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Abdulfatah E, Brown NA, Davenport MS, Reichert ZR, Camelo-Piragua S, Heider A, Huang T, Vaishampayan UN, Skala SL, Montgomery JS, Chinnaiyan AM, Kaffenberger SD, Bawa P, Shao L, Mehra R. Extragonadal germ cell tumors: A clinicopathologic study with emphasis on molecular features, clinical outcomes and associated secondary malignancies. Hum Pathol 2024; 148:41-50. [PMID: 38697270 DOI: 10.1016/j.humpath.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
Extragonadal germ cell tumors (EGCTs) are rare, representing <5% of all germ cell tumors (GCTs). Whilst EGCTs share morphological and immunohistochemical features with their gonadal counterparts, they tend to be more aggressive and are frequently associated with secondary somatic malignancies. The aim of our study was to evaluate the clinical, morphological and immunohistochemical features, and to analyze tumors for chromosomal abnormalities of 12p, in addition to any novel genetic alterations, in a series of EGCTs. Seventy-seven EGCTs were included. Anterior mediastinum was the most common anatomic site, followed by central nervous system, retroperitoneum, sacroccygeal area, and neck. Whole genome SNP array identified isochromosome 12p in 26% of tumors. Additional cytogenetic abnormalities included the presence of gain of chr 21 in 37% of tumors. Somatic-type malignancies were identified in 8% of patients. Disease progression (metastasis and/or recurrence) was documented in 8 patients, most of whom died from their relapse. Three patients who died of disease had somatic-type malignancies. Mediastinal seminomas had a significantly better overall survival when compared to mediastinal non-seminomatous GCTs. Our study demonstrates that EGCTs share similar histologic features, but diverse clinical outcomes compared to their gonadal counterparts. Outcomes vary according to anatomic location and histologic subtypes. Our data corroborate that somatic-type malignancies are frequently encountered in mediastinal EGCTs and that their presence portends a poorer prognosis.
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Affiliation(s)
- Eman Abdulfatah
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Noah A Brown
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Matthew S Davenport
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Zachery R Reichert
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA; Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA; Department of Internal Medicine, Divsion of Hematology/ Oncology, MI, USA
| | | | - Amer Heider
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Tao Huang
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ulka N Vaishampayan
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA; Department of Internal Medicine, Divsion of Hematology/ Oncology, MI, USA
| | - Stephanie L Skala
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA
| | - Jeffrey S Montgomery
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Arul M Chinnaiyan
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Michigan Center for Translational Pathology, Ann Arbor, MI, USA; Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA; Howard Hughes Medical Institute, Ann Arbor, MI, USA
| | | | - Pushpinder Bawa
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Michigan Center for Translational Pathology, Ann Arbor, MI, USA
| | - Lina Shao
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Rohit Mehra
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Michigan Center for Translational Pathology, Ann Arbor, MI, USA; Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA.
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Singhal U, Hollenbeck BK, Kaffenberger SD, Salami SS, George AK, Skolarus TA, Montgomery JS, Wittmann DA, Miller DC, Wei JT, Palapattu GS, Montie JE, Dunn RL, Morgan TM. Comparing Patient-reported Functional Outcomes After Radical Prostatectomy in Historical and Contemporary Practice. J Urol 2023; 210:771-777. [PMID: 37566643 DOI: 10.1097/ju.0000000000003646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE Modifications to surgical technique, particularly the widespread adoption of robotic surgery, have been proposed to improve functional recovery after prostate cancer surgery. However, rigorous comparison of men in historical vs contemporary practice to evaluate the cumulative effect of these changes on urinary and sexual function after radical prostatectomy is lacking. MATERIALS AND METHODS We compared prospectively collected patient-reported urinary and sexual function from historical (PROSTQA [Prostate Cancer Outcomes and Satisfaction With Treatment Quality Assessment study], n=235) and contemporary (MUSIC-PRO [Michigan Urological Surgery Improvement Collaborative Patient Reported Outcome] registry, n=1,215) cohorts at the University of Michigan to understand whether modern techniques have resulted in functional improvements for men undergoing prostate cancer surgery. RESULTS We found significant differences in baseline function, with better urinary (median [IQR]; 100 [93.8-100] vs 93.8 [85.5-100], P < .001) and sexual scores (median [IQR]; 83.3 [66.7-100] vs 74.4 [44.2-87.5], P < .001) prior to treatment in PROSTQA compared to MUSIC-PRO patients, respectively. There was no statistically significant difference in the pattern of urinary incontinence recovery after surgery from 6-24 months between groups (P = .14). However, men in the contemporary MUSIC-PRO group did have significantly better recovery of sexual function compared to men in the historical PROSTQA group (P < .0001). Further, we found that contemporary practice consists of men with more unfavorable demographic and clinical characteristics compared to historical practice. CONCLUSIONS Our results demonstrate that the widespread alterations in prostate cancer surgery over the past 2 decades have yielded improvements in sexual, but not urinary, function recovery.
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Affiliation(s)
- Udit Singhal
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Brent K Hollenbeck
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Samuel D Kaffenberger
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Simpa S Salami
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Arvin K George
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
- James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ted A Skolarus
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Jeffrey S Montgomery
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Daniela A Wittmann
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - David C Miller
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - John T Wei
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Ganesh S Palapattu
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - James E Montie
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Rodney L Dunn
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Todd M Morgan
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
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Schaub JA, O'Connor CL, Dailey M, Hlynka AW, Chang Y, Postiff D, Kaffenberger SD, Palapattu GS, Gillespie BW, Hodgin JB, Shedden K, Bitzer M. Spatial Heterogeneity of Glomerular Phenotypes Affects Kidney Biopsy Findings. Kidney360 2023; 4:1598-1607. [PMID: 37889598 PMCID: PMC10695647 DOI: 10.34067/kid.0000000000000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
Key Points
Glomeruli with pathologic changes are not homogeneously distributed throughout the kidney cortex.Biopsies that do not include the kidney capsule may underdetect glomeruli with pathologic changes.Location of glomeruli with pathologic changes may be related to underlying clinical characteristics.
Background
Detection of rare glomerular phenotypes can affect diagnosis in indication kidney biopsies and in kidney tissue used for research studies. Nephropathologists are aware of potential sampling error when assessing needle biopsy cores, but quantitative data are lacking.
Methods
Kidney tissue from patients undergoing total nephrectomy enrolled in an observational, cross-sectional cohort study was used to characterize glomeruli as typical or atypical, which included globally sclerotic glomeruli (GSGs), segmentally sclerotic glomeruli, ischemic-like, and imploding. A 2D map of the glomerular annotations was generated. Spatial centrality of atypical glomeruli using the L2 metric and differences in pairwise distances between typical or atypical glomeruli were calculated. To determine how the yield of capturing atypical glomerular phenotype was affected by biopsy depth (i.e., not including the renal capsule), simulated kidney biopsies were generated from the 2D map.
Results
The mean number of glomeruli in a nephrectomy specimen was 209 (SD 143), and GSGs were the most common type of atypical glomeruli (median: 13% [interquartile range: 5,31]). Typical glomeruli were more likely to be surrounded by other glomeruli (i.e., centrally located in the kidney cortex) than GSGs, segmentally sclerosed glomeruli, ischemic-like glomeruli, and imploding glomeruli. Atypical glomeruli were 7.3% (95% confidence interval, 4.1 to 10.4) closer together than typical glomeruli and were more likely to be closer together in older patients or those with hypertension. In simulated kidney biopsies, failure to capture the capsule was associated with underdetection of GSGs, ischemic-like glomeruli, and imploding glomeruli.
Conclusions
Spatial analysis of large sections of kidney tissue provided quantitative evidence of spatial heterogeneity of glomerular phenotypes including clustering of atypical glomeruli in individuals with hypertension or older age. Most importantly, deep kidney biopsies that lack subcapsular area underdetect atypical glomerular phenotypes, suggesting that capturing the renal capsule is an important quality control measure for kidney biopsies.
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Affiliation(s)
- Jennifer A Schaub
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Meghan Dailey
- Advanced Research Computing (Information and Technology Services), University of Michigan, Ann Arbor, Michigan
| | - Andrew W Hlynka
- Office of Research, University of Michigan, Ann Arbor, Michigan
| | - Yurui Chang
- Department of Statistics, University of Michigan, Ann Arbor, Michigan
| | - Deborah Postiff
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | | | | | - Brenda W Gillespie
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jeffrey B Hodgin
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Kerby Shedden
- Department of Statistics, University of Michigan, Ann Arbor, Michigan
| | - Markus Bitzer
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Zhu A, Berends JE, Daignault-Newton S, Kaye DR, Parker C, IglayReger H, Morgan TM, Weizer AZ, Kaffenberger SD, Herrel LA, Hafez K, Skolarus TA, Montgomery JS. Use of a physical activity monitor to track perioperative activity of radical cystectomy patients our first glimpse at what our patients are doing before and after surgery. Urol Oncol 2023; 41:206.e11-206.e19. [PMID: 36842878 DOI: 10.1016/j.urolonc.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE To optimize recovery after radical cystectomy (RC), providers stress the importance of ambulation and adequate rest. However, little is known about the activity and sleep habits of patients undergoing RC. Therefore, we utilized a wearable physical activity monitor (PAM) in the perioperative period to provide the first objective data on physical activity and sleep habits for RC patients. MATERIALS AND METHODS We prospectively identified patients ≥60 years old with planned RC. Participants completed a 4-week prehabilitation exercise program prior to surgery. They wore a PAM for 7-day intervals: at baseline, after prehabilitation, at postoperative day (POD) 30 and POD90. We tracked physical activity via metabolic equivalents (METs). METs were categorized by intensity: light (MET 1.5-<3), moderate (MET 3-<6), and vigorous (MET ≥6). We calculated daily step totals. We tracked hours slept and number of sleep awakenings. We correlated activity and sleep with self-reported quality of life (QOL). RESULTS Forty-two patients completed prehabilitation and RC. Moderate intensity exercise decreased at POD30 (61 minutes/d at baseline, 30 minutes/d at POD30, P = 0.005). Physical activity did not significantly differ for light or vigorous activity at any timepoint. RC did not significantly affect sleep. Sleep and physical activity were associated with mental and physical QOL, respectively. CONCLUSIONS This is the first study utilizing patient-worn monitors in RC to track physical activity and sleep. This study gives patients and providers a better understanding of postcystectomy recovery expectations. With these results in mind, interventions may be implemented to optimize activity and sleep in the perioperative period.
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Affiliation(s)
- Alex Zhu
- Department of Urology, Michigan Medicine, Ann Arbor, MI
| | | | | | - Deborah R Kaye
- Division of Urology, Department of Surgery, Duke University, Durham, NC
| | - Chrissy Parker
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI
| | - Heidi IglayReger
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI
| | - Todd M Morgan
- Department of Urology, Michigan Medicine, Ann Arbor, MI
| | - Alon Z Weizer
- Department of Urology, Michigan Medicine, Ann Arbor, MI
| | | | | | - Khaled Hafez
- Department of Urology, Michigan Medicine, Ann Arbor, MI
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Chamie K, Chang SS, Kramolowsky E, Gonzalgo ML, Agarwal PK, Bassett JC, Bjurlin M, Cher ML, Clark W, Cowan BE, David R, Goldfischer E, Guru K, Jalkut MW, Kaffenberger SD, Kaminetsky J, Katz AE, Koo AS, Sexton WJ, Tikhonenkov SN, Trabulsi EJ, Trainer AF, Spilman P, Huang M, Bhar P, Taha SA, Sender L, Reddy S, Soon-Shiong P. IL-15 Superagonist NAI in BCG-Unresponsive Non-Muscle-Invasive Bladder Cancer. NEJM Evid 2023; 2:EVIDoa2200167. [PMID: 38320011 DOI: 10.1056/evidoa2200167] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
IL-15 Superagonist NAI in BCG-Unresponsive NMIBCIn this trial, patients with BCG-unresponsive bladder CIS with or without Ta/T1 papillary disease or BCG-unresponsive high-grade Ta/T1 papillary NMIBC were treated with intravesical NAI, an IL-15 superagonist, plus BCG. Primary end points were CR at 3 or 6 months for patients with CIS disease and DFS rate at 12 months for those with high-grade Ta/T1 disease. CR rate was 71% (58 of 82 patients), and the DFS rate was 55.4%.
