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van Duin IAJ, Verheijden RJ, van Diest PJ, Blokx WAM, El-Sharouni MA, Verhoeff JJC, Leiner T, van den Eertwegh AJM, de Groot JWB, van Not OJ, Aarts MJB, van den Berkmortel FWPJ, Blank CU, Haanen JBAG, Hospers GAP, Piersma D, van Rijn RS, van der Veldt AAM, Vreugdenhil G, Wouters MWJM, Stevense-den Boer MAM, Boers-Sonderen MJ, Kapiteijn E, Suijkerbuijk KPM, Elias SG. A prediction model for response to immune checkpoint inhibition in advanced melanoma. Int J Cancer 2024; 154:1760-1771. [PMID: 38296842 DOI: 10.1002/ijc.34853] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/01/2023] [Accepted: 12/05/2023] [Indexed: 02/02/2024]
Abstract
Predicting who will benefit from treatment with immune checkpoint inhibition (ICI) in patients with advanced melanoma is challenging. We developed a multivariable prediction model for response to ICI, using routinely available clinical data including primary melanoma characteristics. We used a population-based cohort of 3525 patients with advanced cutaneous melanoma treated with anti-PD-1-based therapy. Our prediction model for predicting response within 6 months after ICI initiation was internally validated with bootstrap resampling. Performance evaluation included calibration, discrimination and internal-external cross-validation. Included patients received anti-PD-1 monotherapy (n = 2366) or ipilimumab plus nivolumab (n = 1159) in any treatment line. The model included serum lactate dehydrogenase, World Health Organization performance score, type and line of ICI, disease stage and time to first distant recurrence-all at start of ICI-, and location and type of primary melanoma, the presence of satellites and/or in-transit metastases at primary diagnosis and sex. The over-optimism adjusted area under the receiver operating characteristic was 0.66 (95% CI: 0.64-0.66). The range of predicted response probabilities was 7%-81%. Based on these probabilities, patients were categorized into quartiles. Compared to the lowest response quartile, patients in the highest quartile had a significantly longer median progression-free survival (20.0 vs 2.8 months; P < .001) and median overall survival (62.0 vs 8.0 months; P < .001). Our prediction model, based on routinely available clinical variables and primary melanoma characteristics, predicts response to ICI in patients with advanced melanoma and discriminates well between treated patients with a very good and very poor prognosis.
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Affiliation(s)
- Isabella A J van Duin
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rik J Verheijden
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paul J van Diest
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Willeke A M Blokx
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mary-Ann El-Sharouni
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joost J C Verhoeff
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Alfonsus J M van den Eertwegh
- Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Olivier J van Not
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Christian U Blank
- Department of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - John B A G Haanen
- Department of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Djura Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Rozemarijn S van Rijn
- Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Astrid A M van der Veldt
- Department of Medical Oncology and Radiology & Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Gerard Vreugdenhil
- Department of Internal Medicine, Maxima Medical Centre, Eindhoven, The Netherlands
| | - Michel W J M Wouters
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Marye J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Karijn P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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2
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Meulen LWT, Haasnoot KJC, Vlug MS, Wolfhagen FHJ, Baven-Pronk MAMC, van der Voorn MPJA, Schwartz MP, Vogelaar L, de Vos Tot Nederveen Cappel WH, Seerden TCJ, Hazen WL, Schrauwen RWM, Alvarez Herrero L, Schreuder RM, van Nunen AB, Stoop E, de Bruin GJ, Bos P, Marsman WA, Kuiper E, de Bièvre M, Roomer R, Groen J, Bigirwamungu-Bargeman M, Siersema PD, Elias SG, Masclee A, Moons LM. Training in optical diagnosis in community hospitals is associated with improved recognition and treatment of T1 CRC: a prospective multicenter intervention study (OPTICAL II). Endoscopy 2024. [PMID: 38657659 DOI: 10.1055/a-2313-4996] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND STUDY AIMS Recognition of T1 colorectal cancer (CRC) is difficult, with sensitivities of 35-60% in Western countries. We evaluated the real-life effects of the implementation of the OPTICAL model, a recently developed structured and validated prediction model, in Dutch community hospitals. PATIENTS AND METHODS In this prospective multicenter study, 383 endoscopists from 40 hospitals were invited to follow an e-learning on the OPTICAL-model, to increase sensitivity for detecting T1CRC in non-pedunculated polyps. Next, real-life recognition of T1CRC was evaluated in 25 hospitals. Endoscopic and pathologic reports of T1CRCs detected during the next year were collected retrospectively while endoscopists were unaware of this evaluation. Sensitivity for recognition of T1CRC, R0 resection rate, and treatment modality were compared for trained vs. untrained endoscopists and for recognised vs. unrecognised T1CRCs. RESULTS Within 1 year after the e-learning 251 endoscopists detected 528 non-pedunculated T1CRCs, 118 (47%) of the endoscopist were trained. T1CRCs had a median size of 20mm and were mainly located in the distal colorectum (66%). Trained endoscopists recognised T1CRCs more frequently than untrained endoscopists (sensitivity 74% vs. 62%; mixed model analysis OR 2.90; 95%CI 1.54-5.45. A higher rate of R0 resection was seen for T1CRCs detected by trained endoscopists (69% vs. 56%, OR 1.73; 95%CI 1.03-2.91). CONCLUSION Training in optical recognition of T1CRCs in community hospitals was associated with an increase in sensitivity for T1CRCs. Recognition led to a higher rate of en bloc local excision, resulting in higher R0-resection rates. This may be an important step towards more organ-preserving strategies.
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Affiliation(s)
- Lonne W T Meulen
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, Netherlands
- The Netherlands GROW, School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
| | | | - Marije S Vlug
- Department of Gastroenterology and Hepatology, Dijklander Hospital, Hoorn, Netherlands
| | - Frank H J Wolfhagen
- Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | | | | | - M P Schwartz
- Gastroenterology, Meander Medical Centre, Amersfoort, Netherlands
| | - Lauran Vogelaar
- Department of Gastroenterology and Hepatology, Diakonessenhuis Utrecht Zeist Doorn, Utrecht, Netherlands
| | | | - Tom C J Seerden
- Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, Netherlands
| | - W L Hazen
- Department of Gastroenterology and Hepatology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands
| | - R W M Schrauwen
- Department of Gastroenterology and Hepatology, Bernhoven Hospital Location Uden, Uden, Netherlands
| | - Lorenza Alvarez Herrero
- Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, Netherlands
| | | | - Annick B van Nunen
- Department of Gastroenterology and Hepatology, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands
| | - Esther Stoop
- Department of Gastroenterology and Hepatology, Medical Centre Haaglanden, Den Haag, Netherlands
| | - Gijs J de Bruin
- Department of Gastroenterology and Hepatology, Tergooi Medical Centre, Hilversum, Netherlands
| | - Philip Bos
- Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, Netherlands
| | - Willem A Marsman
- Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Haarlem, Netherlands
| | - Edith Kuiper
- Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, Netherlands
| | - Marc de Bièvre
- Department of Gastroenterology and Hepatology,, VieCuri Medical Centre, Venlo, Netherlands
| | - Robert Roomer
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis, Rotterdam, Netherlands
| | - John Groen
- Department of Gastroenterology and Hepatology, Ziekenhuis Sint Jansdal, Harderwijk, Netherlands
| | | | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Ad Masclee
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Leon Mg Moons
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, Netherlands
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Wijnands AM, Penning de Vries BBL, Lutgens MWMD, Bakhshi Z, Al Bakir I, Beaugerie L, Bernstein CN, Chang-Ho Choi R, Coelho-Prabhu N, Graham TA, Hart AL, Ten Hove JR, Itzkowitz SH, Kirchgesner J, Mooiweer E, Shaffer SR, Shah SC, Elias SG, Oldenburg B. Dynamic Prediction of Advanced Colorectal Neoplasia in Inflammatory Bowel Disease. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00214-3. [PMID: 38431223 DOI: 10.1016/j.cgh.2024.02.014] [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: 10/11/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND & AIMS Colonoscopic surveillance is recommended in patients with colonic inflammatory bowel disease (IBD) given their increased risk of colorectal cancer (CRC). We aimed to develop and validate a dynamic prediction model for the occurrence of advanced colorectal neoplasia (aCRN, including high-grade dysplasia and CRC) in IBD. METHODS We pooled data from 6 existing cohort studies from Canada, The Netherlands, the United Kingdom, and the United States. Patients with IBD and an indication for CRC surveillance were included if they underwent at least 1 follow-up procedure. Exclusion criteria included prior aCRN, prior colectomy, or an unclear indication for surveillance. Predictor variables were selected based on the literature. A dynamic prediction model was developed using a landmarking approach based on Cox proportional hazard modeling. Model performance was assessed with Harrell's concordance-statistic (discrimination) and by calibration curves. Generalizability across surveillance cohorts was evaluated by internal-external cross-validation. RESULTS The surveillance cohorts comprised 3731 patients, enrolled and followed-up in the time period from 1973 to 2021, with a median follow-up period of 5.7 years (26,336 patient-years of follow-up evaluation); 146 individuals were diagnosed with aCRN. The model contained 8 predictors, with a cross-validation median concordance statistic of 0.74 and 0.75 for a 5- and 10-year prediction window, respectively. Calibration plots showed good calibration. Internal-external cross-validation results showed medium discrimination and reasonable to good calibration. CONCLUSIONS The new prediction model showed good discrimination and calibration, however, generalizability results varied. Future research should focus on formal external validation and relate predicted aCRN risks to surveillance intervals before clinical application.
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Affiliation(s)
- Anouk M Wijnands
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Bas B L Penning de Vries
- Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maurice W M D Lutgens
- Department of Gastroenterology and Hepatology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Zeinab Bakhshi
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Ibrahim Al Bakir
- Department of Gastroenterology, Chelsea and Westminster Hospital, London, United Kingdom
| | - Laurent Beaugerie
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hôpital Saint-Antoine, Paris, France
| | - Charles N Bernstein
- University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ryan Chang-Ho Choi
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | | | - Trevor A Graham
- Evolution and Cancer Laboratory, Centre for Genomics and Computational Biology, Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; Genomics and Evolutionary Dynamics Laboratory, Centre for Evolution and Cancer, Institute of Cancer Research, London, United Kingdom
| | - Ailsa L Hart
- Inflammatory Bowel Disease Unit, St Mark's Hospital, London, United Kingdom
| | - Joren R Ten Hove
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Steven H Itzkowitz
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Julien Kirchgesner
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hôpital Saint-Antoine, Paris, France
| | - Erik Mooiweer
- Department of Gastroenterology and Hepatology, Hospital St Jansdal, Harderwijk, The Netherlands
| | - Seth R Shaffer
- University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shailja C Shah
- Division of Gastroenterology, University of California, San Diego, La Jolla, California; Gastroenterology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California
| | - Sjoerd G Elias
- Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bas Oldenburg
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
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4
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Smabers LP, Wensink E, Verissimo CS, Koedoot E, Pitsa KC, Huismans MA, Higuera Barón C, Doorn M, Valkenburg-van Iersel LB, Cirkel GA, Brousali A, Overmeer R, Koopman M, Braat MN, Penning de Vries B, Elias SG, Vries RG, Kranenburg O, Boj SF, Roodhart JM. Organoids as a biomarker for personalized treatment in metastatic colorectal cancer: drug screen optimization and correlation with patient response. J Exp Clin Cancer Res 2024; 43:61. [PMID: 38414064 PMCID: PMC10898042 DOI: 10.1186/s13046-024-02980-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/09/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The inability to predict treatment response of colorectal cancer patients results in unnecessary toxicity, decreased efficacy and survival. Response testing on patient-derived organoids (PDOs) is a promising biomarker for treatment efficacy. The aim of this study is to optimize PDO drug screening methods for correlation with patient response and explore the potential to predict responses to standard chemotherapies. METHODS We optimized drug screen methods on 5-11 PDOs per condition of the complete set of 23 PDOs from patients treated for metastatic colorectal cancer (mCRC). PDOs were exposed to 5-fluorouracil (5-FU), irinotecan- and oxaliplatin-based chemotherapy. We compared medium with and without N-acetylcysteine (NAC), different readouts and different combination treatment set-ups to capture the strongest association with patient response. We expanded the screens using the optimized methods for all PDOs. Organoid sensitivity was correlated to the patient's response, determined by % change in the size of target lesions. We assessed organoid sensitivity in relation to prior exposure to chemotherapy, mutational status and sidedness. RESULTS Drug screen optimization involved excluding N-acetylcysteine from the medium and biphasic curve fitting for 5-FU & oxaliplatin combination screens. CellTiter-Glo measurements were comparable with CyQUANT and did not affect the correlation with patient response. Furthermore, the correlation improved with application of growth rate metrics, when 5-FU & oxaliplatin was screened in a ratio, and 5-FU & SN-38 using a fixed dose of SN-38. Area under the curve was the most robust drug response curve metric. After optimization, organoid and patient response showed a correlation coefficient of 0.58 for 5-FU (n = 6, 95% CI -0.44,0.95), 0.61 for irinotecan- (n = 10, 95% CI -0.03,0.90) and 0.60 for oxaliplatin-based chemotherapy (n = 11, 95% CI -0.01,0.88). Median progression-free survival of patients with resistant PDOs to oxaliplatin-based chemotherapy was significantly shorter than sensitive PDOs (3.3 vs 10.9 months, p = 0.007). Increased resistance to 5-FU in patients with prior exposure to 5-FU/capecitabine was adequately reflected in PDOs (p = 0.003). CONCLUSIONS Our study emphasizes the critical impact of the screening methods for determining correlation between PDO drug screens and mCRC patient outcomes. Our 5-step optimization strategy provides a basis for future research on the clinical utility of PDO screens.
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Affiliation(s)
- Lidwien P Smabers
- Department of Medical Oncology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Emerens Wensink
- Department of Medical Oncology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | | | | | | | - Maarten A Huismans
- Molecular Cancer Research, Center for Molecular Medicine, UMCU, Utrecht, The Netherlands
| | | | | | | | - Geert A Cirkel
- Department of Medical Oncology, Meander Medical Center, Amersfoort, The Netherlands
| | - Anneta Brousali
- Utrecht Platform for Organoid Technology (UPORT), UMCU, Utrecht, The Netherlands
| | | | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Manon N Braat
- Department of Radiology, UMCU, Utrecht, The Netherlands
| | - Bas Penning de Vries
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, UMCU, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, UMCU, Utrecht, The Netherlands
| | | | - Onno Kranenburg
- Utrecht Platform for Organoid Technology (UPORT), UMCU, Utrecht, The Netherlands
- Laboratory of Translational Oncology, Division of Imaging and Cancer, UMCU, Utrecht, The Netherlands
| | | | - Jeanine M Roodhart
- Department of Medical Oncology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.
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5
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Boers J, Eisses B, Zwager MC, van Geel JJL, Bensch F, de Vries EFJ, Hospers GAP, Glaudemans AWJM, Brouwers AH, den Dekker MAM, Elias SG, Kuip EJM, van Herpen CML, Jager A, van der Veldt AAM, Oprea-Lager DE, de Vries EGE, van der Vegt B, Menke-van der Houven van Oordt WC, Schröder CP. Correlation between Histopathological Prognostic Tumor Characteristics and [ 18F]FDG Uptake in Corresponding Metastases in Newly Diagnosed Metastatic Breast Cancer. Diagnostics (Basel) 2024; 14:416. [PMID: 38396455 PMCID: PMC10887896 DOI: 10.3390/diagnostics14040416] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND In metastatic breast cancer (MBC), [18F]fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG-PET/CT) can be used for staging. We evaluated the correlation between BC histopathological characteristics and [18F]FDG uptake in corresponding metastases. PATIENTS AND METHODS Patients with non-rapidly progressive MBC of all subtypes prospectively underwent a baseline histological metastasis biopsy and [18F]FDG-PET. Biopsies were assessed for estrogen, progesterone, and human epidermal growth factor receptor 2 (ER, PR, HER2); Ki-67; and histological subtype. [18F]FDG uptake was expressed as maximum standardized uptake value (SUVmax) and results were expressed as geometric means. RESULTS Of 200 patients, 188 had evaluable metastasis biopsies, and 182 of these contained tumor. HER2 positivity and Ki-67 ≥ 20% were correlated with higher [18F]FDG uptake (estimated geometric mean SUVmax 10.0 and 8.8, respectively; p = 0.0064 and p = 0.014). [18F]FDG uptake was lowest in ER-positive/HER2-negative BC and highest in HER2-positive BC (geometric mean SUVmax 6.8 and 10.0, respectively; p = 0.0058). Although [18F]FDG uptake was lower in invasive lobular carcinoma (n = 31) than invasive carcinoma NST (n = 146) (estimated geometric mean SUVmax 5.8 versus 7.8; p = 0.014), the metastasis detection rate was similar. CONCLUSIONS [18F]FDG-PET is a powerful tool to detect metastases, including invasive lobular carcinoma. Although BC histopathological characteristics are related to [18F]FDG uptake, [18F]FDG-PET and biopsy remain complementary in MBC staging (NCT01957332).
