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Boggi U, Kauffmann E, Napoli N, Barreto SG, Besselink MG, Fusai GK, Hackert T, Abu Hilal M, Marchegiani G, Salvia R, Shrikhande S, Truty M, Werner J, Wolfgang C, Bannone E, Capretti G, Cattelani A, Coppola A, Cucchetti A, De Sio D, Di Dato A, Di Meo G, Fiorillo C, Gianfaldoni C, Ginesini M, Hidalgo Salinas C, Lai Q, Miccoli M, Montorsi R, Pagnanelli M, Poli A, Ricci C, Sucameli F, Tamburrino D, Viti V, Addeo PF, Alfieri S, Bachellier P, Baiocchi G, Balzano G, Barbarello L, Brolese A, Busquets J, Butturini G, Caniglia F, Caputo D, Casadei R, Chunhua X, Colangelo E, Coratti A, Costa F, Crafa F, Dalla Valle R, De Carlis L, de Wilde RF, Del Chiaro M, Di Benedetto F, Di Sebastiano P, Dokmak S, Hogg M, Egorov VI, Ercolani G, Ettorre GM, Falconi M, Ferrari G, Ferrero A, Filauro M, Giardino A, Grazi GL, Gruttaduaria S, Izbicki JR, Jovine E, Katz M, Keck T, Khatkov I, Kiguchi G, Kooby D, Lang H, Lombardo C, Malleo G, Massani M, Mazzaferro V, Memeo R, Miao Y, Mishima K, Molino C, Nagakawa Y, Nakamura M, Nardo B, Panaro F, Pasquali C, Perrone V, Rangelova E, Riu L, Romagnoli R, Romito R, Rosso E, Schulick R, Siriwardena A, Spampinato M, Strobel O, Testini M, Troisi R, Uzunoglo FG, Valente R, Veneroni L, Zerbi A, Vicente E, Vistoli F, Vivarelli M, Wakabayashi G, Zanus G, Zureikat A, Zyromski NJ, Coppola R, D'Andrea V, Davide J, Dervenis C, Frigerio I, Konlon KC, Michelassi F, Montorsi M, Nealon W, Portolani N, Sousa Silva D, Bozzi G, Ferrari V, Trivella MG, Cameron J, Clavien PA, Asbun HJ. REDISCOVER International Guidelines on the Perioperative Care of Surgical Patients With Borderline-resectable and Locally Advanced Pancreatic Cancer. Ann Surg 2024:00000658-990000000-00795. [PMID: 38407228 DOI: 10.1097/sla.0000000000006248] [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: 02/27/2024]
Abstract
OBJECTIVE The REDISCOVER consensus conference aimed at developing and validate guidelines on the perioperative care of patients with borderline resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC). SUMMARY BACKGROUND DATA Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic surgery supports resection of BR-PDAC and, to a lesser extent, LA-PDAC. Guidelines outlining the selection and perioperative care for these patients are lacking. METHODS The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used to develop the REDISCOVER guidelines and create recommendations. The Delphi approach was used to reach consensus (agreement ≥80%) among experts. Recommendations were approved after a debate and vote among international experts in pancreatic surgery and pancreatic cancer management. A Validation Committee used the AGREE II-GRS tool to assess the methodological quality of the guidelines. Moreover, an independent multidisciplinary advisory group revised the statements to ensure adherence to non-surgical guidelines. RESULTS Overall, 34 recommendations were created targeting centralization, training, staging, patient selection for surgery, possibility of surgery in uncommon scenarios, timing of surgery, avoidance of vascular reconstruction, details of vascular resection/reconstruction, arterial divestment, frozen section histology of perivascular tissue, extent of lymphadenectomy, anticoagulation prophylaxis and role of minimally invasive surgery. The level of evidence was however low for 29 of 34 clinical questions. Participants agreed that the most conducive mean to promptly advance our understanding in this field is to establish an international registry addressing this patient population ( https://rediscover.unipi.it/ ). CONCLUSIONS The REDISCOVER guidelines provide clinical recommendations pertaining to pancreatectomy with vascular resection for patients with BR- and LA-PDAC, and serve as the basis of a new international registry for this patient population.
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Affiliation(s)
- Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Emanuele Kauffmann
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Niccolò Napoli
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - S George Barreto
- College of Medicine and Public Health, Flinders University, South Australia, Australia, Division of Surgery and Perioperative Medicine, Flinders Medical Center, Beadfor Park, Australia
| | - Marc G Besselink
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | | | - Thilo Hackert
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Germany
| | - Mohammad Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giovanni Marchegiani
- Hepatopancreatobiliary and Liver Transplant Surgery, Department of Surgery, Oncology and Gastroenterology, DiSCOG, University of Padua, Padua, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Shailesh Shrikhande
- Tata Memorial Hospital, Gastrointestinal and HPB Service, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India
| | - Mark Truty
- Division of Hepatobiliary & Pancreas Surgery, Department of Surgery, Mayo Clinic Rochester, MN, USA
| | - Jens Werner
- Department of General, Visceral, and Transplant Surgery, LMU, University of Munich, Germany
| | - Christopher Wolfgang
- Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Elisa Bannone
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | - Alice Cattelani
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | | | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum Università di Bologna; Bologna, Italy
| | - Davide De Sio
- Gemelli Pancreatic Center, CRMPG (Advanced Pancreatic Research Center), Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Armando Di Dato
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Giovanna Di Meo
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J) University of Bari, Italy
| | - Claudio Fiorillo
- Gemelli Pancreatic Center, CRMPG (Advanced Pancreatic Research Center), Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Cesare Gianfaldoni
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Michael Ginesini
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | | | - Quirino Lai
- Department of General and Specialty Surgery, Sapienza University of Rome, AOU Policlinico Umberto I of Rome, Rome, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberto Montorsi
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | | | - Andrea Poli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudio Ricci
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Italy, Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna (IRCCS AOUBO)
| | - Francesco Sucameli
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Domenico Tamburrino
- Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Virginia Viti
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Pietro F Addeo
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Sergio Alfieri
- Gemelli Pancreatic Center, CRMPG (Advanced Pancreatic Research Center), Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Philippe Bachellier
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Gianluca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia and UOC General Surgery, ASST Cremona, Italy
| | - Gianpaolo Balzano
- Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Linda Barbarello
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Alberto Brolese
- Department of General Surgery & HPB Unit, APSS, Trento, Italy
| | - Juli Busquets
- Division of Pancreatobiliary Surgery and Liver Transplantation, Department of Surgery, Bellvitge University Hospital, IDIBELL, L´Hospitalet de Llobregat, Barcelona, Spain
| | - Giovanni Butturini
- Hepatopancreatobiliary Surgery, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Fabio Caniglia
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Damiano Caputo
- Research Unit of General Surgery, Department of Medicine and Surgery, University Campus Bio-Medico di Roma, Via Alvaro del Portillo 200,00128 Rome, Italy
- Operative Research Unit of General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Riccardo Casadei
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Italy, Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna (IRCCS AOUBO)
| | - Xi Chunhua
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Institute, Nanjing Medical University
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University
| | - Ettore Colangelo
- Department of General Surgery, "G. Mazzini" Hospital, Teramo, Italy
| | - Andrea Coratti
- Department of General and Emergency Surgery, AUSL Toscana Sud Est, Misericordia Hospital of Grosseto, Italy
| | - Francesca Costa
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Francesco Crafa
- Division of General, Oncological and Robotic Surgery, San Giuseppe Moscati Hospital, Avellino Italy
| | | | - Luciano De Carlis
- Division of HPB Surgery and Transplantation, Niguarda Hospital , University of Milano-Bicocca, Milan, Italy
| | - Roeland F de Wilde
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marco Del Chiaro
- Department of Surgery, University of Colorado School of Medicine. Aurora, Colorado, USA
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Pierluigi Di Sebastiano
- Surgical Oncology, Pierangeli Clinic, Department of Innovative Technology in Medicine & Dentistry, G. D'Annunzio University Chieti-Pescara, Italy
| | - Safi Dokmak
- department of HPB surgery and liver transplantation, Beaujon hospital, Clichy, France. University Paris Cité, Paris, France
| | - Melissa Hogg
- Division of HPB Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Vyacheslav I Egorov
- Department for Surgical Oncology and HPB Surgery, Ilyinskaya Hospital, Moscow, Russia
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum Università di Bologna; Bologna, Italy
| | - Giuseppe Maria Ettorre
- Department of General Surgery and Transplantation. San Camillo Forlanini Hospital-POIT. Rome, Italy
| | - Massimo Falconi
- Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Giovanni Ferrari
- Division of Minimally-invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, "Umberto I" Mauriziano Hospital, Turin, Italy
| | - Marco Filauro
- Department of Surgery Galliera Hospital, Genova, Italy
| | - Alessandro Giardino
- Hepatopancreatobiliary Surgery, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Gian Luca Grazi
- Division of HepatoBiliaryPancreatic Surgery, AOU Careggi, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Salvatore Gruttaduaria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center Italy (UPMC Italy), Palermo, Italy
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Jakob R Izbicki
- Department of general visceral and thoracic surgery, University Hospital Eppendorf University of Hamburg, Hamburg, Germany
| | - Elio Jovine
- Department of Surgery, Alma Mater Studiorum University of Bologna, IRCCS Azienda Ospedaliera Universitaria di Bologna
| | - Matthew Katz
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Igor Khatkov
- Department of High Technology Surgery, Moscow Clinical Scientific Center. Moscow, Russia
| | - Gozo Kiguchi
- Department of Surgery, Hirakata Kohsai Hospital, Osaka, Japan
| | - David Kooby
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Hauke Lang
- University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Carlo Lombardo
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Giuseppe Malleo
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Marco Massani
- Department of Surgery, Regional Hospital of Treviso, Treviso, Italy
| | - Vincenzo Mazzaferro
- Department of Oncology and Hemato-oncology, University of Milan HPB Surgery and Liver Transplantation Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Riccardo Memeo
- Department of HPB Surgery, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Yi Miao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Institute, Nanjing Medical University
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Kohei Mishima
- Research Institute against Digestive Cancer (IRCAD), Strasbourg, France
| | - Carlo Molino
- Department of General and Speciality Surgery, General and Pancreatic Surgery Team 1, AORN A. Cardarelli, Naples, Italy
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Bruno Nardo
- Division of General Surgery, Department of Surgery and Robotic, Annunziata Hub Hospital, School of Medicine Surgery and TD, University of Calabria, Cosenza, Italy
| | - Fabrizio Panaro
- Department of Surgery, Division of HBP Surgery & Transplantation. Montpellier University Hospital School of Medicine, Montpellier, France
| | - Claudio Pasquali
- Pancreatic & Digestive Endocrine Surgery Research Group - Department of Surgery, Oncology and Gastroenterology, DiSCOG, University of Padua, Padua, Italy
| | - Vittorio Perrone
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Elena Rangelova
- Section for Upper Abdominal Surgery at the Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Surgery at the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Long Riu
- Second Department of Hepatopancreatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing 100853, China
| | - Renato Romagnoli
- Division of General Surgery 2U - Liver Transplant Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Raffaele Romito
- Division of General Surgery II and HPB Unit, A.O.U. Maggiore della Carità di Novara, Novara, Italy
| | - Edoardo Rosso
- Service de Chirurgie Générale, Mini-Invasive et Robotique, Centre Hôspitalier de
| | - Richard Schulick
- Department of Surgery, University of Colorado School of Medicine. Aurora, Colorado, USA
| | - Ajith Siriwardena
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK
| | - Marcello Spampinato
- Department of General and Minimally Invasive Surgery, "Vito Fazzi" Hospital, Lecce, Italy Luxembourg, Luxembourg, Luxembourg
| | - Oliver Strobel
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J) University of Bari, Italy
| | - Roberto Troisi
- Division of HBP, Minimally Invasive and Robotic Surgery, Transplantation Service Federico II University Hospital - Naples, Italy
| | - Faik G Uzunoglo
- Department of general visceral and thoracic surgery, University Hospital Eppendorf University of Hamburg, Hamburg, Germany
| | | | - Luigi Veneroni
- Chirurgia Generale, Infermi Hospital Rimini, AUSL Romagna, Rimini, Italy
| | | | - Emilio Vicente
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Fabio Vistoli
- Division of General Surgery and Transplantation, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marco Vivarelli
- Division of Hepatobiliary, Pancreatic and Transplantation Surgery, Polytechnic University of Marche, Ospedali Riuniti delle Marche, Ancona, Italy
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
| | - Giacomo Zanus
- Second Division of Surgery-Treviso-Department of Surgery, Oncology and Gastroenterology, DiSCOG, University of Padua, Padua, Italy
| | - Amer Zureikat
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Roberto Coppola
- Research Unit of General Surgery, Department of Medicine and Surgery, University Campus Bio-Medico di Roma, Via Alvaro del Portillo 200,00128 Rome, Italy
- Operative Research Unit of General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Vito D'Andrea
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - José Davide
- Department of Surgery, HEBIPA - Hepatobiliary and Pancreatic Unit, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | - Isabella Frigerio
- Hepatopancreatobiliary Surgery, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Kevin C Konlon
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Fabrizio Michelassi
- Department of Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital at Weill Cornell, New Yourk, NY, USA
| | - Marco Montorsi
- Department of Biomedical Sciences, Humanitas University, Italy
- Division of General and Digestive Surgery, Department of General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - William Nealon
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA; Zucker School of Medicine at Hofstra, New Hyde Park, NY, USA
| | - Nazario Portolani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Italy
| | - Donzília Sousa Silva
- Department of Surgery, HEBIPA - Hepatobiliary and Pancreatic Unit, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | | | | | - John Cameron
- Department of Surgery, John Hopkins University School of Medicine, Baltimore, MD
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Horacio J Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA
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Karam E, Hollenbach M, Abou Ali E, Auriemma F, Anderloni A, Barbier L, Belfiori G, Caillol F, Crippa S, Del Chiaro M, De Ponthaud C, Dahel Y, Falconi M, Giovannini M, Heling D, Inoue Y, Jarnagin WR, Leung G, Lupinacci RM, Mariani A, Masaryk V, Miksch RC, Musquer N, Napoleon B, Oba A, Partelli S, Petrone MC, Prat F, Repici A, Sauvanet A, Salzmann K, Schattner MA, Schulick R, Schwarz L, Soares K, Souche FR, Truant S, Vaillant JC, Wang T, Wedi E, Werner J, Weismüller TJ, Wichmann D, Will U, Zaccari P, Gulla A, Heise C, Regner S, Gaujoux S. Endoscopic and Surgical Management of Non-Metastatic Ampullary Neuroendocrine Neoplasia: A Multi-Institutional Pancreas2000/EPC Study. Neuroendocrinology 2023; 113:1024-1034. [PMID: 37369186 DOI: 10.1159/000531712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/15/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION Ampullary neuroendocrine neoplasia (NEN) is rare and evidence regarding their management is scarce. This study aimed to describe clinicopathological features, management, and prognosis of ampullary NEN according to their endoscopic or surgical management. METHODS From a multi-institutional international database, patients treated with either endoscopic papillectomy (EP), transduodenal surgical ampullectomy (TSA), or pancreaticoduodenectomy (PD) for ampullary NEN were included. Clinical features, post-procedure complications, and recurrences were assessed. RESULTS 65 patients were included, 20 (30.8%) treated with EP, 19 (29.2%) with TSA, and 26 (40%) with PD. Patients were mostly asymptomatic (n = 46; 70.8%). Median tumor size was 17 mm (12-22), tumors were mostly grade 1 (70.8%) and pT2 (55.4%). Two (10%) EP resulted in severe American Society for Gastrointestinal Enterology (ASGE) adverse post-procedure complications and 10 (50%) were R0. Clavien 3-5 complications did not occur after TSA and in 4, including 1 postoperative death (15.4%) of patients after PD, with 17 (89.5%) and 26 R0 resection (100%), respectively. The pN1/2 rate was 51.9% (n = 14) after PD. Tumor size larger than 1 cm (i.e., pT stage >1) was a predictor for R1 resection (p < 0.001). Three-year overall survival and disease-free survival after EP, TSA, and PD were 92%, 68%, 92% and 92%, 85%, 73%, respectively. CONCLUSION Management of ampullary NEN is challenging. EP should not be performed in lesions larger than 1 cm or with a endoscopic ultrasonography T stage beyond T1. Local resection by TSA seems safe and feasible for lesions without nodal involvement. PD should be preferred for larger ampullary NEN at risk of nodal metastasis.
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Affiliation(s)
- Elias Karam
- Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Department of Visceral Surgery, Tours University Hospital, Tours, France
| | - Marcus Hollenbach
- Medical Department II - Gastroenterology, Hepatology, Infectious Diseases, Pulmonology, University of Leipzig Medical Center, Leipzig, Germany
| | - Einas Abou Ali
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Paris, France
| | - Francesco Auriemma
- Rozzano, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital, Milano, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Louise Barbier
- Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Department of Visceral Surgery, Tours University Hospital, Tours, France
| | - Giulio Belfiori
- Department of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Fabrice Caillol
- Department of Endoscopy, Institut Paoli Calmettes, Marseille, France
| | - Stefano Crippa
- Department of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Marco Del Chiaro
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Charles De Ponthaud
- Department of Digestive and HBP Surgery, Groupe Hospitalier Pitié-Salpêtrière APHP, Paris, France
| | - Yanis Dahel
- Department of Endoscopy, Institut Paoli Calmettes, Marseille, France
| | - Massimo Falconi
- Department of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Marc Giovannini
- Department of Endoscopy, Institut Paoli Calmettes, Marseille, France
| | - Dominik Heling
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Yosuke Inoue
- Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Galen Leung
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Renato M Lupinacci
- Department of Digestive Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Alberto Mariani
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Viliam Masaryk
- Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany
| | - Rainer Christoph Miksch
- Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | | | | | - Atsushi Oba
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stefano Partelli
- Department of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Maria C Petrone
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Frédéric Prat
- Department of Digestive, hepatobiliary and endocrine surgery, Cochin Hospital, APHP, and Université de Paris, Paris, France
| | - Alessandro Repici
- Rozzano, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital, Milano, Italy
| | - Alain Sauvanet
- Departement of Digestive Surgery, Beaujon Hospital, APHP, Clichy, France
| | - Katrin Salzmann
- Department of Gastroenterology and Gastrointestinal Oncology, University Medicine Göttingen, Göttingen, Germany
| | - Mark A Schattner
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard Schulick
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lilian Schwarz
- Department of Digestive Surgery, Hôpital Charles-Nicolle, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Kevin Soares
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - François R Souche
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Stéphanie Truant
- Deparment of Digestive Surgery, Centre Hospitalo-Universitaire De Lille, Lille, France
| | - Jean C Vaillant
- Department of Digestive and HBP Surgery, Groupe Hospitalier Pitié-Salpêtrière APHP, Paris, France
| | - Tiegong Wang
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Surgery, Cangzhou Central Hospital, Cangzhou, China
| | - Edris Wedi
- Department of Gastroenterology and Gastrointestinal Oncology, University Medicine Göttingen, Göttingen, Germany
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - Tobias J Weismüller
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
- Department of Internal Medicine - Gastroenterology and Oncology, Vivantes Humboldt Hospital, Berlin, Germany
| | - Dörte Wichmann
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Tübingen, Germany
| | - Uwe Will
- Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany
| | - Piera Zaccari
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Aiste Gulla
- Institute of Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Surgery, MedStar Georgetown University Hospital, General Surgery, Georgetown, Washington, District of Columbia, USA
| | - Christian Heise
- Department of Medicine I - Gastroenterology, Pulmonology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sara Regner
- Section for Surgery, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Sébastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
- Department of Surgery, Sorbonne University, Paris, France
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Oba A, Wu YHA, Schulick R, Del Chiaro M. Author response to: Comment on: Comparing neoadjuvant chemotherapy with or without radiation therapy for pancreatic ductal adenocarcinoma: National Cancer Database cohort analysis. Br J Surg 2022; 110:112. [PMID: 36245252 DOI: 10.1093/bjs/znac340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/20/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Atsushi Oba
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Y H Andrew Wu
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Richard Schulick
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA.,University of Colorado Cancer Center, Denver, Colorado, USA
| | - Marco Del Chiaro
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA.,University of Colorado Cancer Center, Denver, Colorado, USA
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Verosky A, Leonard LD, Quinn C, Vemuru S, Warncke E, Himelhoch B, Huynh V, Wolverton D, Jaiswal K, Ahrendt G, Sams S, Lin CT, Cumbler E, Schulick R, Tevis SE. Patient comprehension of breast pathology report terminology: The need for patient-centered resources. Surgery 2022; 172:831-837. [PMID: 35715235 DOI: 10.1016/j.surg.2022.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND As health care continues to evolve toward information transparency, an increasing number of patients have access to their medical records, including result reports that were not originally designed to be patient-facing. Previous studies have demonstrated that patients have poor understanding of medical terminology. However, patient comprehension of terminology specific to breast pathology reports has not been well studied. We assessed patient understanding of common medical terms found in breast pathology reports. METHODS A survey was administered electronically to patients scheduled for a screening mammogram within a multisite health care system. Participants were asked to objectively define and interpret 8 medical terms common to breast biopsy pathology reports. Patient perception of the utility of various educational tools was also assessed. Demographic information including health literacy, education level, previous cancer diagnosis, and primary language was collected. RESULTS In total, 527 patients completed the survey. Terms including "malignant" and "benign" were the most correctly defined at 80% and 73%, respectively, whereas only 1% correctly defined "high grade." Factors including race/ethnicity and education level were correlated with more correct scores. Patients preferred educational tools that were specific to their diagnosis and available at the time they were reviewing their results. CONCLUSION Patient comprehension of common medical terminology is poor. Potential assumptions of understanding based on patient factors including education, past medical history, and occupation are misinformed. With the newly mandated immediate release of information to patients, there is a pressing need to develop and integrate educational tools to support patients through all aspects of their care.
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Affiliation(s)
- Alexandra Verosky
- School of Medicine, University of Colorado, Denver, CO. https://twitter.com/veroskyalex
| | | | | | - Sudheer Vemuru
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/sudheervemuru
| | - Emily Warncke
- Department of Radiology, University of Colorado, Denver, CO
| | - Ben Himelhoch
- Department of Radiology, University of Colorado, Denver, CO. https://twitter.com/BHimelhoch
| | - Victoria Huynh
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/THuynhMD
| | | | - Kshama Jaiswal
- School of Medicine, University of Colorado, Denver, CO. https://twitter.com/KshamaRJaiswal
| | - Gretchen Ahrendt
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/ahrendt50
| | - Sharon Sams
- Department of Pathology, University of Colorado, Denver, CO
| | - Chen-Tan Lin
- Department of Medicine, University of Colorado, Denver, CO. https://twitter.com/CTLin1
| | - Ethan Cumbler
- Department of Surgery, University of Colorado, Denver, CO; Department of Medicine, University of Colorado, Denver, CO. https://twitter.com/ECumbler
| | - Richard Schulick
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/RichSchulickMD
| | - Sarah E Tevis
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/SarahTevisMD
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5
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Leonard LD, Himelhoch B, Huynh V, Wolverton D, Jaiswal K, Ahrendt G, Sams S, Cumbler E, Schulick R, Tevis SE. Patient and clinician perceptions of the immediate release of electronic health information. Am J Surg 2021; 224:27-34. [PMID: 34903369 DOI: 10.1016/j.amjsurg.2021.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/28/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The 21st Century Cures Act requires that institutions release all electronic health information (EHI) to patients immediately. We aimed to understand patient and clinician attitudes toward the immediate release of EHI to patients. METHODS Patients and clinicians representing distinct specialties at a single academic medical center completed a survey to assess attitudes toward the immediate release of results. Differences between patient and clinician responses were compared using chi-square and student's t-test for categorical and continuous variables, respectively. A two-sided significance level of 0.05 was used for all statistical tests. RESULTS 69 clinicians and 57 patients completed the survey. Both patients (89.7%) and clinicians (80.6%) agreed or strongly agreed-here after referred to as agreed, that providing patients with access to their health information is necessary in delivering high-quality care. However, 62.7% of clinicians agreed that results released immediately would be more confusing than helpful, whereas the minority of patients agreed with this statement (15.8%) (p < 0.05). Providers were also more likely to disagree that patients are comfortable independently interpreting blood work results (p < 0.05), radiology results (p < 0.05) and pathology reports (p < 0.05). With regard to timing, the majority of patients (75.1%) felt their provider should contact them within 24 h of the release of an abnormal result, whereas only 9.0% of clinicians agreed with this timeframe (p < 0.05). DISCUSSIONS Patients and clinicians value information transparency. However, the immediate release of results is controversial, especially among clinicians. The discrepancy between patient and clinician perceptions underlines the importance of setting expectations about the communication of results. Additionally, our results emphasize the need to implement strategies to help improve patient comprehension, decrease patient distress and improve clinician workflows.
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Affiliation(s)
- Laura D Leonard
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 East, 17th Ave. 6th Floor, Aurora, CO, 80045, USA.
| | - Ben Himelhoch
- Department of Radiology, University of Colorado School of Medicine, Anschutz Medical Campus, 12401 East 17th Ave, Aurora, CO, 80045, USA
| | - Victoria Huynh
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 East, 17th Ave. 6th Floor, Aurora, CO, 80045, USA
| | - Dulcy Wolverton
- Department of Radiology, University of Colorado School of Medicine, Anschutz Medical Campus, 12401 East 17th Ave, Aurora, CO, 80045, USA
| | - Kshama Jaiswal
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 East, 17th Ave. 6th Floor, Aurora, CO, 80045, USA
| | - Gretchen Ahrendt
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 East, 17th Ave. 6th Floor, Aurora, CO, 80045, USA
| | - Sharon Sams
- Department of Pathology, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 East 17th Ave, 2nd Floor, Aurora, CO, 80045, USA
| | - Ethan Cumbler
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 East, 17th Ave. 6th Floor, Aurora, CO, 80045, USA; Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 East 17th Ave, 8th Floor, Aurora, CO, 80045, USA
| | - Richard Schulick
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 East, 17th Ave. 6th Floor, Aurora, CO, 80045, USA
| | - Sarah E Tevis
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 East, 17th Ave. 6th Floor, Aurora, CO, 80045, USA
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Huynh V, Christian N, Tuthill K, Colborn K, Schulick R, Tevis S. Development of a Surgical Research Program for Medical Students and its Short-Term Impact on Academic Productivity. J Surg Educ 2021; 78:e68-e71. [PMID: 34266791 DOI: 10.1016/j.jsurg.2021.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To describe the development and implementation of a mentored surgical research program for medical students and its short-term impact on academic productivity. DESIGN Description of an educational research program. SETTING University of Colorado School of Medicine. PARTICIPANTS Rising second-year medical students. METHODS We piloted an 8-week mentored surgical research program with an interactive curriculum that included lectures on fundamental research skills and conferences for early clinical exposure. Each student was paired with a faculty mentor and research project and provided weekly updates at faculty led work-in-progress meetings. Students who completed the program were provided with an end-of-program evaluation of their own learning. Follow-up at 3-months and 6-months post-program completion assessed continued research engagement and productivity. RESULTS Thirteen 1st year medical students completed the pilot program. Eleven (85%) students completed the end-of-program evaluation. All students felt the program was valuable to their future and helped develop their ability to investigate and solve new research questions. All students felt confident or very confident that they had the knowledge and resources to write and submit an abstract to a national meeting, and 10 (91%) felt similarly about writing a manuscript in the future. On 3-month follow-up, 11 (85%) of the 13 students were still engaged with their research labs; six (46%) had submitted an abstract to a national meeting, 3 (23%) of which were accepted for oral presentation. Two (15%) were in the process of drafting a manuscript; none had yet submitted one. At 6-month follow-up, 2 additional students had abstracts accepted for oral presentation. One student had submitted a manuscript, and 3 were in the process of drafting one. CONCLUSIONS Integrating research early into the medical school curriculum helps equip students with the fundamental skills needed for early academic achievement and may help establish success in academic careers.
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Affiliation(s)
- Victoria Huynh
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Nicole Christian
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kathleen Tuthill
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kathryn Colborn
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) and Surgical Outcomes and Applied Research (SOAR) Program, University of Colorado, Aurora, Colorado
| | - Richard Schulick
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sarah Tevis
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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Machairas N, Raptis DA, Velázquez PS, Sauvanet A, de Leon AR, Oba A, Koerkamp BG, Lovasik B, Chan C, Yeo C, Bassi C, Ferrone CR, Kooby D, Moskal D, Tamburrino D, Yoon DS, Barroso E, de Santibañes E, Kauffmann EF, Vigia E, Robin F, Casciani F, Burdío F, Belfiori G, Malleo G, Lavu H, Hartog H, Hwang HK, Han HS, Marques HP, Poves I, Rosado ID, Park JS, Lillemoe KD, Roberts K, Sulpice L, Besselink MG, Abuawwad M, Del Chiaro M, de Santibañes M, Falconi M, D'Silva M, Silva M, Hilal MA, Qadan M, Sell NM, Beghdadi N, Napoli N, Busch OR, Mazza O, Muiesan P, Müller PC, Ravikumar R, Schulick R, Powell-Brett S, Abbas SH, Mackay TM, Stoop TF, Gallagher TK, Boggi U, van Eijck C, Clavien PA, Conlon KCP, Fusai GK. The Impact of Neoadjuvant Treatment on Survival in Patients Undergoing Pancreatoduodenectomy with Concomitant Portomesenteric Venous Resection: An International Multicenter Analysis. Ann Surg 2021; 274:721-728. [PMID: 34353988 DOI: 10.1097/sla.0000000000005132] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate whether neoadjuvant therapy (NAT) critically influenced microscopically complete resection (R0) rates and long-term outcomes for patients with pancreatic ductal adenocarcinoma who underwent pancreatoduodenectomy (PD) with portomesenteric vein resection (PVR) from a diverse, world-wide group of high-volume centers. SUMMARY BACKGROUND DATA Limited size studies suggest that NAT improves R0 rates and overall survival compared to upfront surgery in resectable and borderline resectable pancreatic cancer (R/BR-PDAC) patients. METHODS This multicenter study analyzed consecutive patients with R/BR-PDAC who underwent PD with PVR in 23 high-volume centers from 2009 to 2018. RESULTS Data from 1192 patients with PD and PVR were collected and analyzed. The median age was 68 [interquartile range (IQR) 60-73] years and 52% were males. Some 186 (15.6%) and 131 (10.9%) patients received neoadjuvant chemotherapy (NAC) alone and neoadjuvant chemoradiotherapy (NACRT), respectively. The R0/R1/R2 rates were 57%, 39.3%, and 3.2% in patients who received NAT compared to 46.6%, 49.9%, and 3.5% in patients who did not, respectively (p=0.004). The 1-, 3-, and 5-year OS in patients receiving NAT was 79%, 41%, and 29%, while for those that did not it was 73%, 29%, and 18%, respectively (p<0.001). Multivariable analysis showed no administration of NAT, high tumor grade, lymphovascular invasion, R1/R2 resection, no adjuvant chemotherapy, occurrence of Clavien-Dindo grade 3 or higher postoperative complications within 90 days, preoperative diabetes mellitus, male sex and portal vein involvement were negative independent predictive factors for OS. CONCLUSION Patients with PDAC of the pancreatic head expected to undergo venous reconstruction should routinely be considered for NAT.
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Affiliation(s)
- Nikolaos Machairas
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK Department of Surgery, Parc de Salut Mar, Barcelona, Spain Department of Surgery, Hôpital Beaujon, University of Paris, AP-HP, Clichy, France Department of Pancreatic Surgery, National Institute of Medical Sciences and Nutrition, Mexico City, Mexico Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Colorado, CO, USA Department of Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA Department of Surgery, Massachusetts General Hospital, Boston, MA, USA Department of Surgery, University Hospital of Verona, "Pancreas Institute," Verona, Italy Department of Surgery, San Raffaele Hospital IRCCS, Vita-Salute University, Milano, Italy Department of Surgery, Curry Cabral Hospital, CHLC, Lisbon, Portugal Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina Division of General and Transplant Surgery, University of Pisa, Pisa, Italy Department of HPB and Digestive Surgery, Rennes University Hospital, Rennes, France Department of Surgery, Seoul Naional University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea Department of HPB Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK Department of HPB Surgery and Liver Transplant, Queen Elizabeth Hospital, Birmingham, UK Department of HPB Surgery, St. Vincent's University Hospital, Dublin, Ireland Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland Department of Surgery, Gangnam Severance Hospital, Yonsei University, Seoul, Korea Department of Surgery, Emory Saint Joseph's Hospital, Emory University, Atlanta, GA, USA Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy Division of Surgery and Interventional Sciences, University College London, London, UK
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Leonard LD, Shaw M, Moyer A, Tevis S, Schulick R, McIntyre R, Ballou M, Reiter K, Lace C, Weitzel N, Wiler J, Meacham R, Cumbler E, Steward L. The surgical debrief: Just another checklist or an instrument to drive cultural change? Am J Surg 2021; 223:120-125. [PMID: 34407917 DOI: 10.1016/j.amjsurg.2021.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Post-procedural debrief is recommended to improve patient safety. We examined operating room (OR) clinicians' perceptions of the impact of a multi-disciplinary debrief on OR culture. METHODS A survey was administered to 182 OR clinicians at a major academic medical center. Attitudes toward the surgical debrief and its effect on patient safety and OR culture were evaluated. RESULTS Majority of clinicians (58.2%) believed creating a culture of safety in the OR was a shared care team responsibility, however, surgical attendings and trainees were more likely to assign this responsibility to the surgical attending. Few circulating nurses and trainees felt comfortable initiating a surgical debrief. Overall clinicians agreed that a debrief would impact both patient safety outcomes and OR culture. CONCLUSIONS Clinicians felt implementation of a surgical debrief would positively affect the OR culture of safety by improving interdisciplinary communication and influencing the power hierarchy that exists in many ORs.
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Affiliation(s)
- Laura D Leonard
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA.
| | - Maxwell Shaw
- UCHealth at University of Colorado Anschutz Medical Campus, 1300 E. 17th Place, Aurora, CO, 80045, USA
| | - Amber Moyer
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA
| | - Sarah Tevis
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA
| | - Richard Schulick
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA
| | - Robert McIntyre
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA
| | - Michelle Ballou
- UCHealth at University of Colorado Anschutz Medical Campus, 1300 E. 17th Place, Aurora, CO, 80045, USA
| | - Kaye Reiter
- UCHealth at University of Colorado Anschutz Medical Campus, 1300 E. 17th Place, Aurora, CO, 80045, USA
| | - Christopher Lace
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, 12401 East 17th Ave. 7th Floor, Aurora, CO, 80045, USA
| | - Nathaen Weitzel
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, 12401 East 17th Ave. 7th Floor, Aurora, CO, 80045, USA
| | - Jennifer Wiler
- UCHealth at University of Colorado Anschutz Medical Campus, 1300 E. 17th Place, Aurora, CO, 80045, USA; Department of Emergency Medicine, University of Colorado, Anschutz Medical Campus, 12401 East 17th Ave. 7th Floor, Aurora, CO 80045, USA
| | - Randall Meacham
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA
| | - Ethan Cumbler
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA; Department of Medicine, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 8601, Aurora, CO, 80045, USA
| | - Lauren Steward
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA
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Piper M, Van Court B, Mueller A, Nguyen D, Gadwa J, Bickett T, Schulick R, Messersmith W, Del Chiaro M, Goodman K, Dent A, Kedl R, Lenz L, Karam S. P-218 STAT3 signaling inhibition in regulatory T cells improves immune response to RT in PDAC. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.272] [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: 11/25/2022] Open
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Leonard LD, Cumbler E, Schulick R, Tevis SE. From paternalistic to patient-centered: Strategies to support patients with the immediate release of medical records. Am J Surg 2021; 222:909-910. [PMID: 33933209 DOI: 10.1016/j.amjsurg.2021.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/06/2021] [Accepted: 04/18/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Laura D Leonard
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, United States
| | - Ethan Cumbler
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, United States; Department of Medicine, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 8601, Aurora, CO, 80045, United States
| | - Richard Schulick
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, United States
| | - Sarah E Tevis
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, United States.
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11
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Huynh V, Colborn K, Rojas KE, Christian N, Ahrendt G, Cumbler E, Schulick R, Tevis S. Evaluation of opioid prescribing preferences among surgical residents and faculty. Surgery 2021; 170:1066-1073. [PMID: 33858683 DOI: 10.1016/j.surg.2021.02.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Residents report that faculty preference is a significant driver of opioid prescribing practices. This study compared opioid prescribing preferences of surgical residents and faculty against published guidelines and actual practice and assessed perceptions in communication and transparency around these practices. METHODS Surgical residents and faculty were surveyed to evaluate the number of oxycodone tablets prescribed for common procedures. Quantities were compared between residents, faculty, Opioid Prescribing Engagement Network guidelines, and actual opioids prescribed. Frequency with which faculty communicate prescribing preferences and the desire for feedback and transparency in prescription practices were assessed. RESULTS Fifty-six (72%) residents and 57 (59%) faculty completed the survey. Overall, faculty preferred a median number of tablets greater than recommended by Opioid Prescribing Engagement Network in 5 procedures, while residents did so in 9 of 14 procedures. On average, across all operations, faculty reported prescribing practices compliant with Opioid Prescribing Engagement Network 56.1% of the time, whereas residents did so 47.6% of the time (P = .40). Interestingly, opioids actually prescribed were significantly less than recommended in 7 procedures. Among faculty, 62% reported often or always specifying prescription preferences to residents, while only 9% of residents noted that faculty often did so. Residents (80%) and faculty (75%) were amenable to seeing regular reports of personal opioid prescription practices, and 74% and 65% were amenable to seeing practices compared with peers. Only 34% of residents and 44% of faculty wanted prescription practices made public. CONCLUSION There is a disconnect between opioid prescribing preferences and practice among surgical residents and faculty. Increased transparency through individualized reports and education regarding Opioid Prescribing Engagement Network guidelines with incorporation into the electronic medical record as practice advisories may reduce prescription variability.
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Affiliation(s)
- Victoria Huynh
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO. https://twitter.com/THuynhMD
| | - Kathryn Colborn
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO. https://twitter.com/ColbornKathryn
| | - Kristin E Rojas
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, FL. https://twitter.com/kristinrojasMD
| | - Nicole Christian
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Gretchen Ahrendt
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO. https://twitter.com/@ahrendt50
| | - Ethan Cumbler
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Richard Schulick
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Sarah Tevis
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO.
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12
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Oweida AJ, Mueller AC, Piper M, Milner D, Van Court B, Bhatia S, Phan A, Bickett T, Jordan K, Proia T, Schulick R, Messersmith WA, Del Chiaro M, Clambey E, Gough MJ, Williams J, Hansen K, Goodman K, Karam SD. Response to radiotherapy in pancreatic ductal adenocarcinoma is enhanced by inhibition of myeloid-derived suppressor cells using STAT3 anti-sense oligonucleotide. Cancer Immunol Immunother 2021; 70:989-1000. [PMID: 33097963 PMCID: PMC10991244 DOI: 10.1007/s00262-020-02701-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/14/2020] [Indexed: 12/14/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) has a heterogeneous tumor microenvironment (TME) comprised of myeloid-derived suppressor cells (MDSCs), tumor-associated macrophages, neutrophils, regulatory T cells, and myofibroblasts. The precise mechanisms that regulate the composition of the TME and how they contribute to radiotherapy (RT) response remain poorly understood. In this study, we analyze changes in immune cell populations and circulating chemokines in patient samples and animal models of pancreatic cancer to characterize the immune response to radiotherapy. Further, we identify STAT3 as a key mediator of immunosuppression post-RT. We found granulocytic MDSCs (G-MDSCs) and neutrophils to be increased in response to RT in murine and human PDAC samples. We also found that RT-induced STAT3 phosphorylation correlated with increased MDSC infiltration and proliferation. Targeting STAT3 using an anti-sense oligonucleotide in combination with RT circumvented RT-induced MDSC infiltration, enhanced the proportion of effector T cells, and improved response to RT. In addition, STAT3 inhibition contributed to the remodeling of the PDAC extracellular matrix when combined with RT, resulting in decreased collagen deposition and fibrotic tissue formation. Collectively, our data provide evidence that targeting STAT3 in combination with RT can mitigate the pro-tumorigenic effects of RT and improve tumor response.
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Affiliation(s)
- Ayman J Oweida
- Department of Nuclear Medicine and Radiobiology, University of Sherbrooke, Sherbrooke, Canada
| | - Adam C Mueller
- Thomas Jefferson University, Bodine Center for Cancer Treatment, 1665 Aurora Court Suite 1032, Philadelphia, PA, USA
| | - Miles Piper
- Department of Radiation Oncology, University of Colorado Anschutz Medical Campus, 1665 Aurora Court Suite 1032, Aurora, CO, 80045, USA
| | - Dallin Milner
- Department of Radiation Oncology, University of Colorado Anschutz Medical Campus, 1665 Aurora Court Suite 1032, Aurora, CO, 80045, USA
| | - Benjamin Van Court
- Department of Radiation Oncology, University of Colorado Anschutz Medical Campus, 1665 Aurora Court Suite 1032, Aurora, CO, 80045, USA
| | - Shilpa Bhatia
- Department of Radiation Oncology, University of Colorado Anschutz Medical Campus, 1665 Aurora Court Suite 1032, Aurora, CO, 80045, USA
| | - Andy Phan
- Department of Radiation Oncology, University of Colorado Anschutz Medical Campus, 1665 Aurora Court Suite 1032, Aurora, CO, 80045, USA
| | - Thomas Bickett
- Department of Radiation Oncology, University of Colorado Anschutz Medical Campus, 1665 Aurora Court Suite 1032, Aurora, CO, 80045, USA
| | - Kimberly Jordan
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Theresa Proia
- Bioscience, Oncology, IMED Biotech Unit, AstraZeneca, Boston, MA, USA
| | - Richard Schulick
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Wells A Messersmith
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marco Del Chiaro
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Eric Clambey
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael J Gough
- Earle A. Chiles Research Institute, Providence Medical Center, Portland, OR, USA
| | - Jason Williams
- Department of Biochemistry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kirk Hansen
- Department of Biochemistry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Karyn Goodman
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sana D Karam
- Department of Nuclear Medicine and Radiobiology, University of Sherbrooke, Sherbrooke, Canada.
- Department of Radiation Oncology, University of Colorado Anschutz Medical Campus, 1665 Aurora Court Suite 1032, Aurora, CO, 80045, USA.
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13
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Sandhu GS, Anders R, Blatchford P, Walde A, Alexis Leal, King G, Leong S, Davis SL, Purcell WT, Goodman KA, Schefter T, Michelle Cowan, Herter W, Meguid C, Weiss R, Marsh M, Brown M, Vogel J, Birnbaum E, Ahrendt S, Gleisner A, Schulick R, Chiaro MD, McCarter M, Patel SG, Messersmith WA, Lieu CH. High incidence of prolonged rectal bleeding and advanced stage cancer in early-onset colorectal cancer patients. Colorectal Cancer 2020. [DOI: 10.2217/crc-2020-0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: We examined characteristics of early-onset colorectal cancer (CRC) patients to identified factors, which may lead to earlier diagnosis. Materials & methods: This is a retrospective study with inclusion criteria: CRC diagnosed between 2012 and 2018 and age at diagnosis <50 years. Results: A total of 209 patients were included (mean age 41.8 years). Of those patients 42.5% had rectal cancer and 37.8% were stage IV at initial diagnosis. Of patients with data available for rectal bleeding history (n = 173), 50.8% presented with rectal bleeding and median time from onset of bleeding to diagnosis was 180 days (interquartile range 60–365), with longer duration noted in advanced cancer. Conclusion: Prolonged rectal bleeding history was noted in a significant proportion of early-onset CRC patients, with longer duration of rectal bleeding noted in stage IV patients. Patients and primary care physicians should be made aware of this finding in order to facilitate timely referral for diagnostic workup.
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Affiliation(s)
- Gurprataap Singh Sandhu
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rebekah Anders
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Amy Walde
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alexis Leal
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Gentry King
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stephen Leong
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sarah Lindsey Davis
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - William T Purcell
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Karyn A Goodman
- Department of Radiation Oncology, Mount Sinai Hospital, New York City, NY 10029, USA
| | - Tracey Schefter
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michelle Cowan
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Whitney Herter
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cheryl Meguid
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Reed Weiss
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Megan Marsh
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Matthew Brown
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jon Vogel
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Elisa Birnbaum
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Steven Ahrendt
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ana Gleisner
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Richard Schulick
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Marco Del Chiaro
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Martin McCarter
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Swati G Patel
- Division of Gastroenterology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Wells A Messersmith
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christopher H Lieu
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
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14
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Siriwardena AK, Windsor J, Zyromski N, Marchegiani G, Radenkovic D, Morgan C, Passas I, Olah A, Conlon KC, Smith M, Busch O, Baltatzis M, Besselink MG, Vollmer C, Castillo CFD, Friess H, Garcea G, Burmeister S, Hackert T, Lillemoe KD, Schulick R, Shrikhande SV, Smith A, Gianotti L, Falconi M, Adams D, Adham M, Andersson R, Del Chiaro M, Devar J, Jegatheeswaran S, van Santvoort H, Khatkov I, Izbicki J, Büchler M, Neoptolemos JP, Bassi C, Dervenis C. Standards for reporting on surgery for chronic pancreatitis: a report from the International Study Group for Pancreatic Surgery (ISGPS). Surgery 2020; 168:101-105. [PMID: 32183994 DOI: 10.1016/j.surg.2020.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/23/2020] [Accepted: 02/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The International Study Group for Pancreatic Surgery provides globally accepted definitions for reporting of complications after pancreatic surgery. This International Study Group for Pancreatic Surgery project aims to provide a standardized framework for reporting of the results of operative treatment for chronic pancreatitis. METHODS An International Study Group for Pancreatic Surgery project circulation list was created with pre-existing and new members and including gastroenterologists in addition to surgeons. A computerized search of the literature was undertaken for articles reporting the operative treatment of chronic pancreatitis. The results of the literature search were presented at the first face-to-face meeting of this International Study Group for Pancreatic Surgery project group. A document outlining proposed reporting standards was produced by discussion during an initial meeting of the International Study Group for Pancreatic Surgery. An electronic questionnaire was then sent to all current members of the International Study Group for Pancreatic Surgery. Responses were collated and further discussed at international meetings in North America, Europe, and at the International Association of Pancreatology World Congress in 2019. A final consensus document was produced by integration of multiple iterations. RESULTS The International Study Group for Pancreatic Surgery consensus standards for reporting of surgery in chronic pancreatitis recommends 4 core domains and the necessary variables needed for reporting of results: clinical baseline before operation; the morphology of the diseased gland; a new, standardized, operative terminology; and a minimum outcome dataset. The 4 domains combine to give a comprehensive framework for reports. CONCLUSION Adoption of the 4 domains of the International Study Group for Pancreatic Surgery reporting standards for surgery for chronic pancreatitis will facilitate comparison of results between centers and help to improve the care for patients with this debilitating disease.
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Affiliation(s)
- Ajith K Siriwardena
- Department of Surgery, Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, United Kingdom.
| | - John Windsor
- Department of Surgery, University of Auckland, New Zealand
| | - Nicholas Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Giovanni Marchegiani
- Clinic for Digestive Surgery, Pancreas Institute, Verona University Hospital, Italy
| | - Dejan Radenkovic
- Department of Surgery, Clinical Center of Serbia and School of Medicine, University of Belgrade, Serbia
| | - Catherine Morgan
- Department of Surgical Oncology, Medical University of South Carolina, Charleston, SC
| | - Ioannis Passas
- Department of Surgery, Metropolitan Hospital, Athens, Greece
| | - Attila Olah
- Department of Surgery, Petz Aladar Hospital, Gyor, Hungary
| | - Kevin C Conlon
- Hepato-Pancreatico-Biliary Unit, Department of General Surgery, Trinity College Dublin, Tallaght Hospital, Ireland
| | - Martin Smith
- Department of Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Olivier Busch
- Department of Surgery, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Minas Baltatzis
- Department of Surgery, Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, United Kingdom
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Charles Vollmer
- Department of Surgery, Penn Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Helmut Friess
- Department of Hepato-Pancreato-Biliary Surgery, Klinikum rechts der Isar, Technische Universitat Munchen, Germany
| | - Giuseppe Garcea
- Department of Surgery, University Hospitals of Leicester, United Kingdom
| | - Sean Burmeister
- Department of General, Visceral, and Transplantation Surgery, University of Cape Town Health Sciences Faculty and Surgical Gastroenterology Unit Groote Schuur Hospital, South Africa
| | - Thilo Hackert
- Department of Surgery, University of Heidelberg, Germany
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital and the Harvard Medical School, Boston, MA
| | - Richard Schulick
- Department of GI and HPB Surgical Oncology, University of Colorado School of Medicine, Aurora, CO
| | | | - Andrew Smith
- Department of Surgery, St James University Hospital, Leeds, United Kingdom
| | - Luca Gianotti
- Pancreatic Surgery Unit, School of Medicine and Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Massimo Falconi
- Digestive Surgery Department, San Raffaele Scientific Institute, 'Vita-Salute' University, Milan, Italy
| | - David Adams
- Department of Surgical Oncology, Medical University of South Carolina, Charleston, SC
| | | | - Roland Andersson
- Dept of Hepato-Pancreato-Biliary Surgery, Clinical Sciences Lund, Lund University, Sweden
| | - Marco Del Chiaro
- Department of GI and HPB Surgical Oncology, University of Colorado School of Medicine, Aurora, CO
| | - John Devar
- Department of Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | | | | | - Igor Khatkov
- Moscow Clinical Scientific Center, Moscow University of Medicine and Dentistry, Russian Federation
| | - Jakob Izbicki
- University Medical Center Hamburg-Eppendorf, Germany
| | - Markus Büchler
- Department of Surgery, University of Heidelberg, Germany
| | | | - Claudio Bassi
- Clinic for Digestive Surgery, Pancreas Institute, Verona University Hospital, Italy
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15
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Borgers JSW, Tobin RP, Vorwald VM, Smith JM, Davis DM, Kimball AK, Clambey ET, Couts KL, McWilliams JA, Jordan KR, Torphy RJ, Schulick R, McCarter MD. High-Dimensional Analysis of Postsplenectomy Peripheral Immune Cell Changes. Immunohorizons 2020; 4:82-92. [PMID: 32071067 PMCID: PMC7476217 DOI: 10.4049/immunohorizons.1900089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/22/2020] [Indexed: 12/20/2022] Open
Abstract
Although the consequences of splenectomy are well understood in mice, much less is known about the immunologic changes that occur following splenectomy in humans. We sought to characterize the circulating immune cell populations of patients before and after elective splenectomy to determine if these changes are related to postsplenectomy survival outcomes. Retrospective clinical information was collected from 95 patients undergoing elective splenectomy compared with 91 patients undergoing pancreaticoduodenectomy (Whipple procedure). We further analyzed peripheral blood from five patients in the splenectomy group, collected before and after surgery, using single-cell cytometry by time-of-flight mass spectrometry. We compared pre- and postsplenectomy data to characterize both the major and minor immune cell populations in significantly greater detail. Compared with patients undergoing a Whipple procedure, splenectomized patients had significant and long-lasting elevated counts of lymphocytes, monocytes, and basophils. Cytometry by time-of-flight mass spectroscopy analysis demonstrated that the elevated lymphocytes primarily consisted of naive CD4+ T cells and a population of activated CD25+CD56+CD4+ T cells, whereas the elevated monocyte counts were mainly mature, activated monocytes. We also observed a significant increase in the expression of the chemokine receptors CCR6 and CCR4 on several cellular populations. Taken together, these data indicate that significant immunological changes take place following splenectomy. Whereas other groups have compared splenectomized patients to healthy controls, this study compared patients undergoing elective splenectomy to those undergoing a similar major abdominal surgery. Overall, we found that splenectomy results in significant long-lasting changes in circulating immune cell populations and function.
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Affiliation(s)
- Jessica S W Borgers
- Department of Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045.,Radboud University Medical Center, 6525 GA Nijmegen, the Netherlands
| | - Richard P Tobin
- Department of Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Victoria M Vorwald
- Department of Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Joshua M Smith
- Department of Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Dana M Davis
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Abigail K Kimball
- Department of Anesthesiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Eric T Clambey
- Department of Anesthesiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Kasey L Couts
- Division of Medical Oncology, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045; and
| | - Jennifer A McWilliams
- Department of Immunology and Microbiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Kimberly R Jordan
- Department of Immunology and Microbiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Robert J Torphy
- Department of Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Richard Schulick
- Department of Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045.,University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Martin D McCarter
- Department of Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045; .,University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
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16
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Khorana AA, McKernin SE, Berlin J, Hong TS, Maitra A, Moravek C, Mumber M, Schulick R, Zeh HJ, Katz MHG. Potentially Curable Pancreatic Adenocarcinoma: ASCO Clinical Practice Guideline Update. J Clin Oncol 2019; 37:2082-2088. [PMID: 31180816 DOI: 10.1200/jco.19.00946] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2019] [Indexed: 12/17/2023] Open
Abstract
PURPOSE The purpose of this guideline update is to incorporate recently reported practice-changing evidence into ASCO's recommendations on potentially curable pancreatic adenocarcinoma. METHODS ASCO convened an Expert Panel to evaluate data from PRODIGE 24/CCTG PA.6, a phase III, multicenter, randomized clinical trial of postoperative leucovorin calcium, fluorouracil, irinotecan hydrochloride, and oxaliplatin (FOLFIRINOX) versus gemcitabine alone, presented at the 2018 ASCO Annual Meeting. In addition, PubMed was searched for additional papers that may influence the existing recommendations. RECOMMENDATIONS The Expert Panel only updated Recommendation 4.1 as a result of the practice-changing data. Recommendation 4.1 states that all patients with resected pancreatic adenocarcinoma who did not receive preoperative therapy should be offered 6 months of adjuvant chemotherapy in the absence of medical or surgical contraindications. The modified combination regimen of 5-fluorouracil, oxaliplatin, and irinotecan (mFOLFIRINOX; oxaliplatin 85 mg/m2, leucovorin 400 mg/m2, irinotecan 150 mg/m2 D1, and 5-fluorouracil 2.4 g/m2 over 46 hours every 14 days for 12 cycles) is now preferred in the absence of concerns for toxicity or tolerance; alternatively, doublet therapy with gemcitabine and capecitabine or monotherapy with gemcitabine alone or fluorouracil plus folinic acid alone can be offered.Additional information can be found at www.asco.org/gastrointestinal-cancer-guidelines.
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Affiliation(s)
| | | | | | | | - Anirban Maitra
- 5The University of Texas MD Anderson Cancer Center, Houston, TX
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17
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Nigri G, Early K, Tsoulfas G, Ferreres A, Ferrone CR, Schulick R, Al-Refaie WB, Turner PL, Velmahos G. Correction to: International Scholarship Programs of the American College of Surgeons: Expansion of the Global Surgical Network. World J Surg 2017; 42:1238. [PMID: 29127463 DOI: 10.1007/s00268-017-4330-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In the original article, the top of Fig. 1 was inadvertently cut off. The original article has been corrected. The publisher regrets the error.
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Affiliation(s)
- Giuseppe Nigri
- American College of Surgeons, Chicago, IL, USA. .,Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy.
| | - Kate Early
- American College of Surgeons, Chicago, IL, USA
| | - George Tsoulfas
- American College of Surgeons, Chicago, IL, USA.,Department of Surgery, University of Thessaloniki, Thessaloniki, Greece
| | - Alberto Ferreres
- American College of Surgeons, Chicago, IL, USA.,Department of Surgery, University of Buenos Aires "Dr. Carlos A. Bocalandro" Hospital, Buenos Aires, Argentina
| | - Cristina R Ferrone
- American College of Surgeons, Chicago, IL, USA.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard Schulick
- American College of Surgeons, Chicago, IL, USA.,Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Waddah B Al-Refaie
- American College of Surgeons, Chicago, IL, USA.,MedStar Georgetown University Hospital, Washington, DC, USA
| | - Patricia L Turner
- American College of Surgeons, Chicago, IL, USA.,Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - George Velmahos
- American College of Surgeons, Chicago, IL, USA.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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18
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Khorana AA, Mangu PB, Berlin J, Engebretson A, Hong TS, Maitra A, Mohile SG, Mumber M, Schulick R, Shapiro M, Urba S, Zeh HJ, Katz MHG. Potentially Curable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2017; 35:2324-2328. [PMID: 28398845 DOI: 10.1200/jco.2017.72.4948] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose To update the Potentially Curable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline published on May 31, 2016. The October 2016 update focuses solely on new evidence that pertains to clinical question 4 of the guideline: What is the appropriate adjuvant regimen for patients with pancreatic cancer who have undergone an R0 or R1 resection of their primary tumor? Methods The recently published results of a randomized phase III study prompted an update of this guideline. The high quality of the reported evidence and the potential for its clinical impact prompted the Expert Panel to revise one of the guideline recommendations. Results The ESPAC-4 study, a multicenter, international, open-label randomized controlled phase III trial of adjuvant combination chemotherapy compared gemcitabine and capecitabine with gemcitabine monotherapy in 730 evaluable patients with resected pancreatic ductal adenocarcinoma. Median overall survival was improved in the doublet arm to 28.0 months (95% CI, 23.5 to 31.5 months) versus 25.5 months (95% CI, 22.7 to 27.9 months) for gemcitabine alone (hazard ratio, 0.82; 95% CI, 0.68 to 0.98; P = .032). Grade 3 and 4 adverse events were similar in both arms, although higher rates of hand-foot syndrome and diarrhea occurred in patients randomly assigned to the doublet arm. Recommendations All patients with resected pancreatic cancer who did not receive preoperative therapy should be offered 6 months of adjuvant chemotherapy in the absence of medical or surgical contraindications. The doublet regimen of gemcitabine and capecitabine is preferred in the absence of concerns for toxicity or tolerance; alternatively, monotherapy with gemcitabine or fluorouracil plus folinic acid can be offered. Adjuvant treatment should be initiated within 8 weeks of surgical resection, assuming complete recovery. The remaining recommendations from the original 2016 ASCO guideline are unchanged.
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Affiliation(s)
- Alok A Khorana
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Pancreatic Cancer Action Network, Manhattan Beach, CA; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Pamela B Mangu
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Pancreatic Cancer Action Network, Manhattan Beach, CA; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Jordan Berlin
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Pancreatic Cancer Action Network, Manhattan Beach, CA; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Anitra Engebretson
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Pancreatic Cancer Action Network, Manhattan Beach, CA; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Theodore S Hong
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Pancreatic Cancer Action Network, Manhattan Beach, CA; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Anirban Maitra
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Pancreatic Cancer Action Network, Manhattan Beach, CA; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Supriya G Mohile
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Pancreatic Cancer Action Network, Manhattan Beach, CA; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Matthew Mumber
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Pancreatic Cancer Action Network, Manhattan Beach, CA; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Richard Schulick
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Pancreatic Cancer Action Network, Manhattan Beach, CA; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Marc Shapiro
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Pancreatic Cancer Action Network, Manhattan Beach, CA; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Susan Urba
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Pancreatic Cancer Action Network, Manhattan Beach, CA; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Herbert J Zeh
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Pancreatic Cancer Action Network, Manhattan Beach, CA; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Matthew H G Katz
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Pancreatic Cancer Action Network, Manhattan Beach, CA; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
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Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery 2017; 161:584-591. [PMID: 28040257 DOI: 10.1016/j.surg.2016.11.014] [Citation(s) in RCA: 2375] [Impact Index Per Article: 339.3] [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] [Received: 10/04/2016] [Revised: 11/15/2016] [Accepted: 11/15/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND In 2005, the International Study Group of Pancreatic Fistula developed a definition and grading of postoperative pancreatic fistula that has been accepted universally. Eleven years later, because postoperative pancreatic fistula remains one of the most relevant and harmful complications of pancreatic operation, the International Study Group of Pancreatic Fistula classification has become the gold standard in defining postoperative pancreatic fistula in clinical practice. The aim of the present report is to verify the value of the International Study Group of Pancreatic Fistula definition and grading of postoperative pancreatic fistula and to update the International Study Group of Pancreatic Fistula classification in light of recent evidence that has emerged, as well as to address the lingering controversies about the original definition and grading of postoperative pancreatic fistula. METHODS The International Study Group of Pancreatic Fistula reconvened as the International Study Group in Pancreatic Surgery in order to perform a review of the recent literature and consequently to update and revise the grading system of postoperative pancreatic fistula. RESULTS Based on the literature since 2005 investigating the validity and clinical use of the original International Study Group of Pancreatic Fistula classification, a clinically relevant postoperative pancreatic fistula is now redefined as a drain output of any measurable volume of fluid with an amylase level >3 times the upper limit of institutional normal serum amylase activity, associated with a clinically relevant development/condition related directly to the postoperative pancreatic fistula. Consequently, the former "grade A postoperative pancreatic fistula" is now redefined and called a "biochemical leak," because it has no clinical importance and is no longer referred to a true pancreatic fistula. Postoperative pancreatic fistula grades B and C are confirmed but defined more strictly. In particular, grade B requires a change in the postoperative management; drains are either left in place >3 weeks or repositioned through endoscopic or percutaneous procedures. Grade C postoperative pancreatic fistula refers to those postoperative pancreatic fistula that require reoperation or lead to single or multiple organ failure and/or mortality attributable to the pancreatic fistula. CONCLUSION This new definition and grading system of postoperative pancreatic fistula should lead to a more universally consistent evaluation of operative outcomes after pancreatic operation and will allow for a better comparison of techniques used to mitigate the rate and clinical impact of a pancreatic fistula. Use of this updated classification will also allow for more precise comparisons of surgical quality between surgeons and units who perform pancreatic surgery.
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Affiliation(s)
- Claudio Bassi
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Giovanni Marchegiani
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy.
| | | | - Micheal Sarr
- Mayo Clinic Department of General Surgery, Rochester, NY
| | | | - Mustapha Adham
- Digestive Surgery Department, Lyon Civil Hospital, Lyon, France
| | - Peter Allen
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Roland Andersson
- Department of Surgery, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Horacio J Asbun
- Division of General Surgery, Department of Surgery, Mayo Clinic, Jacksonville, FL
| | - Marc G Besselink
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kevin Conlon
- Department of Surgery, Trinity College Dublin, Tallaght Hospital, Dublin, Ireland
| | - Marco Del Chiaro
- Pancreatic Surgery Unit - Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC) - Karolinska Institutet at Center for Digestive Diseases Karolinska University Hospital, Stockholm, Sweden
| | - Massimo Falconi
- Pancreatic Surgery Unit, San Raffaele Scientific Institute, 'Vita-Salute' University, Milan, Italy
| | - Laureano Fernandez-Cruz
- Department of Surgery, Clinic Hospital of Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Abe Fingerhut
- First Department of Digestive Surgery, Hippokrateon Hospital, University of Athens, Athens, Greece; Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Dirk J Gouma
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Jakob Izbicki
- Department of General, Visceral and Thoracic-Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital and the Harvard Medical School, Boston, MA
| | - John P Neoptolemos
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | | | - Richard Schulick
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | | | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Kyoichi Takaori
- Division of Hepatobiliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - William Traverso
- St. Luke's Clinic - Center For Pancreatic and Liver Diseases, Boise, ID
| | - Charles R Vollmer
- Department of Surgery, Penn Medicine, The University of Pennsylvania, Philadelphia, PA
| | | | - Charles J Yeo
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Roberto Salvia
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Marcus Buchler
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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20
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Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery 2017. [PMID: 28040257 DOI: 10.1016/j.surg.2016.11.014.] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND In 2005, the International Study Group of Pancreatic Fistula developed a definition and grading of postoperative pancreatic fistula that has been accepted universally. Eleven years later, because postoperative pancreatic fistula remains one of the most relevant and harmful complications of pancreatic operation, the International Study Group of Pancreatic Fistula classification has become the gold standard in defining postoperative pancreatic fistula in clinical practice. The aim of the present report is to verify the value of the International Study Group of Pancreatic Fistula definition and grading of postoperative pancreatic fistula and to update the International Study Group of Pancreatic Fistula classification in light of recent evidence that has emerged, as well as to address the lingering controversies about the original definition and grading of postoperative pancreatic fistula. METHODS The International Study Group of Pancreatic Fistula reconvened as the International Study Group in Pancreatic Surgery in order to perform a review of the recent literature and consequently to update and revise the grading system of postoperative pancreatic fistula. RESULTS Based on the literature since 2005 investigating the validity and clinical use of the original International Study Group of Pancreatic Fistula classification, a clinically relevant postoperative pancreatic fistula is now redefined as a drain output of any measurable volume of fluid with an amylase level >3 times the upper limit of institutional normal serum amylase activity, associated with a clinically relevant development/condition related directly to the postoperative pancreatic fistula. Consequently, the former "grade A postoperative pancreatic fistula" is now redefined and called a "biochemical leak," because it has no clinical importance and is no longer referred to a true pancreatic fistula. Postoperative pancreatic fistula grades B and C are confirmed but defined more strictly. In particular, grade B requires a change in the postoperative management; drains are either left in place >3 weeks or repositioned through endoscopic or percutaneous procedures. Grade C postoperative pancreatic fistula refers to those postoperative pancreatic fistula that require reoperation or lead to single or multiple organ failure and/or mortality attributable to the pancreatic fistula. CONCLUSION This new definition and grading system of postoperative pancreatic fistula should lead to a more universally consistent evaluation of operative outcomes after pancreatic operation and will allow for a better comparison of techniques used to mitigate the rate and clinical impact of a pancreatic fistula. Use of this updated classification will also allow for more precise comparisons of surgical quality between surgeons and units who perform pancreatic surgery.
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Affiliation(s)
- Claudio Bassi
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Giovanni Marchegiani
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy.
| | | | - Micheal Sarr
- Mayo Clinic Department of General Surgery, Rochester, NY
| | | | - Mustapha Adham
- Digestive Surgery Department, Lyon Civil Hospital, Lyon, France
| | - Peter Allen
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Roland Andersson
- Department of Surgery, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Horacio J Asbun
- Division of General Surgery, Department of Surgery, Mayo Clinic, Jacksonville, FL
| | - Marc G Besselink
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kevin Conlon
- Department of Surgery, Trinity College Dublin, Tallaght Hospital, Dublin, Ireland
| | - Marco Del Chiaro
- Pancreatic Surgery Unit - Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC) - Karolinska Institutet at Center for Digestive Diseases Karolinska University Hospital, Stockholm, Sweden
| | - Massimo Falconi
- Pancreatic Surgery Unit, San Raffaele Scientific Institute, 'Vita-Salute' University, Milan, Italy
| | - Laureano Fernandez-Cruz
- Department of Surgery, Clinic Hospital of Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Abe Fingerhut
- First Department of Digestive Surgery, Hippokrateon Hospital, University of Athens, Athens, Greece; Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Dirk J Gouma
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Jakob Izbicki
- Department of General, Visceral and Thoracic-Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital and the Harvard Medical School, Boston, MA
| | - John P Neoptolemos
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | | | - Richard Schulick
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | | | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Kyoichi Takaori
- Division of Hepatobiliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - William Traverso
- St. Luke's Clinic - Center For Pancreatic and Liver Diseases, Boise, ID
| | - Charles R Vollmer
- Department of Surgery, Penn Medicine, The University of Pennsylvania, Philadelphia, PA
| | | | - Charles J Yeo
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Roberto Salvia
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Marcus Buchler
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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Stumpf P, Jones B, Amini A, Chang S, Edil B, Gajdos C, Goodman K, McCarter M, McKinney K, Meier J, Pokharel S, Schulick R, Wagh M, Wani S, Schefter T. Contouring of Pancreatic Tumor Volume Is Highly Variable on Interobserver Analysis in the Planning of Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1130] [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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Stewart CL, Meguid C, Chapman B, Schulick R, Edil BH. Evolving Trends Towards Minimally Invasive Surgery for Solid-Pseudopapillary Neoplasms. Ann Surg Oncol 2016; 23:4165-4168. [PMID: 27510845 DOI: 10.1245/s10434-016-5491-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Solid-pseudopapillary neoplasms are rare pancreatic neoplasms with low malignant potential that predominantly arise in young women. We sought to characterize this population and the evolving trend at our institution towards laparoscopic management. METHODS We identified all patients at our institution that were surgically treated for solid-pseudopapillary neoplasm from 2008-2015. Demographic and clinical information were queried from the medical record, and descriptive statistics were performed. Student's t test and chi-square analysis were used for comparison where appropriate. RESULTS We identified 11 women and 1 man (average age 26 years; range 14-48 years) who were surgically treated for solid-pseudopapillary neoplasms; 5 with distal pancreatectomy (4 open, 1 laparoscopic), 6 with pancreaticoduodenectomy (3 open, 3 laparoscopic), and 1 open enucleation. From 2008 to 2013, seven of eight (87 %) procedures were performed open. Since 2014, three of four (75 %) procedures have successfully been completed laparoscopically (see video clips). Length of stay was similar for patients who had open versus laparoscopic procedures (8 vs. 9 days, p = 0.61). Two-thirds of patients (5/8) who had open procedures experienced postoperative complications compared with half (2/4) of patients who had laparoscopic procedures (p = 0.28). There have been no recurrences. CONCLUSIONS Minimally invasive surgical management of solid-pseudopapillary neoplasms is becoming more popular, can be performed safely, and appears to have comparable outcomes to an open approach. Quality of life is an important metric for this relatively young population and may be improved with a laparoscopic approach, which warrants further investigation.
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Affiliation(s)
- Camille L Stewart
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
| | | | - Brandon Chapman
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Richard Schulick
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.,University of Colorado Hospital, Aurora, CO, USA
| | - Barish H Edil
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.,University of Colorado Hospital, Aurora, CO, USA
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23
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Khorana AA, Mangu PB, Berlin J, Engebretson A, Hong TS, Maitra A, Mohile SG, Mumber M, Schulick R, Shapiro M, Urba S, Zeh HJ, Katz MHG. Potentially Curable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2016; 34:2541-56. [PMID: 27247221 DOI: 10.1200/jco.2016.67.5553] [Citation(s) in RCA: 252] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations to oncologists and others on potentially curative therapy for patients with localized pancreatic cancer. METHODS ASCO convened a panel of medical oncology, radiation oncology, surgical oncology, palliative care, and advocacy experts and conducted a systematic review of literature from January 2002 to June 2015. Outcomes included overall survival, disease-free survival, progression-free survival, and adverse events. RESULTS Nine randomized controlled trials met the systematic review criteria. RECOMMENDATIONS A multiphase computed tomography scan of the abdomen and pelvis or magnetic resonance imaging should be performed for all patients to assess the anatomic relationships of the primary tumor and for the presence of intra-abdominal metastases. Baseline performance status, comorbidity profile, and goals of care should be evaluated and established. Primary surgical resection is recommended for all patients who have no metastases, appropriate performance and comorbidity profiles, and no radiographic interface between primary tumor and mesenteric vasculature. Preoperative therapy is recommended for patients who meet specific characteristics. All patients with resected pancreatic cancer who did not receive preoperative therapy should be offered 6 months of adjuvant chemotherapy in the absence of contraindications. Adjuvant chemoradiation may be offered to patients who did not receive preoperative therapy with microscopically positive margins (R1) after resection and/or who had node-positive disease after completion of 4 to 6 months of systemic adjuvant chemotherapy. Patients should have a full assessment of symptoms, psychological status, and social supports and should receive palliative care early. Patients who have completed treatment and have no evidence of disease should be monitored. Additional information is available at www.asco.org/guidelines/PCPC and www.asco.org/guidelineswiki.
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Affiliation(s)
- Alok A Khorana
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Pamela B Mangu
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Jordan Berlin
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Anitra Engebretson
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Theodore S Hong
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Anirban Maitra
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Supriya G Mohile
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Matthew Mumber
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Richard Schulick
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Marc Shapiro
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Susan Urba
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Herbert J Zeh
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
| | - Matthew H G Katz
- Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA
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Abdelfatah E, Guzzetta AA, Nagarajan N, Wolfgang CL, Pawlik TM, Choti MA, Schulick R, Montgomery EA, Meyer C, Thornton K, Herman J, Terezakis S, Frassica D, Ahuja N. Long-term outcomes in treatment of retroperitoneal sarcomas: A 15 year single-institution evaluation of prognostic features. J Surg Oncol 2016; 114:56-64. [PMID: 27076350 DOI: 10.1002/jso.24256] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 03/28/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Retroperitoneal sarcomas are connective tissue tumors arising in the retroperitoneum. Surgical resection is the mainstay of treatment. Debate has arisen over extent of resection, changes in histological classification/grading, and interest in incorporating radiotherapy. Therefore, we reviewed our institution's experience to evaluate prognostic factors. METHODS Retrospective chart review of all primary RPS patients at Johns Hopkins Hospital from 1994 to 2010. Histologic diagnosis and grading were re-evaluated with current criteria. Prognostic factors for survival, and recurrence were assessed. RESULTS One hundred thirty-one primary RPS patients met inclusion criteria. Median survival for patients who undergo en-bloc resection to negative margins (R0/R1) is 81.7 months. Surgical margins and grade were the most important factors for survival along with age, gender, presence of metastases and resection of ≥5 organs. Five-year survival for R0/R1 resection was 60%, similar to compartmental resection. Radiotherapy significantly decreased local recurrence (P = 0.026) on multivariate analysis. Grade in leiomyosarcomas and dedifferentiation in liposarcomas dictated patterns of local versus distal recurrence. CONCLUSIONS En bloc surgical resection to R0/R1 margins remains the cornerstone of therapy and provides comparable outcomes to compartmental resections. Grade remains important for prognosis, and histology dictates recurrence patterns. Radiotherapy appears promising for local control and warrants further investigation. J. Surg. Oncol. 2016;114:56-64. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Eihab Abdelfatah
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Angela A Guzzetta
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Neeraja Nagarajan
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher L Wolfgang
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy M Pawlik
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael A Choti
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard Schulick
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth A Montgomery
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christian Meyer
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katherine Thornton
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph Herman
- Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephanie Terezakis
- Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deborah Frassica
- Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nita Ahuja
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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25
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Springer S, Wang Y, Molin MD, Masica DL, Jiao Y, Kinde I, Blackford A, Raman SP, Wolfgang CL, Tomita T, Niknafs N, Douville C, Ptak J, Dobbyn L, Allen PJ, Klimstra DS, Schattner MA, Schmidt CM, Yip-Schneider M, Cummings OW, Brand RE, Zeh HJ, Singhi AD, Scarpa A, Salvia R, Malleo G, Zamboni G, Falconi M, Jang JY, Kim SW, Kwon W, Hong SM, Song KB, Kim SC, Swan N, Murphy J, Geoghegan J, Brugge W, Fernandez-Del Castillo C, Mino-Kenudson M, Schulick R, Edil BH, Adsay V, Paulino J, van Hooft J, Yachida S, Nara S, Hiraoka N, Yamao K, Hijioka S, van der Merwe S, Goggins M, Canto MI, Ahuja N, Hirose K, Makary M, Weiss MJ, Cameron J, Pittman M, Eshleman JR, Diaz LA, Papadopoulos N, Kinzler KW, Karchin R, Hruban RH, Vogelstein B, Lennon AM. A combination of molecular markers and clinical features improve the classification of pancreatic cysts. Gastroenterology 2015; 149:1501-10. [PMID: 26253305 PMCID: PMC4782782 DOI: 10.1053/j.gastro.2015.07.041] [Citation(s) in RCA: 291] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/28/2015] [Accepted: 07/22/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS The management of pancreatic cysts poses challenges to both patients and their physicians. We investigated whether a combination of molecular markers and clinical information could improve the classification of pancreatic cysts and management of patients. METHODS We performed a multi-center, retrospective study of 130 patients with resected pancreatic cystic neoplasms (12 serous cystadenomas, 10 solid pseudopapillary neoplasms, 12 mucinous cystic neoplasms, and 96 intraductal papillary mucinous neoplasms). Cyst fluid was analyzed to identify subtle mutations in genes known to be mutated in pancreatic cysts (BRAF, CDKN2A, CTNNB1, GNAS, KRAS, NRAS, PIK3CA, RNF43, SMAD4, TP53, and VHL); to identify loss of heterozygozity at CDKN2A, RNF43, SMAD4, TP53, and VHL tumor suppressor loci; and to identify aneuploidy. The analyses were performed using specialized technologies for implementing and interpreting massively parallel sequencing data acquisition. An algorithm was used to select markers that could classify cyst type and grade. The accuracy of the molecular markers was compared with that of clinical markers and a combination of molecular and clinical markers. RESULTS We identified molecular markers and clinical features that classified cyst type with 90%-100% sensitivity and 92%-98% specificity. The molecular marker panel correctly identified 67 of the 74 patients who did not require surgery and could, therefore, reduce the number of unnecessary operations by 91%. CONCLUSIONS We identified a panel of molecular markers and clinical features that show promise for the accurate classification of cystic neoplasms of the pancreas and identification of cysts that require surgery.
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Affiliation(s)
- Simeon Springer
- The Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, The Johns Hopkins University, Baltimore, MD, USA,The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA
| | - Yuxuan Wang
- The Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, The Johns Hopkins University, Baltimore, MD, USA,The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA
| | - Marco Dal Molin
- The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA,Department of Pathology, The Johns Hopkins University, Baltimore, MD, USA
| | - David L. Masica
- The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA,Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, USA,The Johns Hopkins Medical Institutions and the Institute for Computational Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Yuchen Jiao
- The Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, The Johns Hopkins University, Baltimore, MD, USA,The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA
| | - Isaac Kinde
- The Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, The Johns Hopkins University, Baltimore, MD, USA,The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA
| | - Amanda Blackford
- Department of Biostatistics and Bioinformatics, The Johns Hopkins University, Baltimore, MD, USA
| | - Siva P. Raman
- Department of Radiology, The Johns Hopkins University, Baltimore, MD, USA
| | - Christopher L. Wolfgang
- The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA,Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA,Department of Oncology, The Johns Hopkins University, Baltimore, MD, USA
| | - Tyler Tomita
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, USA,The Johns Hopkins Medical Institutions and the Institute for Computational Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Noushin Niknafs
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, USA,The Johns Hopkins Medical Institutions and the Institute for Computational Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Christopher Douville
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, USA,The Johns Hopkins Medical Institutions and the Institute for Computational Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Janine Ptak
- The Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, The Johns Hopkins University, Baltimore, MD, USA,The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA
| | - Lisa Dobbyn
- The Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, The Johns Hopkins University, Baltimore, MD, USA,The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA
| | - Peter J. Allen
- Department of Surgery, Memorial Sloan-Kettering Cancer Center
| | | | - Mark A. Schattner
- Department of Gastroenterology, Memorial Sloan-Kettering Cancer Center
| | | | | | | | | | | | | | - Aldo Scarpa
- ARC-Net Research Centre ad Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Italy,Department of Pathology, General Surgery B, University and Hospital Trust of Verona, Italy
| | - Roberto Salvia
- Department of Surgery, University and Hospital Trust of Verona, Negrar, Italy
| | - Giuseppe Malleo
- Department of Surgery, University and Hospital Trust of Verona, Negrar, Italy
| | - Giuseppe Zamboni
- Department of Pathology, General Surgery B, University and Hospital Trust of Verona, Italy,Department of Pathology, Ospedale Sacro Cuore-Don Calabraia, Negrar, Italy
| | - Massimo Falconi
- Division of Pancreatic Surgery, Department of Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sun-Whe Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Byung Song
- Department of Hepatobiliary and Pancreas Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Song Cheol Kim
- Department of Hepatobiliary and Pancreas Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Niall Swan
- Department of Histopathology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Jean Murphy
- Department of Histopathology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Justin Geoghegan
- Department of Surgery, St. Vincent’s University Hospital, Dublin, Ireland
| | - William Brugge
- Department of Gastroenterology, Massachusetts General Hospital
| | | | | | | | | | | | - Jorge Paulino
- Department of Pathology, Centro Hepatobiliopancreático e Transplantação – Hospital Curry Cabral, Lisbon, Portugal
| | - Jeanin van Hooft
- Department of Gastroenterology and Hepatology, Amsterdam Medical Center, Netherlands
| | - Shinichi Yachida
- Department of Hepatobiliary and Pancreatic Surgery, Pathology and Cancer Genomics, National Cancer Center Hospital and National Cancer Center Research Institute, Tokyo, Japan
| | - Satoshi Nara
- Department of Hepatobiliary and Pancreatic Surgery, Pathology and Cancer Genomics, National Cancer Center Hospital and National Cancer Center Research Institute, Tokyo, Japan
| | - Nobuyoshi Hiraoka
- Department of Hepatobiliary and Pancreatic Surgery, Pathology and Cancer Genomics, National Cancer Center Hospital and National Cancer Center Research Institute, Tokyo, Japan
| | - Kenji Yamao
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Susuma Hijioka
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | | | - Michael Goggins
- The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA,Department of Oncology, The Johns Hopkins University, Baltimore, MD, USA,Department of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Marcia Irene Canto
- Department of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Nita Ahuja
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Kenzo Hirose
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Martin Makary
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Matthew J. Weiss
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - John Cameron
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Meredith Pittman
- The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA,Department of Pathology, The Johns Hopkins University, Baltimore, MD, USA
| | - James R. Eshleman
- The Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, The Johns Hopkins University, Baltimore, MD, USA,The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA
| | - Luis A. Diaz
- The Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, The Johns Hopkins University, Baltimore, MD, USA,The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA,Department of Oncology, The Johns Hopkins University, Baltimore, MD, USA
| | - Nickolas Papadopoulos
- The Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, The Johns Hopkins University, Baltimore, MD, USA,The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA
| | - Kenneth W. Kinzler
- The Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, The Johns Hopkins University, Baltimore, MD, USA,The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Karchin
- The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA,Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, USA,Department of Oncology, The Johns Hopkins University, Baltimore, MD, USA,The Johns Hopkins Medical Institutions and the Institute for Computational Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Ralph H. Hruban
- The Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, The Johns Hopkins University, Baltimore, MD, USA,The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA,Department of Pathology, The Johns Hopkins University, Baltimore, MD, USA,Department of Oncology, The Johns Hopkins University, Baltimore, MD, USA
| | - Bert Vogelstein
- The Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, The Johns Hopkins University, Baltimore, MD, USA,The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA
| | - Anne Marie Lennon
- The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, Maryland; Department of Surgery, The Johns Hopkins University, Baltimore, Maryland; Department of Medicine, The Johns Hopkins University, Baltimore, Maryland.
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26
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Zhu Y, Byers J, Paniccia A, Kaplan J, Koenig M, Schulick R, Edil B. Abstract 1279: Expression of B7-H5 in human pancreatic caner. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-1279] [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
The B7-H5/CD28H pathway is the most recently identified costimulatory pathway of the B7 family. Here we investigated how the ligand B7-H5 is expressed in normal human pancreas tissues, as well as its expression changes in pancreas cancer. By immunohistochemical (IHC) staining of frozen specimens from patients undergoing pancreatic resection, we found that B7-H5 protein was constitutively expressed on normal ductal epithelium within the pancreas. Other cell types from normal pancreas, like acinar cells or islet cells, did not express B7-H5. In adenocarcinoma, B7-H5 staining was decreased or absent, though normal ducts adjacent to tumors were highly B7-H5-positive. No B7-H5 protein was found on other cancer types such as neuroendocrine tumors. Our study suggests that loss of the B7-H5 signal might contribute to immune evasion of pancreatic ductal adenocarcinoma.
Citation Format: Yuwen Zhu, Joshua Byers, Alessandro Paniccia, Jeffrey Kaplan, Michelle Koenig, Richard Schulick, Barish Edil. Expression of B7-H5 in human pancreatic caner. [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 1279. doi:10.1158/1538-7445.AM2015-1279
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Affiliation(s)
- Yuwen Zhu
- University of Colorado Denver, Aurora, CO
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27
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Howard K, Lo KK, Ao L, Gamboni F, Edil BH, Schulick R, Barnett CC. Intercellular adhesion molecule-1 mediates murine colon adenocarcinoma invasion. J Surg Res 2013; 187:19-23. [PMID: 24360118 DOI: 10.1016/j.jss.2013.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 10/29/2013] [Accepted: 11/01/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Intercellular adhesion molecule-1 (ICAM-1) modulates cell-cell adhesion and is a receptor for cognate ligands on leukocytes. Upregulation of ICAM-1 has been demonstrated in malignant transformation of adenomas and is associated with poor prognosis for many malignancies. ICAM-1 is upregulated on the invasive front of pancreatic metastases and melanomas. These data suggest that the upregulated ICAM-1 expression promotes malignant progression. We hypothesize that the downregulation of ICAM-1 will mitigate tumor progression. METHODS Mouse colon adenocarcinoma cells (MC38) were evaluated for the expression of ICAM-1 using Western immunoblot analysis. Short hairpin RNA (shRNA) transduction was used to downregulate ICAM-1. Tumor invasion determined via a modified Boyden chamber was used as a surrogate of tumor progression examining MC38 cells, MC38 ICAM-1 knockdowns, and MC38 transduced with vehicle control. The cells were cultured in full media for 24 h and serum-starved for 24 h. A total of 5 × 10(4) cells were plated and allowed to migrate for 24 h using full media with 10% fetal bovine serum as a chemoattractant. Inserts were fixed and stained with crystal violet. Blinded investigators counted the cells using a stereomicroscope. Statistical analysis was performed by analysis of variance with Fischer protected least significant difference and a P value of <0.05 was considered statistically significant. RESULTS ICAM-1 was constitutively expressed on MC38 cells. Transduction with anti-ICAM-1 shRNA vector downregulated ICAM-1 protein expression by 30% according to the Western blot analysis (P < 0.03) and decreased ICAM-1 messenger RNA expression by 70% according to the reverse transcription-polymerase chain reaction. shRNA knockdown cells had a significant reduction in invasion >45% (P < 0.03). There were no significant differences between the invasion rates of MC38 and MC38 vehicle controls. CONCLUSIONS Downregulation of ICAM-1 mitigates MC38 invasion. These data suggest that targeted downregulation of tumor ICAM-1 is a potential therapeutic target.
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Affiliation(s)
- Kenton Howard
- Department of Surgery, Denver Health Medical Center, University of Colorado, Denver Campus, Denver, Colorado
| | - Karen K Lo
- Department of Surgery, Denver Health Medical Center, University of Colorado, Denver Campus, Denver, Colorado
| | - Lihua Ao
- Department of Surgery, Denver Health Medical Center, University of Colorado, Denver Campus, Denver, Colorado
| | - Fabia Gamboni
- Department of Surgery, Denver Health Medical Center, University of Colorado, Denver Campus, Denver, Colorado
| | - Barish H Edil
- Department of Surgery, Denver Health Medical Center, University of Colorado, Denver Campus, Denver, Colorado
| | - Richard Schulick
- Department of Surgery, Denver Health Medical Center, University of Colorado, Denver Campus, Denver, Colorado
| | - Carlton C Barnett
- Department of Surgery, Denver Health Medical Center, University of Colorado, Denver Campus, Denver, Colorado.
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28
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Dholakia AS, Hacker-Prietz A, Wild AT, Raman SP, Wood LD, Huang P, Laheru DA, Zheng L, De Jesus-Acosta A, Le DT, Schulick R, Edil B, Ellsworth S, Pawlik TM, Iacobuzio-Donahue CA, Hruban RH, Cameron JL, Fishman EK, Wolfgang CL, Herman JM. Resection of borderline resectable pancreatic cancer after neoadjuvant chemoradiation does not depend on improved radiographic appearance of tumor-vessel relationships. ACTA ACUST UNITED AC 2013; 2:413-425. [PMID: 25755849 DOI: 10.1007/s13566-013-0115-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Neoadjuvant therapy increases rates of margin-negative resection of borderline resectable pancreatic ductal adenocarcinoma (BL-PDAC). Criteria for BL-PDAC resection following neoadjuvant chemotherapy and radiation therapy (NCRT) have not been clearly defined. METHODS Fifty consecutive patients with BL-PDAC who received NCRT from 2007 to 2012 were identified. Computed tomography (CT) scans pre- and post-treatment were centrally reviewed. RESULTS Twenty-nine patients (58 %) underwent resection following NCRT, while 21 (42 %) remained unresected. Patients selected for and successfully undergoing resection were more likely to have better performance status and absence of the following features on pre- and post-treatment CT: superior mesenteric vein/portal vein encasement, superior mesenteric artery involvement, tumor involvement of two or more vessels, and questionable/overt metastases (all p <0.05). Tumor volume and degree of tumor-vessel involvement did not significantly change in both groups after NCRT (all p > 0.05). The median overall survival was 22.9 months in resected versus 13.0 months in unresected patients (p < 0.001). Of patients undergoing resection, 93 % were margin-negative, 72 % were node-negative, and 54 % demonstrated moderate pathologic response to NCRT. CONCLUSION Apparent radiographic extent of vascular involvement does not change significantly after NCRT. Patients without metastatic disease should be chosen for surgical exploration based on adequate performance status and lack of disease progression.
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Affiliation(s)
- Avani S Dholakia
- Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231, USA
| | - Amy Hacker-Prietz
- Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231, USA
| | - Aaron T Wild
- Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231, USA
| | - Siva P Raman
- Department of Radiology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 601 N. Broadway, Baltimore, MD 21231, USA
| | - Laura D Wood
- Department of Pathology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg Suite 2242, Baltimore, MD 21231, USA
| | - Peng Huang
- Department of Oncology Biostatistics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 1103, Baltimore, MD 21205, USA
| | - Daniel A Laheru
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans St., Baltimore, MD 21287, USA
| | - Lei Zheng
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans St., Baltimore, MD 21287, USA
| | - Ana De Jesus-Acosta
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans St., Baltimore, MD 21287, USA
| | - Dung T Le
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans St., Baltimore, MD 21287, USA
| | - Richard Schulick
- Department of Surgery, University of Colorado, 12631 E. 17th Avenue, Suite 6117, Aurora, CO 80045, USA
| | - Barish Edil
- Department of Surgery, University of Colorado, 12631 E. 17th Avenue, Suite 6117, Aurora, CO 80045, USA
| | - Susannah Ellsworth
- Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231, USA
| | - Timothy M Pawlik
- Department of Surgery, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Christine A Iacobuzio-Donahue
- Department of Pathology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg Suite 2242, Baltimore, MD 21231, USA
| | - Ralph H Hruban
- Department of Pathology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg Suite 2242, Baltimore, MD 21231, USA
| | - John L Cameron
- Department of Surgery, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Elliot K Fishman
- Department of Radiology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 601 N. Broadway, Baltimore, MD 21231, USA
| | - Christopher L Wolfgang
- Department of Surgery, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Joseph M Herman
- Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231, USA
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Del Chiaro M, Verbeke C, Salvia R, Klöppel G, Werner J, McKay C, Friess H, Manfredi R, Van Cutsem E, Löhr M, Segersvärd R, Adham M, Albin N, Andren-Sandberg Å, Arnelo U, Bruno M, Cahen D, Cappelli C, Costamagna G, Del Chiaro M, Delle Fave G, Esposito I, Falconi M, Friess H, Ghaneh P, Gladhaug IP, Haas S, Hauge T, Izbicki JR, Klöppel G, Lerch M, Lundell L, Lüttges J, Löhr M, Manfredi R, Mayerle J, McKay C, Oppong K, Pukitis A, Rangelova E, Rosch T, Salvia R, Schulick R, Segersvärd R, Sufferlein T, Van Cutsem E, Van der Merwe SW, Verbeke C, Werner J, Zamboni G. European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis 2013; 45:703-11. [PMID: 23415799 DOI: 10.1016/j.dld.2013.01.010] [Citation(s) in RCA: 301] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 01/08/2013] [Accepted: 01/09/2013] [Indexed: 12/11/2022]
Abstract
Cystic lesions of the pancreas are increasingly recognized. While some lesions show benign behaviour (serous cystic neoplasm), others have an unequivocal malignant potential (mucinous cystic neoplasm, branch- and main duct intraductal papillary mucinous neoplasm and solid pseudo-papillary neoplasm). European expert pancreatologists provide updated recommendations: diagnostic computerized tomography and/or magnetic resonance imaging are indicated in all patients with cystic lesion of the pancreas. Endoscopic ultrasound with cyst fluid analysis may be used but there is no evidence to suggest this as a routine diagnostic method. The role of pancreatoscopy remains to be established. Resection should be considered in all symptomatic lesions, in mucinous cystic neoplasm, main duct intraductal papillary mucinous neoplasm and solid pseudo-papillary neoplasm as well as in branch duct intraductal papillary mucinous neoplasm with mural nodules, dilated main pancreatic duct >6mm and possibly if rapidly increasing in size. An oncological partial resection should be performed in main duct intraductal papillary mucinous neoplasm and in lesions with a suspicion of malignancy, otherwise organ preserving procedures may be considered. Frozen section of the transection margin in intraductal papillary mucinous neoplasm is suggested. Follow up after resection is recommended for intraductal papillary mucinous neoplasm, solid pseudo-papillary neoplasm and invasive cancer.
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Affiliation(s)
- Marco Del Chiaro
- Division of Surgery, CLINTEC, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
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Soares KC, Olino K, Edil B, Zhou D, Wamwea A, Leubner A, Schulick R, Pardoll D, Jaffee E, Zheng L. Abstract PR9: Granulocyte macrophage colony stimulating factor (GM-CSF) pancreas tumor vaccine in combination with blockade of PD-1 in a preclinical model of pancreatic cancer. Cancer Res 2013. [DOI: 10.1158/1538-7445.tumimm2012-pr9] [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
Introduction: Our phase I/II human clinical trials utilizing a GM-CSF secreting allogeneic pancreas tumor vaccine (GVAX) have been shown to be safe and effective in inducing anti-tumor immune response in pancreatic adenocarcinoma patients. GVAX treated patients have demonstrated infiltration of PD-1+ T cells which is a major immunosuppressive mechanism in the tumor microenvironment. We hypothesized that the use of a PD-1 blocking antibody and GVAX will improve vaccine therapy and pancreatic cancer survival.
Methods: Mice were orthotopically transplanted with 2 x 106 Panc02 pancreatic tumor cells to form liver metastases by a hemisplenectomy technique on day 0. Following tumor transplantation, wild-type or PD-1 knockout mice were treated subcutaneously with a mouse GM-CSF secreting pancreatic tumor vaccine (mouse GVAX) in combination with anti-PD-1 antibodies or IgG isotype control. GVAX was given subcutaneously to mice on days 4, 7, 14, and 21 following tumor transplantation, together with a single low-dose of Cytoxan on day 3. Anti-PD-1 antibodies or IgG were administered twice weekly starting post-operative day 3.
Results: PD-1 knockout mice challenged with pancreatic liver metastases had a significant survival advantage over wild-type mice (p=0.0002). Wild-type mice showed improved survival both with anti-PD-1 antibody alone (p=0.008) or in combination with vaccine (p<0.0001) versus IgG controls. GVAX in combination with anti-PD-1 antibodies versus anti-PD-1 antibodies alone shows a statistically significant improved survival (p<0.05). Memory T cell analysis demonstrated a strong trend toward increased tumor infiltration of CD8+ effector memory T cells in the combinatorial treatment group versus vaccine alone (66.67% vs 26.47%, p= 0.1). Tumor antigen (mesothelin)-specific cytotoxic CD8+ tumor infiltrating lymphocytes were increased in the combination treatment group (GVAX and anti-PD1 therapy) versus GVAX alone (13.4% vs 5.29%).
Conclusions: PD-1 blockade through monoclonal antibodies or genetic knockout in combination with vaccine result in a synergistic anti-tumor effect in a preclinical model of pancreatic cancer versus treatment with anti-PD1 alone. Additionally, anti-PD1 treatment facilitates tumor infiltration of functionally activated mesothelin specific CD8+ T cells. Anti-PD-1 blockade antibody is currently being tested in phase II clinical trials for treating chemotherapy-refractory solid tumor patients. Our study provides a strong rationale for combining PD-1 antibody with GVAX therapy for pancreatic cancer treatment.
This abstract is also presented as Poster B28.
Citation Format: Kevin C. Soares, Kelly Olino, Barish Edil, Donger Zhou, Anthony Wamwea, Ashley Leubner, Richard Schulick, Drew Pardoll, Elizabeth Jaffee, Lei Zheng. Granulocyte macrophage colony stimulating factor (GM-CSF) pancreas tumor vaccine in combination with blockade of PD-1 in a preclinical model of pancreatic cancer. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology: Multidisciplinary Science Driving Basic and Clinical Advances; Dec 2-5, 2012; Miami, FL. Philadelphia (PA): AACR; Cancer Res 2013;73(1 Suppl):Abstract nr PR9.
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Affiliation(s)
| | - Kelly Olino
- 1Johns Hopkins Medical School, Baltimore, MD,
| | - Barish Edil
- 2University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Donger Zhou
- 1Johns Hopkins Medical School, Baltimore, MD,
| | | | | | | | | | | | - Lei Zheng
- 1Johns Hopkins Medical School, Baltimore, MD,
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Gajdos C, Schulick R. Cost-Effectiveness of Treatment Strategies for Primary Operable Pancreatic Head Adenocarcinoma: Do We Have More Scientific Evidence to Call for Further Centralization of Care? Ann Surg Oncol 2012; 20:5-6. [DOI: 10.1245/s10434-012-2615-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Gajdos C, Schulick R. Cost Effectiveness of Treatment Strategies for Primary Operable Pancreatic Head Adenocarcinoma: Do We Have More Scientific Evidence to Call for Further Centralization of Care? Ann Surg Oncol 2012; 19:3639-40. [DOI: 10.1245/s10434-012-2517-x] [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: 01/20/2023]
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Ede V, Harmon J, Magnuson T, Schulick R, Asiyanbola B. The Importance of Negative Studies and Basic Applied Biomedical Research in the Development of Biomedical Devices. J Surg Res 2012; 174:e55-6. [DOI: 10.1016/j.jss.2011.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 08/25/2011] [Accepted: 09/07/2011] [Indexed: 10/17/2022]
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Canto MI, Hruban RH, Fishman EK, Kamel IR, Schulick R, Zhang Z, Topazian M, Takahashi N, Fletcher J, Petersen G, Klein AP, Axilbund J, Griffin C, Syngal S, Saltzman JR, Mortele KJ, Lee J, Tamm E, Vikram R, Bhosale P, Margolis D, Farrell J, Goggins M. Frequent detection of pancreatic lesions in asymptomatic high-risk individuals. Gastroenterology 2012; 142:796-804; quiz e14-5. [PMID: 22245846 PMCID: PMC3321068 DOI: 10.1053/j.gastro.2012.01.005] [Citation(s) in RCA: 454] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 12/16/2011] [Accepted: 01/05/2012] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS The risk of pancreatic cancer is increased in patients with a strong family history of pancreatic cancer or a predisposing germline mutation. Screening can detect curable, noninvasive pancreatic neoplasms, but the optimal imaging approach is not known. We determined the baseline prevalence and characteristics of pancreatic abnormalities using 3 imaging tests to screen asymptomatic, high-risk individuals (HRIs). METHODS We screened 225 asymptomatic adult HRIs at 5 academic US medical centers once, using computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasonography (EUS). We compared results in a blinded, independent fashion. RESULTS Ninety-two of 216 HRIs (42%) were found to have at least 1 pancreatic mass (84 cystic, 3 solid) or a dilated pancreatic duct (n = 5) by any of the imaging modalities. Fifty-one of the 84 HRIs with a cyst (60.7%) had multiple lesions, typically small (mean, 0.55 cm; range, 2-39 mm), in multiple locations. The prevalence of pancreatic lesions increased with age; they were detected in 14% of subjects younger than 50 years old, 34% of subjects 50-59 years old, and 53% of subjects 60-69 years old (P < .0001). CT, MRI, and EUS detected a pancreatic abnormality in 11%, 33.3%, and 42.6% of the HRIs, respectively. Among these abnormalities, proven or suspected neoplasms were identified in 85 HRIs (82 intraductal papillary mucinous neoplasms and 3 pancreatic endocrine tumors). Three of 5 HRIs who underwent pancreatic resection had high-grade dysplasia in less than 3 cm intraductal papillary mucinous neoplasms and in multiple intraepithelial neoplasias. CONCLUSIONS Screening of asymptomatic HRIs frequently detects small pancreatic cysts, including curable, noninvasive high-grade neoplasms. EUS and MRI detect pancreatic lesions better than CT.
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Affiliation(s)
- Marcia Irene Canto
- Department of Medicine (Division of Gastroenterology), The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, USA.
| | - Ralph H. Hruban
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions
| | - Elliot K. Fishman
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions
| | - Ihab R. Kamel
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions
| | - Richard Schulick
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions
| | - Zhe Zhang
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions
| | - Mark Topazian
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, Mayo Clinic
| | - Naoki Takahashi
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, Mayo Clinic
| | - Joel Fletcher
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, Mayo Clinic
| | - Gloria Petersen
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, Mayo Clinic
| | - Alison P. Klein
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions
| | - Jennifer Axilbund
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions
| | - Constance Griffin
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions
| | - Sapna Syngal
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, Dana Farber Cancer Institute,Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, Brigham and Women's Hospital
| | - John R. Saltzman
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, Brigham and Women's Hospital
| | - Koenraad J. Mortele
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, Brigham and Women's Hospital
| | - Jeffrey Lee
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, MD Anderson Cancer Center
| | - Eric Tamm
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, MD Anderson Cancer Center
| | - Raghunandan Vikram
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, MD Anderson Cancer Center
| | - Priya Bhosale
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, MD Anderson Cancer Center
| | - Daniel Margolis
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, University of California Los Angeles
| | - James Farrell
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, University of California Los Angeles
| | - Michael Goggins
- Department of Medicine (Gastroenterology), Epidemiology, Oncology, Biostatistics, Radiology, Anesthesia, Surgery, and Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions
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Gray PJ, Wang J, Pawlik TM, Edil BH, Schulick R, Hruban RH, Dao H, Cameron J, Wolfgang C, Herman JM. Factors influencing survival in patients undergoing palliative bypass for pancreatic adenocarcinoma. J Surg Oncol 2012; 106:66-71. [PMID: 22308098 DOI: 10.1002/jso.23047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 01/03/2012] [Indexed: 01/31/2023]
Abstract
PURPOSE The purpose of this study is to identify factors predictive of early mortality following palliative bypass in patients with previously unsuspected advanced pancreatic adenocarcinoma to provide a basis for the selection of appropriate therapies. METHODS All patients with pancreatic adenocarcinoma who underwent a bypass procedure at our institution between 9/30/1994 and 1/31/2006 were reviewed. Patients with peri-operative mortality were excluded from the analysis. Univariate analysis was performed on peri-operative data to identify factors associated with early mortality (death within 6 months of surgery). Patients having multiple risk factors were assigned an overall prognostic score based on the sum of these factors. RESULTS Of the 397 patients with pancreatic adenocarcinoma analyzed, four factors were found to predict early mortality following palliative bypass: Presence of distant metastatic disease (HR 2.59, P < 0.0001), poor tumor differentiation (HR 1.71, P = 0.009), severe pre-operative nausea and vomiting (HR 1.48, P = 0.013), and lack of previous placement of a biliary stent (HR 1.36, P = 0.048). Patients with a prognostic score of 0 were significantly more likely to survive past 6 months than patients with a prognostic score of 1 (HR 2.71, P < 0.0001), 2 (HR 3.70, P < 0.0001), or ≥3 (HR 5.63, P < 0.0001). CONCLUSIONS In a cohort of patients undergoing a palliative bypass procedure, specific peri-operative factors can be used to identify patients who are at risk of early mortality. These factors may be helpful in selecting appropriate interventions for this group of patients.
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Sheinberg R, Gao WD, Wand G, Abraham S, Schulick R, Roy R, Mitter N. Case 1—2012 A Perfect Storm: Fatality Resulting From Metoclopramide Unmasking A Pheochromocytoma and Its Management. J Cardiothorac Vasc Anesth 2012; 26:161-5. [DOI: 10.1053/j.jvca.2011.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Indexed: 01/08/2023]
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Yovino S, Maidment BW, Herman JM, Pandya N, Goloubeva O, Wolfgang C, Schulick R, Laheru D, Hanna N, Alexander R, Regine WF. Analysis of local control in patients receiving IMRT for resected pancreatic cancers. Int J Radiat Oncol Biol Phys 2012; 83:916-20. [PMID: 22284684 DOI: 10.1016/j.ijrobp.2011.08.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 08/02/2011] [Accepted: 08/04/2011] [Indexed: 12/31/2022]
Abstract
PURPOSE Intensity-modulated radiotherapy (IMRT) is increasingly incorporated into therapy for pancreatic cancer. A concern regarding this technique is the potential for geographic miss and decreased local control. We analyzed patterns of first failure among patients treated with IMRT for resected pancreatic cancer. METHODS AND MATERIALS Seventy-one patients who underwent resection and adjuvant chemoradiation for pancreas cancer are included in this report. IMRT was used for all to a median dose of 50.4 Gy. Concurrent chemotherapy was 5-FU-based in 72% of patients and gemcitabine-based in 28%. RESULTS At median follow-up of 24 months, 49/71 patients (69%) had failed. The predominant failure pattern was distant metastases in 35/71 patients (49%). The most common site of metastases was the liver. Fourteen patients (19%) developed locoregional failure in the tumor bed alone in 5 patients, regional nodes in 4 patients, and concurrently with metastases in 5 patients. Median overall survival (OS) was 25 months. On univariate analysis, nodal status, margin status, postoperative CA 19-9 level, and weight loss during treatment were predictive for OS. On multivariate analysis, higher postoperative CA19-9 levels predicted for worse OS on a continuous basis (p < 0.01). A trend to worse OS was seen among patients with more weight loss during therapy (p = 0.06). Patients with positive nodes and positive margins also had significantly worse OS (HR for death 2.8, 95% CI 1.1-7.5; HR for death 2.6, 95% CI 1.1-6.2, respectively). Grade 3-4 nausea and vomiting was seen in 8% of patients. Late complication of small bowel obstruction occurred in 4 (6%) patients. CONCLUSIONS This is the first comprehensive report of patterns of failure among patients treated with adjuvant IMRT for pancreas cancer. IMRT was not associated with an increase in local recurrences in our cohort. These data support the use of IMRT in the recently activated EORTC/US Intergroup/RTOG 0848 adjuvant pancreas trial.
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Affiliation(s)
- Susannah Yovino
- Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Roberts NJ, Jiao Y, Yu J, Kopelovich L, Petersen GM, Bondy ML, Gallinger S, Schwartz AG, Syngal S, Cote ML, Axilbund J, Schulick R, Ali SZ, Eshleman JR, Velculescu VE, Goggins M, Vogelstein B, Papadopoulos N, Hruban RH, Kinzler KW, Klein AP. ATM mutations in patients with hereditary pancreatic cancer. Cancer Discov 2011; 2:41-6. [PMID: 22585167 DOI: 10.1158/2159-8290.cd-11-0194] [Citation(s) in RCA: 357] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
UNLABELLED Pancreatic cancers are the fourth most-common cause of cancer-related deaths in the Western world, with >200,000 cases reported in 2010. Although up to 10% of these cases occur in familial patterns, the hereditary basis for predisposition in the vast majority of affected families is unknown. We used next-generation sequencing, including whole-genome and whole-exome analyses, and identified heterozygous, constitutional, ataxia telangiectasia mutated (ATM) gene mutations in 2 kindreds with familial pancreatic cancer. Mutations segregated with disease in both kindreds and tumor analysis demonstrated LOH of the wild-type allele. By using sequence analysis of an additional 166 familial pancreatic cancer probands, we identified 4 additional patients with deleterious mutations in the ATM gene, whereas we identified no deleterious mutations in 190 spouse controls (P = 0.046). When we considered only the mostly severely affected families with 3 or more pancreatic cancer cases, 4 deleterious mutations were found in 87 families (P = 0.009). Our results indicate that inherited ATM mutations play an important role in familial pancreatic cancer predisposition. SIGNIFICANCE The genes responsible for the majority of cases of familial pancreatic ductal adenocarcinoma are unknown. We here identify ATM as a predisposition gene for pancreatic ductal adenocarcinoma. Our results have important implications for the management of patients in affected families and illustrate the power of genome-wide sequencing to identify the basis of familial cancer syndromes.
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Affiliation(s)
- Nicholas J Roberts
- Ludwig Center for Cancer Genetics and Howard Hughes Medical Institutions, Johns Hopkins Kimmel Cancer Center, Baltimore, Maryland, USA
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Olino K, Wada S, Edil BH, Pan X, Meckel K, Weber W, Slansky J, Tamada K, Lauer P, Brockstedt D, Pardoll D, Schulick R, Yoshimura K. Tumor-associated antigen expressing Listeria monocytogenes induces effective primary and memory T-cell responses against hepatic colorectal cancer metastases. Ann Surg Oncol 2011; 19 Suppl 3:S597-607. [PMID: 21979110 PMCID: PMC4498288 DOI: 10.1245/s10434-011-2037-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Indexed: 12/11/2022]
Abstract
Purpose Despite advances in therapy for the treatment of metastatic colorectal cancer, many patients die of hepatic disease. Current immunotherapeutic strategies are likely limited by inhibitory signals from the tumor. To successfully eliminate tumor deposits within an organ, an appropriate immunologic milieu to amplify antitumor responses must be developed. Methods We used a murine model utilizing the CT26 colon cancer cell line to analyze primary and memory tumor-specific T-cell responses induced by an attenuated actin A and internalin B deleted immunodominant tumor-associated antigen expressing strain of Listeria monocytogenes for the treatment of metastatic colorectal cancer. Results Treatment of mice bearing established hepatic metastases with this L. monocytogenes strain led to the generation of a strong initial tumor-specific cytotoxic CD8+ T-cell response that successfully treated 90% of animals. Tumor antigen-specific central and effector memory T cells were also generated and protected against tumor rechallenge. These cell populations, when measured before and after tumor rechallenge, showed a marked expansion of antigen-specific effector CD8+ effector memory T cells. This strain of L. monocytogenes was able to down-modulate the expression of the immune checkpoint molecule, PD-1, within the tumor microenvironment but had variable effects on CTLA-4 expression. Conclusions This L. monocytogenes strain generated a highly effective antitumor T-cell response, providing a basis for the development of this vaccine platform in patients with liver metastases. Electronic supplementary material The online version of this article (doi:10.1245/s10434-011-2037-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kelly Olino
- Department of Surgery, Sidney Kimmel Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Mori T, Wada S, Olino K, Weber W, Edil B, Meckel K, Pan X, Pardoll D, Schulick R, Sukumar S, Yoshimura K. Abstract LB-456: The intraductal injection of 5-fluorouracil induces immune response to eradicate and prevent breast cancer. Cancer Res 2011. [DOI: 10.1158/1538-7445.am2011-lb-456] [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
Chemotherapy has been shown to act as an immune response modifier. Many groups, incuding our own, are using chemotherapy to induce immune responses such as by using low doses of cyclophosphamide. Our previous work has demonstrated that anti-cancer agents can eliminate new/existing tumors with minimal toxicity in rat and mouse models of breast cancer. Here we demonstrate that intraductal (i.duc), but not the intravenous (IV) route of injection, of chemotherapy to mammary glands alters the tumor environment to effectively induce immune effector cells. We used the mouse HER2/neu (neu/N) transgenic, spontaneous mammary tumor model.
5-fluorouracil (5FU) was administered intraductally to the mammary glands on the left side of parous mice whereas the mammary glands on right side received no treatment (NT). The mammary tumor incidence in the 5FU treated side was significantly lower compared to mice that received NT, and IV treated group. Interestingly the incidence of mammary tumors in the untreated side of 5FU-treated mice was also significantly lower compared to the NT and IV group.
We hypothesized that the protection afforded to the contralateral chain of mammary glands by ipsilateral i.duc administration of 5FU, may be mediated through an immunological mechanism. Twenty week parous mice were administered 5FU either through i.duc injection, only to left side teats, IV injection, or NT. The mice received 5FU 2 times in a 4 week interval. A week after the second treatment, the mice were sacrificed and the regional lymphnodes (RLN) of the 3rd and 4th mammary glands and spleen were removed. We isolated lymphocyte from RLN and spleen to analyze by flowcytometry. The number of CD8 T cell showed no change among the groups in the RLN but was significantly lower in the i.duc group in the spleen. The number of CD62LLOW+ T cell in 5FU treated side of RLN was significantly higher compared to the IV and NT group. On the other hand the number of CD62LLOW+ was low in the spleen.
To study the population of systemic memory T cell in the peripheral blood, blood was harvested into Trucount tubes and analyzed with memory T cells surface marker. Twenty week parous mice was administered 5FU i.duc injection only to the left side, IV injection, or NT every 4weeks for a total of 3 times. Cancer cells were injected into the left side of 4th mammary gland fat pad of the mice at 16 weeks after initial procedure. One hundred μl blood was collected 5 days before and 5 days after cancer cell injection. The mice treated by i.duc 5FU showed increased numbers of CD95+/CD62L low effector memory T (TEM) cells, whereas the mice treated with IV 5FU did not recruit TEM cells significantly. There was no significant change in CD95+/CD62L high central memory T cells before and after treatment and among the groups.
In summary, i.duc administration of 5FU into mammary glands effectively induced immune effector cells and prevented mammary tumor growth in neu/N transgenic mice.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr LB-456. doi:10.1158/1538-7445.AM2011-LB-456
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Affiliation(s)
| | - Satoshi Wada
- 2Departments of Oncology, Johns Hopkins University, Baltimore, MD
| | - Kelly Olino
- 3Departments of Surgery, Johns Hopkins University, Baltimore, MD
| | - Walter Weber
- 2Departments of Oncology, Johns Hopkins University, Baltimore, MD
| | - Barish Edil
- 4Departments of Surgery and Oncology, Johns Hopkins University, Baltimore, MD
| | - Kristen Meckel
- 2Departments of Oncology, Johns Hopkins University, Baltimore, MD
| | - Xiaoyu Pan
- 2Departments of Oncology, Johns Hopkins University, Baltimore, MD
| | - Drew Pardoll
- 2Departments of Oncology, Johns Hopkins University, Baltimore, MD
| | - Richard Schulick
- 4Departments of Surgery and Oncology, Johns Hopkins University, Baltimore, MD
| | | | - Kiyoshi Yoshimura
- 4Departments of Surgery and Oncology, Johns Hopkins University, Baltimore, MD
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Maidment B, Yovino S, Herman J, Goloubeva O, Wolfgang C, Schulick R, Laheru D, Hanna N, Alexander R, Regine W. Analysis of Local Control in Patients Receiving IMRT for Resected Pancreas Cancer. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.472] [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: 10/19/2022]
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Affiliation(s)
- Ralph H Hruban
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, 401 North Broadway, Weinberg 2242, Baltimore, MD 21231, USA.
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Harinck F, Canto MI, Schulick R, Goggins M, Poley JW, Fockens P, Kluijt I, Bruno M. Surveillance in individuals at high risk of pancreatic cancer: too early to tell? Gut 2010; 59:1005; author reply 1006-7. [PMID: 20581252 DOI: 10.1136/gut.2009.197004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Shi C, Klein AP, Goggins M, Maitra A, Canto M, Ali S, Schulick R, Palmisano E, Hruban RH. Increased Prevalence of Precursor Lesions in Familial Pancreatic Cancer Patients. Clin Cancer Res 2009; 15:7737-7743. [PMID: 19996207 DOI: 10.1158/1078-0432.ccr-09-0004] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE: Histologic findings in 51 pancreata resected from patients with a strong family history of pancreatic cancer were compared with the findings in 40 pancreata resected from patients with sporadic pancreatic cancer. None of the patients in the familial group had a known inherited syndrome other than familial pancreatic cancer. EXPERIMENTAL DESIGN: Precursor lesions, including pancreatic intraepithelial neoplasia (PanIN), intraductal papillary mucinous neoplasm (IPMN), and incipient IPMN, were quantified. Invasive cancers were classified using established histologic criteria. RESULTS: The individual precursor lesions identified in both groups were histologically similar. Precursor lesions were more common in the familial cases than in the sporadic cases. The relative rate of PanINs per square centimeter was 2.75-fold higher (95% confidence interval, 2.05-3.70; adjusted for age) in familial compared with sporadic cases. PanIN-3 lesions were more common in familial versus sporadic pancreatic cancer patients (relative rate, 4.20; 95% confidence interval, 2.22-7.93; adjusted for age). High-grade incipient IPMNs were only observed in the familial cases. Nine of the 51 (18%) familial pancreatic cancers and 4 of the 40 (10%) sporadic cancers arose in association with an IPMN. No significant differences were found in the types of invasive cancers. CONCLUSIONS: Noninvasive precursor lesions are more common in patients with a strong family history of pancreatic cancer than in patients with sporadic disease, and precursor lesions are of a higher grade in patients with a strong family history of pancreatic cancer. These findings can form a basis for the design of screening tests for the early detection of pancreatic neoplasia. (Clin Cancer Res 2009;15(24):7737-43).
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Affiliation(s)
- Chanjuan Shi
- Authors' Affiliations: The Sol Goldman Pancreatic Cancer Research Center and Departments of Pathology, Oncology, Medicine, and Surgery, The Johns Hopkins Medical Institutions; and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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45
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Wang L, Brune KA, Visvanathan K, Laheru D, Herman J, Wolfgang C, Schulick R, Cameron JL, Goggins M, Hruban RH, Klein AP. Elevated cancer mortality in the relatives of patients with pancreatic cancer. Cancer Epidemiol Biomarkers Prev 2009. [PMID: 19843679 DOI: 10.1158/1055-9965.epi-09 -0557] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Most inherited cancer syndromes are characterized by the familial clustering of cancers at several organ sites. To determine if cancers, other than pancreatic cancer, cluster in pancreatic cancer kindreds, we examined mortality patterns among the relatives of National Familial Pancreatic Tumor Registry probands. Over 200,000 person-years of follow-up from 8,564 first-degree relatives of probands and 1,007 spouse controls were included in these analyses. We compared mortality rates of National Familial Pancreatic Tumor Registry participants to US population rates using weighed standardized mortality ratios (wSMR). Analyses were stratified by family history of pancreatic cancer (sporadic versus familial), family history of young onset pancreatic cancer (<50 years), and family history score. Cancer mortality was increased in both the relatives of sporadic probands [wSMR 1.55, 95% confidence interval (95% CI) 1.39-1.73] and familial probands (wSMR 1.41, 95% CI 1.26-1.58). Relatives of familial probands had a significantly increased risk of dying from breast (wSMR 1.66, 95% CI 1.15-2.34), ovarian (wSMR 2.05, 95% CI 1.10-3.49), and bile duct cancers (wSMR 2.89, 95% CI 1.04-6.39). Relatives of sporadic probands were at increased risk of dying from bile duct cancer (wSMR 3.01, 95% CI 1.09-6.67). Relatives of young onset probands were at higher risk of dying from cancers of the breast (wSMR 1.98, 95% CI 1.01-3.52), colon (wSMR 2.31, 95% CI 1.30-3.81) and prostate (wSMR 2.31, 95% CI 1.14-4.20). Increased cancer mortality was not observed in the spouse controls. Our results show that relatives of pancreatic cancer patients are at higher risk of developing cancers at other sites and highlight the importance of complete family history in clinical risk assessment.
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Affiliation(s)
- Li Wang
- 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21231, USA
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46
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Wang L, Brune KA, Visvanathan K, Laheru D, Herman J, Wolfgang C, Schulick R, Cameron JL, Goggins M, Hruban RH, Klein AP. Elevated cancer mortality in the relatives of patients with pancreatic cancer. Cancer Epidemiol Biomarkers Prev 2009; 18:2829-34. [PMID: 19843679 DOI: 10.1158/1055-9965.epi-09-0557] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Most inherited cancer syndromes are characterized by the familial clustering of cancers at several organ sites. To determine if cancers, other than pancreatic cancer, cluster in pancreatic cancer kindreds, we examined mortality patterns among the relatives of National Familial Pancreatic Tumor Registry probands. Over 200,000 person-years of follow-up from 8,564 first-degree relatives of probands and 1,007 spouse controls were included in these analyses. We compared mortality rates of National Familial Pancreatic Tumor Registry participants to US population rates using weighed standardized mortality ratios (wSMR). Analyses were stratified by family history of pancreatic cancer (sporadic versus familial), family history of young onset pancreatic cancer (<50 years), and family history score. Cancer mortality was increased in both the relatives of sporadic probands [wSMR 1.55, 95% confidence interval (95% CI) 1.39-1.73] and familial probands (wSMR 1.41, 95% CI 1.26-1.58). Relatives of familial probands had a significantly increased risk of dying from breast (wSMR 1.66, 95% CI 1.15-2.34), ovarian (wSMR 2.05, 95% CI 1.10-3.49), and bile duct cancers (wSMR 2.89, 95% CI 1.04-6.39). Relatives of sporadic probands were at increased risk of dying from bile duct cancer (wSMR 3.01, 95% CI 1.09-6.67). Relatives of young onset probands were at higher risk of dying from cancers of the breast (wSMR 1.98, 95% CI 1.01-3.52), colon (wSMR 2.31, 95% CI 1.30-3.81) and prostate (wSMR 2.31, 95% CI 1.14-4.20). Increased cancer mortality was not observed in the spouse controls. Our results show that relatives of pancreatic cancer patients are at higher risk of developing cancers at other sites and highlight the importance of complete family history in clinical risk assessment.
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Affiliation(s)
- Li Wang
- 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21231, USA
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Voong KR, Davison J, Pawlik TM, Uy MO, Hsu CC, Winter J, Hruban RH, Laheru D, Rudra S, Swartz MJ, Nathan H, Edil BH, Schulick R, Cameron JL, Wolfgang CL, Herman JM. Resected pancreatic adenosquamous carcinoma: clinicopathologic review and evaluation of adjuvant chemotherapy and radiation in 38 patients. Hum Pathol 2009; 41:113-22. [PMID: 19801164 DOI: 10.1016/j.humpath.2009.07.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [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: 05/27/2009] [Revised: 07/20/2009] [Accepted: 07/22/2009] [Indexed: 02/08/2023]
Abstract
Pancreatic adenosquamous carcinoma is a rare morphological variant of pancreatic adenocarcinoma with an especially poor prognosis. The purpose of this study is to identify clinicopathologic features associated with prognosis, assess whether the percentage of squamous differentiation in pancreatic adenosquamous carcinoma is associated with an inferior prognosis, and examine the impact of adjuvant chemoradiation therapy on overall survival. Forty-five (1.2%) of 3651 patients who underwent pancreatic resection at the Johns Hopkins Hospital, Baltimore, MD, between 1986 and 2007 were identified with adenocarcinoma of the pancreas with any squamous differentiation. All pathologic specimens were re-reviewed. Statistical analyses were performed on the 38 patients amenable to adjuvant chemoradiation therapy for whom clinical outcome data could be obtained. Median age was 68 years (61% male). Sixty-one percent underwent pancreaticoduodenectomy. Median tumor size was 5.0 cm. Seventy-six percent of carcinomas were node positive, 37% were margin-positive resections, and 68% had 30% or more squamous differentiation. Median overall survival of the pancreatic adenosquamous carcinoma cohort was 10.9 months (range, 2.1-140.6 months; 95% confidence interval, 8.2-12.5 months). Adjuvant chemoradiation therapy was associated with superior overall survival in patients with pancreatic adenosquamous carcinoma (P = .005). Adjuvant chemoradiation therapy was associated with improved survival in patients with tumors 3 cm or larger and vascular or perineural invasion (P = .02, .03, .02, respectively). The proportion of squamous differentiation was not associated with median overall survival (< 30% versus > or = 30%, P = .82). Survival after pancreatic resection of pancreatic adenosquamous carcinoma is poor. Treatment with adjuvant chemoradiation therapy is associated with improved survival. The proportion of squamous differentiation in resected pancreatic adenosquamous carcinoma specimens does not appear to impact overall survival.
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Affiliation(s)
- K Ranh Voong
- Department of Radiation Oncology and Molecular Radiation Sciences, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Hospital, Baltimore, MD 21231-6681, USA
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Blackford A, Serrano OK, Wolfgang CL, Parmigiani G, Jones S, Zhang X, Parsons DW, Lin JCH, Leary RJ, Eshleman JR, Goggins M, Jaffee EM, Iacobuzio-Donahue CA, Maitra A, Cameron JL, Olino K, Schulick R, Winter J, Herman JM, Laheru D, Klein AP, Vogelstein B, Kinzler KW, Velculescu VE, Hruban RH. SMAD4 gene mutations are associated with poor prognosis in pancreatic cancer. Clin Cancer Res 2009; 15:4674-9. [PMID: 19584151 DOI: 10.1158/1078-0432.ccr-09-0227] [Citation(s) in RCA: 273] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Recently, the majority of protein coding genes were sequenced in a collection of pancreatic cancers, providing an unprecedented opportunity to identify genetic markers of prognosis for patients with adenocarcinoma of the pancreas. EXPERIMENTAL DESIGN We previously sequenced more than 750 million base pairs of DNA from 23,219 transcripts in a series of 24 adenocarcinomas of the pancreas. In addition, 39 genes that were mutated in more than one of these 24 cancers were sequenced in a separate panel of 90 well-characterized adenocarcinomas of the pancreas. Of these 114 patients, 89 underwent pancreaticoduodenectomy, and the somatic mutations in these cancers were correlated with patient outcome. RESULTS When adjusted for age, lymph node status, margin status, and tumor size, SMAD4 gene inactivation was significantly associated with shorter overall survival (hazard ratio, 1.92; 95% confidence interval, 1.20-3.05; P = 0.006). Patients with SMAD4 gene inactivation survived a median of 11.5 months, compared with 14.2 months for patients without SMAD4 inactivation. By contrast, mutations in CDKN2A or TP53 or the presence of multiple (> or =4) mutations or homozygous deletions among the 39 most frequently mutated genes were not associated with survival. CONCLUSIONS SMAD4 gene inactivation is associated with poorer prognosis in patients with surgically resected adenocarcinoma of the pancreas.
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Affiliation(s)
- Amanda Blackford
- Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21231, USA
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Zhou J, Hsu CC, Winter JM, Pawlik TM, Laheru D, Hughes MA, Donehower R, Wolfgang C, Akbar U, Schulick R, Cameron J, Herman JM. Adjuvant chemoradiation versus surgery alone for adenocarcinoma of the ampulla of Vater. Radiother Oncol 2009; 92:244-8. [PMID: 19541379 DOI: 10.1016/j.radonc.2009.05.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 04/30/2009] [Accepted: 05/10/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND PURPOSE To examine the role of adjuvant chemoradiation (CRT) in patients with resected ampullary adenocarcinoma. MATERIALS AND METHODS The records of patients who underwent curative surgery for ampullary adenocarcinoma at a single institution between 1992 and 2007 were reviewed. Final analysis included 111 patients, 45% of which also received adjuvant CRT. RESULTS Median overall survival (OS) was 36.2 months for all patients. Adverse prognostic factors for OS included T stage (T3/4 vs. T1/T2, p=0.046), node status (positive vs. negative, p<0.001), and histological grade (grade 3 vs. 1/2, p=0.09). Patients receiving CRT were more likely to have advanced T-stage (p=0.001), node positivity (p<0.001), and poor histologic grade (p=0.015). Patients who received CRT were also significantly younger (p=0.001). On univariate analysis, adjuvant CRT failed to result in a significant difference in survival when compared to surgery alone (median OS: 33.4 vs. 36.2 months, p=0.969). Patients with node-positive resections who underwent CRT had a non-significant improvement in survival (median OS: 21.6 vs. 13.0 months, p=0.092). Thirty-three percent of patients developed distant metastasis. Common sites of distant metastasis included liver (23%) and peritoneum (7%). CONCLUSIONS Adjuvant chemoradiation following curative resection for ampullary adenocarcinoma did not lead to a statistically significant benefit in overall survival. A significant proportion of patients still developed distant metastatic disease suggesting a need for more effective systemic adjuvant therapy.
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Affiliation(s)
- Jessica Zhou
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, 401 N. Broadway, Baltimore, MD 21231, USA
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Hidalgo M, Garrido-Laguna I, Uson M, De Oliveira E, Schulick R, Hruban RH, Maitra A, Jimeno A, Rubio-Viqueira B, Rajeshkumar NV. Activity of gemcitabine in direct patient-derived xenografts and clinical outcome: Validation of an in vivo model for drug development. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4528 Background: Novel drugs are urgently needed for pancreatic ductal adenocarcinoma (PDA). Current preclinical models may not recapitulate the biology of human cancers. Direct xenografts have the potential to better represent the biology of human cancer. We have completed a clinical trial in which surgically resected PDAs were xenografted into nude mice thus generating an in vivo platform for drug development and biomarker identification. Methods: PDAs resected at Johns Hopkins Hospital are implanted into nude mice. From November 2005 to December 2008, 240 patients were consented, 236 operated, 102 were resectable PDAs thus fulfilling the inclusion criteria. 104 patients had other histologies and 34 were unresectable PDAs. Xenografted tumors were treated with gemcitabine and the activity in the xenograft correlated with patient clinical outcome. Results: Out of these 102 cases, 77 were xenografted, 53 were engrafted and reached the treatment phase. 35 out of the 53 originator patients were clinically treated with gemcitabine. The median overall survival of resected patients was 646 days (similar to 660 days from CONKO-001 trial). Patients whose carcinomas engrafted had a shorter median overall survival (319 vs. 728 days, p=0.002), probably reflecting a more aggressive tumor biology in the engrafted group. The response rate of gemcitabine in xenografts based on RECIST criteria was 8% (similar to response rate to gemcitabine in phase III trial by Moore et al.). In the adjuvant setting, the median disease free survival (DFS) was significantly longer in those patients predicted as sensitive by the xenograft model (568 vs. 286 days, p=0.037). In the metastatic setting, the median time to progression (TTP) was longer in those patients predicted as sensitive by the model (126 vs. 73 days) though this difference was not statistically significant. Overall the correlation between gemcitabine activity in this model and clinical outcome as measured by DFS was 0.71 in the subgroup of patients whose xenografts had a TGI lower than -10%. Conclusions: This preclinical model predicts gemcitabine outcome in the clinic in the adjuvant setting. Further studies to analyze the causes of shorter survival in patients whose PDA engrafted are warranted. No significant financial relationships to disclose.
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Affiliation(s)
- M. Hidalgo
- Johns Hopkins University, Baltimore, MD; Centro Integral Oncologico Clara Campal, Madrid, Spain
| | - I. Garrido-Laguna
- Johns Hopkins University, Baltimore, MD; Centro Integral Oncologico Clara Campal, Madrid, Spain
| | - M. Uson
- Johns Hopkins University, Baltimore, MD; Centro Integral Oncologico Clara Campal, Madrid, Spain
| | - E. De Oliveira
- Johns Hopkins University, Baltimore, MD; Centro Integral Oncologico Clara Campal, Madrid, Spain
| | - R. Schulick
- Johns Hopkins University, Baltimore, MD; Centro Integral Oncologico Clara Campal, Madrid, Spain
| | - R. H. Hruban
- Johns Hopkins University, Baltimore, MD; Centro Integral Oncologico Clara Campal, Madrid, Spain
| | - A. Maitra
- Johns Hopkins University, Baltimore, MD; Centro Integral Oncologico Clara Campal, Madrid, Spain
| | - A. Jimeno
- Johns Hopkins University, Baltimore, MD; Centro Integral Oncologico Clara Campal, Madrid, Spain
| | - B. Rubio-Viqueira
- Johns Hopkins University, Baltimore, MD; Centro Integral Oncologico Clara Campal, Madrid, Spain
| | - N. V. Rajeshkumar
- Johns Hopkins University, Baltimore, MD; Centro Integral Oncologico Clara Campal, Madrid, Spain
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