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Affiliation(s)
- Karim Chamie
- Department of Urology, UCLA Medical Center, Los Angeles
| | - Sam S Chang
- Department of Urology, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville
| | | | - Mark L Gonzalgo
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami
| | | | - Jeffrey C Bassett
- Hoag Urologic Oncology, Hoag Memorial Presbyterian Hospital, Newport Beach, CA
| | - Marc Bjurlin
- Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Michael L Cher
- Department of Urology, Wayne State University, Detroit
- Karmanos Cancer Center, Detroit
| | | | | | - Richard David
- Genesis Healthcare Partners, Greater Los Angeles Division, Sherman Oaks, CA
| | | | - Khurshid Guru
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Mark W Jalkut
- Associated Urologists of North Carolina, Raleigh, NC
| | | | | | | | - Alec S Koo
- Genesis Healthcare Partners, Torrance, CA
| | | | | | - Edouard J Trabulsi
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia
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Farha M, Cotta B, Vince R, Nallandhighal S, Kaffenberger SD, Palmbos P, Alva AS, Morgan TM, Palapattu GS, Salami S, Udager AM. Prognostic value and therapeutic implications of an integrative molecular subtype and immune content classifier in localized muscle-invasive bladder cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.530] [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
530 Background: Localized muscle-invasive bladder cancer (MIBC) exhibits heterogeneous molecular features and outcomes, with a 5-year mortality rate of approximately 30%. Immune checkpoint blockade (ICB) has the potential to improve oncological outcomes but molecular tools are needed to identify those most likely to benefit. Here, we integrate transcriptomically derived tumor immune microenvironment (TIME) data with molecular subtypes to create a novel integrative classifier with prognostic and therapeutic implications. Methods: RNAseq data from patients with localized muscle-invasive bladder cancer (MIBC) from the Cancer Genome Atlas BLCA (TCGA-BLCA) project was utilized (n = 187). CIBERSORT was used for immune cell deconvolution, and unsupervised hierarchical clustering divided the cohort based on similar immune profiles. Consensus molecular clustering information for the cohort was obtained from Kamoun et al. Overall survival (OS) of each cluster were analyzed. The tumor immune dysfunction and exclusion (TIDE) tool, which uses a genomic signature validated on immunotherapy treated melanoma patients to model tumor immune evasion, was then used to predict response to ICB. Results: In the TCGA-BLCA cohort, there were two distinct clusters enriched with macrophages, CL1-M0Hi (n = 18) and CL5-M2Hi (n = 35). Compared to the rest of the cohort, these two macrophage enriched clusters combined exhibited a decreased OS (33.1 mo vs. NR, p = 0.01). TIDE tool predicted ICB response was lowest in CL1 (6/18, 33%; p = 0.09), CL5 (12/35, 34%; p = 0.02), and the Ba/Sq molecular cluster (16/57, 28%; p = 1.3x10-5). Patients designated as CL1 or CL5 by immune clustering and Ba/Sq by molecular consensus were combined into a subgroup (n = 20). Compared to the rest of the cohort, this Ba/Sq_MacrophageHi subgroup had a higher body mass index (31.0 vs. 25.8 BMI, p = 0.0004), more whites (95% vs. 64%, p = 0.03), and had a higher stage (80% Stage III/IV vs. 20% Stage I/II, p = 0.05). The Ba/Sq_MacrophageHi cluster demonstrated higher PD-L1 expression (mean Z score 0.15 vs. -0.09; p = 0.008), there was a higher degree of T cell exclusion (mean Z score 0.16 vs. -0.06; p = 0.003) and cancer-associated fibroblasts (mean Z score 0.03 vs. -0.02; p = 3.4x10-5). Overall, the predicted response to ICB by TIDE in the Ba/Sq_MacrophageHi was lower (OR 0.15, 0.03-0.55 p = 0.002) and OS was significantly shorter (median 16.7 mos vs. 54.9 mo, p = 0.04). Conclusions: We demonstrated the prognostic significance of the Basal/Squamous subtype with macrophage enrichment in patients with localized MIBC. Pending further prospective validation, this sub-population may be less amenable to ICB treatment.
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Affiliation(s)
- Mark Farha
- University of Michigan Department of Medical Education, Ann Arbor, MI
| | | | - Randy Vince
- University of Michigan Cancer Center, Ann Arbor, MI
| | | | | | | | | | | | | | - Simpa Salami
- University of Michigan Department of Urology, Ann Arbor, MI
| | - Aaron M. Udager
- University of Michigan Department of Pathology, Ann Arbor, MI
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Wittmann D, Varlamos C, Rodriguez-Galano N, Day L, Grube G, Shifferd J, Erickson K, Duby A, Morgan TM, Hollenbeck BK, Skolarus TA, Salami SS, Kaffenberger SD, Montie JE. Developing a Patient-Centered Model of Prostate Cancer Care: Patient Satisfaction With a Survivorship Program Embedded in Urologic-Oncologic Care. Urology 2021; 160:161-167. [PMID: 34896123 DOI: 10.1016/j.urology.2021.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/10/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate patients' and partners' satisfaction with a prostate cancer survivorship program embedded in urologic-oncologic care. As a part of quality improvement activity, we developed a patient and partner-centered, biopsychosocial support program for men and partners coping with the urinary and sexual side-effects of surgical treatment for prostate cancer. The program became a part of usual care for all prostate cancer patients. METHODS Patients who saw both an advanced practice provider and a sex therapist between August 1, 2018 and July 31, 2019 were eligible. Surveys packets were sent to 146 patients with surveys included for partners (N = 292). We used descriptive statistics to characterize participant responses. RESULTS Responses were received from 88 patients and 70 partners (56% response rate for the group). Patients and partners reported very high or fairly high satisfaction with the rehabilitation activities of the program (86-97% and 90%-100%, respectively); 91% of patients and 84% of partners thought having pre-operative education and post-operative rehabilitation was a good or fairly good idea; 83% of patients and 79% of partners would very much or somewhat recommend the program to a friend who was considering surgical treatment for prostate cancer. CONCLUSION Embedding a patient and partner-centered prostate cancer survivorship support program in oncologic care can positively impact patients' and partners' engagement in and satisfaction with post-operative rehabilitation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - T A Skolarus
- University of Michigan; Center for Clinical Management Research, VA Ann Arbor Healthcare System
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Abstract
Active surveillance of renal masses, which includes serial imaging with the possibility of delayed treatment, has emerged as a viable alternative to immediate therapeutic intervention in selected patients. Active surveillance is supported by evidence that many benign masses are resected unnecessarily, and treatment of small cancers has not substantially reduced cancer-specific mortality. These data are a call to radiologists to improve the diagnosis of benign renal masses and differentiate cancers that are biologically aggressive (prompting treatment) from those that are indolent (allowing treatment deferral). Current evidence suggests that active surveillance results in comparable cancer-specific survival with a low risk of developing metastasis. Radiology is central in this. Imaging is used at the outset to estimate the probability of malignancy and degree of aggressiveness in malignant masses and to follow up masses for growth and morphologic change. Percutaneous biopsy is used to provide a more definitive histologic diagnosis and to guide treatment decisions, including whether active surveillance is appropriate. Emerging applications that may improve imaging assessment of renal masses include standardized assessment of cystic and solid masses and radiomic analysis. This article reviews the current and future role of radiology in the care of patients with renal masses undergoing active surveillance.
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Affiliation(s)
- Nicola Schieda
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Satheesh Krishna
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Ivan Pedrosa
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Samuel D Kaffenberger
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Matthew S Davenport
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Stuart G Silverman
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
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9
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Stensland KD, Kaffenberger SD, George AK, Morgan TM, Miller DC, Salami SS, Dunn RL, Palapattu GS, Montgomery JS, Hollenbeck BK, Skolarus TA. Prostate cancer clinical trial completion: The role of geography. Contemp Clin Trials 2021; 111:106600. [PMID: 34673273 DOI: 10.1016/j.cct.2021.106600] [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: 07/01/2021] [Revised: 09/23/2021] [Accepted: 10/14/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND/AIMS One in five cancer clinical trials fails with another third failing to meet enrollment goals. Prior efforts to improve enrollment focus on patient facing interventions, but geographic factors such as regional cancer incidence may doom trials before they even begin. For these reasons, we examined associations of regional prostate cancer incidence with trial termination, and identified scientifically-underserved areas where future trials might thrive. METHODS We merged US phase 2-3 prostate cancer clinical trial data from ClinicalTrials.gov with prostate cancer incidence data from statecancerprofiles.cancer.gov. We matched trial information from 293 closed and 560 active trials with incidence data for 2947 counties. Using multivariable logistic regression, we identified associations with trial termination. We identified 'scientifically-underserved' counties with the highest cancer incidence quintile (>61 annual cases) but lowest active trials quintile (0 or 1 trial). RESULTS Of 293 closed trials, one in three was terminated (n = 96, 32.8%). On multivariable analysis, only lower regional prostate cancer incidence was associated with higher likelihood of premature trial termination (OR 0.98, 95% CI [0.96-0.99] for every 100 cases, p = 0.03). We identified 188 counties with >61 annual prostate cancer cases but 0 or 1 active trials, indicating potential scientifically-underserved areas. CONCLUSIONS In this novel study, we found prostate cancer trials in areas with low prostate cancer incidence were more likely to fail. We also identified scientifically-underserved areas where trials might thrive. Our findings provide a more nuanced understanding of clinical trial feasibility and upstream opportunities for improvement.
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Affiliation(s)
- Kristian D Stensland
- Department of Urology, Dow Division of Health Services Research, University of Michigan, USA; Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | | | - Arvin K George
- Department of Urology, Division of Urologic Oncology, University of Michigan, USA; VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, USA
| | - Todd M Morgan
- Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | - David C Miller
- Department of Urology, Dow Division of Health Services Research, University of Michigan, USA; Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | - Simpa S Salami
- Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | - Rodney L Dunn
- Department of Urology, Dow Division of Health Services Research, University of Michigan, USA
| | - Ganesh S Palapattu
- Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | - Jeffrey S Montgomery
- Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | - Brent K Hollenbeck
- Department of Urology, Dow Division of Health Services Research, University of Michigan, USA; Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | - Ted A Skolarus
- Department of Urology, Dow Division of Health Services Research, University of Michigan, USA; Department of Urology, Division of Urologic Oncology, University of Michigan, USA; VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, USA.
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10
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Sessine MS, Das S, Park B, Salami SS, Kaffenberger SD, Kasputis A, Solorzano M, Luke M, Vince RA, Kaye DR, Borza T, Stoffel EM, Cobain E, Merajver SD, Jacobs MF, Milliron KJ, Caba L, van Neste L, Mondul AM, Morgan TM. Initial Findings from a High Genetic Risk Prostate Cancer Clinic. Urology 2021; 156:96-103. [PMID: 34280438 DOI: 10.1016/j.urology.2021.05.078] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To improve prostate cancer screening for high-risk men, we developed an early detection clinic for patients at high genetic risk of developing prostate cancer. Despite the rapidly growing understanding of germline variants in driving aggressive prostate cancer and the increased availability of genetic testing, there is little evidence surrounding how best to screen these men. METHODS We are reporting on the first 45 patients enrolled, men between the ages of 35-75, primarily with known pathogenic germline variants in prostate cancer susceptibility genes. Screening consists of an intake lifestyle survey, PSA, DRE, and SelectMDx urine assay. A biopsy was recommended for any of the following indications: 1) abnormal DRE, 2) PSA above threshold, or 3) SelectMDx above threshold. The primary outcomes were number needed to screen, and number needed to biopsy to diagnose a patient with prostate cancer. RESULTS Patients enrolled in the clinic included those with BRCA1 (n=7), BRCA2 (n=16), Lynch Syndrome (n=6), and CHEK2 (n = 4) known pathogenic germline variants. The median age and PSA were 58 (range 35-71) and 1.4 ng/ml (range 0.1-11.4 ng/ml), respectively. 12 patients underwent a prostate needle biopsy and there were 4positive biopsies for prostate cancer. CONCLUSION These early data support the feasibility of opening a dedicated clinic for men at high genetic risk of prostate cancer. This early report on the initial enrollment of our long-term study will help optimize early detection protocols and provide evidence for personalized prostate cancer screening in men with key pathogenic germline variants.
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Affiliation(s)
| | - Sanjay Das
- Department of Urology, Michigan Medicine
| | - Bumsoo Park
- Department of Urology, Michigan Medicine; Department of Family Medicine, Michigan Medicine
| | | | | | | | | | | | | | | | - Tudor Borza
- Department of Urology, University of Wisconsin School of Medicine and Public Health; Division of Urology, William S Middleton Memorial Veterans Hospital
| | | | - Erin Cobain
- Medical Genetics, Rogel Cancer Center, Michigan Medicine
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11
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Balar AV, Milowsky MI, O'Donnell PH, Alva AS, Kollmeier M, Rose TL, Pitroda S, Kaffenberger SD, Rosenberg JE, Francese K, Hochman T, Goldberg JD, Griglun S, Leis D, Steinberg GD, Wysock J, Schiff PB, Sanfilippo NJ, Taneja S, Huang WC. Pembrolizumab (pembro) in combination with gemcitabine (Gem) and concurrent hypofractionated radiation therapy (RT) as bladder sparing treatment for muscle-invasive urothelial cancer of the bladder (MIBC): A multicenter phase 2 trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4504] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4504 Background: Trimodality bladder preservation therapy (TMT) is a standard treatment option for clinically localized MIBC with curative intent. Pembro has shown activity in MIBC in the neoadjuvant setting and may combine well with TMT to improve outcomes. This trial evaluated the safety and efficacy of pembro added to TMT in MIBC. Methods: This multicenter phase 2 trial included pts with cT2 – T4aN0M0 MIBC who declined or were ineligible for cystectomy (RC), ECOG PS 0/1, eGFR > 30 cc/min, and no contraindications to pelvic RT or pembro. No perioperative chemotx for MIBC was permitted. Pts received pembro 200 mg x 1 followed 2-3 weeks by maximal TURBT and then whole bladder RT (52 Gy/20 fx; IMRT preferred) with twice wkly gem 27 mg/m2 and pembro Q3 wks x 3 treatments. 12 wks post-RT, CT/MR AP, TUR of tumor bed and cytology were performed to document response. Up to 6 pts were enrolled to a safety cohort (SC) followed by 48 pts in efficacy cohort (EC). The primary endpt is 2-yr bladder-intact disease-free survival (BIDFS: first of MIBC or regional nodal recurrence, distant metastases, or death) assessed by serial cysto/cytology and CT/MRI. EC had 85% power to detect a 20% absolute improvement in 2-yr BIDFS rate over 60% historical rate (RTOG Pooled analysis; Mak JCO 2014). Key secondary endpts were safety, 12 wks CR rate, metastases-free survival and overall survival. Tumor tissue was collected at study entry, maximal TURBT and post-treatment TUR of tumor bed with serial PBMCs for correlative analyses. Results: From 5/2016 to 10/2020, 54 pts (6 SC, 48 EC; 72% M) enrolled at 5 centers; Median age 67 (65-89) for SC and 74 (51-97) for EC. C-stage (74% cT2, 22% cT3, and 4% cT4). 39 (72%) declined RC. All 6 pts in SC and 42/48 (88%) of EC pts completed all study therapy; 1/48 (2%), 2/48 (4%), and 4/48 (8%) discontinued RT/Gem, Gem or Pembro, respectively, most often due to toxicity. As of 1/2021 (median F/U 40.9 mos (38.6-50.8) SC and 11.7 mos (0.6 – 32.2) EC), no recurrences in SC, and 12/48 EC pts had any recurrence (6 NMIBC, 0 MIBC, 2 regional and 4 distant). The estimated 1 yr BIDFS rate is 77% (95% CI: 0.60-0.87). 12 wks CR rate was 100% in SC and 83% for EC (1 PR, 3 NR, 1 Progression, 11 NE; 2 still on active study). In the EC, 35% of pts had a Gr ≥3 TEAE (Gr 3 events included UTI 8%, diarrhea 4%, colitis 4%, bladder pain/obstruction 4%, neutropenia 2%, thrombocytopenia 2%). Notable Pembro Gr ≥3 TRAE included 3 pts (6%) Gr 3 GI toxicity and 1 pt Gr 4 colonic perforation. 1 patient died due to fungemia, unrelated to study therapy. Conclusions: Pembro added to hypofractionated RT and twice weekly gem was well-tolerated with promising efficacy in this early analysis. Pembro-related toxicity was consistent with prior monotherapy trials. Selected correlative analyses from serially collected blood and tissue specimens will be presented. Clinical trial information: NCT02621151.
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Affiliation(s)
| | - Matthew I. Milowsky
- University of North Carolina Department of Medicine, Division of Hematology/Oncology, Chapel Hill, NC
| | | | | | | | - Tracy L Rose
- The University of North Carolina at Chapel Hill (UNC-CH) School of Medicine and UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | - Jonathan E. Rosenberg
- Genitourinary Medical Oncology Service, Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Tsivia Hochman
- Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | | | - Sarah Griglun
- Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Dayna Leis
- Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Gary D. Steinberg
- Department of Surgery, The University of Chicago Medicine, Chicago, IL
| | - James Wysock
- Department of Urology, New York University School of Medicine, New York, NY
| | - Peter B. Schiff
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY
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12
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Jairath NK, Dal Pra A, Vince R, Dess RT, Jackson WC, Tosoian JJ, McBride SM, Zhao SG, Berlin A, Mahal BA, Kishan AU, Den RB, Freedland SJ, Salami SS, Kaffenberger SD, Pollack A, Tran P, Mehra R, Morgan TM, Weiner AB, Mohamad O, Carroll PR, Cooperberg MR, Karnes RJ, Nguyen PL, Michalski JM, Tward JD, Feng FY, Schaeffer EM, Spratt DE. A Systematic Review of the Evidence for the Decipher Genomic Classifier in Prostate Cancer. Eur Urol 2021; 79:374-383. [DOI: 10.1016/j.eururo.2020.11.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/13/2020] [Indexed: 12/13/2022]
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13
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Dess RT, Suresh K, Zelefsky MJ, Freedland SJ, Mahal BA, Cooperberg MR, Davis BJ, Horwitz EM, Terris MK, Amling CL, Aronson WJ, Kane CJ, Jackson WC, Hearn JWD, Deville C, DeWeese TL, Greco S, McNutt TR, Song DY, Sun Y, Mehra R, Kaffenberger SD, Morgan TM, Nguyen PL, Feng FY, Sharma V, Tran PT, Stish BJ, Pisansky TM, Zaorsky NG, Moraes FY, Berlin A, Finelli A, Fossati N, Gandaglia G, Briganti A, Carroll PR, Karnes RJ, Kattan MW, Schipper MJ, Spratt DE. Development and Validation of a Clinical Prognostic Stage Group System for Nonmetastatic Prostate Cancer Using Disease-Specific Mortality Results From the International Staging Collaboration for Cancer of the Prostate. JAMA Oncol 2021; 6:1912-1920. [PMID: 33090219 DOI: 10.1001/jamaoncol.2020.4922] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance In 2016, the American Joint Committee on Cancer (AJCC) established criteria to evaluate prediction models for staging. No localized prostate cancer models were endorsed by the Precision Medicine Core committee, and 8th edition staging was based on expert consensus. Objective To develop and validate a pretreatment clinical prognostic stage group system for nonmetastatic prostate cancer. Design, Setting, and Participants This multinational cohort study included 7 centers from the United States, Canada, and Europe, the Shared Equal Access Regional Cancer Hospital (SEARCH) Veterans Affairs Medical Centers collaborative (5 centers), and the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry (43 centers) (the STAR-CAP cohort). Patients with cT1-4N0-1M0 prostate adenocarcinoma treated from January 1, 1992, to December 31, 2013 (follow-up completed December 31, 2017). The STAR-CAP cohort was randomly divided into training and validation data sets; statisticians were blinded to the validation data until the model was locked. A Surveillance, Epidemiology, and End Results (SEER) cohort was used as a second validation set. Analysis was performed from January 1, 2018, to November 30, 2019. Exposures Curative intent radical prostatectomy (RP) or radiotherapy with or without androgen deprivation therapy. Main Outcomes and Measures Prostate cancer-specific mortality (PCSM). Based on a competing-risk regression model, a points-based Score staging system was developed. Model discrimination (C index), calibration, and overall performance were assessed in the validation cohorts. Results Of 19 684 patients included in the analysis (median age, 64.0 [interquartile range (IQR), 59.0-70.0] years), 12 421 were treated with RP and 7263 with radiotherapy. Median follow-up was 71.8 (IQR, 34.3-124.3) months; 4078 (20.7%) were followed up for at least 10 years. Age, T category, N category, Gleason grade, pretreatment serum prostate-specific antigen level, and the percentage of positive core biopsy results among biopsies performed were included as variables. In the validation set, predicted 10-year PCSM for the 9 Score groups ranged from 0.3% to 40.0%. The 10-year C index (0.796; 95% CI, 0.760-0.828) exceeded that of the AJCC 8th edition (0.757; 95% CI, 0.719-0.792), which was improved across age, race, and treatment modality and within the SEER validation cohort. The Score system performed similarly to individualized random survival forest and interaction models and outperformed National Comprehensive Cancer Network (NCCN) and Cancer of the Prostate Risk Assessment (CAPRA) risk grouping 3- and 4-tier classification systems (10-year C index for NCCN 3-tier, 0.729; for NCCN 4-tier, 0.746; for Score, 0.794) as well as CAPRA (10-year C index for CAPRA, 0.760; for Score, 0.782). Conclusions and Relevance Using a large, diverse international cohort treated with standard curative treatment options, a proposed AJCC-compliant clinical prognostic stage group system for prostate cancer has been developed. This system may allow consistency of reporting and interpretation of results and clinical trial design.
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Affiliation(s)
- Robert T Dess
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor
| | | | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen J Freedland
- Division of Urology, Department of Surgery, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Durham VA Medical Center, Durham, North Carolina
| | - Brandon A Mahal
- Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston
| | - Matthew R Cooperberg
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Martha K Terris
- Section of Urology, Medical College of Georgia, Augusta, Georgia
| | - Christopher L Amling
- Division of Urology, Department of Surgery, Oregon Health and Science University, Portland
| | - William J Aronson
- Department of Urology, University of California, Los Angeles, School of Medicine
| | - Christopher J Kane
- Department of Urology, University of California, San Diego, Health System
| | - William C Jackson
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor
| | - Jason W D Hearn
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Theodore L DeWeese
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Stephen Greco
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Todd R McNutt
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Daniel Y Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Yilun Sun
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor.,Department of Biostatistics, University of Michigan, Ann Arbor
| | - Rohit Mehra
- Department of Pathology, University of Michigan, Ann Arbor
| | | | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Felix Y Feng
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center.,Department of Radiation Oncology, University of California, San Francisco.,Department of Medicine, University of California, San Francisco
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Phuoc T Tran
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Fabio Ynoe Moraes
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Finelli
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Nicola Fossati
- Department of Urology, Scientific Institute and University Vita-Salute San Raffaele Hospital, Milan, Italy
| | - Giorgio Gandaglia
- Department of Urology, Scientific Institute and University Vita-Salute San Raffaele Hospital, Milan, Italy
| | - Alberto Briganti
- Department of Urology, Scientific Institute and University Vita-Salute San Raffaele Hospital, Milan, Italy
| | - Peter R Carroll
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center
| | | | - Michael W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Matthew J Schipper
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor.,Department of Biostatistics, University of Michigan, Ann Arbor
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor
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14
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Kaye DR, Schafer C, Thelen-Perry S, Parker C, Iglay-Reger H, Daignault-Newton S, Qin Y, Morgan TM, Weizer AZ, Kaffenberger SD, Herrel LA, Hafez KS, Lee CT, Skolarus TA, Englesbe MJ, Montgomery JS. The Feasibility and Impact of a Presurgical Exercise Intervention Program (Prehabilitation) for Patients Undergoing Cystectomy for Bladder Cancer. Urology 2020; 145:106-112. [DOI: 10.1016/j.urology.2020.05.104] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/21/2020] [Accepted: 05/17/2020] [Indexed: 01/22/2023]
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15
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Corona LE, Singhal U, Hafez K, Herrel LA, Kaffenberger SD, Montgomery JS, Morgan TM, Weizer AZ, Qin Y, Ambani SN. Rethinking the one-size-fits-most approach to venous thromboembolism prophylaxis after radical cystectomy. Urol Oncol 2020; 38:797.e1-797.e6. [PMID: 32624425 DOI: 10.1016/j.urolonc.2020.05.007] [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: 01/25/2020] [Revised: 04/10/2020] [Accepted: 05/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Empirically dosed enoxaparin is routinely given in the postoperative period for venous thromboembolism (VTE) prophylaxis after radical cystectomy (RC). Patient-specific factors may alter its pharmacokinetics, and it is unclear whether this leads to levels sufficient for antithrombosis. We sought to evaluate variability of anti-factor Xa levels in a cohort of RC patients receiving perioperative enoxaparin prophylaxis. MATERIAL AND METHODS Patients undergoing RC at a single institution were placed on a postoperative pathway that included enoxaparin. An anti-factor Xa level was drawn 2 to 4 hours after the third dose. The target range for prophylaxis was 0.3 IU/ml to 0.5 IU/ml. RESULTS The primary outcome was anti-factor Xa level. Demographics, operative time, hospital course, and 30-days post-operative VTE were compared by anti-factor Xa level group using univariate and multivariable analyses. Between January 2018 and 2019, 107 RC patients remained on pathway and were included in our analysis. Sixty-five (61%) were below target range for VTE prophylaxis. A single VTE event (0.9%) occurred in a subprophylactic individual. The subprophylactic group had a significantly higher body mass index (P < 0.01) than those within target range. CONCLUSIONS Higher body mass index was associated with subprophylactic enoxaparin dosing after RC. Nearly two-thirds of patients had below target anti-factor Xa levels. This suggests that dosing could be further individualized, but given the low incidence of VTE, implications of dose-adjusted prophylaxis on VTE prevention remain unknown.
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Affiliation(s)
- Lauren E Corona
- University of Michigan, Department of Urology, Ann Arbor, MI.
| | - Udit Singhal
- University of Michigan, Department of Urology, Ann Arbor, MI
| | - Khaled Hafez
- University of Michigan, Department of Urology, Ann Arbor, MI
| | | | | | | | - Todd M Morgan
- University of Michigan, Department of Urology, Ann Arbor, MI
| | - Alon Z Weizer
- University of Michigan, Department of Urology, Ann Arbor, MI
| | - Yongmei Qin
- University of Michigan, Department of Urology, Ann Arbor, MI
| | - Sapan N Ambani
- University of Michigan, Department of Urology, Ann Arbor, MI
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16
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Abdulfatah E, Kennedy JM, Hafez K, Davenport MS, Xiao H, Weizer AZ, Palapattu GS, Morgan TM, Mannan R, Wang XM, Dhanasekaran SM, Kaffenberger SD, Spratt DE, Kunju L, Wu A, Lew M, Udager AM, Chinnaiyan AM, Mehra R. Clinicopathological characterisation of renal cell carcinoma in young adults: a contemporary update and review of literature. Histopathology 2020; 76:875-887. [PMID: 31872452 DOI: 10.1111/his.14051] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/21/2019] [Indexed: 11/28/2022]
Abstract
AIMS Renal cell carcinomas are relatively rare in children and young adults. While well characterised in adults, the morphological and molecular characterisation of these tumours in young patients is relatively lacking. The objective of this study was to explore the spectrum of renal cell carcinoma (RCC) subtypes in children and young adults and to determine their clinico-pathological, immunohistochemical and molecular characteristics by evaluating a large retrospective cohort of renal cell carcinoma patients age 30 years or younger. METHODS AND RESULTS Sixty-eight cases with confirmed diagnosis of renal cell carcinoma at age 30 years or younger were identified at our institution. Clear cell carcinoma accounted for the most common subtype seen in this age group. Translocation renal cell carcinoma and rare familial syndrome subtypes such as succinate dehydrogenase deficient renal cell carcinoma and tuberous sclerosis complex-associated renal cell carcinoma were found relatively more frequently in this cohort. Despite applying the 2016 WHO classification criteria, a high proportion of the tumours in our series remained unclassified. CONCLUSIONS Our results suggest that renal cell carcinoma in children and young adults is a relatively rare disease that shares many histological similarities to renal cell carcinoma occurring in adults and yet demonstrate some unique clinical-pathological differences. Microphthalmia-associated transcription (MiT) family translocation RCC and rare familial syndrome subtypes are relatively more frequent in the paediatric and adolescent age groups than in adults. Clear cell RCC still accounted for the most common subtype seen in this age group. MiT family translocation RCC patients presented with advanced stage disease and had poor clinical outcomes. The large and heterogeneous subgroup of unclassified renal cell carcinoma contains phenotypically distinct tumours with further potential for future subcategories in the renal cell carcinoma classification.