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Affiliation(s)
- Jorianne Boers
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (J.B.); (B.E.); (J.J.L.v.G.); (F.B.); (G.A.P.H.); (E.G.E.d.V.)
| | - Bertha Eisses
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (J.B.); (B.E.); (J.J.L.v.G.); (F.B.); (G.A.P.H.); (E.G.E.d.V.)
| | - Mieke C. Zwager
- Department of Pathology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (M.C.Z.); (B.v.d.V.)
| | - Jasper J. L. van Geel
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (J.B.); (B.E.); (J.J.L.v.G.); (F.B.); (G.A.P.H.); (E.G.E.d.V.)
| | - Frederike Bensch
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (J.B.); (B.E.); (J.J.L.v.G.); (F.B.); (G.A.P.H.); (E.G.E.d.V.)
| | - Erik F. J. de Vries
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (E.F.J.d.V.); (A.W.J.M.G.); (A.H.B.)
| | - Geke A. P. Hospers
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (J.B.); (B.E.); (J.J.L.v.G.); (F.B.); (G.A.P.H.); (E.G.E.d.V.)
| | - Andor W. J. M. Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (E.F.J.d.V.); (A.W.J.M.G.); (A.H.B.)
| | - Adrienne H. Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (E.F.J.d.V.); (A.W.J.M.G.); (A.H.B.)
| | - Martijn A. M. den Dekker
- Department of Radiology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands;
| | - Sjoerd G. Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 Utrecht, The Netherlands;
| | - Evelien J. M. Kuip
- Department of Medical Oncology, Radboud Medical Center, 6500 Nijmegen, The Netherlands; (E.J.M.K.); (C.M.L.v.H.)
| | - Carla M. L. van Herpen
- Department of Medical Oncology, Radboud Medical Center, 6500 Nijmegen, The Netherlands; (E.J.M.K.); (C.M.L.v.H.)
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 Rotterdam, The Netherlands; (A.J.); (A.A.M.v.d.V.)
| | - Astrid A. M. van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 Rotterdam, The Netherlands; (A.J.); (A.A.M.v.d.V.)
| | - Daniela E. Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location VU University Medical Center, 1081 Amsterdam, The Netherlands;
| | - Elisabeth G. E. de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (J.B.); (B.E.); (J.J.L.v.G.); (F.B.); (G.A.P.H.); (E.G.E.d.V.)
| | - Bert van der Vegt
- Department of Pathology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (M.C.Z.); (B.v.d.V.)
| | | | - Carolina P. Schröder
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (J.B.); (B.E.); (J.J.L.v.G.); (F.B.); (G.A.P.H.); (E.G.E.d.V.)
- Department of Medical Oncology, Dutch Cancer Institute, 1066 Amsterdam, The Netherlands
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van der Schee L, Haasnoot KJC, Elias SG, Gijsbers K, Alderlieste YA, Backes Y, van Berkel AM, Boersma F, Ter Borg F, Breekveldt ECH, Kessels K, Koopman M, Lansdorp-Vogelaar I, van Leerdam ME, Rasschaert G, Schreuder RM, Schrauwen RWM, Seerden TCJ, Spanier MBW, Terhaar Sive Droste JS, Toes-Zoutendijk E, Tuynman J, Vink GR, de Vos Tot Nederveen Cappel WH, Vleggaar FP, Lacle MM, Moons LM. Oncological outcomes of screen-detected and non-screen-detected T1 colorectal cancers. Endoscopy 2024. [PMID: 38325403 DOI: 10.1055/a-2263-2841] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND AND STUDY AIMS The incidence of T1 colorectal cancers (CRC) has increased with the implementation of CRC screening programs. It is unknown if outcomes and and risk models for T1 CRC patients, based on non-screen-detected cases, can be extrapolated to screen-detected T1 CRC. This study aims to compare stage distribution and oncological outcomes of T1 CRC patients within and outside the screening program. PATIENTS AND METHODS Data from T1 CRC patients diagnosed between 2014-2017 were collected from 12 hospitals in the Netherlands. The presence of lymph node metastasis (LNM) at diagnosis was compared between screen-detected and non-screen-detected patients using multivariable logistic regression. Cox proportional hazard regression was employed to analyze differences in time to recurrence (TTR), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). Additionally, the performance of conventional risk factors for LNM was evaluated in both groups. RESULTS 1803 patients were included, of which 1114 (62%) were screen-detected. Median follow-up was 51 months (IQR 30). The proportion of LNM did not significantly differ between screen- and non-screen-detected patients (12.6% vs 8.9%; OR 1.41; 95% CI 0.89-2.23), and a prediction model for LNM performed equally in both groups. Three and 5-year TTR, MFS, and CSS were similar for patients within and outside the screening program. However, OS was significantly higher in screen-detected T1 CRC patients (adjusted HR 0.51; 95% CI 0.38-0.68). CONCLUSIONS Screen-detected and non-screen-detected T1 CRCs have similar stage distributions and oncological outcomes and can therefore be treated equally. However, screen-detected T1 CRC patients exhibit a lower rate of non-CRC-related mortality, resulting in higher OS.
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Affiliation(s)
- Lisa van der Schee
- Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, Netherlands
- Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Kim Gijsbers
- Gastroenterology & Hepatology, Deventer Hospital, Deventer, Netherlands
- Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Y A Alderlieste
- Gastroenterology & Hepatology, Beatrixziekenhuis, Gorinchem, Netherlands
| | - Yara Backes
- Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Femke Boersma
- Gastroenterology & Hepatology, Gelre Hospitals, Apeldoorn, Netherlands
| | - F Ter Borg
- Gastroenterology & Hepatology, Deventer Hospital, Deventer, Netherlands
| | - Emilie C H Breekveldt
- Public Health, Erasmus MC, Rotterdam, Netherlands
- Gastrointestinal Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Koen Kessels
- Gastroenterology & Hepatology, Sint Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - Miriam Koopman
- Medical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Monique E van Leerdam
- Gastrointestinal Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
- Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - R W M Schrauwen
- Gastroenterology & Hepatology, Bernhoven Hospital Location Uden, Uden, Netherlands
| | - Tom C J Seerden
- Gastroenterology & Hepatology, Amphia Hospital, Breda, Netherlands
| | | | | | | | - Jurriaan Tuynman
- Surgery, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Geraldine R Vink
- Medical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
- Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | | | - Frank P Vleggaar
- Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, Netherlands
| | - M M Lacle
- Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Leon Mg Moons
- Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, Netherlands
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7
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Peters J, van Dijck JAAM, Elias SG, Otten JDM, Broeders MJM. The prognostic potential of mammographic growth rate of invasive breast cancer in the Nijmegen breast cancer screening cohort. J Med Screen 2024:9691413231222765. [PMID: 38295359 DOI: 10.1177/09691413231222765] [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] [Indexed: 02/02/2024]
Abstract
OBJECTIVES Insight into the aggressiveness of potential breast cancers found in screening may optimize recall decisions. Specific growth rate (SGR), measured on mammograms, may provide valuable prognostic information. This study addresses the association of SGR with prognostic factors and overall survival in patients with invasive carcinoma of no special type (NST) from a screened population. METHODS In this historic cohort study, 293 women with NST were identified from all participants in the Nijmegen screening program (2003-2007). Information on clinicopathological factors was retrieved from patient files and follow-up on vital status through municipalities. On consecutive mammograms, tumor volumes were estimated. After comparing five growth functions, SGR was calculated using the best-fitting function. Regression and multivariable survival analyses described associations between SGR and prognostic factors as well as overall survival. RESULTS Each one standard deviation increase in SGR was associated with an increase in the Nottingham prognostic index by 0.34 [95% confidence interval (CI): 0.21-0.46]. Each one standard deviation increase in SGR increased the odds of a tumor with an unfavorable subtype (based on histologic grade and hormone receptors; odds ratio 2.14 [95% CI: 1.45-3.15]) and increased the odds of diagnosis as an interval cancer (versus screen-detected; odds ratio 1.57 [95% CI: 1.20-2.06]). After a median of 12.4 years of follow-up, 78 deaths occurred. SGR was not associated with overall survival (hazard ratio 1.12 [95% CI: 0.87-1.43]). CONCLUSIONS SGR may indicate prognostically relevant differences in tumor aggressiveness if serial mammograms are available. A potential association with cause-specific survival could not be determined and is of interest for future research.
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Affiliation(s)
- Jim Peters
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos A A M van Dijck
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johannes D M Otten
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mireille J M Broeders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Expert Centre for Screening (LRCB), Nijmegen, The Netherlands
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8
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Janssen LM, Janse MHA, Penning de Vries BBL, van der Velden BHM, Wolters-van der Ben EJM, van den Bosch SM, Sartori A, Jovelet C, Agterof MJ, Ten Bokkel Huinink D, Bouman-Wammes EW, van Diest PJ, van der Wall E, Elias SG, Gilhuijs KGA. Predicting response to neoadjuvant chemotherapy with liquid biopsies and multiparametric MRI in patients with breast cancer. NPJ Breast Cancer 2024; 10:10. [PMID: 38245552 PMCID: PMC10799888 DOI: 10.1038/s41523-024-00611-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 12/07/2023] [Indexed: 01/22/2024] Open
Abstract
Accurate prediction of response to neoadjuvant chemotherapy (NAC) can help tailor treatment to individual patients' needs. Little is known about the combination of liquid biopsies and computer extracted features from multiparametric magnetic resonance imaging (MRI) for the prediction of NAC response in breast cancer. Here, we report on a prospective study with the aim to explore the predictive potential of this combination in adjunct to standard clinical and pathological information before, during and after NAC. The study was performed in four Dutch hospitals. Patients without metastases treated with NAC underwent 3 T multiparametric MRI scans before, during and after NAC. Liquid biopsies were obtained before every chemotherapy cycle and before surgery. Prediction models were developed using penalized linear regression to forecast residual cancer burden after NAC and evaluated for pathologic complete response (pCR) using leave-one-out-cross-validation (LOOCV). Sixty-one patients were included. Twenty-three patients (38%) achieved pCR. Most prediction models yielded the highest estimated LOOCV area under the curve (AUC) at the post-treatment timepoint. A clinical-only model including tumor grade, nodal status and receptor subtype yielded an estimated LOOCV AUC for pCR of 0.76, which increased to 0.82 by incorporating post-treatment radiological MRI assessment (i.e., the "clinical-radiological" model). The estimated LOOCV AUC was 0.84 after incorporation of computer-extracted MRI features, and 0.85 when liquid biopsy information was added instead of the radiological MRI assessment. Adding liquid biopsy information to the clinical-radiological resulted in an estimated LOOCV AUC of 0.86. In conclusion, inclusion of liquid biopsy-derived markers in clinical-radiological prediction models may have potential to improve prediction of pCR after NAC in breast cancer.
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Affiliation(s)
- L M Janssen
- Image Sciences Institute, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M H A Janse
- Image Sciences Institute, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - B B L Penning de Vries
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - B H M van der Velden
- Image Sciences Institute, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | - A Sartori
- Agena Bioscience GmbH, Hamburg, Germany
| | - C Jovelet
- Stilla Technologies, Villejuif, France
| | - M J Agterof
- Department of Medical Oncology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - D Ten Bokkel Huinink
- Department of Medical Oncology, Alexander Monro Hospital, Bilthoven, The Netherlands
| | - E W Bouman-Wammes
- Department of Medical Oncology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - E van der Wall
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - S G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - K G A Gilhuijs
- Image Sciences Institute, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
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9
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Menne Guricová K, Groen V, Pos F, Monninkhof E, Elias SG, Haustermans K, Smeenk RJ, van der Voort van Zyp J, Draulans C, Isebaert S, van Houdt PJ, Kerkmeijer LGW, van der Heide UA. Risk Modeling for Individualization of the FLAME Focal Boost Approach in External Beam Radiation Therapy for Patients With Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2024; 118:66-73. [PMID: 37725026 DOI: 10.1016/j.ijrobp.2023.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 07/16/2023] [Accepted: 07/29/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE The FLAME trial (NCT01168479) showed that isotoxic focal boosting to the intraprostatic lesion(s) in patients with intermediate- and high-risk prostate cancer improves 5-year disease-free survival (DFS). Although the near-minimum dose to the gross tumor volume (D98%) was associated with improved outcomes, a closer look suggested that this might not be the same for all patients. Therefore, we investigated whether risk factors that are associated with a benefit of focal boosting can be identified. METHODS AND MATERIALS We described the distribution of clinical characteristics and the number of high-risk factors with respect to the D98% in 526 FLAME trial patients. We used penalized Cox regression to develop a prediction model. To investigate a potential benefit in patient subgroups, we compared the model-based predictions of 5-year DFS assuming standard whole-gland radiation therapy of 77 Gy to the predictions assuming an additional focal boost with D98% of 95 Gy. RESULTS Patients with high-risk factors were well represented in the group of 120 patients that received D98% > 85 Gy and showed fewer recurrences compared with the group that received 77 Gy. Applying the model simulating a standard dose of 77 Gy, we predicted a high DFS for grade group (GG) 1 patients, whereas patients with high-risk characteristics appeared to show a low DFS. All risk groups showed a high level of DFS when simulating D98% of 95 Gy. CONCLUSIONS Our results suggest that GG 1 patients already show a low level of failure at a standard dose of 77 Gy, limiting the additional benefit of focal boosting. In contrast, patients with high-risk characteristics, especially GG 4 or 5, show a low 5-year DFS, while focal boosting might improve this substantially. This suggests that reaching a high focal boost dose may be particularly beneficial for these patients.
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Affiliation(s)
- Karolína Menne Guricová
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Veerle Groen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Evelyn Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Robert J Smeenk
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Cédric Draulans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Sofie Isebaert
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Petra J van Houdt
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands.
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10
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Wijnands AM, Elias SG, Dekker E, Fidder HH, Hoentjen F, ten Hove JR, Maljaars PWJ, van der Meulen‐de Jong AE, Mooiweer E, Ouwehand RJ, Penning de Vries BBL, Ponsioen CY, van Schaik FDM, Oldenburg B. Smoking and colorectal neoplasia in patients with inflammatory bowel disease: Dose-effect relationship. United European Gastroenterol J 2023; 11:612-620. [PMID: 37505117 PMCID: PMC10493358 DOI: 10.1002/ueg2.12426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/17/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND AND AIMS Prior studies on the effect of smoking on the risk of colitis-associated colorectal neoplasia (CRN) have reported conflicting results. We aimed to further elucidate the association between smoking, including possible dose-effects, and the development of colorectal neoplasia in patients with inflammatory bowel disease (IBD). METHODS We performed a prospective multicenter cohort study including patients with colonic IBD enrolled in a surveillance program in four academic hospitals between 2011 and 2021. The effects of smoking status and pack-years at study entry on subsequent recurrent events of CRN (including indefinite, low- and high-grade dysplasia, and colorectal cancer [CRC]) were evaluated using uni- and multivariable Prentice, Williams, and Peterson total-time Cox proportional hazard models. Adjustment was performed for extensive disease, prior/index dysplasia, sex, age, first-degree relative with CRC, primary sclerosing cholangitis, and endoscopic inflammation. RESULTS In 501 of the enrolled 576 patients, at least one follow-up surveillance was performed after the study index (median follow-up 5 years). CRN occurred at least once in 105 patients. Ever smoking was not associated with recurrent CRN risk (adjusted hazard ratio [aHR] 1.04, 95% confidence interval [CI] 0.75-1.44), but an increasing number of pack-years was associated with an increased risk of recurrent CRN (aHR per 10 pack-years 1.17, 95% CI 1.03-1.32; p < 0.05). Separate analyses per IBD type did not reveal differences. CONCLUSIONS This study found that an increase in pack-years is associated with a higher risk of recurrent CRN in patients with IBD, independent of established CRN risk factors (NCT01464151).
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Affiliation(s)
- Anouk M. Wijnands
- Department of Gastroenterology and HepatologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Sjoerd G. Elias
- Department of EpidemiologyJulius Center for Health Sciences and Primary CareUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and HepatologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Herma H. Fidder
- Department of Gastroenterology and HepatologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Frank Hoentjen
- Department of Gastroenterology and HepatologyRadboud University Medical CentreNijmegenThe Netherlands
- Division of GastroenterologyDepartment of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Joren R. ten Hove
- Department of Gastroenterology and HepatologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - P. W. Jeroen Maljaars
- Department of Gastroenterology and HepatologyLeiden University Medical CentreLeidenThe Netherlands
| | | | - Erik Mooiweer
- Department of Gastroenterology and HepatologyHospital St JansdalHarderwijkThe Netherlands
| | - Renske J. Ouwehand
- Department of Gastroenterology and HepatologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Bas B. L. Penning de Vries
- Department of EpidemiologyJulius Center for Health Sciences and Primary CareUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Cyriel Y. Ponsioen
- Department of Gastroenterology and HepatologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Fiona D. M. van Schaik
- Department of Gastroenterology and HepatologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Bas Oldenburg
- Department of Gastroenterology and HepatologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
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11
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de Wit JG, Vonk J, Voskuil FJ, de Visscher SAHJ, Schepman KP, Hooghiemstra WTR, Linssen MD, Elias SG, Halmos GB, Plaat BEC, Doff JJ, Rosenthal EL, Robinson D, van der Vegt B, Nagengast WB, van Dam GM, Witjes MJH. EGFR-targeted fluorescence molecular imaging for intraoperative margin assessment in oral cancer patients: a phase II trial. Nat Commun 2023; 14:4952. [PMID: 37587149 PMCID: PMC10432510 DOI: 10.1038/s41467-023-40324-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 07/21/2023] [Indexed: 08/18/2023] Open
Abstract
Inadequate surgical margins occur frequently in oral squamous cell carcinoma surgery. Fluorescence molecular imaging (FMI) has been explored for intraoperative margin assessment, but data are limited to phase-I studies. In this single-arm phase-II study (NCT03134846), our primary endpoints were to determine the sensitivity, specificity and positive predictive value of cetuximab-800CW for tumor-positive margins detection. Secondary endpoints were safety, close margin detection rate and intrinsic cetuximab-800CW fluorescence. In 65 patients with 66 tumors, cetuximab-800CW was well-tolerated. Fluorescent spots identified in the surgical margin with signal-to-background ratios (SBR) of ≥2 identify tumor-positive margins with 100% sensitivity, 85.9% specificity, 58.3% positive predictive value, and 100% negative predictive value. An SBR of ≥1.5 identifies close margins with 70.3% sensitivity, 76.1% specificity, 60.5% positive predictive value, and 83.1% negative predictive value. Performing frozen section analysis aimed at the fluorescent spots with an SBR of ≥1.5 enables safe, intraoperative adjustment of surgical margins.
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Affiliation(s)
- Jaron G de Wit
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Jasper Vonk
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Floris J Voskuil
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Department of Pathology & Medical Biology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Sebastiaan A H J de Visscher
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Kees-Pieter Schepman
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Wouter T R Hooghiemstra
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Matthijs D Linssen
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Jan J Doff
- Department of Pathology & Medical Biology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Eben L Rosenthal
- Department of Otolaryngology, Vanderbilt University Medical Centre, Nashville, Tennessee, United States of America
| | - Dominic Robinson
- Center for Optical Diagnostics and Therapy, Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Bert van der Vegt
- Department of Pathology & Medical Biology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Wouter B Nagengast
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Gooitzen M van Dam
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- TRACER Europe B.V. / AxelaRx, Groningen, the Netherlands
| | - Max J H Witjes
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
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12
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Verweij ME, Tanaka MD, Kensen CM, van der Heide UA, Marijnen CAM, Janssen T, Vijlbrief T, van Grevenstein WMU, Moons LMG, Koopman M, Lacle MM, Braat MNGJA, Chalabi M, Maas M, Huibregtse IL, Snaebjornsson P, Grotenhuis BA, Fijneman R, Consten E, Pronk A, Smits AB, Heikens JT, Eijkelenkamp H, Elias SG, Verkooijen HM, Schoenmakers MMC, Meijer GJ, Intven M, Peters FP. Towards Response ADAptive Radiotherapy for organ preservation for intermediate-risk rectal cancer (preRADAR): protocol of a phase I dose-escalation trial. BMJ Open 2023; 13:e065010. [PMID: 37321815 PMCID: PMC10277084 DOI: 10.1136/bmjopen-2022-065010] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/07/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Organ preservation is associated with superior functional outcome and quality of life (QoL) compared with total mesorectal excision (TME) for rectal cancer. Only 10% of patients are eligible for organ preservation following short-course radiotherapy (SCRT, 25 Gy in five fractions) and a prolonged interval (4-8 weeks) to response evaluation. The organ preservation rate could potentially be increased by dose-escalated radiotherapy. Online adaptive magnetic resonance-guided radiotherapy (MRgRT) is anticipated to reduce radiation-induced toxicity and enable radiotherapy dose escalation. This trial aims to establish the maximum tolerated dose (MTD) of dose-escalated SCRT using online adaptive MRgRT. METHODS AND ANALYSIS The preRADAR is a multicentre phase I trial with a 6+3 dose-escalation design. Patients with intermediate-risk rectal cancer (cT3c-d(MRF-)N1M0 or cT1-3(MRF-)N1M0) interested in organ preservation are eligible. Patients are treated with a radiotherapy boost of 2×5 Gy (level 0), 3×5 Gy (level 1), 4×5 Gy (level 2) or 5×5 Gy (level 3) on the gross tumour volume in the week following standard SCRT using online adaptive MRgRT. The trial starts on dose level 1. The primary endpoint is the MTD based on the incidence of dose-limiting toxicity (DLT) per dose level. DLT is a composite of maximum one in nine severe radiation-induced toxicities and maximum one in three severe postoperative complications, in patients treated with TME or local excision within 26 weeks following start of treatment. Secondary endpoints include the organ preservation rate, non-DLT, oncological outcomes, patient-reported QoL and functional outcomes up to 2 years following start of treatment. Imaging and laboratory biomarkers are explored for early response prediction. ETHICS AND DISSEMINATION The trial protocol has been approved by the Medical Ethics Committee of the University Medical Centre Utrecht. The primary and secondary trial results will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER WHO International Clinical Trials Registry (NL8997; https://trialsearch.who.int).
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Affiliation(s)
- Maaike E Verweij
- Department of Radiation-Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Max D Tanaka
- Department of Radiation-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Chavelli M Kensen
- Department of Radiation-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Uulke A van der Heide
- Department of Radiation-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Corrie A M Marijnen
- Department of Radiation-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Tomas Janssen
- Department of Radiation-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Tineke Vijlbrief
- Department of Radiation-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Leon M G Moons
- Department of Gastroenterology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Miangela M Lacle
- Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Manon N G J A Braat
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Myriam Chalabi
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Monique Maas
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Inge L Huibregtse
- Department of Gastroenterology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Petur Snaebjornsson
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Remond Fijneman
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Esther Consten
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis Utrecht Zeist Doorn, Utrecht, The Netherlands
| | - Anke B Smits
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Joost T Heikens
- Department of Surgery, Hospital Rivierenland, Tiel, The Netherlands
| | - Hidde Eijkelenkamp
- Department of Radiation-Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Helena M Verkooijen
- Department of Radiation-Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Gert J Meijer
- Department of Radiation-Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Martijn Intven
- Department of Radiation-Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Femke P Peters
- Department of Radiation-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Strating E, Verhagen MP, Wensink E, Dünnebach E, Wijler L, Aranguren I, De la Cruz AS, Peters NA, Hageman JH, van der Net MMC, van Schelven S, Laoukili J, Fodde R, Roodhart J, Nierkens S, Snippert H, Gloerich M, Rinkes IB, Elias SG, Kranenburg O. Co-cultures of colon cancer cells and cancer-associated fibroblasts recapitulate the aggressive features of mesenchymal-like colon cancer. Front Immunol 2023; 14:1053920. [PMID: 37261365 PMCID: PMC10228738 DOI: 10.3389/fimmu.2023.1053920] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/03/2023] [Indexed: 06/02/2023] Open
Abstract
Background Poor prognosis in colon cancer is associated with a high content of cancer-associated fibroblasts (CAFs) and an immunosuppressive tumor microenvironment. The relationship between these two features is incompletely understood. Here, we aimed to generate a model system for studying the interaction between cancer cells and CAFs and their effect on immune-related cytokines and T cell proliferation. Methods CAFs were isolated from colon cancer liver metastases and were immortalized to prolong lifespan and improve robustness and reproducibility. Established medium and matrix compositions that support the growth of patient-derived organoids were adapted to also support CAF growth. Changes in growth pattern and cellular re-organization were assessed by confocal microscopy, live cell imaging, and immunofluorescence. Single cell RNA sequencing was used to study CAF/organoid co-culture-induced phenotypic changes in both cell types. Conditioned media were used to quantify the production of immunosuppressive factors and to assess their effect on T cell proliferation. Results We developed a co-culture system in which colon cancer organoids and CAFs spontaneously organize into superstructures with a high capacity to contract and stiffen the extracellular matrix (ECM). CAF-produced collagen IV provided a basement membrane supporting cancer cell organization into glandular structures, reminiscent of human cancer histology. Single cell RNA sequencing analysis showed that CAFs induced a partial epithelial-to-mesenchymal-transition in a subpopulation of cancer cells, similar to what is observed in the mesenchymal-like consensus molecular subtype 4 (CMS4) colon cancer. CAFs in co-culture were characterized by high expression of ECM components, ECM-remodeling enzymes, glycolysis, hypoxia, and genes involved in immunosuppression. An expression signature derived from CAFs in co-culture identified a subpopulation of glycolytic myofibroblasts specifically residing in CMS1 and CMS4 colon cancer. Medium conditioned by co-cultures contained high levels of the immunosuppressive factors TGFβ1, VEGFA and lactate, and potently inhibited T cell proliferation. Conclusion Co-cultures of organoids and immortalized CAFs recapitulate the histological, biophysical, and immunosuppressive features of aggressive mesenchymal-like human CRC. The model can be used to study the mechanisms of immunosuppression and to test therapeutic strategies targeting the cross-talk between CAFs and cancer cells. It can be further modified to represent distinct colon cancer subtypes and (organ-specific) microenvironments.
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Affiliation(s)
- Esther Strating
- Laboratory Translational Oncology, Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Emerens Wensink
- Department of Medical Oncology, Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ester Dünnebach
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Liza Wijler
- Laboratory Translational Oncology, Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht, Netherlands
| | - Itziar Aranguren
- Laboratory Translational Oncology, Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht, Netherlands
| | - Alberto Sanchez De la Cruz
- Laboratory Translational Oncology, Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht, Netherlands
| | - Niek A. Peters
- Laboratory Translational Oncology, Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht, Netherlands
| | - Joris H. Hageman
- Center for Molecular Medicine, Division LAB, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mirjam M. C. van der Net
- Center for Molecular Medicine, Division LAB, University Medical Center Utrecht, Utrecht, Netherlands
| | - Susanne van Schelven
- Laboratory Translational Oncology, Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jamila Laoukili
- Laboratory Translational Oncology, Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht, Netherlands
| | - Riccardo Fodde
- Department of Pathology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Jeanine Roodhart
- Department of Medical Oncology, Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht, Netherlands
| | - Stefan Nierkens
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Hugo Snippert
- Center for Molecular Medicine, Division LAB, University Medical Center Utrecht, Utrecht, Netherlands
| | - Martijn Gloerich
- Center for Molecular Medicine, Division LAB, University Medical Center Utrecht, Utrecht, Netherlands
| | - Inne Borel Rinkes
- Laboratory Translational Oncology, Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sjoerd G. Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Onno Kranenburg
- Laboratory Translational Oncology, Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht, Netherlands
- Utrecht Platform for Organoid Technology, Utrecht University, Utrecht, Netherlands
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14
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Millen R, De Kort WWB, Koomen M, van Son GJF, Gobits R, Penning de Vries B, Begthel H, Zandvliet M, Doornaert P, Raaijmakers CPJ, Geurts MH, Elias SG, van Es RJJ, de Bree R, Devriese LA, Willems SM, Kranenburg O, Driehuis E, Clevers H. Patient-derived head and neck cancer organoids allow treatment stratification and serve as a tool for biomarker validation and identification. Med 2023; 4:290-310.e12. [PMID: 37178682 DOI: 10.1016/j.medj.2023.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 01/06/2023] [Revised: 03/20/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Organoids are in vitro three-dimensional structures that can be grown from patient tissue. Head and neck cancer (HNC) is a collective term used for multiple tumor types including squamous cell carcinomas and salivary gland adenocarcinomas. METHODS Organoids were established from HNC patient tumor tissue and characterized using immunohistochemistry and DNA sequencing. Organoids were exposed to chemo- and radiotherapy and a panel of targeted agents. Organoid response was correlated with patient clinical response. CRISPR-Cas9-based gene editing of organoids was applied for biomarker validation. FINDINGS A HNC biobank consisting of 110 models, including 65 tumor models, was generated. Organoids retained DNA alterations found in HNC. Comparison of organoid and patient response to radiotherapy (primary [n = 6] and adjuvant [n = 15]) indicated potential for guiding treatment options in the adjuvant setting. In organoids, the radio-sensitizing potential of cisplatin and carboplatin could be validated. However, cetuximab conveyed radioprotection in most models. HNC-targeted treatments were tested on 31 models, indicating possible novel treatment options with the potential for treatment stratification in the future. Activating PIK3CA mutations did not predict alpelisib response in organoids. Protein arginine methyltransferase 5 (PRMT5) inhibitors were identified as a potential treatment option for cyclin-dependent kinase inhibitor 2A (CDKN2A) null HNC. CONCLUSIONS Organoids hold potential as a diagnostic tool in personalized medicine for HNC. In vitro organoid response to radiotherapy (RT) showed a trend that mimics clinical response, indicating the predictive potential of patient-derived organoids. Moreover, organoids could be used for biomarker discovery and validation. FUNDING This work was funded by Oncode PoC 2018-P0003.
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Affiliation(s)
- Rosemary Millen
- Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW), Utrecht, the Netherlands.
| | - Willem W B De Kort
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mandy Koomen
- Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW), Utrecht, the Netherlands
| | - Gijs J F van Son
- Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW), Utrecht, the Netherlands; Princess Maxima Center, Utrecht, the Netherlands
| | - Roán Gobits
- Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW), Utrecht, the Netherlands
| | - Bas Penning de Vries
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Harry Begthel
- Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW), Utrecht, the Netherlands
| | - Maurice Zandvliet
- Department of Clinical Sciences - Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Patricia Doornaert
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Maarten H Geurts
- Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW), Utrecht, the Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Robert J J van Es
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lot A Devriese
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Stefan M Willems
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Pathology, University Medical Center Groningen, Groningen, the Netherlands
| | - Onno Kranenburg
- Utrecht Platform for Organoid Technology (U-PORT), Utrecht Medical Center Utrecht, Utrecht, the Netherlands
| | - Else Driehuis
- Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW), Utrecht, the Netherlands.
| | - Hans Clevers
- Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW), Utrecht, the Netherlands.
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15
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de Maar JS, Luyendijk M, Suelmann BBM, van der Kruijssen DEW, Elias SG, Siesling S, van der Wall E. Comparison between de novo and metachronous metastatic breast cancer: the presence of a primary tumour is not the only difference-a Dutch population-based study from 2008 to 2018. Breast Cancer Res Treat 2023; 198:253-264. [PMID: 36648694 DOI: 10.1007/s10549-022-06837-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/04/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim of this study was to compare characteristics and survival of patients with de novo and metachronous metastatic breast cancer. METHODS Data of patients with metastatic breast cancer were obtained from the Netherlands Cancer Registry. Patients were categorized as having de novo metastatic breast cancer (n = 8656) if they had distant metastases at initial presentation, or metachronous metastatic disease (n = 2374) in case they developed metastases within 5 or 10 years after initial breast cancer diagnosis. Clinicopathological characteristics and treatments of these two groups were compared, after which multiple imputation was performed to account for missing data. Overall survival was compared for patients treated with systemic therapy in the metastatic setting, using Kaplan Meier curves and multivariable Cox proportional hazards models. The hazard ratio for overall survival of de novo versus metachronous metastases was assessed accounting for time-varying effects. RESULTS Compared to metachronous patients, patients with de novo metastatic breast cancer were more likely to be ≥ 70 years, to have invasive lobular carcinoma, clinical T3 or T4 tumours, loco-regional lymph node metastases, HER2 positivity, bone only disease and to have received systemic therapy in the metastatic setting. They were less likely to have triple negative tumours and liver or brain metastases. Patients with de novo metastases survived longer (median 34.7 months) than patients with metachronous metastases (median 24.3 months) and the hazard ratio (0.75) varied over time. CONCLUSIONS Differences in clinicopathological characteristics and survival between de novo and metachronous metastatic breast cancer highlight that these are distinct patients groups.
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Affiliation(s)
- Josanne S de Maar
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne Luyendijk
- Department of Research and Development, Netherlands Comprehensive Cancer Centre (IKNL), Utrecht, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Britt B M Suelmann
- Department of Medical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dave E W van der Kruijssen
- Department of Medical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Centre (IKNL), Utrecht, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Elsken van der Wall
- Department of Medical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
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16
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van der Kruijssen DEW, van der Kuil AJS, Vink GR, Punt CJA, de Wilt JHW, Elias SG, Koopman M. Time-varying prognostic value of primary tumor sidedness in metastatic colorectal cancer: A population-based study and meta-analysis. Int J Cancer 2023; 152:1360-1369. [PMID: 36346099 PMCID: PMC10098852 DOI: 10.1002/ijc.34347] [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: 03/29/2022] [Revised: 09/13/2022] [Accepted: 09/23/2022] [Indexed: 11/11/2022]
Abstract
We studied the prognostic value of primary tumor sidedness in metastatic colorectal cancer over time and across treatment lines. Population data on synchronous metastatic colorectal cancer patients were extracted from the Netherlands Cancer Registry and SEER database. Pubmed, EMBASE and Cochrane library were searched for prospective studies on metastatic colorectal cancer to conduct a meta-analysis. Inclusion criteria consisted of metastatic disease, systemic treatment with palliative intent and specification of primary tumor location. Data were pooled using a random-effects model. For the population-based data, multivariable Cox models were constructed. The Grambsch-Therneau test was conducted to evaluate the potential time-varying nature of sidedness. Meta-regression incorporating treatment-line as variable was conducted to test the pre-specified hypothesis that the prognostic value of sidedness varies over time. Analysis of 12 885 and 16 160 synchronous metastatic colorectal cancer patients registered in the Netherlands Cancer Registry and SEER database, respectively, indicated a time-varying prognostic value of sidedness (P < .01). Thirty-one studies were selected for the meta-analysis (9558 patients for overall survival analysis). Pooled univariable hazard ratioleft-sided/right-sided for overall survival was 0.71 (95% CI: 0.65-0.76) in 1st-line, 0.76 (0.54-1.06) in 2nd-line and 1.01 (0.86-1.19) in 3rd-line studies. Hazard ratios were significantly influenced by treatment line (P = .035). The prognostic value of sidedness of the primary tumor in metastatic colorectal cancer patients treated with palliative systemic therapy decreases over time since diagnosis, suggesting that sidedness may not be a useful stratification factor in late-line trials. This decrease in prognostic value should be taken into account when providing prognostic information to patients.
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Affiliation(s)
- Dave E W van der Kruijssen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Auke J S van der Kuil
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geraldine R Vink
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Research and development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Cornelis J A Punt
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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17
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Ragusi MAA, van der Velden BHM, Meeuwis C, Tetteroo E, Coerkamp EG, van Nijnatten TJA, Jansen FH, Wolters-van der Ben EJM, Jongen L, van Raamt F, Dorrius MD, Verloop J, Viergever MA, Pijnappel RM, Elias SG, Gilhuijs KGA. Long-term Survival in Breast Cancer Patients Is Associated with Contralateral Parenchymal Enhancement at MRI: Outcomes of the SELECT Study. Radiology 2023; 307:e221922. [PMID: 36975820 DOI: 10.1148/radiol.221922] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Background Several single-center studies found that high contralateral parenchymal enhancement (CPE) at breast MRI was associated with improved long-term survival in patients with estrogen receptor (ER)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer. Due to varying sample sizes, population characteristics, and follow-up times, consensus of the association is currently lacking. Purpose To confirm whether CPE is associated with long-term survival in a large multicenter retrospective cohort, and to investigate if CPE is associated with endocrine therapy effectiveness. Materials and Methods This multicenter observational cohort included women with unilateral ER-positive HER2-negative breast cancer (tumor size ≤50 mm and ≤three positive lymph nodes) who underwent MRI from January 2005 to December 2010. Overall survival (OS), recurrence-free survival (RFS), and distant RFS (DRFS) were assessed. Kaplan-Meier analysis was performed to investigate differences in absolute risk after 10 years, stratified according to CPE tertile. Multivariable Cox proportional hazards regression analysis was performed to investigate whether CPE was associated with prognosis and endocrine therapy effectiveness. Results Overall, 1432 women (median age, 54 years [IQR, 47-63 years]) were included from 10 centers. Differences in absolute OS after 10 years were stratified according to CPE tertile as follows: 88.5% (95% CI: 88.1, 89.1) in tertile 1, 85.8% (95% CI: 85.2, 86.3) in tertile 2, and 85.9% (95% CI: 85.4, 86.4) in tertile 3. CPE was independently associated with OS, with a hazard ratio (HR) of 1.17 (95% CI: 1.0, 1.36; P = .047), but was not associated with RFS (HR, 1.11; P = .16) or DRFS (HR, 1.11; P = .19). The effect of endocrine therapy on survival could not be accurately assessed; therefore, the association between endocrine therapy efficacy and CPE could not reliably be estimated. Conclusion High contralateral parenchymal enhancement was associated with a marginally decreased overall survival in patients with estrogen receptor-positive and human epidermal growth factor receptor 2-negative breast cancer, but was not associated with recurrence-free survival (RFS) or distant RFS. Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Honda and Iima in this issue.
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Affiliation(s)
- Max A A Ragusi
- From the Department of Radiology/Image Sciences Institute (M.A.A.R., B.H.M.v.d.V., M.A.V., R.M.P., K.G.A.G.) and Department of Epidemiology, Julius Center for Health Sciences and Primary Care (S.G.E.), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands (C.M.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands (E.G.C.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands (T.J.A.v.N.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.J.A.v.N.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (F.H.J.); Department of Radiology, St. Antonius Hospital, Utrecht, the Netherlands (E.J.M.W.v.d.B.); Department of Radiology, Diakonessenhuis, Utrecht, the Netherlands (L.J.); Department of Radiology, Gelre Hospital, Apeldoorn, the Netherlands (F.v.R.); Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands (M.D.D.); and Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (J.V.)
| | - Bas H M van der Velden
- From the Department of Radiology/Image Sciences Institute (M.A.A.R., B.H.M.v.d.V., M.A.V., R.M.P., K.G.A.G.) and Department of Epidemiology, Julius Center for Health Sciences and Primary Care (S.G.E.), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands (C.M.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands (E.G.C.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands (T.J.A.v.N.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.J.A.v.N.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (F.H.J.); Department of Radiology, St. Antonius Hospital, Utrecht, the Netherlands (E.J.M.W.v.d.B.); Department of Radiology, Diakonessenhuis, Utrecht, the Netherlands (L.J.); Department of Radiology, Gelre Hospital, Apeldoorn, the Netherlands (F.v.R.); Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands (M.D.D.); and Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (J.V.)
| | - Carla Meeuwis
- From the Department of Radiology/Image Sciences Institute (M.A.A.R., B.H.M.v.d.V., M.A.V., R.M.P., K.G.A.G.) and Department of Epidemiology, Julius Center for Health Sciences and Primary Care (S.G.E.), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands (C.M.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands (E.G.C.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands (T.J.A.v.N.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.J.A.v.N.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (F.H.J.); Department of Radiology, St. Antonius Hospital, Utrecht, the Netherlands (E.J.M.W.v.d.B.); Department of Radiology, Diakonessenhuis, Utrecht, the Netherlands (L.J.); Department of Radiology, Gelre Hospital, Apeldoorn, the Netherlands (F.v.R.); Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands (M.D.D.); and Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (J.V.)
| | - Eric Tetteroo
- From the Department of Radiology/Image Sciences Institute (M.A.A.R., B.H.M.v.d.V., M.A.V., R.M.P., K.G.A.G.) and Department of Epidemiology, Julius Center for Health Sciences and Primary Care (S.G.E.), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands (C.M.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands (E.G.C.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands (T.J.A.v.N.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.J.A.v.N.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (F.H.J.); Department of Radiology, St. Antonius Hospital, Utrecht, the Netherlands (E.J.M.W.v.d.B.); Department of Radiology, Diakonessenhuis, Utrecht, the Netherlands (L.J.); Department of Radiology, Gelre Hospital, Apeldoorn, the Netherlands (F.v.R.); Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands (M.D.D.); and Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (J.V.)
| | - Emile G Coerkamp
- From the Department of Radiology/Image Sciences Institute (M.A.A.R., B.H.M.v.d.V., M.A.V., R.M.P., K.G.A.G.) and Department of Epidemiology, Julius Center for Health Sciences and Primary Care (S.G.E.), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands (C.M.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands (E.G.C.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands (T.J.A.v.N.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.J.A.v.N.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (F.H.J.); Department of Radiology, St. Antonius Hospital, Utrecht, the Netherlands (E.J.M.W.v.d.B.); Department of Radiology, Diakonessenhuis, Utrecht, the Netherlands (L.J.); Department of Radiology, Gelre Hospital, Apeldoorn, the Netherlands (F.v.R.); Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands (M.D.D.); and Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (J.V.)
| | - Thiemo J A van Nijnatten
- From the Department of Radiology/Image Sciences Institute (M.A.A.R., B.H.M.v.d.V., M.A.V., R.M.P., K.G.A.G.) and Department of Epidemiology, Julius Center for Health Sciences and Primary Care (S.G.E.), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands (C.M.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands (E.G.C.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands (T.J.A.v.N.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.J.A.v.N.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (F.H.J.); Department of Radiology, St. Antonius Hospital, Utrecht, the Netherlands (E.J.M.W.v.d.B.); Department of Radiology, Diakonessenhuis, Utrecht, the Netherlands (L.J.); Department of Radiology, Gelre Hospital, Apeldoorn, the Netherlands (F.v.R.); Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands (M.D.D.); and Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (J.V.)
| | - Frits H Jansen
- From the Department of Radiology/Image Sciences Institute (M.A.A.R., B.H.M.v.d.V., M.A.V., R.M.P., K.G.A.G.) and Department of Epidemiology, Julius Center for Health Sciences and Primary Care (S.G.E.), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands (C.M.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands (E.G.C.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands (T.J.A.v.N.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.J.A.v.N.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (F.H.J.); Department of Radiology, St. Antonius Hospital, Utrecht, the Netherlands (E.J.M.W.v.d.B.); Department of Radiology, Diakonessenhuis, Utrecht, the Netherlands (L.J.); Department of Radiology, Gelre Hospital, Apeldoorn, the Netherlands (F.v.R.); Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands (M.D.D.); and Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (J.V.)
| | - Elian J M Wolters-van der Ben
- From the Department of Radiology/Image Sciences Institute (M.A.A.R., B.H.M.v.d.V., M.A.V., R.M.P., K.G.A.G.) and Department of Epidemiology, Julius Center for Health Sciences and Primary Care (S.G.E.), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands (C.M.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands (E.G.C.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands (T.J.A.v.N.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.J.A.v.N.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (F.H.J.); Department of Radiology, St. Antonius Hospital, Utrecht, the Netherlands (E.J.M.W.v.d.B.); Department of Radiology, Diakonessenhuis, Utrecht, the Netherlands (L.J.); Department of Radiology, Gelre Hospital, Apeldoorn, the Netherlands (F.v.R.); Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands (M.D.D.); and Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (J.V.)
| | - Lisa Jongen
- From the Department of Radiology/Image Sciences Institute (M.A.A.R., B.H.M.v.d.V., M.A.V., R.M.P., K.G.A.G.) and Department of Epidemiology, Julius Center for Health Sciences and Primary Care (S.G.E.), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands (C.M.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands (E.G.C.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands (T.J.A.v.N.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.J.A.v.N.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (F.H.J.); Department of Radiology, St. Antonius Hospital, Utrecht, the Netherlands (E.J.M.W.v.d.B.); Department of Radiology, Diakonessenhuis, Utrecht, the Netherlands (L.J.); Department of Radiology, Gelre Hospital, Apeldoorn, the Netherlands (F.v.R.); Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands (M.D.D.); and Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (J.V.)
| | - Fleur van Raamt
- From the Department of Radiology/Image Sciences Institute (M.A.A.R., B.H.M.v.d.V., M.A.V., R.M.P., K.G.A.G.) and Department of Epidemiology, Julius Center for Health Sciences and Primary Care (S.G.E.), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands (C.M.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands (E.G.C.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands (T.J.A.v.N.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.J.A.v.N.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (F.H.J.); Department of Radiology, St. Antonius Hospital, Utrecht, the Netherlands (E.J.M.W.v.d.B.); Department of Radiology, Diakonessenhuis, Utrecht, the Netherlands (L.J.); Department of Radiology, Gelre Hospital, Apeldoorn, the Netherlands (F.v.R.); Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands (M.D.D.); and Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (J.V.)
| | - Monique D Dorrius
- From the Department of Radiology/Image Sciences Institute (M.A.A.R., B.H.M.v.d.V., M.A.V., R.M.P., K.G.A.G.) and Department of Epidemiology, Julius Center for Health Sciences and Primary Care (S.G.E.), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands (C.M.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands (E.G.C.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands (T.J.A.v.N.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.J.A.v.N.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (F.H.J.); Department of Radiology, St. Antonius Hospital, Utrecht, the Netherlands (E.J.M.W.v.d.B.); Department of Radiology, Diakonessenhuis, Utrecht, the Netherlands (L.J.); Department of Radiology, Gelre Hospital, Apeldoorn, the Netherlands (F.v.R.); Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands (M.D.D.); and Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (J.V.)
| | - Janneke Verloop
- From the Department of Radiology/Image Sciences Institute (M.A.A.R., B.H.M.v.d.V., M.A.V., R.M.P., K.G.A.G.) and Department of Epidemiology, Julius Center for Health Sciences and Primary Care (S.G.E.), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands (C.M.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands (E.G.C.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands (T.J.A.v.N.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.J.A.v.N.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (F.H.J.); Department of Radiology, St. Antonius Hospital, Utrecht, the Netherlands (E.J.M.W.v.d.B.); Department of Radiology, Diakonessenhuis, Utrecht, the Netherlands (L.J.); Department of Radiology, Gelre Hospital, Apeldoorn, the Netherlands (F.v.R.); Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands (M.D.D.); and Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (J.V.)
| | - Max A Viergever
- From the Department of Radiology/Image Sciences Institute (M.A.A.R., B.H.M.v.d.V., M.A.V., R.M.P., K.G.A.G.) and Department of Epidemiology, Julius Center for Health Sciences and Primary Care (S.G.E.), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands (C.M.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands (E.G.C.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands (T.J.A.v.N.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.J.A.v.N.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (F.H.J.); Department of Radiology, St. Antonius Hospital, Utrecht, the Netherlands (E.J.M.W.v.d.B.); Department of Radiology, Diakonessenhuis, Utrecht, the Netherlands (L.J.); Department of Radiology, Gelre Hospital, Apeldoorn, the Netherlands (F.v.R.); Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands (M.D.D.); and Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (J.V.)
| | - Ruud M Pijnappel
- From the Department of Radiology/Image Sciences Institute (M.A.A.R., B.H.M.v.d.V., M.A.V., R.M.P., K.G.A.G.) and Department of Epidemiology, Julius Center for Health Sciences and Primary Care (S.G.E.), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands (C.M.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands (E.G.C.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands (T.J.A.v.N.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.J.A.v.N.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (F.H.J.); Department of Radiology, St. Antonius Hospital, Utrecht, the Netherlands (E.J.M.W.v.d.B.); Department of Radiology, Diakonessenhuis, Utrecht, the Netherlands (L.J.); Department of Radiology, Gelre Hospital, Apeldoorn, the Netherlands (F.v.R.); Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands (M.D.D.); and Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (J.V.)
| | - Sjoerd G Elias
- From the Department of Radiology/Image Sciences Institute (M.A.A.R., B.H.M.v.d.V., M.A.V., R.M.P., K.G.A.G.) and Department of Epidemiology, Julius Center for Health Sciences and Primary Care (S.G.E.), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands (C.M.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands (E.G.C.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands (T.J.A.v.N.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.J.A.v.N.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (F.H.J.); Department of Radiology, St. Antonius Hospital, Utrecht, the Netherlands (E.J.M.W.v.d.B.); Department of Radiology, Diakonessenhuis, Utrecht, the Netherlands (L.J.); Department of Radiology, Gelre Hospital, Apeldoorn, the Netherlands (F.v.R.); Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands (M.D.D.); and Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (J.V.)
| | - Kenneth G A Gilhuijs
- From the Department of Radiology/Image Sciences Institute (M.A.A.R., B.H.M.v.d.V., M.A.V., R.M.P., K.G.A.G.) and Department of Epidemiology, Julius Center for Health Sciences and Primary Care (S.G.E.), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands (C.M.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands (E.G.C.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands (T.J.A.v.N.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.J.A.v.N.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (F.H.J.); Department of Radiology, St. Antonius Hospital, Utrecht, the Netherlands (E.J.M.W.v.d.B.); Department of Radiology, Diakonessenhuis, Utrecht, the Netherlands (L.J.); Department of Radiology, Gelre Hospital, Apeldoorn, the Netherlands (F.v.R.); Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands (M.D.D.); and Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (J.V.)
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18
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Overwater A, Elias SG, Schoon EJ, Bergman JJGHM, Pouw RE, Weusten BLAM. The course of pain and dysphagia after radiofrequency ablation for Barrett's esophagus-related neoplasia. Endoscopy 2023; 55:255-260. [PMID: 36070753 DOI: 10.1055/a-1929-1448] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is effective for eradication of Barrett's esophagus (BE) neoplasia, but little is known on the course of pain and dysphagia after RFA. We aimed to describe the course of post-RFA symptoms and to identify possible associated risk factors. METHODS In this multicenter, observational cohort study, all RFA procedures registered in a prospective database were included. Patient and treatment characteristics were collected from medical records and patients self-registered post-procedural symptoms in electronic symptom diaries for 14 days. Mixed model regression was used for the analyses. RESULTS In total, 255 diaries were completed. Post-RFA pain was reported for 95 % (95 %CI 93-98) of procedures (median duration 14 days; 25th-75th percentiles [p25-p75] 11-14) and major pain for 64 % (95 %CI 58-69; median duration 8 days, p25-p75 3-13). Post-procedural pain significantly increased with BE length, younger age, and no prior ablation. Dysphagia was present after 83 % (95 %CI 79-88) of procedures (median duration 13 days, p25-p75 9-14). The risk of dysphagia decreased with age and increased when patients experienced more pain. CONCLUSIONS RFA treatment for BE-related neoplasia seems a significant burden for patients, and post-procedural symptoms should be taken into account when counseling patients before starting endoscopic eradication therapy.
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Affiliation(s)
- Anouk Overwater
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands.,Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Erik J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Jacques J G H M Bergman
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Roos E Pouw
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands.,Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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19
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van Duin IAJ, Elias SG, van den Eertwegh AJM, de Groot JWB, Blokx WAM, van Diest PJ, Leiner T, Verhoeff JJC, Verheijden RJ, van Not OJ, Aarts MJB, van den Berkmortel FWPJ, Blank CU, Haanen JBAG, Hospers GAP, Kamphuis AM, Piersma D, van Rijn RS, van der Veldt AAM, Vreugdenhil G, Wouters MWJM, Stevense-den Boer MAM, Boers-Sonderen MJ, Kapiteijn E, Suijkerbuijk KPM. Time interval from primary melanoma to first distant recurrence in relation to patient outcomes in advanced melanoma. Int J Cancer 2023; 152:2493-2502. [PMID: 36843274 DOI: 10.1002/ijc.34479] [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: 01/02/2023] [Accepted: 01/26/2023] [Indexed: 02/28/2023]
Abstract
Since the introduction of BRAF(/MEK) inhibition and immune checkpoint inhibition (ICI), the prognosis of advanced melanoma has greatly improved. Melanoma is known for its remarkably long time to first distant recurrence (TFDR), which can be decades in some patients and is partly attributed to immune-surveillance. We investigated the relationship between TFDR and patient outcomes after systemic treatment for advanced melanoma. We selected patients undergoing first-line systemic therapy for advanced melanoma from the nationwide Dutch Melanoma Treatment Registry. The association between TFDR and progression-free survival (PFS) and overall survival (OS) was assessed by Cox proportional hazard regression models. The TFDR was modeled categorically, linearly, and flexibly using restricted cubic splines. Patients received anti-PD-1-based treatment (n = 1844) or BRAF(/MEK) inhibition (n = 1618). For ICI-treated patients with a TFDR <2 years, median OS was 25.0 months, compared to 37.3 months for a TFDR >5 years (P = .014). Patients treated with BRAF(/MEK) inhibition with a longer TFDR also had a significantly longer median OS (8.6 months for TFDR <2 years compared to 11.1 months for >5 years, P = .004). The hazard of dying rapidly decreased with increasing TFDR until approximately 5 years (HR 0.87), after which the hazard of dying further decreased with increasing TFDR, but less strongly (HR 0.82 for a TFDR of 10 years and HR 0.79 for a TFDR of 15 years). Results were similar when stratifying for type of treatment. Advanced melanoma patients with longer TFDR have a prolonged PFS and OS, irrespective of being treated with first-line ICI or targeted therapy.
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Affiliation(s)
- Isabella A J van Duin
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alfonsus J M van den Eertwegh
- Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Willeke A M Blokx
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joost J C Verhoeff
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rik J Verheijden
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Olivier J van Not
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Christian U Blank
- Department of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Medical Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - John B A G Haanen
- Department of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Anna M Kamphuis
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Djura Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Rozemarijn S van Rijn
- Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Astrid A M van der Veldt
- Department of Medical Oncology and Radiology & Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Gerard Vreugdenhil
- Department of Internal Medicine, Maxima Medical Centre, Eindhoven, The Netherlands
| | - Michel W J M Wouters
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Marye J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
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20
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Wensink GE, Bolhuis K, Elferink MAG, Fijneman RJA, Kranenburg O, Borel Rinkes IHM, Koopman M, Swijnenburg RJ, Vink GR, Hagendoorn J, Punt CJA, Roodhart JML, Elias SG. Predicting early extrahepatic recurrence after local treatment of colorectal liver metastases. Br J Surg 2023; 110:362-371. [PMID: 36655278 PMCID: PMC10364507 DOI: 10.1093/bjs/znac461] [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: 10/01/2022] [Revised: 11/16/2022] [Accepted: 12/19/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patients who develop early extrahepatic recurrence (EHR) may not benefit from local treatment of colorectal liver metastases (CRLMs). This study aimed to develop a prediction model for early EHR after local treatment of CRLMs using a national data set. METHODS A Cox regression prediction model for EHR was developed and validated internally using data on patients who had local treatment for CRLMs with curative intent. Performance assessment included calibration, discrimination, net benefit, and generalizability by internal-external cross-validation. The prognostic relevance of early EHR (within 6 months) was evaluated by landmark analysis. RESULTS During a median follow-up of 35 months, 557 of the 1077 patients had EHR and 249 died. Median overall survival was 19.5 (95 per cent c.i. 15.6 to 23.0) months in patients with early EHR after CRLM treatment, compared with not reached (45.3 months to not reached) in patients without an early EHR. The EHR prediction model included side and stage of the primary tumour, RAS/BRAFV600E mutational status, and number and size of CRLMs. The range of 6-month EHR predictions was 5.9-56.0 (i.q.r. 12.9-22.0) per cent. The model demonstrated good calibration and discrimination. The C-index through 6 and 12 months was 0.663 (95 per cent c.i. 0.624 to 0.702) and 0.661 (0.632 to 0.689) respectively. The observed 6-month EHR risk was 6.5 per cent for patients in the lowest quartile of predicted risk compared with 32.0 per cent in the highest quartile. CONCLUSION Early EHR after local treatment of CRLMs can be predicted.
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Affiliation(s)
- G E Wensink
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Karen Bolhuis
- Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.,Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marloes A G Elferink
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Remond J A Fijneman
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Onno Kranenburg
- Department of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.,Utrecht Platform for Organoid Technology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Inne H M Borel Rinkes
- Department of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Geraldine R Vink
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Jeroen Hagendoorn
- Department of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Cornelis J A Punt
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jeanine M L Roodhart
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
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21
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Sharouni MAE, Lo SN, Varey AH, Elias SG, Witkamp AJ, Sigurdsson V, Suijkerbuijk KP, van Diest PJ, van Gils CH, Blokx WA, Scolyer RA, Thompson JF. Plain Language Summary - Development and validation of risk calculators for people with "thin" melanomas on their skin to predict the likelihood that their cancer will return. Future Oncol 2023; 19:97-102. [PMID: 36762595 DOI: 10.2217/fon-2022-0525] [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] [Indexed: 02/11/2023] Open
Abstract
WHAT IS THIS SUMMARY ABOUT? This is a summary of an article describing the development of risk calculators for use in people who develop a type of melanoma on their skin called "thin" melanoma to predict the likelihood that their cancer will return. The article was originally published in the Journal of Clinical Oncology in 2021. HOW WERE THE CALCULATORS DEVELOPED? Calculations were performed to predict the chance of people with thin melanomas surviving without their melanoma recurring. Three graphical prediction calculators (called nomograms) were developed, along with easy-to-use online calculators using the same underlying calculation methods. The model was developed using data for 25,930 Dutch people diagnosed with thin melanomas (called the "development set"). To test its ability to predict melanoma recurrence, it was then compared with data for 2,968 Australian people with melanoma (the "validation set"). The calculators developed in the Dutch patients were found to accurately predict the risk of melanoma recurring for people with melanoma in the Australian "validation" group. WHAT DO THE RESULTS MEAN? The calculators provide estimates of the risk of the melanoma returning for people with thin melanomas. The easy-to-use online calculators are freely available on a smartphone, tablet or computer, and will assist in providing accurate estimates of recurrence risks for individuals with thin melanomas, allowing more intensive follow-up of those whose predicted risk of their melanoma returning is high.
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Affiliation(s)
- Mary-Ann El Sharouni
- Department of Dermatology, University Medic al Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia.,Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
| | - Alexander Hr Varey
- Department of Dermatology, University Medic al Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia.,Department of Plastic & Reconstructive Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Sjoerd G Elias
- Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Arjen J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Vigfús Sigurdsson
- Department of Dermatology, University Medic al Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Karijn Pm Suijkerbuijk
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Carla H van Gils
- Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Willeke Am Blokx
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia.,Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia.,Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia.,Department of Melanoma & Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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22
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Verhoeff SR, Oosting SF, Elias SG, van Es SC, Gerritse SL, Angus L, Heskamp S, Desar IM, Menke-van der Houven van Oordt CW, van der Veldt AA, Arens AI, Brouwers AH, Eisses B, Mulders PF, Hoekstra OS, Zwezerijnen GJ, van der Graaf WT, Aarntzen EH, Oyen WJ, van Herpen CM. [89Zr]Zr-DFO-girentuximab and [18F]FDG PET/CT to Predict Watchful Waiting Duration in Patients with Metastatic Clear-cell Renal Cell Carcinoma. Clin Cancer Res 2023; 29:592-601. [PMID: 36394882 PMCID: PMC9890134 DOI: 10.1158/1078-0432.ccr-22-0921] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/11/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Watchful waiting (WW) can be considered for patients with metastatic clear-cell renal cell carcinoma (mccRCC) with good or intermediate prognosis, especially those with <2 International Metastatic RCC Database Consortium criteria and ≤2 metastatic sites [referred to as watch and wait ("W&W") criteria]. The IMaging PAtients for Cancer drug SelecTion-Renal Cell Carcinoma study objective was to assess the predictive value of [18F]FDG PET/CT and [89Zr]Zr-DFO-girentuximab PET/CT for WW duration in patients with mccRCC. EXPERIMENTAL DESIGN Between February 2015 and March 2018, 48 patients were enrolled, including 40 evaluable patients with good (n = 14) and intermediate (n = 26) prognosis. Baseline contrast-enhanced CT, [18F]FDG and [89Zr]Zr-DFO-girentuximab PET/CT were performed. Primary endpoint was the time to disease progression warranting systemic treatment. Maximum standardized uptake values (SUVmax) were measured using lesions on CT images coregistered to PET/CT. High and low uptake groups were defined on the basis of median geometric mean SUVmax of RECIST-measurable lesions across patients. RESULTS The median WW time was 16.1 months [95% confidence interval (CI): 9.0-31.7]. The median WW period was shorter in patients with high [18F]FDG tumor uptake than those with low uptake (9.0 vs. 36.2 months; HR, 5.6; 95% CI: 2.4-14.7; P < 0.001). Patients with high [89Zr]Zr-DFO-girentuximab tumor uptake had a median WW period of 9.3 versus 21.3 months with low uptake (HR, 1.7; 95% CI: 0.9-3.3; P = 0.13). Patients with "W&W criteria" had a longer median WW period of 21.3 compared with patients without: 9.3 months (HR, 1.9; 95% CI: 0.9-3.9; Pone-sided = 0.034). Adding [18F]FDG uptake to the "W&W criteria" improved the prediction of WW duration (P < 0.001); whereas [89Zr]Zr-DFO-girentuximab did not (P = 0.53). CONCLUSIONS In patients with good- or intermediate-risk mccRCC, low [18F]FDG uptake is associated with prolonged WW. This study shows the predictive value of the "W&W criteria" for WW duration and shows the potential of [18F]FDG-PET/CT to further improve this.
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Affiliation(s)
- Sarah R. Verhoeff
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sjoukje F. Oosting
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sjoerd G. Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Suzanne C. van Es
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sophie L. Gerritse
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Medical Oncology, Amsterdam UMC location VUMC, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Lindsay Angus
- Departments of Medical Oncology and Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Sandra Heskamp
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ingrid M.E. Desar
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Astrid A.M. van der Veldt
- Departments of Medical Oncology and Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Anne I.J. Arens
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Adrienne H. Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bertha Eisses
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Peter F.A. Mulders
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Otto S. Hoekstra
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location VUMC, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Gerben J.C. Zwezerijnen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location VUMC, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Winette T.A. van der Graaf
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Erik H.J.G. Aarntzen
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wim J.G. Oyen
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Radiology and Nuclear Medicine, Rijnstate, Arnhem, the Netherlands.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Carla M.L. van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.,Corresponding Author: Carla M.L. van Herpen, Radboud University Nijmegen Medical Center, Nijmegen 6500 HB, the Netherlands. Phone: 312-4361-4038; Fax: 312-4361-5025; E-mail:
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23
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ter Maat L, van Duin IA, Elias SG, Leiner T, Verhoeff JJ, Arntz ER, Troenokarso MF, Blokx WA, Isgum I, de Wit GA, van den Berkmortel FW, Boers-Sonderen MJ, Boomsma MF, van den Eertwegh FJ, de Groot JWB, Piersma D, Vreugdenhil A, Westgeest HM, Kapiteijn E, van Diest PJ, Pluim J, de Jong PA, Suijkerbuijk KP, Veta M. CT radiomics compared to a clinical model for predicting checkpoint inhibitor treatment outcomes in patients with advanced melanoma. Eur J Cancer 2023; 185:167-177. [PMID: 36996627 DOI: 10.1016/j.ejca.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Predicting checkpoint inhibitors treatment outcomes in melanoma is a relevant task, due to the unpredictable and potentially fatal toxicity and high costs for society. However, accurate biomarkers for treatment outcomes are lacking. Radiomics are a technique to quantitatively capture tumour characteristics on readily available computed tomography (CT) imaging. The purpose of this study was to investigate the added value of radiomics for predicting clinical benefit from checkpoint inhibitors in melanoma in a large, multicenter cohort. METHODS Patients who received first-line anti-PD1±anti-CTLA4 treatment for advanced cutaneous melanoma were retrospectively identified from nine participating hospitals. For every patient, up to five representative lesions were segmented on baseline CT, and radiomics features were extracted. A machine learning pipeline was trained on the radiomics features to predict clinical benefit, defined as stable disease for more than 6 months or response per RECIST 1.1 criteria. This approach was evaluated using a leave-one-centre-out cross validation and compared to a model based on previously discovered clinical predictors. Lastly, a combination model was built on the radiomics and clinical model. RESULTS A total of 620 patients were included, of which 59.2% experienced clinical benefit. The radiomics model achieved an area under the receiver operator characteristic curve (AUROC) of 0.607 [95% CI, 0.562-0.652], lower than that of the clinical model (AUROC=0.646 [95% CI, 0.600-0.692]). The combination model yielded no improvement over the clinical model in terms of discrimination (AUROC=0.636 [95% CI, 0.592-0.680]) or calibration. The output of the radiomics model was significantly correlated with three out of five input variables of the clinical model (p < 0.001). DISCUSSION The radiomics model achieved a moderate predictive value of clinical benefit, which was statistically significant. However, a radiomics approach was unable to add value to a simpler clinical model, most likely due to the overlap in predictive information learned by both models. Future research should focus on the application of deep learning, spectral CT-derived radiomics, and a multimodal approach for accurately predicting benefit to checkpoint inhibitor treatment in advanced melanoma.
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24
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Moons LMG, Bastiaansen BAJ, Richir MC, Hazen WL, Tuynman J, Elias SG, Schrauwen RWM, Vleggaar FP, Dekker E, Bos P, Fariña Sarasqueta A, Lacle M, Hompes R, Didden P. Endoscopic intermuscular dissection for deep submucosal invasive cancer in the rectum: a new endoscopic approach. Endoscopy 2022; 54:993-998. [PMID: 35073588 DOI: 10.1055/a-1748-8573] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The risk of lymph node metastasis associated with deep submucosal invasion should be balanced against the mortality and morbidity of total mesorectal excision (TME). Dissection through the submucosa hinders radical deep resection, and full-thickness resection may influence the outcome of completion TME. Endoscopic intermuscular dissection (EID) in between the circular and longitudinal part of the muscularis propria could potentially provide an R0 resection while leaving the rectal wall intact. METHODS In this prospective cohort study, the data of patients treated with EID for suspected deep submucosal invasive rectal cancer between 2018 and 2020 were analyzed. Study outcomes were the percentages of technical success, R0 resection, curative resection, and adverse events. RESULTS 67 patients (median age 67 years; 73 % men) were included. The median lesion size was 25 mm (interquartile range 20-33 mm). The rates of overall technical success, R0 resection, and curative resection were 96 % (95 %CI 89 %-99 %), 81 % (95 %CI 70 %-89 %), and 45 % (95 %CI 33 %-57 %). Only minor adverse events occurred in eight patients (12 %). CONCLUSION EID for deep invasive T1 rectal cancer appears to be feasible and safe, and the high R0 resection rate creates the potential of rectal preserving therapy in 45 % of patients.
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Affiliation(s)
- Leon M G Moons
- Department of Gastroenterology & Hepatology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Milan C Richir
- Department of Surgery, UMC Utrecht, Utrecht, The Netherlands
| | - Wouter L Hazen
- Department of Gastroenterology & Hepatology, Elizabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Jurriaan Tuynman
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Ruud W M Schrauwen
- Department of Gastroenterology & Hepatology, Bernhoven, Uden, The Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology & Hepatology, UMC Utrecht, Utrecht, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology & Hepatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Philip Bos
- Department of Gastroenterology & Hepatology, Gelderse Vallei, Ede, The Netherlands
| | | | - Miangela Lacle
- Department of Pathology, UMC Utrecht, Utrecht, The Netherlands
| | - Roel Hompes
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Paul Didden
- Department of Gastroenterology & Hepatology, UMC Utrecht, Utrecht, The Netherlands
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25
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van der Schoot GG, Ormel HL, Westerink NDL, May AM, Elias SG, Hummel YM, Lefrandt JD, van der Meer P, van Melle JP, Poppema BJ, Stel JM, van der Velden AW, Vrieling AH, Wempe JB, ten Wolde MG, Nijland M, de Vries EG, Gietema JA, Walenkamp AM. Optimal Timing of a Physical Exercise Intervention to Improve Cardiorespiratory Fitness. JACC CardioOncol 2022; 4:491-503. [DOI: 10.1016/j.jaccao.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
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26
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Janssen LM, Suelmann BBM, Elias SG, Janse MHA, van Diest PJ, van der Wall E, Gilhuijs KGA. Improving prediction of response to neoadjuvant treatment in patients with breast cancer by combining liquid biopsies with multiparametric MRI: protocol of the LIMA study - a multicentre prospective observational cohort study. BMJ Open 2022; 12:e061334. [PMID: 36127090 PMCID: PMC9490628 DOI: 10.1136/bmjopen-2022-061334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The response to neoadjuvant chemotherapy (NAC) in breast cancer has important prognostic implications. Dynamic prediction of tumour regression by NAC may allow for adaption of the treatment plan before completion, or even before the start of treatment. Such predictions may help prevent overtreatment and related toxicity and correct for undertreatment with ineffective regimens. Current imaging methods are not able to fully predict the efficacy of NAC. To successfully improve response prediction, tumour biology and heterogeneity as well as treatment-induced changes have to be considered. In the LIMA study, multiparametric MRI will be combined with liquid biopsies. In addition to conventional clinical and pathological information, these methods may give complementary information at multiple time points during treatment. AIM To combine multiparametric MRI and liquid biopsies in patients with breast cancer to predict residual cancer burden (RCB) after NAC, in adjunct to standard clinico-pathological information. Predictions will be made before the start of NAC, approximately halfway during treatment and after completion of NAC. METHODS In this multicentre prospective observational study we aim to enrol 100 patients. Multiparametric MRI will be performed prior to NAC, approximately halfway and after completion of NAC. Liquid biopsies will be obtained immediately prior to every cycle of chemotherapy and after completion of NAC. The primary endpoint is RCB in the surgical resection specimen following NAC. Collected data will primarily be analysed using multivariable techniques such as penalised regression techniques. ETHICS AND DISSEMINATION Medical Research Ethics Committee Utrecht has approved this study (NL67308.041.19). Informed consent will be obtained from each participant. All data are anonymised before publication. The findings of this study will be submitted to international peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04223492.
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Affiliation(s)
- Liselore M Janssen
- Image Sciences Institute, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Britt B M Suelmann
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Markus H A Janse
- Image Sciences Institute, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Elsken van der Wall
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kenneth G A Gilhuijs
- Image Sciences Institute, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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27
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Janssen LM, den Dekker BM, Gilhuijs KGA, van Diest PJ, van der Wall E, Elias SG. MRI to assess response after neoadjuvant chemotherapy in breast cancer subtypes: a systematic review and meta-analysis. NPJ Breast Cancer 2022; 8:107. [PMID: 36123365 PMCID: PMC9485124 DOI: 10.1038/s41523-022-00475-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/11/2022] [Indexed: 11/09/2022] Open
Abstract
This meta-analysis aimed to estimate and compare sensitivity, specificity, positive- (PPV) and negative predictive value (NPV) of magnetic resonance imaging (MRI) for predicting pathological complete remission (pCR) after neoadjuvant chemotherapy (NAC) in patients with early-stage breast cancer. We stratified for molecular subtype by immunohistochemistry (IHC) and explored the impact of other factors. Two researchers systematically searched PUBMED and EMBASE to select relevant studies and extract data. For meta-analysis of sensitivity and specificity, we used bivariate random-effects models. Twenty-six included studies contained 4497 patients. There was a significant impact of IHC subtype on post-NAC MRI accuracy (p = 0.0082) for pCR. The pooled sensitivity was 0.67 [95% CI 0.58-0.74] for the HR-/HER2-, 0.65 [95% CI 0.56-0.73] for the HR-/HER2+, 0.55 [95% CI 0.45-0.64] for the HR+/HER2- and 0.60 [95% CI 0.50-0.70] for the HR+/HER2+ subtype. The pooled specificity was 0.85 [95% CI 0.81-0.88] for the HR-/HER2-, 0.81 [95% CI 0.74-0.86] for the HR-/HER2+, 0.88[95% CI 0.84-0.91] for the HR+/HER2- and 0.74 [95% CI 0.63-0.83] for the HR+/HER2+ subtype. The PPV was highest in the HR-/HER2- subtype and lowest in the HR+/HER2- subtype. MRI field strength of 3.0 T was associated with a higher sensitivity compared to 1.5 T (p = 0.00063). The accuracy of MRI for predicting pCR depends on molecular subtype, which should be taken into account in clinical practice. Higher MRI field strength positively impacts accuracy. When intervention trials based on MRI response evaluation are designed, the impact of IHC subtype and field strength on MR accuracy should be considered.
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Affiliation(s)
- L M Janssen
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - B M den Dekker
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - K G A Gilhuijs
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - E van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - S G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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28
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Ter Maat LS, van Duin IAJ, Elias SG, van Diest PJ, Pluim JPW, Verhoeff JJC, de Jong PA, Leiner T, Veta M, Suijkerbuijk KPM. Imaging to predict checkpoint inhibitor outcomes in cancer. A systematic review. Eur J Cancer 2022; 175:60-76. [PMID: 36096039 DOI: 10.1016/j.ejca.2022.07.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/17/2022] [Accepted: 07/21/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Checkpoint inhibition has radically improved the perspective for patients with metastatic cancer, but predicting who will not respond with high certainty remains difficult. Imaging-derived biomarkers may be able to provide additional insights into the heterogeneity in tumour response between patients. In this systematic review, we aimed to summarise and qualitatively assess the current evidence on imaging biomarkers that predict response and survival in patients treated with checkpoint inhibitors in all cancer types. METHODS PubMed and Embase were searched from database inception to 29th November 2021. Articles eligible for inclusion described baseline imaging predictive factors, radiomics and/or imaging machine learning models for predicting response and survival in patients with any kind of malignancy treated with checkpoint inhibitors. Risk of bias was assessed using the QUIPS and PROBAST tools and data was extracted. RESULTS In total, 119 studies including 15,580 patients were selected. Of these studies, 73 investigated simple imaging factors. 45 studies investigated radiomic features or deep learning models. Predictors of worse survival were (i) higher tumour burden, (ii) presence of liver metastases, (iii) less subcutaneous adipose tissue, (iv) less dense muscle and (v) presence of symptomatic brain metastases. Hazard rate ratios did not exceed 2.00 for any predictor in the larger and higher quality studies. The added value of baseline fluorodeoxyglucose positron emission tomography parameters in predicting response to treatment was limited. Pilot studies of radioactive drug tracer imaging showed promising results. Reports on radiomics were almost unanimously positive, but numerous methodological concerns exist. CONCLUSIONS There is well-supported evidence for several imaging biomarkers that can be used in clinical decision making. Further research, however, is needed into biomarkers that can more accurately identify which patients who will not benefit from checkpoint inhibition. Radiomics and radioactive drug labelling appear to be promising approaches for this purpose.
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Affiliation(s)
- Laurens S Ter Maat
- Image Science Institute, University Medical Center Utrecht, Utrecht, the Netherlands; Utrecht University, Utrecht, the Netherlands
| | - Isabella A J van Duin
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; Utrecht University, Utrecht, the Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; Utrecht University, Utrecht, the Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands; Utrecht University, Utrecht, the Netherlands
| | - Josien P W Pluim
- Image Science Institute, University Medical Center Utrecht, Utrecht, the Netherlands; Medical Image Analysis, Department Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Utrecht University, Utrecht, the Netherlands
| | - Joost J C Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands; Utrecht University, Utrecht, the Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands; Utrecht University, Utrecht, the Netherlands
| | - Tim Leiner
- Utrecht University, Utrecht, the Netherlands; Department of Radiology, Mayo Clinical, Rochester, MN, USA
| | - Mitko Veta
- Medical Image Analysis, Department Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Utrecht University, Utrecht, the Netherlands
| | - Karijn P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; Utrecht University, Utrecht, the Netherlands.
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29
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Peters NA, Constantinides A, Ubink I, van Kuik J, Bloemendal HJ, van Dodewaard JM, Brink MA, Schwartz TP, Lolkema MP, Lacle MM, Moons LM, Geesing J, van Grevenstein WM, Roodhart JML, Koopman M, Elias SG, Borel Rinkes IH, Kranenburg O. Consensus molecular subtype 4 (CMS4)-targeted therapy in primary colon cancer: A proof-of-concept study. Front Oncol 2022; 12:969855. [PMID: 36147916 PMCID: PMC9486194 DOI: 10.3389/fonc.2022.969855] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMesenchymal Consensus Molecular Subtype 4 (CMS4) colon cancer is associated with poor prognosis and therapy resistance. In this proof-of-concept study, we assessed whether a rationally chosen drug could mitigate the distinguishing molecular features of primary CMS4 colon cancer.MethodsIn the ImPACCT trial, informed consent was obtained for molecular subtyping at initial diagnosis of colon cancer using a validated RT-qPCR CMS4-test on three biopsies per tumor (Phase-1, n=69 patients), and for neoadjuvant CMS4-targeting therapy with imatinib (Phase-2, n=5). Pre- and post-treatment tumor biopsies were analyzed by RNA-sequencing and immunohistochemistry. Imatinib-induced gene expression changes were associated with molecular subtypes and survival in an independent cohort of 3232 primary colon cancer.ResultsThe CMS4-test classified 52/172 biopsies as CMS4 (30%). Five patients consented to imatinib treatment prior to surgery, yielding 15 pre- and 15 post-treatment samples for molecular analysis. Imatinib treatment caused significant suppression of mesenchymal genes and upregulation of genes encoding epithelial junctions. The gene expression changes induced by imatinib were associated with improved survival and a shift from CMS4 to CMS2.ConclusionImatinib may have value as a CMS-switching drug in primary colon cancer and induces a gene expression program that is associated with improved survival.
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Affiliation(s)
- Niek A. Peters
- Lab Translational Oncology, Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Alexander Constantinides
- Lab Translational Oncology, Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Inge Ubink
- Lab Translational Oncology, Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Joyce van Kuik
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Haiko J. Bloemendal
- Department of Internal Medicine, Meander Medical Center, Amersfoort, Netherlands
- Department of Internal Medicine/Oncology, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | | | - Menno A. Brink
- Department of Gastroenterology, Meander Medical Center, Amersfoort, Netherlands
| | - Thijs P. Schwartz
- Department of Gastroenterology, Meander Medical Center, Amersfoort, Netherlands
| | | | - Miangela M. Lacle
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Leon M. Moons
- Department of Gastroenterology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Joost Geesing
- Department of Gastroenterology, Diakonessenhuis, Utrecht, Netherlands
| | - Wilhelmina M.U. van Grevenstein
- Department of Surgical Oncology, Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jeanine M. L. Roodhart
- Lab Translational Oncology, Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Sjoerd G. Elias
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Inne H.M. Borel Rinkes
- Lab Translational Oncology, Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Surgical Oncology, Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- *Correspondence: Inne H.M. Borel Rinkes, ; Onno Kranenburg,
| | - Onno Kranenburg
- Lab Translational Oncology, Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- *Correspondence: Inne H.M. Borel Rinkes, ; Onno Kranenburg,
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Noordhoek I, Bastiaannet E, de Glas NA, Scheepens J, Esserman LJ, Wesseling J, Scholten AN, Schröder CP, Elias SG, Kroep JR, Portielje JEA, Kleijn M, Liefers GJ. Validation of the 70-gene signature test (MammaPrint) to identify patients with breast cancer aged ≥ 70 years with ultralow risk of distant recurrence: A population-based cohort study. J Geriatr Oncol 2022; 13:1172-1177. [PMID: 35871138 DOI: 10.1016/j.jgo.2022.07.006] [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: 12/13/2021] [Revised: 04/22/2022] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION When risk estimation in older patients with hormone receptor positive breast cancer (HR + BC) is based on the same factors as in younger patients, age-related factors regarding recurrence risk and other-cause mortality are not considered. Genomic risk assessment could help identify patients with ultralow risk BC who can forgo adjuvant treatment. However, assessment tools should be validated specifically for older patients. This study aims to determine whether the 70-gene signature test (MammaPrint) can identify patients with HR + BC aged ≥70 years with ultralow risk for distant recurrence. MATERIALS AND METHODS Inclusion criteria: ≥70 years; invasive HR + BC; T1-2N0-3M0. EXCLUSION CRITERIA HER2 + BC; neoadjuvant therapy. MammaPrint assays were performed following standardized protocols. Clinical risk was determined with St. Gallen risk classification. Primary endpoint was 10-year cumulative incidence rate of distant recurrence in relation to genomic risk. Subdistribution hazard ratios (sHR) were estimated from Fine and Gray analyses. Multivariate analyses were adjusted for adjuvant endocrine therapy and clinical risk. RESULTS This study included 418 patients, median age 78 years (interquartile range [IQR] 73-83). Sixty percent of patients were treated with endocrine therapy. MammaPrint classified 50 patients as MammaPrint-ultralow, 224 patients as MammaPrint-low, and 144 patients as MammaPrint-high risk. Regarding clinical risk, 50 patients were classified low, 237 intermediate, and 131 high. Discordance was observed between clinical and genomic risk in 14 MammaPrint-ultralow risk patients who were high clinical risk, and 84 patients who were MammaPrint-high risk, but low or intermediate clinical risk. Median follow-up was 9.2 years (IQR 7.9-10.5). The 10-year distant recurrence rate was 17% (95% confidence interval [CI] 11-23) in MammaPrint-high risk patients, 8% (4-12) in MammaPrint-low (HR 0.46; 95%CI 0.25-0.84), and 2% (0-6) in MammaPrint-ultralow risk patients (HR 0.11; 95%CI 0.02-0.81). After adjustment for clinical risk and endocrine therapy, MammaPrint-high risk patients still had significantly higher 10-year distant recurrence rate than MammaPrint-low (sHR 0.49; 95%CI 0.26-0.90) and MammaPrint-ultralow patients (sHR 0.12; 95%CI 0.02-0.85). Of the 14 MammaPrint-ultralow, high clinical risk patients none developed a distant recurrence. DISCUSSION These data add to the evidence validating MammaPrint's ultralow risk threshold. Even in high clinical risk patients, MammaPrint-ultralow risk patients remained recurrence-free ten years after diagnosis. These findings justify future studies into using MammaPrint to individualize adjuvant treatment in older patients.
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Affiliation(s)
- I Noordhoek
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - E Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - N A de Glas
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - J Scheepens
- Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - L J Esserman
- Department of Surgical Oncology, University of California San Francisco, United States of America
| | - J Wesseling
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands; Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - A N Scholten
- Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - C P Schröder
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - S G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - J R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - J E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - M Kleijn
- Department of Medical Affairs, Agendia N.V., Amsterdam, the Netherlands
| | - G J Liefers
- Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
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van Geel JJL, Boers J, Elias SG, Glaudemans AWJM, de Vries EFJ, Hospers GAP, van Kruchten M, Kuip EJM, Jager A, Menke-van der Houven van Oordt WC, van der Vegt B, de Vries EGE, Schröder CP. Clinical Validity of 16α-[ 18F]Fluoro-17β-Estradiol Positron Emission Tomography/Computed Tomography to Assess Estrogen Receptor Status in Newly Diagnosed Metastatic Breast Cancer. J Clin Oncol 2022; 40:3642-3652. [PMID: 35584346 DOI: 10.1200/jco.22.00400] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Determining the estrogen receptor (ER) status is essential in metastatic breast cancer (MBC) management. Whole-body ER imaging with 16α-[18F]fluoro-17β-estradiol positron emission tomography ([18F]FES-PET) is increasingly used for this purpose. To establish the clinical validity of the [18F]FES-PET, we studied the diagnostic accuracy of qualitative and quantitative [18F]FES-PET assessment to predict ER expression by immunohistochemistry in a metastasis. METHODS In a prospective multicenter trial, 200 patients with newly diagnosed MBC underwent extensive workup including molecular imaging. For this subanalysis, ER expression in the biopsied metastasis was related to qualitative whole-body [18F]FES-PET evaluation and quantitative [18F]FES uptake in the corresponding metastasis. A review and meta-analysis regarding [18F]FES-PET diagnostic performance were performed. RESULTS Whole-body [18F]FES-PET assessment predicted ER expression in the biopsied metastasis with good accuracy: a sensitivity of 95% (95% CI, 89 to 97), a specificity of 80% (66 to 89), a positive predictive value (PPV) of 93% (87 to 96), and a negative predictive value (NPV) of 85% (72 to 92) in 181 of 200 evaluable patients. Quantitative [18F]FES uptake predicted ER immunohistochemistry in the corresponding metastasis with a sensitivity/specificity of 91%/69% and a PPV/NPV of 90%/71% in 156 of 200 evaluable patients. For bone metastases, PPV/NPV was 92%/81%. Meta-analysis with addition of our data has increased diagnostic performance and narrowed the 95% CIs compared with previous studies with a sensitivity/specificity of both 86% (81 to 90 and 73 to 93, respectively). CONCLUSION In this largest prospective series so far, we established the clinical validity of [18F]FES-PET to determine tumor ER status in MBC. In view of the high diagnostic accuracy of qualitatively assessed whole-body [18F]FES-PET, this noninvasive imaging modality can be considered a valid alternative to a biopsy of a metastasis to determine ER status in newly MBC (ClinicalTrials.gov identifier: NCT01957332).
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Affiliation(s)
- Jasper J L van Geel
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jorianne Boers
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Erik F J de Vries
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Michel van Kruchten
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Evelien J M Kuip
- Department of Medical Oncology, Radboud Medical Center, Nijmegen, the Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | - Bert van der Vegt
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Carolina P Schröder
- Department of Medical Oncology, Dutch Cancer Institute, Amsterdam and University Medical Center Groningen, Groningen, the Netherlands
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Bolhuis K, Wensink GE, Elferink MAG, Bond MJG, Dijksterhuis WPM, Fijneman RJA, Kranenburg OW, Rinkes IHMB, Koopman M, Swijnenburg RJ, Vink GR, Hagendoorn J, Punt CJA, Elias SG, Roodhart JML. External Validation of Two Established Clinical Risk Scores Predicting Outcome after Local Treatment of Colorectal Liver Metastases in a Nationwide Cohort. Cancers (Basel) 2022; 14:cancers14102356. [PMID: 35625968 PMCID: PMC9139295 DOI: 10.3390/cancers14102356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022] Open
Abstract
Optimized surgical techniques and systemic therapy have increased the number of patients with colorectal liver metastases (CRLM) eligible for local treatment. To increase postoperative survival, we need to stratify patients to customize therapy. Most clinical risk scores (CRSs) which predict prognosis after CRLM resection were based on the outcome of studies in specialized centers, and this may hamper the generalizability of these CRSs in unselected populations and underrepresented subgroups. We aimed to externally validate two CRSs in a population-based cohort of patients with CRLM. A total of 1105 patients with local treatment of CRLM, diagnosed in 2015/2016, were included from a nationwide population-based database. Survival outcomes were analyzed. The Fong and more recently developed GAME CRS were externally validated, including in pre-specified subgroups (≤70/>70 years and with/without perioperative systemic therapy). The three-year DFS was 22.8%, and the median OS in the GAME risk groups (high/moderate/low) was 32.4, 46.7, and 68.1 months, respectively (p < 0.005). The median OS for patients with versus without perioperative therapy was 47.6 (95%CI [39.8, 56.2]) and 54.9 months (95%CI [48.8, 63.7]), respectively (p = 0.152), and for below/above 70 years, it was 54.9 (95%CI [49.3−64.1]) and 44.2 months (95%CI [37.1−54.3]), respectively (p < 0.005). The discriminative ability for OS of Fong CRS was 0.577 (95%CI [0.554, 0.601]), and for GAME, it was 0.596 (95%CI [0.572, 0.621]), and was comparable in the subgroups. In conclusion, both CRSs showed predictive ability in a population-based cohort and in predefined subgroups. However, the limited discriminative ability of these CRSs results in insufficient preoperative risk stratification for clinical decision-making.
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Affiliation(s)
- Karen Bolhuis
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1081 HV Amsterdam, The Netherlands; (K.B.); (W.P.M.D.)
| | - G. Emerens Wensink
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands; (G.E.W.); (M.K.); (G.R.V.); (S.G.E.)
| | - Marloes A. G. Elferink
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), 3511 DT Utrecht, The Netherlands;
| | - Marinde J. G. Bond
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CG Utrecht, The Netherlands; (M.J.G.B.); (C.J.A.P.)
| | - Willemieke P. M. Dijksterhuis
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1081 HV Amsterdam, The Netherlands; (K.B.); (W.P.M.D.)
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), 3511 DT Utrecht, The Netherlands;
| | - Remond J. A. Fijneman
- Department of Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands;
| | - Onno W. Kranenburg
- Utrecht Platform for Organoid Technology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands;
- Department of Surgery, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands; (I.H.M.B.R.); (J.H.)
| | - Inne H. M. Borel Rinkes
- Department of Surgery, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands; (I.H.M.B.R.); (J.H.)
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands; (G.E.W.); (M.K.); (G.R.V.); (S.G.E.)
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Geraldine R. Vink
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands; (G.E.W.); (M.K.); (G.R.V.); (S.G.E.)
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), 3511 DT Utrecht, The Netherlands;
| | - Jeroen Hagendoorn
- Department of Surgery, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands; (I.H.M.B.R.); (J.H.)
| | - Cornelis J. A. Punt
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CG Utrecht, The Netherlands; (M.J.G.B.); (C.J.A.P.)
| | - Sjoerd G. Elias
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands; (G.E.W.); (M.K.); (G.R.V.); (S.G.E.)
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CG Utrecht, The Netherlands; (M.J.G.B.); (C.J.A.P.)
| | - Jeanine M. L. Roodhart
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands; (G.E.W.); (M.K.); (G.R.V.); (S.G.E.)
- Correspondence: ; Tel.: +31-88-7556265
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Overwater A, Rueb K, Elias SG, de Bree R, Weusten BLAM. Esophageal Second Primary Tumors in Patients With Head and Neck Squamous Cell Carcinoma: Incidence, Risk Factors, and Overall Survival. Am J Gastroenterol 2022; 117:794-797. [PMID: 35213400 DOI: 10.14309/ajg.0000000000001711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/23/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The aim of this registry-based cohort study was to evaluate the potential role of endoscopic esophageal surveillance for esophageal second primary tumors (ESPTs) in Western patients with head and neck squamous cell carcinoma (HNSCC). METHODS Outcomes were cumulative incidence and risk factors for ESPTs and its effect on overall survival. RESULTS A total of 47 ESPTs were observed in 1,708 patients with HNSCC, with 10-year cumulative incidence (95% confidence interval) of 2.9% (2.1-3.7). Alcohol and HNSCC location were significant predictors for ESPTs. ESPTs significantly increased the risk of dying (adjusted hazard ratio 3.36, 95% confidence interval 2.16-5.22). DISCUSSION Endoscopic esophageal surveillance of Western patients with HNSCC with high risk of ESPTs seems justified.
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Affiliation(s)
- Anouk Overwater
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Kuna Rueb
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Laoukili J, Constantinides A, Wassenaar ECE, Elias SG, Raats DAE, van Schelven SJ, van Wettum J, Volckmann R, Koster J, Huitema ADR, Nienhuijs SW, de Hingh IHJT, Wiezer RJ, van Grevenstein HMU, Rinkes IHMB, Boerma D, Kranenburg O. Peritoneal metastases from colorectal cancer belong to Consensus Molecular Subtype 4 and are sensitised to oxaliplatin by inhibiting reducing capacity. Br J Cancer 2022; 126:1824-1833. [PMID: 35194192 PMCID: PMC9174226 DOI: 10.1038/s41416-022-01742-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/19/2022] [Accepted: 02/03/2022] [Indexed: 01/13/2023] Open
Abstract
Background Peritoneal metastases (PM) in colorectal cancer (CRC) are associated with therapy resistance and poor survival. Oxaliplatin monotherapy is widely applied in the intraperitoneal treatment of PM, but fails to yield clinical benefit. We aimed to identify the mechanism(s) underlying PM resistance to oxaliplatin and to develop strategies overcoming such resistance. Experimental design We generated a biobank consisting of 35 primary tumour regions and 59 paired PM from 12 patients. All samples were analysed by RNA sequencing. We also generated a series of PM-derived organoid (PMDO) cultures and used these to design and test strategies to overcome resistance to oxaliplatin. Results PM displayed various hallmarks of aggressive CRC biology. The vast majority of PM and paired primary tumours belonged to the Consensus Molecular Subtype 4 (CMS4). PMDO cultures were resistant to oxaliplatin and expressed high levels of glutamate-cysteine ligase (GCLC) causing detoxification of oxaliplatin through glutathione synthesis. Genetic or pharmacological targeting of GCLC sensitised PMDOs to a 1-h exposure to oxaliplatin, through increased platinum-DNA adduct formation. Conclusions These results link oxaliplatin resistance of colorectal PM to their CMS4 status and high reducing capacity. Inhibiting the reducing capacity of PM may be an effective strategy to overcome PM resistance to oxaliplatin. ![]()
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Affiliation(s)
- Jamila Laoukili
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Emma C E Wassenaar
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Danielle A E Raats
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.,Utrecht Platform for Organoid Technology, Utrecht University, Utrecht, the Netherlands
| | - Susanne J van Schelven
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jonathan van Wettum
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Richard Volckmann
- Department of Oncogenomics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jan Koster
- Department of Oncogenomics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Alwin D R Huitema
- Department of Pharmacy and Pharmacology, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Department of Clinical Pharmacy, University Medical Centre, Utrecht, the Netherlands.,Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Ignace H J T de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.,School for Oncology and Developmental Biology, GROW, Maastricht, The Netherlands
| | - René J Wiezer
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Inne H M Borel Rinkes
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Djamila Boerma
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - Onno Kranenburg
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands. .,Utrecht Platform for Organoid Technology, Utrecht University, Utrecht, the Netherlands.
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van der Kruijssen DEW, Elias SG, de Wilt JHW. Comments on the CAIRO4 Trial Secondary Outcomes Report-Reply. JAMA Surg 2022; 157:551-552. [PMID: 35171236 DOI: 10.1001/jamasurg.2021.7585] [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: 11/14/2022]
Affiliation(s)
- Dave E W van der Kruijssen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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Ragusi MAA, Bismeijer T, van der Velden BHM, Loo CE, Canisius S, Wesseling J, Wessels LFA, Elias SG, Gilhuijs KGA. Contralateral parenchymal enhancement on MRI is associated with tumor proteasome pathway gene expression and overall survival of early ER+/HER2-breast cancer patients. Breast 2021; 60:230-237. [PMID: 34763270 PMCID: PMC8591464 DOI: 10.1016/j.breast.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/26/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To assess whether contralateral parenchymal enhancement (CPE) on MRI is associated with gene expression pathways in ER+/HER2-breast cancer, and if so, whether such pathways are related to survival. Methods Preoperative breast MRIs were analyzed of early ER+/HER2-breast cancer patients eligible for breast-conserving surgery included in a prospective observational cohort study (MARGINS). The contralateral parenchyma was segmented and CPE was calculated as the average of the top-10% delayed enhancement. Total tumor RNA sequencing was performed and gene set enrichment analysis was used to reveal gene expression pathways associated with CPE (N = 226) and related to overall survival (OS) and invasive disease-free survival (IDFS) in multivariable survival analysis. The latter was also done for the METABRIC cohort (N = 1355). Results CPE was most strongly correlated with proteasome pathways (normalized enrichment statistic = 2.04, false discovery rate = .11). Patients with high CPE showed lower tumor proteasome gene expression. Proteasome gene expression had a hazard ratio (HR) of 1.40 (95% CI = 0.89, 2.16; P = .143) for OS in the MARGINS cohort and 1.53 (95% CI = 1.08, 2.14; P = .017) for IDFS, in METABRIC proteasome gene expression had an HR of 1.09 (95% CI = 1.01, 1.18; P = .020) for OS and 1.10 (95% CI = 1.02, 1.18; P = .012) for IDFS. Conclusion CPE was negatively correlated with tumor proteasome gene expression in early ER+/HER2-breast cancer patients. Low tumor proteasome gene expression was associated with improved survival in the METABRIC data. Contralateral parenchymal enhancement on MRI was associated with tumor proteasome gene expression in ER+/HER2-breast cancer. A high contralateral parenchymal enhancement was associated with a low proteasome gene expression in the breast cancer. Low proteasome tumor gene expression was associated with improved survival in an independent patient cohort.
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Affiliation(s)
- Max A A Ragusi
- Department of Radiology / Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
| | - Tycho Bismeijer
- Division of Molecular Carcinogenesis - Oncode Institute, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Bas H M van der Velden
- Department of Radiology / Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Claudette E Loo
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Sander Canisius
- Division of Molecular Carcinogenesis - Oncode Institute, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Division of Molecular Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Jelle Wesseling
- Division of Molecular Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Lodewyk F A Wessels
- Division of Molecular Carcinogenesis - Oncode Institute, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Faculty of Electrical Engineering, Mathematics, and Computer Science, Delft University of Technology, Mekelweg 5, 2628 CD Delft, the Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands
| | - Kenneth G A Gilhuijs
- Department of Radiology / Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
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Scholten AN, Schröder CP, Elias SG, Liefers GJ. [Treatment of older breast cancer patients: de-escalation in oncology]. Ned Tijdschr Geneeskd 2021; 165:D5626. [PMID: 34854608] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The prognosis of breast cancer patients has greatly improved in recent decades. Innovations in imaging techniques, pathological assessment, optimized surgical and radiotherapy techniques have contributed to this. Much of the improvement is due to the increase of the range of effective systemic treatment and the continual expansion of the indication for this purpose. However, broadening the guidelines for adjuvant systemic treatments, results in a smaller absolute gain. The balance between effectiveness and side-effects could therefore be compromised, which is an incentive to search for possibilities for de-escalation to prevent potential damage, without unnecessarily increasing the risk of recurrence. Currently, in The Netherlands this is being investigated in older breast cancer patients.
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van der Kruijssen DEW, Elias SG, Vink GR, van Rooijen KL, 't Lam-Boer J, Mol L, Punt CJA, de Wilt JHW, Koopman M. Sixty-Day Mortality of Patients With Metastatic Colorectal Cancer Randomized to Systemic Treatment vs Primary Tumor Resection Followed by Systemic Treatment: The CAIRO4 Phase 3 Randomized Clinical Trial. JAMA Surg 2021; 156:1093-1101. [PMID: 34613339 DOI: 10.1001/jamasurg.2021.4992] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance The role of primary tumor resection (PTR) in synchronous patients with metastatic colorectal cancer (mCRC) who had unresectable metastases and few or absent symptoms of their primary tumor is unclear. Studying subgroups with low postoperative mortality may identify patients who potentially benefit from PTR. Objective To determine the difference in 60-day mortality between patients randomized to systemic treatment only vs PTR followed by systemic treatment, and to explore risk factors associated with 60-day mortality. Design, Setting, and Participants CAIRO4 is a randomized phase 3 trial initiated in 2012 in which patients with mCRC were randomized to systemic treatment only or PTR followed by systemic treatment with palliative intent. This multicenter study was conducted by the Danish and Dutch Colorectal Cancer Group in general and academic hospitals in Denmark and the Netherlands. Patients included between August 2012 and December 2019 with histologically proven colorectal cancer, unresectable metastases, and a primary tumor with few or absent symptoms were eligible. Interventions Systemic treatment, consisting of fluoropyrimidine-based chemotherapy with bevacizumab vs PTR followed by fluoropyrimidine-based chemotherapy with bevacizumab. Main Outcomes and Measures The aim of the current analysis was to compare 60-day mortality rates in both treatment arms. A secondary aim was the identification of risk factors for 60-day mortality in the treatment arms. These aims were not predefined in the study protocol. Results A total of 196 patients were included in the intention-to-treat analysis (112 [57%] men; median [IQR] age, 65 [59-70] years). Sixty-day mortality was 3% (95% CI, 1%-9%) in the systemic treatment arm and 11% (95% CI, 6%-19%) in the PTR arm (P = .03). In a per-protocol analysis, 60-day mortality was 2% (95% CI, 1%-7%) vs 10% (95% CI, 5%-18%; P = .048). Patients with elevated serum levels of lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, and/or neutrophils who were randomized to PTR had a significantly higher 60-day mortality than patients without these characteristics. Conclusions and Relevance Patients with mCRC who were randomized to PTR followed by systemic treatment had a higher 60-day mortality than patients randomized to systemic treatment. Especially patients randomized to the PTR arm with elevated serum levels of lactate dehydrogenase, neutrophils, aspartate aminotransferase, and/or alanine aminotransferase were at high risk of postoperative mortality. Final study results on overall survival have to be awaited. Trial Registration ClinicalTrials.gov Identifier: NCT01606098.
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Affiliation(s)
- Dave E W van der Kruijssen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Geraldine R Vink
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Karlijn L van Rooijen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jorine 't Lam-Boer
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Linda Mol
- Clinical Research Department, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Cornelis J A Punt
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Gal R, Monninkhof EM, van Gils CH, Groenwold RHH, Elias SG, van den Bongard DHJG, Peeters PHM, Verkooijen HM, May AM. Effects of exercise in breast cancer patients: implications of the trials within cohorts (TwiCs) design in the UMBRELLA Fit trial. Breast Cancer Res Treat 2021; 190:89-101. [PMID: 34427806 PMCID: PMC8557193 DOI: 10.1007/s10549-021-06363-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/08/2021] [Indexed: 11/12/2022]
Abstract
Purpose The Trials within Cohorts (TwiCs) design aims to overcome problems faced in conventional RCTs. We evaluated the TwiCs design when estimating the effect of exercise on quality of life (QoL) and fatigue in inactive breast cancer survivors. Methods UMBRELLA Fit was conducted within the prospective UMBRELLA breast cancer cohort. Patients provided consent for future randomization at cohort entry. We randomized inactive patients 12–18 months after cohort enrollment. The intervention group (n = 130) was offered a 12-week supervised exercise intervention. The control group (n = 130) was not informed and received usual care. Six-month exercise effects on QoL and fatigue as measured in the cohort were analyzed with intention-to-treat (ITT), instrumental variable (IV), and propensity scores (PS) analyses. Results Fifty-two percent (n = 68) of inactive patients accepted the intervention. Physical activity increased in patients in the intervention group, but not in the control group. We found no benefit of exercise for dimensions of QoL (ITT difference global QoL: 0.8, 95% CI = − 2.2; 3.8) and fatigue, except for a small beneficial effect on physical fatigue (ITT difference: − 1.1, 95% CI = − 1.8; − 0.3; IV: − 1.9, 95% CI = − 3.3; − 0.5, PS: − 1.2, 95% CI = − 2.3; − 0.2). Conclusion TwiCs gave insight into exercise intervention acceptance: about half of inactive breast cancer survivors accepted the offer and increased physical activity levels. The offer resulted in no improvement on QoL, and a small beneficial effect on physical fatigue. Trial registration Netherlands Trial Register (NTR5482/NL.52062.041.15), date of registration: December 07, 2015.
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Affiliation(s)
- Roxanne Gal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | | | - Petra H M Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Helena M Verkooijen
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA, Utrecht, the Netherlands.
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van der Kruijssen DEW, van Rooijen KL, Kurk SA, de Wilt JHW, Punt CJA, Vink GR, Elias SG, Koopman M. Role of Up-Front Primary Tumor Resection and Tumor Sidedness in the Survival of Synchronous Metastatic Colon Cancer Patients. Dig Surg 2021; 38:283-289. [PMID: 34320508 DOI: 10.1159/000517477] [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: 10/20/2020] [Accepted: 05/25/2021] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Uncertainty exists about a possible survival benefit of primary tumor resection (PTR) in synchronous metastatic colon cancer (mCC). Since sidedness of the primary tumor is regarded as an important prognostic factor, our objective was to study the interaction between PTR and sidedness in synchronous mCC. METHODS In this retrospective study, we used data from 2 first-line phase 3 randomized controlled trials (RCTs). A mixed Cox regression model was used to study the multiplicative interaction between PTR and sidedness. We adjusted for age, treatment arm, WHO performance status, number of affected organs by metastases, serum lactate dehydrogenase, and year of enrollment. RESULTS We found that PTR is associated with better survival in both right-sided (hazard ratio [HR] 0.59 [95% confidence interval 0.42-0.8 2]) and left-sided mCC (HR 0.70 [95% confidence interval 0.52-0.93]). The interaction between PTR and sidedness was not significant (p = 0.45). CONCLUSION Our data suggest that the prognostic value of PTR is independent of sidedness. Validation of these results will be performed in ongoing RCTs.
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Affiliation(s)
- Dave E W van der Kruijssen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karlijn L van Rooijen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sophie A Kurk
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cornelis J A Punt
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geraldine R Vink
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Kist de Ruijter L, Hooiveld-Noeken JS, Giesen D, Lub-de Hooge MN, Kok IC, Brouwers AH, Elias SG, Nguyen MTL, Lu H, Gietema JA, Jalving M, de Groot DJA, Vasiljeva O, de Vries EGE. First-in-Human Study of the Biodistribution and Pharmacokinetics of 89Zr-CX-072, a Novel Immunopet Tracer Based on an Anti-PD-L1 Probody. Clin Cancer Res 2021; 27:5325-5333. [PMID: 34253583 DOI: 10.1158/1078-0432.ccr-21-0453] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/24/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE CX-072, a PD-L1-targeting Probody therapeutic, is engineered to be activated by tumor proteases that remove a masking peptide. To study effects on biodistribution and pharmacokinetics, we performed 89Zr-CX-072 positron emission tomography (PET) imaging. EXPERIMENTAL DESIGN Patients received ∼1 mg, 37 MBq 89Zr-CX-072 plus 0, 4, or 9 mg unlabeled CX-072 and PET scans at days 2, 4, and 7. After that, treatment comprised 10 mg/kg CX-072 q2 weeks (n = 7) + 3 mg/kg ipilimumab q3w 4× (n = 1). Normal organ tracer uptake was expressed as standardized uptake value (SUV)mean and tumor uptake as SUVmax. PD-L1 expression was measured immunohistochemically in archival tumor tissue. RESULTS Three of the eight patients included received 10-mg protein dose resulting in a blood pool mean SUVmean ± SD of 4.27 ± 0.45 on day 4, indicating sufficient available tracer. Tumor uptake was highest at day 7, with a geometric mean SUVmax 5.89 (n = 113) and present in all patients. The median follow-up was 12 weeks (4-76+). One patient experienced stable disease and two patients a partial response. PD-L1 tumor expression was 90% in one patient and ≤1% in the other patients. Mean SUVmean ± SD day 4 at 10 mg in the spleen was 8.56 ± 1.04, bone marrow 2.21 ± 0.46, and liver 4.97 ± 0.97. Four patients out of seven showed uptake in normal lymph nodes and Waldeyer's ring. The tracer was intact in the serum or plasma. CONCLUSIONS 89Zr-CX-072 showed tumor uptake, even in lesions with ≤1% PD-L1 expression, and modest uptake in normal lymphoid organs, with no unexpected uptake in other healthy tissues.
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Affiliation(s)
- Laura Kist de Ruijter
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jahlisa S Hooiveld-Noeken
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Danique Giesen
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marjolijn N Lub-de Hooge
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Iris C Kok
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Adrienne H Brouwers
- Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Hong Lu
- CytomX Therapeutics Inc., South San Francisco, California
| | - Jourik A Gietema
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mathilde Jalving
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Derk J A de Groot
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Olga Vasiljeva
- CytomX Therapeutics Inc., South San Francisco, California.
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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van der Kruijssen DEW, Brouwer NPM, van der Kuil AJS, Verhoeven RHA, Elias SG, Vink GR, Punt CJA, de Wilt JHW, Koopman M. Interaction Between Primary Tumor Resection, Primary Tumor Location, and Survival in Synchronous Metastatic Colorectal Cancer: A Population-Based Study. Am J Clin Oncol 2021; 44:315-324. [PMID: 33899807 DOI: 10.1097/coc.0000000000000823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Location of the primary tumor has prognostic value and predicts the effect of certain therapeutics in synchronous metastatic colorectal cancer. We investigated whether the association between primary tumor resection (PTR) and overall survival (OS) also depends on tumor location. METHODS Data on synchronous metastatic colorectal cancer patients from the Netherlands Cancer Registry (n=16,106) and Surveillance, Epidemiology, and End Results (SEER) registry (n=19,584) were extracted. Cox models using time-varying covariates were implemented. Median OS for right-sided colon cancer (RCC), left-sided colon cancer, and rectal cancer was calculated using inverse probability weighting and a landmark point of 6 months after diagnosis as reference. RESULTS The association between PTR and OS was dependent on tumor location (P<0.05), with a higher median OS of upfront PTR versus upfront systemic therapy in Netherlands Cancer Registry (NCR) of 1.9 (95% confidence interval: 0.9-2.8), 4.3 (3.3-5.6), and 3.4 (0.6-7.6) months in RCC, left-sided colon cancer and rectal cancer, respectively. In SEER data, the difference was 6.0 (4.0-8.0), 8.0 (5.0-10.0), and 10.0 (7.0-13.0) months, respectively. Hazard plots indicate a higher hazard of death 2 to 3 months after PTR in RCC. CONCLUSION Upfront PTR is associated with improved survival regardless of primary tumor location. Patients with RCC appear to have less benefit because of higher mortality during 2 to 3 months after PTR.
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Affiliation(s)
| | - Nelleke P M Brouwer
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Rob H A Verhoeven
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL)
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Geraldine R Vink
- Department of Medical Oncology, University Medical Center Utrecht
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL)
| | - Cornelis J A Punt
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht
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Ragusi MA, Winter-Warnars GA, Wesseling J, Linn SC, Beets-Tan RG, van der Velden BH, Elias SG, Gilhuijs KG, Loo CE. Prognostic value of breast MRI characteristics before and during neoadjuvant endocrine therapy in patients with ER+/HER2- breast cancer. Br J Radiol 2021; 94:20201125. [PMID: 34142870 PMCID: PMC8248214 DOI: 10.1259/bjr.20201125] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To investigate whether BIRADS MRI characteristics before or during neoadjuvant endocrine therapy (NET) are associated with the preoperative endocrine prognostic index (PEPI) in ER+/HER2- breast cancer patients. Methods: This retrospective observational cohort study included 35 ER+/HER2- patients with 38 tumors (3 bilateral cases) treated with NET. The pre- and midtreatment (after 3 months) MRIs were evaluated by two breast radiologists for BIRADS imaging characteristics, shrinkage pattern, and radiologic response. PEPI was used as end point. PEPI is based on the post-treatment surgical specimen’s pT- and pN-stage, Ki67, and ER-status. Tumors were assigned PEPI-1 (good prognosis) or PEPI-2/3 (poor prognosis). We investigated whether pre- and midtreatment BIRADS characteristics were associated with PEPI. Results: Median patient age was 65 years (interquartile interval [IQI]: 53, 70). 17 tumors (44.7%) were associated with good prognosis (PEPI-1), and 21 tumors (55.3%) with poor prognosis (PEPI-2/3). A larger reduction in tumor size after 3 months of NET was significantly associated with PEPI; 10 mm (IQI: 5, 13.5) in PEPI-1 tumors vs 4.5 mm (IQI: 3, 7; p = .045) in PEPI-2/3 tumors. Other BIRADS characteristics, shrinkage pattern or radiologic response were not associated with PEPI. Conclusion: Only a larger reduction in tumor size on MRI after 3 months of NET was associated with PEPI-1 (good prognosis) in ER+/HER2- breast cancer patients. Advances in knowledge: MRI characteristics previously reported to be associated with prognosis during neoadjuvant chemotherapy are not necessarily associated with prognosis during NET in ER+/HER2- breast cancer patients.
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Affiliation(s)
- Max Aa Ragusi
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Department of Radiology/Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gonneke Ao Winter-Warnars
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Jelle Wesseling
- Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Sabine C Linn
- Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Regina G Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Bas Hm van der Velden
- Department of Radiology/Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kenneth Ga Gilhuijs
- Department of Radiology/Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Claudette E Loo
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Wijler LA, Raats DAE, Elias SG, Dijk FJ, Quirindongo H, May AM, Furber MJW, Dorresteijn B, van Dijk M, Kranenburg O. Specialized nutrition improves muscle function and physical activity without affecting chemotherapy efficacy in C26 tumour-bearing mice. J Cachexia Sarcopenia Muscle 2021; 12:796-810. [PMID: 33956410 PMCID: PMC8200448 DOI: 10.1002/jcsm.12703] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/04/2021] [Accepted: 03/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Skeletal muscle wasting and fatigue are commonly observed in cancer patients receiving chemotherapy and associated with reduced treatment outcome and quality of life. Nutritional support may mitigate these side effects, but potential interference with chemotherapy efficacy could be of concern. Here, we investigated the effects of an ω-3 polyunsaturated fatty acid (eicosapentaenoic acid and docosahexaenoic acid), leucine-enriched, high-protein (100% whey), additional vitamin D, and prebiotic fibres 'specific nutritional composition' (SNC) and chemotherapy on state-of-the-art tumour organoids and muscle cells and studied muscle function, physical activity, systemic inflammation, and chemotherapy efficacy in a mouse model of aggressive colorectal cancer (CRC). METHODS Tumour-bearing mice received a diet with or without SNC. Chemotherapy treatment consisted of oxaliplatin and 5-fluorouracil. Tumour formation was monitored by calliper measurements. Physical activity was continuously monitored by infrared imaging. Ex vivo muscle performance was determined by myography, muscle fatty acid composition by gas chromatography, and plasma cytokine levels by Luminex xMAP technology. Patient-derived CRC organoids and C2C12 myotubes were used to determine whether SNC affects chemotherapy sensitivity in vitro. RESULTS Specific nutritional composition increased muscle contraction capacity of chemotherapy-treated tumour-bearing mice (P < 0.05) and enriched ω-3 fatty acid composition in muscle without affecting treatment efficacy (P < 0.0001). Mice receiving SNC maintained physical activity after chemotherapy and showed decreased systemic inflammation. Therapeutic response of CRC organoids was unaffected by SNC nutrients, while cell viability and protein synthesis of muscle cells significantly improved. CONCLUSIONS The results show that specialized nutritional support can be used to maintain muscle function and physical activity levels during chemotherapy without increasing tumour viability. Therefore, nutritional strategies have potential value in promoting cancer and chemotherapy tolerance.
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Affiliation(s)
- Liza A Wijler
- Laboratory of Translational Oncology, Division of Imaging and Cancer, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Danielle A E Raats
- Laboratory of Translational Oncology, Division of Imaging and Cancer, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | - Anne M May
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | | | - Onno Kranenburg
- Laboratory of Translational Oncology, Division of Imaging and Cancer, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.,Utrecht Platform for Organoid Technology, Utrecht University, Utrecht, The Netherlands
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45
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El Sharouni MA, Ahmed T, Varey AHR, Elias SG, Witkamp AJ, Sigurdsson V, Suijkerbuijk KPM, van Diest PJ, Scolyer RA, van Gils CH, Thompson JF, Blokx WAM, