patients with positive TTF-1 expression had a median survival of greater than 57.3 months, whereas those with negative expression had a median survival of 39.4 +/- 5.2 months (log-rank test, P = 0.0067). In this study we found that TTF-1 is predominately expressed in adenocarcinoma. The loss of TTF-1 expression was associated with aggressive behavior of NSCLCs. The results from this study strongly indicate that further investigation is warranted to better define the role of TTF-1 as a prognostic factor in this malignancy.
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Affiliation(s)
- Dongfeng Tan
- Lung Cancer Program, Roswell Park Cancer Institute, State University of New York, Buffalo, USA
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Sabel MS, Gibbs JF, Cheney R, McKinley BP, Lee JS, Kraybill WG. Evolution of sentinel lymph node biopsy for melanoma at a National Cancer Institute-designated cancer center. Surgery 2000; 128:556-63. [PMID: 11015088 DOI: 10.1067/msy.2000.108053] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [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: 11/22/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) has rapidly evolved into the standard of care for clinically node-negative melanoma. Since adopting sentinel lymph node (SLN) technology in 1993, we have periodically reviewed our institution's results and made several modifications. METHODS From January 1993 to December 1998, 182 patients with clinically node-negative primary cutaneous melanoma underwent SLNB. Charts were retrospectively reviewed and assessed for the technique for the identification of the SLN, the pathologic analysis, and the use of intraoperative frozen section. RESULTS The accuracy of SLN identification improved from 91% to 100% with the combination of isosulfan blue dye and radiolabeled colloid over isosulfan blue dye alone. Routine versus selective lymphoscintigraphy identified 7 in-transit SLNs and increased detection of dual nodal basin drainage (15%-27%). Identification of micrometastases in the SLN increased from 14% to 24% after a modification of pathologic evaluation. The positive SLN was the only involved node in most patients (80%). Intraoperative frozen section had a sensitivity of 58% and was of benefit in only 13 of 124 patients (10%). CONCLUSIONS Several modifications to the identification of the SLNs and the detection of metastatic melanoma have improved our outcome with SLNB. A careful, periodic review of results to identify areas for improvement at each institution is crucial to the success of SLNB for melanoma.
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Affiliation(s)
- M S Sabel
- Division of Surgery and Department of Pathology, Roswell Park Cancer Institute and State University of New York at Buffalo, Buffalo, NY 14263, USA
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Gibbs JF, Huang PP, Zhang PJ, Kraybill WG, Cheney R. Accuracy of pathologic techniques for the diagnosis of metastatic melanoma in sentinel lymph nodes. Ann Surg Oncol 1999; 6:699-704. [PMID: 10560857 DOI: 10.1007/s10434-999-0691-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [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: 10/25/2022]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy can accurately predict the presence of metastatic melanoma (MM) and has been used to identify patients with occult metastases. We present an analysis of the sensitivity and specificity of standard pathological techniques including intraoperative frozen section, permanent section, and immunohistochemistry in diagnosing MM within the SLN. METHODS Sixty-nine consecutive patients with primary malignant melanoma thickness of >1.0 mm or thinner lesions invading the reticular dermis (Clark level IV) who underwent SLN biopsy were reviewed. Lymph nodes were examined intraoperatively by frozen section (FS), permanent section (H&E), and by immunohistochemistry (IH) for S-100 protein and HMB45. RESULTS MM was found in 14 of 69 cases (20%). Permanent section H&E was performed in all cases, FS in 64 cases, and IH in 65 cases. FS analysis diagnosed MM in 4 of 14 cases (29%), was suspicious in 2 of 14 (14%), and falsely negative (FN) in 8 of 14 (57%) ultimately found to be positive with further workup. Within the FN group, MM was identified on review of the original FS slides in 3 of 8 cases (38%). Furthermore, within the FN group, the remaining 5 cases were identified as positive for MM by either permanent and/or deeper H&E sections and IH. IH alone with permanent H&E sections would have diagnosed MM in only 8 of 10 cases (80%) that were FS negative or suspicious. In no cases was MM identified by IH alone with the permanent and deeper H&E sections being negative. It is noteworthy that no false-positive cases were identified. CONCLUSIONS Intraoperative FS has low sensitivity in identifying MM within the SLN. IH alone does not increase the diagnostic yield. A combination of permanent H&E sections with deeper levels and S-100 and HMB45 IH dramatically increases the overall diagnostic sensitivity of SLN biopsy. Definitive diagnosis should await permanent H&E sections and IH staining.
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Affiliation(s)
- J F Gibbs
- Division of Surgical Oncology, Roswell Park Cancer Institute, State University of New York at Buffalo, 14263, USA
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Bernstein ZP, Wilson BD, Oseroff AR, Jones CM, Dozier SE, Brooks JS, Cheney R, Foulke L, Mang TS, Bellnier DA, Dougherty TJ. Photofrin photodynamic therapy for treatment of AIDS-related cutaneous Kaposi's sarcoma. AIDS 1999; 13:1697-704. [PMID: 10509571 DOI: 10.1097/00002030-199909100-00013] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Kaposi's sarcoma, the most common malignancy in AIDS patients, often presents with painful cutaneous lesions that are difficult to treat effectively despite a wide variety of therapeutic approaches. We used photodynamic therapy in an attempt to provide effective palliative treatment for this disease. METHODS Photodynamic therapy utilizes the activation by light of a photosensitizing drug that preferentially accumulates in tumor tissue such as Kaposi's sarcoma. We enrolled 25 patients who received 1.0 mg/kg of Photofrin 48 h before exposure to 100-400 J/cm2 of 630 nm light. RESULTS Of the 348 lesions treated, 289 were evaluable: 32.5% had complete clinical response, 63.3% had partial clinical response and 4.2% were clinical failures. There was a strong correlation between response and light dose: 54% of lesions achieved a complete clinical response at optimum light dose (> 250 J/cm2). There was no correlation of response with CD4 cell count nor was there a change in CD4 cell count post-treatment. At 400 J/cm2 full field scabbing and necrosis occurred in 90% of the treated fields. Thus, the maximum tolerated dose was determined to be 300 J/cm2. At light doses of 250 J/cm2 and below the toxicities were limited to erythema and edema in the treatment field. Forty-three biopsies were taken 0.5 h to 4 months post-treatment. These showed little change in the B and T cell infiltrates identified. Kaposi's sarcoma cells disappeared post-treatment in certain lesions. CONCLUSION Photofrin is effective palliative treatment for HIV-associated Kaposi's sarcoma.
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Affiliation(s)
- Z P Bernstein
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
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Greenberg JB, MacGowan R, Neumann M, Long A, Cheney R, Fernando D, Sterk C, Wiebel W. Linking injection drug users to medical services: role of street outreach referrals. Health Soc Work 1998; 23:298-309. [PMID: 9834883 DOI: 10.1093/hsw/23.4.298] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Street outreach workers in HIV prevention have expanded their role to include referring injection drug users to medical services. However, little is known about whether drug users act on these referrals. The study discussed in this article examined the level of exposure to street outreach reported by injection drug users, the most common medical referrals acted on as a result of such contacts, and the predictors of acting on these referrals. Findings indicate that injection drug users with four or more contacts with street outreach workers during the preceding six months were more likely to report acting on referrals. To maximize the relevance of outreach for encouraging medical treatment, both street outreach workers and social workers in health care could benefit from cross training that focuses on strengthening the referral process.
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Affiliation(s)
- J B Greenberg
- National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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MacGowan RJ, Sterk CE, Long A, Cheney R, Seeman M, Anderson JE. New needle and syringe use, and use of needle exchange programmes by street recruited injection drug users in 1993. Int J Epidemiol 1998; 27:302-8. [PMID: 9602414 DOI: 10.1093/ije/27.2.302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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: 11/12/2022] Open
Abstract
BACKGROUND Needle exchange programmes (NEP) provide injection drug users (IDU) with sterile injection equipment and receive used needles in exchange. In this paper we describe the use of new syringes and NEP by IDU and characteristics associated with using NEP in 1993. METHODS Street-recruited IDU were interviewed in five US locations: Atlanta, Philadelphia, Chicago, New York City, and Los Angeles (LA) county. RESULTS Most (75-95%) reported it was easy to get a new syringe and for their last injection, 45-77% used a new syringe and 2-18% used a syringe previously used by another IDU. Use of NEP ranged from 8% to 16% in Chicago, Philadelphia, and LA County. In LA County not having injected 'speedball' in the last 30 days, last injection with a new syringe, and reporting it was very easy to get a new syringe were associated with NEP use. In Philadelphia, NEP use was associated with 'speedball' injection in the last 30 days, and in Chicago, not injecting with 'speedball' and injecting with cocaine were associated with NEP use. CONCLUSIONS In 1993, most street-recruited IDU in Chicago, Philadelphia, and LA County had not used NEP. Factors associated with NEP use were not consistent across sites. Dispersion of NEP and removal of legal barriers restricting access to sterile syringes may be more important in increasing the use of sterile syringes and NEP than client characteristics.
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Affiliation(s)
- R J MacGowan
- Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, Atlanta, GA 30333, USA
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