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Affiliation(s)
- Eman Abdulfatah
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - John M Kennedy
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Khaled Hafez
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Matthew S Davenport
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Radiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Hong Xiao
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Alon Z Weizer
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ganesh S Palapattu
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Todd M Morgan
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Rahul Mannan
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA.,Michigan Center for Translational Pathology, Ann Arbor, MI, USA
| | - Xiao-Ming Wang
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA.,Michigan Center for Translational Pathology, Ann Arbor, MI, USA
| | - Saravana M Dhanasekaran
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA.,Michigan Center for Translational Pathology, Ann Arbor, MI, USA
| | | | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lakshmi Kunju
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Angela Wu
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Madelyn Lew
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Aaron M Udager
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA.,Michigan Center for Translational Pathology, Ann Arbor, MI, USA.,Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA
| | - Arul M Chinnaiyan
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA.,Michigan Center for Translational Pathology, Ann Arbor, MI, USA.,Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA.,Howard Hughes Medical Institute, Ann Arbor, MI, USA
| | - Rohit Mehra
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA.,Michigan Center for Translational Pathology, Ann Arbor, MI, USA.,Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA
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Kaffenberger SD, Brown J, Merrill N, Marchetti K, Bao LW, Cheng X, Udager AM, Herrel LA, Vandecan N, Montgomery JS, Hafez K, Weizer A, Morgan TM, Alva AS, Soellner M, Merajver S. Rapid organoid development, drug screening, and neoadjuvant chemotherapy response prediction for patients with locally advanced bladder cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
543 Background: Neoadjuvant chemotherapy prior to radical cystectomy (RC) for muscle-invasive urothelial carcinoma (UCCx) is the standard of care though the absolute survival benefit is small, and some patients progress during chemotherapy. While progress has been made in the prediction of sensitivity to platinum-based chemotherapies, providing more accurate, personalized, and clinically-relevant chemotherapy response prediction is an unmet need. We present our early and ongoing experience with rapid, organoid-based drug-screening. Methods: one gram of tumor was procured from patients undergoing TURBT or RC and divided between DNA/RNA sequencing, organoid drug-screening, and patient-derived xenografts. Tissue was dissociated, filtered, and resuspended in organoid media for serial passage and drug screening. Drugs were tested at “Cmax” concentration, which is the maximum plasma concentration in human trials so as to provide physiologic relevance. Results were normalized to control such that a value of 100 indicated no drug effect compared to control, and a value of 0 indicated complete response. Number of drugs screened was dependent upon tissue available, but was often 20-30. Results: 25 patients have undergone rapid organoid development and drug testing to date. Clinical correlations with chemotherapy response are ongoing. Drug response analyses were available 5-10 days following procedure. Select drug response data from the 9 most recent patient organoid samples are presented in the Table. DNA and RNA sequencing and PDX models are in progress. Conclusions: This platform allows for the rapid determination of neoadjuvant chemotherapy response and may further guide selection of therapeutic agents in patients with locally advanced bladder cancer.[Table: see text]
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Affiliation(s)
| | - Jason Brown
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | | | | | | | - Xu Cheng
- University of Michigan, Ann Arbor, MI
| | | | | | | | | | - Khaled Hafez
- Department of Urology, University of Michigan, Ann Arbor, MI
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Silverman SG, Pedrosa I, Ellis JH, Hindman NM, Schieda N, Smith AD, Remer EM, Shinagare AB, Curci NE, Raman SS, Wells SA, Kaffenberger SD, Wang ZJ, Chandarana H, Davenport MS. Bosniak Classification of Cystic Renal Masses, Version 2019: An Update Proposal and Needs Assessment. Radiology 2019; 292:475-488. [PMID: 31210616 DOI: 10.1148/radiol.2019182646] [Citation(s) in RCA: 226] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cystic renal cell carcinoma (RCC) is almost certainly overdiagnosed and overtreated. Efforts to diagnose and treat RCC at a curable stage result in many benign neoplasms and indolent cancers being resected without clear benefit. This is especially true for cystic masses, which compared with solid masses are more likely to be benign and, when malignant, less aggressive. For more than 30 years, the Bosniak classification has been used to stratify the risk of malignancy in cystic renal masses. Although it is widely used and still effective, the classification does not formally incorporate masses identified at MRI or US or masses that are incompletely characterized but are highly likely to be benign, and it is affected by interreader variability and variable reported malignancy rates. The Bosniak classification system cannot fully differentiate aggressive from indolent cancers and results in many benign masses being resected. This proposed update to the Bosniak classification addresses some of these shortcomings. The primary modifications incorporate MRI, establish definitions for previously vague imaging terms, and enable a greater proportion of masses to enter lower-risk classes. Although the update will require validation, it aims to expand the number of cystic masses to which the Bosniak classification can be applied while improving its precision and accuracy for the likelihood of cancer in each class.
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Affiliation(s)
- Stuart G Silverman
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Ivan Pedrosa
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - James H Ellis
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Nicole M Hindman
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Nicola Schieda
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Andrew D Smith
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Erick M Remer
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Atul B Shinagare
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Nicole E Curci
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Steven S Raman
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Shane A Wells
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Samuel D Kaffenberger
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Zhen J Wang
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Hersh Chandarana
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Matthew S Davenport
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
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Salami SS, Kaplan JB, Nallandhighal S, Takhar M, Tosoian JJ, Lee M, Yoon J, Hovelson DH, Plouffe KR, Kaffenberger SD, Schaeffer EM, Karnes RJ, Lotan TL, Morgan TM, George AK, Montgomery JS, Davenport MS, You S, Tomlins SA, Curci NE, Kim HL, Spratt DE, Udager AM, Palapattu GS. Biologic Significance of Magnetic Resonance Imaging Invisibility in Localized Prostate Cancer. JCO Precis Oncol 2019; 3:1900054. [PMID: 32914029 DOI: 10.1200/po.19.00054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Multiparametric magnetic resonance imaging (mpMRI) is used widely for prostate cancer (PCa) evaluation. Approximately 35% of aggressive tumors, however, are not visible on mpMRI. We sought to identify the molecular alterations associated with mpMRI-invisible tumors and determine whether mpMRI visibility is associated with PCa prognosis. METHODS Discovery and validation cohorts included patients who underwent mpMRI before radical prostatectomy and were found to harbor both mpMRI-visible (Prostate Imaging and Reporting Data System 3 to 5) and -invisible (Prostate Imaging and Reporting Data System 1 or 2) foci on surgical pathology. Next-generation sequencing was performed to determine differential gene expression between mpMRI-visible and -invisible foci. A genetic signature for tumor mpMRI visibility was derived in the discovery cohort and assessed in an independent validation cohort. Its association with long-term oncologic outcomes was evaluated in a separate testing cohort. RESULTS The discovery cohort included 10 patients with 26 distinct PCa foci on surgical pathology, of which 12 (46%) were visible and 14 (54%) were invisible on preoperative mpMRI. Next-generation sequencing detected prioritized genetic mutations in 14 (54%) tumor foci (n = 8 mpMRI visible, n = 6 mpMRI invisible). A nine-gene signature (composed largely of cell organization/structure genes) associated with mpMRI visibility was derived (area under the curve = 0.89), and the signature predicted MRI visibility with 75% sensitivity and 100% specificity (area under the curve = 0.88) in the validation cohort. In the testing cohort (n = 375, median follow-up 8 years) there was no significant difference in biochemical recurrence, distant metastasis, or cancer-specific mortality in patients with predicted mpMRI-visible versus -invisible tumors (all P > .05). CONCLUSION Compared with mpMRI-invisible disease, mpMRI-visible tumors are associated with underexpression of cellular organization genes. mpMRI visibility does not seem to be predictive of long-term cancer outcomes, highlighting the need for biopsy strategies that detect mpMRI-invisible tumors.
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Affiliation(s)
- Simpa S Salami
- Michigan Medicine, Ann Arbor, MI.,University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | | | | | | | | | - Junhee Yoon
- Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | - Samuel D Kaffenberger
- Michigan Medicine, Ann Arbor, MI.,University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | | | | | - Todd M Morgan
- Michigan Medicine, Ann Arbor, MI.,University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Arvin K George
- Michigan Medicine, Ann Arbor, MI.,University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Jeffrey S Montgomery
- Michigan Medicine, Ann Arbor, MI.,University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | | | - Scott A Tomlins
- Michigan Medicine, Ann Arbor, MI.,University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | - Hyung L Kim
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - Daniel E Spratt
- University of Michigan Rogel Cancer Center, Ann Arbor, MI.,Michigan Medicine, Ann Arbor, MI
| | - Aaron M Udager
- Michigan Medicine, Ann Arbor, MI.,University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Ganesh S Palapattu
- Michigan Medicine, Ann Arbor, MI.,University of Michigan Rogel Cancer Center, Ann Arbor, MI.,Medical University of Vienna, Vienna, Austria
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20
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Davenport MS, Hu EM, Zhang A, Shinagare AB, Smith AD, Pedrosa I, Kaffenberger SD, Silverman SG. Standardized report template for indeterminate renal masses at CT and MRI: a collaborative product of the SAR Disease-Focused Panel on Renal Cell Carcinoma. Abdom Radiol (NY) 2019; 44:1423-1429. [PMID: 30511089 DOI: 10.1007/s00261-018-1851-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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] [Indexed: 01/14/2023]
Abstract
PURPOSE To create a succinct yet comprehensive evidence-based structured report template for indeterminate renal masses characterized at CT and MRI. METHODS This IRB-exempt, iterative, multi-institutional quality improvement project was informed by published data derived from a multi-institutional survey and a multi-institutional review of CT and MRI radiology reports. A two-stage blinded Delphi process by the 16-member 12-institution Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma was conducted to create a structured report template for indeterminate renal masses evaluated at CT and MRI. Individual reporting characteristics were scored by members as 'core,' 'optional,' or 'exclude.' Threshold for inclusion was ≥ 80% support. If < 80% members considered a characteristic a 'core' feature, but ≥ 80% considered it either 'core' or 'optional,' it was considered an 'optional' feature. If neither was the case, the characteristic was excluded. Free-text comments were permitted. Characteristics considered 'core' by 50-99% of respondents in Round 1 (i.e., nonunanimous support) and uninvestigated free-text comments were assessed in Round 2. Core and optional structured reporting templates were derived. RESULTS The response rate was 100% in Round 1 (16/16) and Round 2 (16/16). In Round 1, 5 characteristics had unanimous support as 'core' features. Following Round 2, 13 characteristics had ≥ 80% support as 'core' features, and 10 characteristics had ≥ 80% support as 'optional' features. Structured report templates were derived. DISCUSSION Structured 'core' and 'optional' templates for indeterminate renal masses at CT and MRI were derived, which may improve compliance with reporting preferred and essential imaging characteristics.
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Affiliation(s)
- Matthew S Davenport
- Department of Radiology, Michigan Medicine, 1500 E. Medical Center Dr. B2-A209P, Ann Arbor, MI, 48108, USA.
- Michigan Radiology Quality Collaborative, Ann Arbor, MI, USA.
- Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Houston, TX, USA.
| | - Eric M Hu
- Department of Radiology, Michigan Medicine, 1500 E. Medical Center Dr. B2-A209P, Ann Arbor, MI, 48108, USA
- Michigan Radiology Quality Collaborative, Ann Arbor, MI, USA
| | - Andrew Zhang
- Department of Radiology, Michigan Medicine, 1500 E. Medical Center Dr. B2-A209P, Ann Arbor, MI, 48108, USA
- Michigan Radiology Quality Collaborative, Ann Arbor, MI, USA
| | | | | | | | - Samuel D Kaffenberger
- Department of Radiology, Michigan Medicine, 1500 E. Medical Center Dr. B2-A209P, Ann Arbor, MI, 48108, USA
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21
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Salami SS, Kaplan JB, Nallandhighal S, Takhar M, Tosoian JJ, Lee M, Yoon J, Hovelson DH, Plouffe KR, Kaffenberger SD, George AK, Montgomery JS, Davenport M, You S, Tomlins SA, Curci NE, Kim HL, Spratt DE, Udager AM, Palapattu GS. Radiogenomic characterization of multifocal prostate cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.126] [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
126 Background: Up to 20% of patients with negative multiparametric magnetic resonance imaging (MRI) harbor Gleason score ≥7 prostate cancer (PCa). We sought to elucidate the molecular basis of and determine the prognostic significance of PCa visibility on MRI. Methods: We identified a retrospective cohort of patients who underwent MRI prior to prostatectomy with both MRI visible (PIRADS 3 – 5) and invisible PCa. MRI for each patient was re-reviewed and co-registered with whole-mount histopathology. DNA and RNA were co-isolated from all tumor foci pre-identified on FFPE specimens. High depth, targeted DNA and RNA next generation sequencing was performed to characterize the molecular profile of each tumor focus using the Oncomine Comprehensive Panel (DNA) and a custom targeted RNAseq panel assessing PCa relevant alterations. A multigene RNAseq model was developed and validated in two independent cohorts to predict MRI visible PCa and to determine the prognostic significance of MRI visibility. Results: A total of 26 primary tumor foci from 10 patients were analyzed. Of the 14 (54%) invisible lesions on MRI, 5 (36%) were Gleason 3+4 = 7 and the remainder were Gleason 6. We detected high-confidence prioritized PCa relevant mutations in 54% (14/26) of tumor foci, 43% (6/14) of which were in MRI invisible lesions. Notable point mutations were in APC, AR, ARID1B, ATM, ATRX, BRCA2, FAT1, MAP3K1, NF1, SPEN, SPOP, and TP53. A 9-gene RNA signature, the majority of which were under-expressed cellular organization and structure genes, was developed to predict MRI visibility with an AUC of 0.89. Validation of this signature in an independent data set (n = 16) yielded an AUC of 0.88 with a specificity of 100% for predicting MRI visible tumors. Using this signature in a cohort of 375 patients with clinical follow up, we found that predicted MRI visibility status was not an independent predictor of biochemical recurrence, metastasis-free survival, or PCa specific mortality (all p > 0.05). Conclusions: We observed under-expression of cellular organization and structural genes in MRI visible tumors compared to MRI invisible cancer foci. Using our validated signature to predict MRI visibility status, we found that MRI visibility is not a significant predictor of oncological outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Junhee Yoon
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | | | | | | | | | - Sungyong You
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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22
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Simon CT, Skala SL, Magers MJ, Weizer A, Kaffenberger SD, Chinnaiyan AM, Spratt DE, Montgomery J, Mehra R, Lew M. The utility of upper urinary tract urine cytology before and after application of the Paris system. Diagn Cytopathol 2018; 47:421-427. [DOI: 10.1002/dc.24127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/20/2018] [Accepted: 10/24/2018] [Indexed: 02/06/2023]
Affiliation(s)
| | - Stephanie L. Skala
- Department of PathologyUniversity of Michigan Health System Ann Arbor Michigan
| | | | - Alon Weizer
- Department of UrologyUniversity of Michigan Health System Ann Arbor Michigan
| | | | - Arul M. Chinnaiyan
- Department of PathologyUniversity of Michigan Health System Ann Arbor Michigan
| | - Daniel E. Spratt
- Department of UrologyUniversity of Michigan Health System Ann Arbor Michigan
| | - Jeffrey Montgomery
- Department of UrologyUniversity of Michigan Health System Ann Arbor Michigan
| | - Rohit Mehra
- Department of PathologyUniversity of Michigan Health System Ann Arbor Michigan
| | - Madelyn Lew
- Department of PathologyUniversity of Michigan Health System Ann Arbor Michigan
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23
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Hu EM, Zhang A, Silverman SG, Pedrosa I, Wang ZJ, Smith AD, Chandarana H, Doshi A, Shinagare AB, Remer EM, Kaffenberger SD, Miller DC, Davenport MS. Multi-institutional analysis of CT and MRI reports evaluating indeterminate renal masses: comparison to a national survey investigating desired report elements. Abdom Radiol (NY) 2018; 43:3493-3502. [PMID: 29666953 DOI: 10.1007/s00261-018-1609-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 01/07/2023]
Abstract
PURPOSE To determine the need for a standardized renal mass reporting template by analyzing reports of indeterminate renal masses and comparing their contents to stated preferences of radiologists and urologists. METHODS The host IRB waived regulatory oversight for this multi-institutional HIPAA-compliant quality improvement effort. CT and MRI reports created to characterize an indeterminate renal mass were analyzed from 6 community (median: 17 reports/site) and 6 academic (median: 23 reports/site) United States practices. Report contents were compared to a published national survey of stated preferences by academic radiologists and urologists from 9 institutions. Descriptive statistics and Chi-square tests were calculated. RESULTS Of 319 reports, 85% (271; 192 CT, 79 MRI) reported a possibly malignant mass (236 solid, 35 cystic). Some essential elements were commonly described: size (99% [269/271]), mass type (solid vs. cystic; 99% [268/271]), enhancement (presence vs. absence; 92% [248/271]). Other essential elements had incomplete penetrance: the presence or absence of fat in solid masses (14% [34/236]), size comparisons when available (79% [111/140]), Bosniak classification for cystic masses (54% [19/35]). Preferred but non-essential elements generally were described in less than half of reports. Nephrometry scores usually were not included for local therapy candidates (12% [30/257]). Academic practices were significantly more likely than community practices to include mass characterization details, probability of malignancy, and staging. Community practices were significantly more likely to include management recommendations. CONCLUSIONS Renal mass reporting elements considered essential or preferred often are omitted in radiology reports. Variation exists across radiologists and practice settings. A standardized template may mitigate these inconsistencies.
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Affiliation(s)
- Eric M Hu
- Michigan Medicine, Ann Arbor, MI, USA.,Michigan Radiology Quality Collaborative, Ann Arbor, MI, USA
| | - Andrew Zhang
- Michigan Medicine, Ann Arbor, MI, USA.,Michigan Radiology Quality Collaborative, Ann Arbor, MI, USA
| | - Stuart G Silverman
- Brigham and Women's, Boston, MA, USA.,Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Ivan Pedrosa
- UT Southwestern, Dallas, TX, USA.,Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Zhen J Wang
- UCSF, San Francisco, CA, USA.,Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Andrew D Smith
- UAB, Birmingham, AL, USA.,Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Hersh Chandarana
- NYU, New York, NY, USA.,Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Ankur Doshi
- NYU, New York, NY, USA.,Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Atul B Shinagare
- Brigham and Women's, Boston, MA, USA.,Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Erick M Remer
- Cleveland Clinic, Cleveland, OH, USA.,Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Samuel D Kaffenberger
- Michigan Medicine, Ann Arbor, MI, USA.,Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI, USA
| | - David C Miller
- Michigan Medicine, Ann Arbor, MI, USA.,Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI, USA
| | - Matthew S Davenport
- Michigan Medicine, Ann Arbor, MI, USA. .,Michigan Radiology Quality Collaborative, Ann Arbor, MI, USA. .,Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA. .,Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI, USA. .,Department of Radiology, 1500 E. Medical Center Dr. B2-A209P, Ann Arbor, MI, 48108, USA.
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24
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Hu EM, Zhang A, Silverman SG, Pedrosa I, Wang ZJ, Smith AD, Chandarana H, Doshi A, Shinagare AB, Remer EM, Kaffenberger SD, Miller DC, Davenport MS. Correction to: Multi-institutional analysis of CT and MRI reports evaluating indeterminate renal masses: comparison to a national survey investigating desired report elements. Abdom Radiol (NY) 2018; 43:3206. [PMID: 29767283 DOI: 10.1007/s00261-018-1632-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: 11/24/2022]
Abstract
The original version of this article contained an error in author name. The co-author's name was published as Ivan M. Pedrosa, instead it should be Ivan Pedrosa. The original article has been corrected.
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Affiliation(s)
- Eric M Hu
- Michigan Medicine, Ann Arbor, MI, USA
- Michigan Radiology Quality Collaborative, Ann Arbor, MI, USA
| | - Andrew Zhang
- Michigan Medicine, Ann Arbor, MI, USA
- Michigan Radiology Quality Collaborative, Ann Arbor, MI, USA
| | - Stuart G Silverman
- Brigham and Women's, Boston, MA, USA
- Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Ivan Pedrosa
- UT Southwestern, Dallas, TX, USA
- Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Zhen J Wang
- UCSF, San Francisco, CA, USA
- Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Andrew D Smith
- UAB, Birmingham, AL, USA
- Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Hersh Chandarana
- NYU, New York, NY, USA
- Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Ankur Doshi
- NYU, New York, NY, USA
- Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Atul B Shinagare
- Brigham and Women's, Boston, MA, USA
- Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Erick M Remer
- Cleveland Clinic, Cleveland, OH, USA
- Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Samuel D Kaffenberger
- Michigan Medicine, Ann Arbor, MI, USA
- Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI, USA
| | - David C Miller
- Michigan Medicine, Ann Arbor, MI, USA
- Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI, USA
| | - Matthew S Davenport
- Michigan Medicine, Ann Arbor, MI, USA.
- Michigan Radiology Quality Collaborative, Ann Arbor, MI, USA.
- Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA.
- Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI, USA.
- Department of Radiology, 1500 E. Medical Center Dr. B2-A209P, Ann Arbor, MI, 48108, USA.
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25
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Modi PK, Hollenbeck BK, Oerline M, Weizer AZ, Montgomery JS, Kaffenberger SD, Ryan AM, Ellimoottil C. Real-World Impact of Minimally Invasive Versus Open Radical Cystectomy on Perioperative Outcomes and Spending. Urology 2018; 125:86-91. [PMID: 30366043 DOI: 10.1016/j.urology.2018.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/04/2018] [Accepted: 10/09/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the effect of the minimally invasive approach on spending and perioperative outcomes for patients undergoing radical cystectomy for bladder cancer. In a randomized control trial conducted at high-volume centers, robotic, and open cystectomy were shown to have similar outcomes. However, because the majority of cystectomies are performed in low-volume centers, it is unknown whether these findings are broadly generalizable. MATERIALS AND METHODS We identified Medicare patients who underwent radical cystectomy for bladder cancer between 2008 and 2015. We examined the length of stay, readmission rate, and 90-day spending after minimally invasive or open cystectomy. We used multiple regressions to estimate the association between minimally invasive surgery and the outcomes, accounting for patient, hospital, and surgeon factors that may influence these outcomes. RESULTS Of 4760 patients, 693 (14.6%) underwent minimally invasive cystectomy and 4067 (85.4%) had an open approach. Minimally invasive cystectomy was associated with shorter length of stay (10.1 days vs 11.9 days, P <.001), but no difference in readmission rate (27.4% vs 26.8%, P = .77). Minimally invasive cystectomy was associated with lower adjusted 90-day episode spending ($34,369 vs $38,071, P <.001). CONCLUSION In patients across diverse institutions in the United States, minimally invasive cystectomy was associated with a shorter length of stay than open cystectomy and reduced 90-day episode spending, but with no significant difference in readmission rate.
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Affiliation(s)
- Parth K Modi
- Department of Urology, Division of Urologic Oncology, University of Michigan, Ann Arbor, MI; Department of Urology, Division of Health Services Research, University of Michigan, Ann Arbor, MI.
| | - Brent K Hollenbeck
- Department of Urology, Division of Urologic Oncology, University of Michigan, Ann Arbor, MI; Department of Urology, Division of Health Services Research, University of Michigan, Ann Arbor, MI
| | - Mary Oerline
- Department of Urology, Division of Health Services Research, University of Michigan, Ann Arbor, MI
| | - Alon Z Weizer
- Department of Urology, Division of Urologic Oncology, University of Michigan, Ann Arbor, MI
| | - Jeffrey S Montgomery
- Department of Urology, Division of Urologic Oncology, University of Michigan, Ann Arbor, MI
| | - Samuel D Kaffenberger
- Department of Urology, Division of Urologic Oncology, University of Michigan, Ann Arbor, MI
| | - Andrew M Ryan
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI
| | - Chad Ellimoottil
- Department of Urology, Division of Health Services Research, University of Michigan, Ann Arbor, MI
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26
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Udager AM, McDaniel AS, Hovelson DH, Fields K, Salami SS, Kaffenberger SD, Spratt DE, Montgomery JS, Weizer AZ, Reichert ZR, Alva AS, Chinnaiyan AM, Tomlins SA, Mehra R. Frequent PD-L1 Protein Expression and Molecular Correlates in Urinary Bladder Squamous Cell Carcinoma. Eur Urol 2018; 74:529-531. [DOI: 10.1016/j.eururo.2018.06.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/13/2018] [Indexed: 11/25/2022]
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27
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Davenport MS, Chandarana H, Curci NE, Doshi A, Kaffenberger SD, Pedrosa I, Remer EM, Schieda N, Shinagare AB, Smith AD, Wang ZJ, Wells SA, Silverman SG. Society of Abdominal Radiology disease-focused panel on renal cell carcinoma: update on past, current, and future goals. Abdom Radiol (NY) 2018; 43:2213-2220. [PMID: 29948056 DOI: 10.1007/s00261-018-1663-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The disease-focused panel (DFP) program was created by the Society of Abdominal Radiology (SAR) as a mechanism to "improve patient care, education, and research" in a "particular disease or a particular aspect of a disease". The DFP on renal cell carcinoma (RCC) was proposed in 2014 and has been functional for 4 years. Although nominally focused on RCC, the scope of the DFP has included indeterminate renal masses because many cannot be assigned a specific diagnosis when detected. Since its founding, the DFP has been active in a variety of clinical, research, and educational projects to optimize the care of patients with known or suspected RCC. The DFP is utilizing multi-institutional and cross-disciplinary collaboration to differentiate benign from malignant disease, optimize the management of early stage RCC, and ultimately to differentiate indolent from aggressive cancers. Several additional projects have worked to develop a quantitative biomarker that predicts metastatic RCC response to anti-angiogenic therapy. While disease focus is the premise by which all DFPs are created, it is likely that in the future the RCC DFP will need to expand or create new panels that will focus on other specific aspects of RCC-a result that the program's founders envisioned. New knowledge creates a need for more focus.
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Affiliation(s)
- Matthew S Davenport
- Michigan Medicine, Ann Arbor, MI, USA.
- Michigan Radiology Quality Collaborative, Ann Arbor, MI, USA.
- Department of Radiology, Michigan Medicine, 1500 E. Medical Center Dr. B2-A209P, Ann Arbor, MI, 48108, USA.
| | | | | | - Ankur Doshi
- NYU Langone Medical Center, New York, NY, USA
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28
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Jackson WC, Suresh K, Tumati V, Dess RT, Soni PD, Zhao SG, Zumsteg ZS, Hannan R, Hollenbeck BK, George A, Kaffenberger SD, Salami SS, Hearn JW, Morgan TM, Mehra R, Schipper M, Feng FY, Desai NB, Spratt DE. Impact of Biochemical Failure After Salvage Radiation Therapy on Prostate Cancer–specific Mortality: Competition Between Age and Time to Biochemical Failure. Eur Urol Oncol 2018; 1:276-282. [DOI: 10.1016/j.euo.2018.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/30/2018] [Accepted: 04/20/2018] [Indexed: 10/28/2022]
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Affiliation(s)
| | - David C Miller
- Department of Urology, University of Michigan, Ann Arbor
| | - Matthew E Nielsen
- Department of Urology, University of North Carolina at Chapel Hill
- Department of Epidemiology, University of North Carolina at Chapel Hill
- Department of Health Policy and Management, University of North Carolina at Chapel Hill
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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30
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Spratt DE, Suresh K, Osawa T, Schipper M, Jackson WC, Abugharib A, Lebastchi A, Smith D, Montgomery JS, Palapattu GS, Priya Kunju L, Wu A, Lew M, Tomlins SA, Chinnaiyan AM, Weizer AZ, Hafez KS, Kaffenberger SD, Udager A, Mehra R. Detailed pathologic analysis on the co-occurrence of non-seminomatous germ cell tumor subtypes in matched orchiectomy and retroperitoneal lymph node dissections. Med Oncol 2018; 35:21. [PMID: 29387987 DOI: 10.1007/s12032-018-1090-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/19/2018] [Indexed: 11/30/2022]
Abstract
The frequency of co-occurrence between germ cell tumor (GCT) components in non-seminomatous germ cell tumor (NSGCT) orchiectomy specimens and their correlation with histologic findings in subsequent retroperitoneal lymph node dissection (RPLND) specimens have not been well characterized. The objective of the study was to report the first detailed clinicopathologic analysis of NSGCT orchiectomy and RPLND samples to determine the likelihood and agreement of the co-occurrence of GCT components. A total of 118 consecutive patients with NSGCT treated between 1988 and 2012 who underwent both orchiectomy and RPLND at a single academic tertiary care center were analyzed. Statistical analysis of co-occurrence likelihood and agreement of GCT components was performed, both within and between orchiectomy and RPLND specimens. Embryonal carcinoma was the most frequent component present in orchiectomy specimens, and there were multiple significant associations between orchiectomy GCT components; seminoma occurred less frequently with embryonal carcinoma (OR 0.29 [95% confidence interval (CI) 0.11-0.75]; p < 0.01), and teratoma more frequently occurred with choriocarcinoma (OR 9.64 [95% CI 1.22-76.12]; p = 0.01). Presence of teratoma in the orchiectomy specimen predicted for a fourfold increase in distant metastasis on multivariate analysis (HR 4.92 [1.14-18.9]; p = 0.02). The only significant association of co-occurrence in the RPLND specimen was between embryonal carcinoma and teratoma (OR 0.01 [95% CI 0-0.07]; p < 0.001), where it was significantly less likely for them to occur together. Our findings are limited by their retrospective nature. The co-occurrence of GCT components within orchiectomy specimens does not appear to be a completely random process. However, there is less agreement and more randomness between the occurrence of the GCT components in matched orchiectomy and RPLND samples. In this report, we look at the co-occurrence of different GCT components within matched orchiectomy and RPLND pathology specimens and show that co-occurrence is not a completely random process.
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Affiliation(s)
- Daniel E Spratt
- Department of Radiation Oncology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Krithika Suresh
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Takahiro Osawa
- Graduate School of Medicine, Hokkaido University, N15 W7 Kita-ku, Sapporo, 060-8638, Japan
| | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.,Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - William C Jackson
- Department of Radiation Oncology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Ahmed Abugharib
- Department of Radiation Oncology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Amir Lebastchi
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - David Smith
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | | | - Ganesh S Palapattu
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA.,Department of Urology, Medical University of Vienna, Vienna, Austria
| | - L Priya Kunju
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Angela Wu
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Madelyn Lew
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Scott A Tomlins
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Arul M Chinnaiyan
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA.,Michigan Center for Translational Pathology, Ann Arbor, MI, USA.,Howard Hughes Medical Institute, Ann Arbor, MI, USA
| | - Alon Z Weizer
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Khaled S Hafez
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | | | - Aaron Udager
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Rohit Mehra
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA.,Michigan Center for Translational Pathology, Ann Arbor, MI, USA
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31
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Kaffenberger SD, Weizer AZ. Editorial Comment. J Urol 2017; 198:1038. [DOI: 10.1016/j.juro.2017.06.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Alon Z. Weizer
- Department of Urology, University of Michigan, Ann Arbor, Michigan
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Bagrodia A, Woldu S, Penson DF, Kutikov A, Kaffenberger SD. Re: Sophia C. Kamran, Thomas Seisen, Sarah C. Markt, et al. Contemporary Treatment Patterns and Outcomes for Clinical Stage IS Testicular Cancer. Eur Urol 2018;73:262-70. Eur Urol 2017; 73:e98-e99. [PMID: 29032846 DOI: 10.1016/j.eururo.2017.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 09/15/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Aditya Bagrodia
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Solomon Woldu
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David F Penson
- Vanderbilt University Medical Center, Nashville, TN, USA
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Viswanathan VS, Ryan MJ, Dhruv HD, Gill S, Eichhoff OM, Seashore-Ludlow B, Kaffenberger SD, Eaton JK, Shimada K, Aguirre AJ, Viswanathan SR, Chattopadhyay S, Tamayo P, Yang WS, Rees MG, Chen S, Boskovic ZV, Javaid S, Huang C, Wu X, Tseng YY, Roider EM, Gao D, Cleary JM, Wolpin BM, Mesirov JP, Haber DA, Engelman JA, Boehm JS, Kotz JD, Hon CS, Chen Y, Hahn WC, Levesque MP, Doench JG, Berens ME, Shamji AF, Clemons PA, Stockwell BR, Schreiber SL. Dependency of a therapy-resistant state of cancer cells on a lipid peroxidase pathway. Nature 2017; 547:453-457. [PMID: 28678785 DOI: 10.1038/nature23007] [Citation(s) in RCA: 1053] [Impact Index Per Article: 150.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 05/24/2017] [Indexed: 12/16/2022]
Abstract
Plasticity of the cell state has been proposed to drive resistance to multiple classes of cancer therapies, thereby limiting their effectiveness. A high-mesenchymal cell state observed in human tumours and cancer cell lines has been associated with resistance to multiple treatment modalities across diverse cancer lineages, but the mechanistic underpinning for this state has remained incompletely understood. Here we molecularly characterize this therapy-resistant high-mesenchymal cell state in human cancer cell lines and organoids and show that it depends on a druggable lipid-peroxidase pathway that protects against ferroptosis, a non-apoptotic form of cell death induced by the build-up of toxic lipid peroxides. We show that this cell state is characterized by activity of enzymes that promote the synthesis of polyunsaturated lipids. These lipids are the substrates for lipid peroxidation by lipoxygenase enzymes. This lipid metabolism creates a dependency on pathways converging on the phospholipid glutathione peroxidase (GPX4), a selenocysteine-containing enzyme that dissipates lipid peroxides and thereby prevents the iron-mediated reactions of peroxides that induce ferroptotic cell death. Dependency on GPX4 was found to exist across diverse therapy-resistant states characterized by high expression of ZEB1, including epithelial-mesenchymal transition in epithelial-derived carcinomas, TGFβ-mediated therapy-resistance in melanoma, treatment-induced neuroendocrine transdifferentiation in prostate cancer, and sarcomas, which are fixed in a mesenchymal state owing to their cells of origin. We identify vulnerability to ferroptic cell death induced by inhibition of a lipid peroxidase pathway as a feature of therapy-resistant cancer cells across diverse mesenchymal cell-state contexts.
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Affiliation(s)
| | - Matthew J Ryan
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA
| | - Harshil D Dhruv
- Cancer and Cell Biology Division, The Translational Genomics Research Institute, 445 N 5th Street, Phoenix, Arizona 85004, USA
| | - Shubhroz Gill
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA
| | - Ossia M Eichhoff
- Department of Dermatology, University of Zurich, University Hospital of Zurich, Wagistrasse 14, CH-8952, Schlieren, Zürich, Switzerland
| | | | - Samuel D Kaffenberger
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA
| | - John K Eaton
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA
| | - Kenichi Shimada
- Laboratory of Systems Pharmacology, Harvard Medical School, 200 Longwood Avenue, Boston, Massachusetts 02115, USA
| | - Andrew J Aguirre
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02115, USA
| | - Srinivas R Viswanathan
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02115, USA
| | | | - Pablo Tamayo
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA.,Moores Cancer Center &Department of Medicine, School of Medicine, University of California San Diego, La Jolla, California 92093, USA
| | - Wan Seok Yang
- Department of Biological Sciences, St. John's University, 8000 Utopia Parkway, Queens, New York 11439, USA
| | - Matthew G Rees
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA
| | - Sixun Chen
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA
| | - Zarko V Boskovic
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA
| | - Sarah Javaid
- Massachusetts General Hospital Cancer Center, 149 13th Street, Charlestown, Massachusetts 02129, USA
| | - Cherrie Huang
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA
| | - Xiaoyun Wu
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA
| | - Yuen-Yi Tseng
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA
| | - Elisabeth M Roider
- Department of Dermatology, University of Zurich, University Hospital of Zurich, Wagistrasse 14, CH-8952, Schlieren, Zürich, Switzerland
| | - Dong Gao
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA
| | - James M Cleary
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02115, USA
| | - Brian M Wolpin
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02115, USA
| | - Jill P Mesirov
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA.,Moores Cancer Center &Department of Medicine, School of Medicine, University of California San Diego, La Jolla, California 92093, USA
| | - Daniel A Haber
- Massachusetts General Hospital Cancer Center, 149 13th Street, Charlestown, Massachusetts 02129, USA.,Howard Hughes Medical Institute, Chevy Chase, Maryland 20815, USA
| | - Jeffrey A Engelman
- Oncology Disease Area, Novartis Institute for Biomedical Research, Cambridge, Massachusetts 02139, USA
| | - Jesse S Boehm
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA
| | - Joanne D Kotz
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA
| | - Cindy S Hon
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA
| | - Yu Chen
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA
| | - William C Hahn
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02115, USA
| | - Mitchell P Levesque
- Department of Dermatology, University of Zurich, University Hospital of Zurich, Wagistrasse 14, CH-8952, Schlieren, Zürich, Switzerland
| | - John G Doench
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA
| | - Michael E Berens
- Cancer and Cell Biology Division, The Translational Genomics Research Institute, 445 N 5th Street, Phoenix, Arizona 85004, USA
| | - Alykhan F Shamji
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA
| | - Paul A Clemons
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA
| | - Brent R Stockwell
- Department of Biological Sciences, Department of Chemistry, Columbia University, 550 West 120th Street, New York, New York 10027, USA
| | - Stuart L Schreiber
- Broad Institute, 415 Main Street, Cambridge, Massachusetts 02142, USA.,Howard Hughes Medical Institute, Chevy Chase, Maryland 20815, USA.,Department of Chemistry and Chemical Biology, Harvard University, 12 Oxford St., Cambridge, Massachusetts 02138, USA
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Şenbabaoğlu Y, Gejman RS, Winer AG, Liu M, Van Allen EM, de Velasco G, Miao D, Ostrovnaya I, Drill E, Luna A, Weinhold N, Lee W, Manley BJ, Khalil DN, Kaffenberger SD, Chen Y, Danilova L, Voss MH, Coleman JA, Russo P, Reuter VE, Chan TA, Cheng EH, Scheinberg DA, Li MO, Choueiri TK, Hsieh JJ, Sander C, Hakimi AA. Erratum to: Tumor immune microenvironment characterization in clear cell renal cell carcinoma identifies prognostic and immunotherapeutically relevant messenger RNA signatures. Genome Biol 2017; 18:46. [PMID: 28249590 PMCID: PMC5333404 DOI: 10.1186/s13059-017-1180-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 02/23/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Yasin Şenbabaoğlu
- Computational Biology Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Present address: Swim Across America/Ludwig Collaborative Laboratory, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Ron S Gejman
- Molecular Pharmacology and Chemistry Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Andrew G Winer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ming Liu
- Immunology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eliezer M Van Allen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Diana Miao
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Irina Ostrovnaya
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Esther Drill
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Augustin Luna
- Computational Biology Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nils Weinhold
- Computational Biology Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William Lee
- Computational Biology Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brandon J Manley
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Danny N Khalil
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Samuel D Kaffenberger
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yingbei Chen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ludmila Danilova
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Vavilov Institute of General Genetics, Russian Academy of Sciences, Moscow, Russia
| | - Martin H Voss
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan A Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timothy A Chan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Human Oncology & Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Emily H Cheng
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Human Oncology & Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David A Scheinberg
- Molecular Pharmacology and Chemistry Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Ming O Li
- Immunology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - James J Hsieh
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Human Oncology & Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chris Sander
- Computational Biology Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A Ari Hakimi
- Computational Biology Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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35
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Bagrodia A, Lee BH, Lee W, Cha EK, Sfakianos JP, Iyer G, Pietzak EJ, Gao SP, Zabor EC, Ostrovnaya I, Kaffenberger SD, Syed A, Arcila ME, Chaganti RS, Kundra R, Eng J, Hreiki J, Vacic V, Arora K, Oschwald DM, Berger MF, Bajorin DF, Bains MS, Schultz N, Reuter VE, Sheinfeld J, Bosl GJ, Al-Ahmadie HA, Solit DB, Feldman DR. Genetic Determinants of Cisplatin Resistance in Patients With Advanced Germ Cell Tumors. J Clin Oncol 2016; 34:4000-4007. [PMID: 27646943 DOI: 10.1200/jco.2016.68.7798] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Owing to its exquisite chemotherapy sensitivity, most patients with metastatic germ cell tumors (GCTs) are cured with cisplatin-based chemotherapy. However, up to 30% of patients with advanced GCT exhibit cisplatin resistance, which requires intensive salvage treatment, and have a 50% risk of cancer-related death. To identify a genetic basis for cisplatin resistance, we performed whole-exome and targeted sequencing of cisplatin-sensitive and cisplatin-resistant GCTs. Methods Men with GCT who received a cisplatin-containing chemotherapy regimen and had available tumor tissue were eligible to participate in this study. Whole-exome sequencing or targeted exon-capture-based sequencing was performed on 180 tumors. Patients were categorized as cisplatin sensitive or cisplatin resistant by using a combination of postchemotherapy parameters, including serum tumor marker levels, radiology, and pathology at surgical resection of residual disease. Results TP53 alterations were present exclusively in cisplatin-resistant tumors and were particularly prevalent among primary mediastinal nonseminomas (72%). TP53 pathway alterations including MDM2 amplifications were more common among patients with adverse clinical features, categorized as poor risk according to the International Germ Cell Cancer Collaborative Group (IGCCCG) model. Despite this association, TP53 and MDM2 alterations predicted adverse prognosis independent of the IGCCCG model. Actionable alterations, including novel RAC1 mutations, were detected in 55% of cisplatin-resistant GCTs. Conclusion In GCT, TP53 and MDM2 alterations were associated with cisplatin resistance and inferior outcomes, independent of the IGCCCG model. The finding of frequent TP53 alterations among mediastinal primary nonseminomas may explain the more frequent chemoresistance observed with this tumor subtype. A substantial portion of cisplatin-resistant GCTs harbor actionable alterations, which might respond to targeted therapies. Genomic profiling of patients with advanced GCT could improve current risk stratification and identify novel therapeutic approaches for patients with cisplatin-resistant disease.
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Affiliation(s)
- Aditya Bagrodia
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Byron H Lee
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - William Lee
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Eugene K Cha
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - John P Sfakianos
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Gopa Iyer
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Eugene J Pietzak
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Sizhi Paul Gao
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Emily C Zabor
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Irina Ostrovnaya
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Samuel D Kaffenberger
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Aijazuddin Syed
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Maria E Arcila
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Raju S Chaganti
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Ritika Kundra
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Jana Eng
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Joseph Hreiki
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Vladimir Vacic
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Kanika Arora
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Dayna M Oschwald
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Michael F Berger
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Dean F Bajorin
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Manjit S Bains
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Nikolaus Schultz
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Victor E Reuter
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Joel Sheinfeld
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - George J Bosl
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Hikmat A Al-Ahmadie
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - David B Solit
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
| | - Darren R Feldman
- Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Memorial Sloan Kettering Cancer Center; John P. Sfakianos, Icahn School of Medicine at Mount Sinai; Gopa Iyer, Michael F. Berger, Dean F. Bajorin, Manjit S. Bains, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman, Weill Cornell Medical College; and Vladimir Vacic, Kanika Arora, Dayna M. Oschwald, New York Genome Center, New York, NY
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Bagrodia A, Kaffenberger SD, Lee B, Lee W, Cha EK, Sfakianos J, Gao SP, Zabor EC, Ostrovnaya I, Eng J, Berger MF, Bajorin DF, Schultz N, Sheinfeld J, Bosl GJ, Al-Ahmadie H, Solit DB, Feldman DR. Actionable targets in patients with cisplatin-resistant advanced germ cell tumors. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
473 Background: Approximately 30% of patients with advanced germ cell tumor (aGCT) will progress after first-line chemotherapy. Nearly half of these patients will die of progressive GCT. We describe potentially actionable mutations in a cohort of patients with platinum-resistant aGCT through targeted sequencing. Methods: 76 patients with cisplatin-resistant (CR) disease were sequenced using the Memorial Sloan Kettering Integrated Mutation Profiling of Actionable Cancer Targets (MSK-IMPACT) assay that examines 341 cancer-related genes. Patients were categorized as CR if they met any of the following criteria: 1) incomplete response to first-line cisplatin-based chemotherapy; 2) nonteratomatous tumor progression after standard chemotherapy; 3) nonteratomatous GCT identified at postchemo surgery. We grouped all somatic mutations into core signal transduction pathways or canonical cell functions to identify potential precise targets for therapy. Results: The majority of patients had nonseminoma histology (n = 64, 84%). International Germ Cell Cancer Collaborative Group risk was good, intermediate, and poor in 34%, 13%, and 53% of patients. 17 patients died of disease. In total, 51 potentially actionable alterations were identified in 36/76 (47%) patients. In the TP53 pathway, 7 MDM2 amplifications and 4 MYCN amplifications that may sensitize to nutlin-3 inhibitors were identified. Within the receptor tyrosine kinase pathway, 3 KIT mutations, 1 KDR amplification, and 1 MET amplification were seen that may sensitize to tyrosine kinase inhibitors. Eleven KRAS mutations, 3 NRAS mutations, 3 BRAF mutations, and 2 RAC1 mutations were see among the RAS pathway with preclinical data suggesting efficacy towards respective inhibitors. Actionable targets were also among the PI3-K, WNT, and cell cycle pathways. Potential targets with chromatin modifying or tumor suppressor functions were also seen. Conclusions: We describe actionable alterations that may guide treatment selection in a significant proportion of patients with CR aGCT. Targeted sequencing of these patients may allow us to enrich future clinical trials with patients whose tumors harbor alterations in the drug target of interest.
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Affiliation(s)
| | | | - Byron Lee
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - William Lee
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eugene K. Cha
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Jana Eng
- Memorial Sloan Kettering Cancer Center, New York, NY
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Winer AG, Senbabaoglu Y, Gejman R, Ostrovnaya I, Kaffenberger SD, Voss MH, Coleman JA, Russo P, Hsieh J, Sander C, Hakimi AA. The immune landscape of renal cell carcinoma and its association with intratumoral clonality. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.605] [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
605 Background: Clear cell renal cell carcinoma (ccRCC) is among the most highly infiltrated tumors despite a relatively low mutation burden. Despite success in treating subsets of these patients with immunotherapy, the high immune-infiltration of ccRCC remains a conundrum that has not been sufficiently addressed. Methods: We utilized an original RNAseq-based aggregate immune score (Senbabaoglu Y, bioRxiv, 2015) to compare immune infiltration levels across 20 tumor types profiled in The Cancer Genome Atlas (TCGA) and validated our results with an independent cohort of ccRCC patients (Sato Y, Nat Genet, 2013). We also evaluated the immunogenic effect of intratumoral heterogeneity (ITH) through an analysis of clonal architecture in ccRCC tumors from both of the aforementioned data sets using the SciClone (Miller C, PLoS Comput Biol, 2014) algorithm. Results: We identified ccRCC as an immunogenic outlier that is unique from other highly infiltrated tumors in its exceptional overexpression of antigen presentation machinery compared to normal tissue. In a focused decomposition of immune cell levels within the 415 ccRCC tumors from TCGA, three unique clusters of tumors emerged primarily separated by varying degrees of T cell infiltration; termed (1) T-cell-enriched, (2) heterogeneous, and (3) non-infiltrated groups. These clusters were validated in an independent ccRCC cohort of 101 patients. A comparison of the degree of clonality with immune infiltration levels revealed that tumors with less ITH (i.e. fewer subclones) had significantly higher immune infiltration in both the TCGA and the validation cohort . Conclusions: Our findings provide novel insight into the immune landscape of ccRCC tumors and explore a potential mechanism for the immunogenicity of these tumors. Such information can potentially be used to aid in predicting therapeutic response to immunomodulatory agents.
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Affiliation(s)
| | | | | | | | | | | | | | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - James Hsieh
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Chris Sander
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - A. Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
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McKay RR, Lin X, Albiges L, Fay AP, Kaymakcalan MD, Mickey SS, Ghoroghchian PP, Bhatt RS, Kaffenberger SD, Simantov R, Choueiri TK, Heng DY. Statins and survival outcomes in patients with metastatic renal cell carcinoma. Eur J Cancer 2016; 52:155-62. [DOI: 10.1016/j.ejca.2015.10.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/02/2015] [Accepted: 10/07/2015] [Indexed: 11/26/2022]
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Bagrodia A, Kaffenberger SD, Vacchio MJ, Murray KS, Winer AG, Cha EK, Sankin A, Dalbagni G, Coleman JA. Impact of perioperative blood transfusion on oncologic outcomes in patients treated with radical nephroureterectomy for upper tract urothelial carcinoma. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.7_suppl.358] [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
358 Background: Patients treated for urothelial carcinoma of the urinary bladder treated with radical cystectomy and pelvic lymph node dissection have worse clinical outcomes if they receive perioperative blood transfusion. We evaluated the impact of perioperative blood transfusion on oncologic outcomes in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Methods: We conducted a single-center, retrospective review of 405 patients treated with RNU for UTUC. Clinicopathologic characteristics were recorded. Hospital charts were reviewed to determine if patients received perioperative blood transfusion. Characteristics were compared between groups based on transfusion status using Chi-square analyses. Survival was assessed using the Kaplan-Meier method. Cox regression analysis addressed cancer-specific mortality (CSM). Results: Median age was 71.4 years (IQR 63.7-76.5) and the majority of patients were male (64%). Median follow up was 43.4 months (IQR 16.7-86.6). CSM occurred in 26.2% of patients. Perioperative transfusion was associated with higher rates of invasive T stage (>/=T2), (62% vs. 47%, p=0.019) and lymph node positive disease (23% vs. 10.3%, p=0.029). Three year disease-specific survival (DSS) was 80% for the entire cohort. DSS was significantly shorter (p=0.003) for patients receiving transfusion (66.3%, 95% CI 53.7%-76.3%) than those who did not (83.3%, 95% CI 78.3%-87.3%). Transfusion was an independent predictor of CSM on multivariable analysis including gender, grade, invasive T stage, nodal status, and transfusion (Table 1). Conclusions: Perioperative blood transfusion may be associated with adverse pathologic and oncologic outcomes in patients undergoing RNU for UTUC. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Eugene K. Cha
- Memorial Sloan Kettering Cancer Center, New York, NY
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Kaffenberger SD, Ciriello G, Winer AG, Voss MH, Maranchie JK, Tamboli P, Rathmell K, Choueiri TK, Motzer RJ, Coleman JA, Russo P, Hsieh J, Hakimi AA. Proteomic stratification of clear cell renal cell carcinoma utilizing The Cancer Genome Atlas (TCGA) with external validation. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.7_suppl.406] [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
406 Background: Proteomics represents the ultimate convergence of DNA and expression alterations. We therefore sought to leverage TCGA reverse phase protein array (RPPA) data with an independent proteomic platform to identify druggable targets and pathways associated with prognosis in clear cell renal cell carcinoma (ccRCC). Methods: Unsupervised hierarchical consensus clustering was performed and differentially expressed proteins were identified for pathway analysis. Associations with clinicogenomic factors were assessed and Cox proportional hazards models were performed for disease-specific survival (DSS). Results: RPPA clustering of 324 patients from the ccRCC TCGA revealed 5 robust clusters characterized by alterations in specific pathways and divergent prognoses. Cluster 1 was characterized by poor DSS, decreased expression of receptor tyrosine kinases (RTK) and upregulation of the mTOR pathway. It was also associated with mTOR pathway genomic alterations, sarcomatoid histology and the ccb prognostic mRNA signature (all p<0.001). Cluster 2 was characterized by increased expression of RTKs and interestingly, had upregulation of the mTOR pathway with excellent DSS. After accounting for stage and grade, cluster designation remained independently associated with DSS (HR 0.23 for cluster 2, 95% CI 0.08-0.68; p=0.008). External validation was performed on a separate cohort of 189 patients with a different quantitative proteomics platform. A panel of phosphoproteins (pHER1, pHER2, pHER3, pSHC, pMEK, pAKT), highly discriminant between the most divergent RPPA clusters (1 and 2) was evaluated. Those at the highest quartile of activation in > 3 proteins were associated with improved DSS (HR 0.19, 95% CI 0.05-0.082; p=0.03). Patients with mTOR pathway activation segregated to those with coincident RTK activation (n=83) and those without (n=13). Conclusions: We have identified and validated proteomic signatures which cluster ccRCC patients into 5 prognostic groups. Furthermore, two distinct mTOR-activated clusters—one with high RTK activity and one with increased mTOR pathway genomic alterations were revealed, which may have prognostic and therapeutic implications.
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Affiliation(s)
| | | | | | | | | | - Pheroze Tamboli
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kimryn Rathmell
- The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - James Hsieh
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - A. Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
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Corcoran AT, Kaffenberger SD, Clark PE, Walton J, Handorf E, Piotrowski Z, Tomaszewski JJ, Ginzburg S, Mehrazin R, Plimack E, Chen DYT, Smaldone MC, Uzzo RG, Morgan TM, Kutikov A. Hypoalbuminaemia is associated with mortality in patients undergoing cytoreductive nephrectomy. BJU Int 2014; 116:351-7. [PMID: 25123843 DOI: 10.1111/bju.12897] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 12/13/2022]
Abstract
OBJECTIVE To evaluate whether poor nutrition is associated with mortality in patients undergoing cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC). PATIENTS AND METHODS A multi-institutional review of prospective databases identified 246 patients meeting inclusion criteria who underwent CN for mRCC from 1993 to 2012. Nutritional markers evaluated were: body mass index <18.5 kg/m(2) , serum albumin <3.5 g/dL, or preoperative weight loss of ≥5% of body weight. Primary outcomes were overall (OS) and disease-specific survival (DSS). Secondary outcome was 'early mortality' defined as death at ≤6 months of surgery. Survival curves were estimated using the Kaplan-Meier product-limit method and multivariate analysis using logistic regression was used to test associations between nutritional markers and survival outcomes. RESULTS In all, 119 patients (median follow-up 17 months) were categorised as having any abnormal nutrition parameter (48%). Hypoalbuminaemia was the only independent predictor of OS and DSS (OS: median 8 vs 23 months, P < 0.001; DSS: 11 vs 33 months, P < 0.001). On multivariate analysis, hypoalbuminaemia remained a significant predictor of death for both overall [hazard ratio (HR) 2, 95% confidence interval (CI) 1.4-2.8; P < 0.001) and disease-specific mortality (HR 2.2, 95% CI 1.4-3.3; P < 0.001). Hypoalbuminaemia was also associated with early mortality (overall: P < 0.001 and disease specific: P = 0.002). CONCLUSION Patients with mRCC and hypoalbuminaemia undergoing CN have decreased OS and CSS, and increased risk of all-cause and disease-specific early mortality. As such, serum albumin may help risk stratify patients selected as candidates for CN. Furthermore, future work should evaluate whether nutritional depletion is a modifiable risk factor.
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Affiliation(s)
- Anthony T Corcoran
- Department of Urology, SUNY Stony Brook Medical Center, Stony Brook, NY, USA
| | | | - Peter E Clark
- Department of Urology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - John Walton
- Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Elizabeth Handorf
- Biostatistics & Bioinformatics Facility, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Zack Piotrowski
- Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Jeffery J Tomaszewski
- Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Serge Ginzburg
- Department of Urology, Einstein Healthcare Network/Urologic Institute of Southeastern Pennsylvania, Philadelphia, PA, USA
| | - Reza Mehrazin
- Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Elizabeth Plimack
- Medical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - David Y T Chen
- Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Marc C Smaldone
- Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Robert G Uzzo
- Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Todd M Morgan
- Department of Urology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
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Abstract
Failure of non-surgical primary treatment for localized prostate cancer is a common occurrence, with rates of disease recurrence ranging from 20% to 60%. In a large proportion of patients, disease recurrence is clinically localized and therefore potentially curable. Unfortunately, due to the complex and potentially morbid nature of salvage treatment, radical salvage surgery is uncommonly performed. In an attempt to decrease the morbidity of salvage therapy without sacrificing oncologic efficacy, a number of experienced centers have utilized robotic assistance to perform minimally invasive salvage radical prostatectomy. Herein, we critically evaluate the existing literature on salvage robotic radical prostatectomy with a focus on patient selection, perioperative complications and functional and early oncologic outcomes. These results are compared with contemporary and historical open salvage radical prostatectomy series and supplemented with insights we have gained from our experience with salvage robotic radical prostatectomy. The body of evidence by which conclusions regarding the efficacy and safety of robotic salvage radical prostatectomy can be drawn comprises fewer than 200 patients with limited follow-up. Preliminary results are promising and some outcomes have been favorable when compared with contemporary open salvage prostatectomy series. Advantages of the robotic platform in the performance of salvage radical prostatectomy include decreased blood loss, short length of stay and improved visualization. Greater experience is required to confirm the long-term oncologic efficacy and functional outcomes as well as the generalizability of results achieved at experienced centers.
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Affiliation(s)
- Samuel D Kaffenberger
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, TN 37215, United States
| | - Joseph A Smith
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, TN 37215, United States
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43
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Lallas CD, Trabulsi EJ, Kaffenberger SD, Touijer KA. Treatment of exophytic renal cancer smaller than 3 cm: surgery versus active surveillance. J Urol 2014; 193:16-8. [PMID: 25444964 DOI: 10.1016/j.juro.2014.10.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Costas D Lallas
- Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennslvania
| | - Edouard J Trabulsi
- Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennslvania
| | - Samuel D Kaffenberger
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karim A Touijer
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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44
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Ching CB, Hays SR, Kaffenberger SD, Stephany HA, Luckett TR, Clayton DB, Tanaka ST, Thomas JC, Adams MC, Brock JW, Pope JC. Pediatric chronic orchialgia: patient population and patterns of care. J Pediatr Urol 2014; 10:799-803. [PMID: 24768521 DOI: 10.1016/j.jpurol.2014.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 09/13/2013] [Accepted: 01/06/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE A major hurdle in management of any chronic pain syndrome is understanding the population in which it occurs. We describe our pediatric population of patients with peripubertal and postpubertal chronic orchialgia. PATIENTS AND METHODS Pediatric patients ≥ 10 years of age seen between 2002 and 2012 were identified by ICD code 608.9, Male Genital Disorder NOS. Patients were included if they had orchialgia without identifiable cause lasting >3 months. Patient history, diagnostic evaluations, treatments, and outcomes were assessed. RESULTS Seventy-nine pediatric patients were identified. The mean age was 13.3 years (range 10-18); mean duration of orchialgia was 16.3 months (range 3-85). Thirty-three of 79 (42%) had concomitant medical conditions and/or psychiatric-behavioral issues. The mean follow-up was 7.1 months (range 0-70.4) with 41/79 (52%) having more than one office visit follow-up. Eleven patients were referred to a pediatric pain clinic; 10 out of 11 (91%) were evaluated there. Overall, 16 out of 41 (39%) had resolution of pain: nine out of 41 (22%) responding to conservative management vs seven of 10 (70%) responding to pain clinic management (3 to anti-neuropathic medications, 4 to nerve block). CONCLUSION Many pediatric patients with chronic orchialgia have co-morbidities amenable to multidisciplinary collaborative coordination of care. Referral to pediatric pain clinic can be of significant benefit.
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Affiliation(s)
- Christina B Ching
- Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Stephen R Hays
- Department of Anesthesiology, Vanderbilt University School of Medicine & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA; Department of Pediatrics, Vanderbilt University School of Medicine & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Samuel D Kaffenberger
- Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Heidi A Stephany
- Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Twila R Luckett
- Perioperative Services & Pediatric Pain Service, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Douglass B Clayton
- Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Stacy T Tanaka
- Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - John C Thomas
- Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Mark C Adams
- Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - John W Brock
- Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - John C Pope
- Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
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Abstract
The controversial recent recommendation by the United States Preventive Services Task Force (USPSTF) against prostate-specific antigen (PSA) screening for early-stage prostate cancer has caused much debate. Whereas USPSTF recommendations against routine screening mammography in younger women resulted in fierce public outcry and eventual alteration in the language of the recommendation, the same public and political response has not been seen with PSA screening for prostate cancer. It is of paramount importance to ensure improved efficiency and transparency of the USPSTF recommendation process, and resolution of concerns with the current USPSTF recommendation against PSA screening for all ages.
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Affiliation(s)
- Samuel D Kaffenberger
- Department of Urologic Surgery, Vanderbilt University, 2525 West End Avenue, Nashville, TN, USA
| | - David F Penson
- Department of Urologic Surgery, VA Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC), Vanderbilt University, 2525 West End Avenue, Nashville, TN, USA; Center for Surgical Quality and Outcomes Research, Vanderbilt University, 2525 West End Avenue, Suite 1200, Nashville, TN 37203-1738, USA.
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46
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Zaid HB, Kaffenberger SD, Chang SS. Improvements in safety and recovery following cystectomy: reassessing the role of pre-operative bowel preparation and interventions to speed return of post-operative bowel function. Curr Urol Rep 2013; 14:78-83. [PMID: 23397271 DOI: 10.1007/s11934-012-0300-y] [Citation(s) in RCA: 6] [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: 12/11/2022]
Abstract
For radical cystectomy, historical practice trends have favored the use of preoperative bowel preparations to reduce complications, including surgical site infections, ileus, and anastomotic leaks. However, emerging data has questioned this practice. Postoperative cystectomy care also remains in flux, as new pharmacologic agents that may potentiate earlier return of bowel function are studied. We review the current literature with regards to preoperative and postoperative cystectomy bowel management.
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Affiliation(s)
- Harras B Zaid
- Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN 37232-2765, USA.
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47
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Stimson C, Patel SG, Zaid HB, Kaffenberger SD, Resnick MJ, Barocas DA, Cookson MS, Chang SS. 1619 ACCESS TO CARE PREDICTS ADEQUATE PELVIC LYMPH NODE DISSECTION IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR MUSCLE-INVASIVE BLADDER CANCER. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.3169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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48
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Stimson C, Patel SG, Zaid HB, Resnick MJ, Barocas DA, Kaffenberger SD, Cookson MS, Chang SS. 1631 DISPARITIES IN THE UTILIZATION OF RADICAL CYSTECTOMY IN YOUNG PATIENTS WITHOUT COMORBIDITY: AN UNFORTUNATE TALE OF MISSED OPPORTUNITY. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.3181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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49
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Kaffenberger SD, Keegan KA, Bansal NK, Morgan TM, Tang DH, Barocas DA, Penson DF, Davis R, Clark PE, Chang SS, Cookson MS, Herrell SD, Smith JA. Salvage robotic assisted laparoscopic radical prostatectomy: a single institution, 5-year experience. J Urol 2012; 189:507-13. [PMID: 23000849 DOI: 10.1016/j.juro.2012.09.057] [Citation(s) in RCA: 47] [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] [Accepted: 09/13/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE Salvage robotic assisted laparoscopic prostatectomy is a treatment option for certain patients with recurrent prostate cancer after primary therapy. Data regarding patient selection, complication rates and cancer outcomes are scarce. We report the largest, single institution series to date, to our knowledge, of salvage robotic assisted laparoscopic prostatectomy. MATERIALS AND METHODS We reviewed our database of 4,234 patients treated with robotic assisted laparoscopic prostatectomy at Vanderbilt University and identified 34 men who had surgery after the failure of prior definitive ablative therapy. Each patient had biopsy proven recurrent prostate cancer and no evidence of metastases. The primary outcome measure was biochemical failure. RESULTS Median time from primary therapy to salvage robotic assisted laparoscopic prostatectomy was 48.5 months with a median preoperative prostate specific antigen of 3.86 ng/ml. Most patients had Gleason scores of 7 or greater on preoperative biopsy, although 12 (35%) had Gleason 8 or greater disease. After a median followup of 16 months 18% of patients had biochemical failure. The positive margin rate was 26%, of which 33% had biochemical failure after surgery. On univariable analysis there was a significant association between prostate specific antigen doubling time and biochemical failure (HR 0.77, 95% CI 0.60-0.99, p = 0.049) as well as between Gleason score at original diagnosis and biochemical failure (HR 3.49, 95% CI 1.18-10.3, p = 0.023). There were 2 Clavien II-III complications, namely a pulmonary embolism and a rectal laceration. Postoperatively 39% of patients had excellent continence. CONCLUSIONS Salvage robotic assisted laparoscopic prostatectomy is safe, with many favorable outcomes compared to open salvage radical prostatectomy series. Advantages include superior visualization of the posterior prostatic plane, modest blood loss, low complication rates and short length of stay.
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Affiliation(s)
- Samuel D Kaffenberger
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37215, USA
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50
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Kaffenberger SD, Morgan TM, Stratton KL, Boachie AM, Barocas DA, Chang SS, Cookson MS, Herrell SD, Smith JA, Clark PE. ABO blood group is a predictor of survival in patients undergoing surgery for renal cell carcinoma. BJU Int 2012; 110:E641-6. [PMID: 22958439 DOI: 10.1111/j.1464-410x.2012.11366.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED What's known on the subject? and What does the study add? Some evidence suggests that ABO blood type may be a risk factor for cancer incidence and prognosis. For example, a large study recently discovered an increased incidence of pancreatic cancer in patients with non-O blood type; however, it is not known whether blood group correlates with outcomes in patients with RCC. We found a significant and independent association between ABO blood group and overall survival in patients undergoing surgery for locoregional RCC. Specifically, we identified non-O blood type as a predictor of mortality. OBJECTIVE • To determine whether ABO blood group is associated with survival after nephrectomy or partial nephrectomy for renal cell carcinoma (RCC). PATIENTS AND METHODS • We conducted a retrospective cohort study of 900 patients who underwent surgery for locoregional RCC between 1997 and 2008 at a single institution. • Covariates included age, gender, race, American Society of Anesthesiology Physical Status, preoperative anaemia and hypoalbuminemia, tumour characteristics, lymph node status, procedure performed, transfusion status and ABO blood group. • Primary outcomes were overall (OS) and disease-specific survival (DSS). • Univariable survival analyses were performed using the Kaplan-Meier and log-rank methods. Multivariable analysis was performed using a Cox proportional hazards model. RESULTS • The 3-year OS estimate was 75% (95%CI 70-79%) for O blood group and 68% (95% CI 63-73%) for non-O blood group (P= 0.072). The 3-year DSS was 81% (95% CI 76-85%) for O blood group and 76% (95%CI 71-80%) for non-O blood group (P= 0.053). • In the multivariable analysis for OS, non-O blood type was significantly associated with decreased OS (HR 1.68, 95%CI 1.18-2.39; P= 0.004) but not DSS (HR 1.53, 95%CI 0.97-2.41; P= 0.065). CONCLUSION • These data suggest that ABO blood group is independently associated with OS in patients undergoing surgery for locoregional RCC. ABO blood group has not been previously recognized as a predictor of survival in RCC.
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Affiliation(s)
- Samuel D Kaffenberger
- Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN 37215, USA.
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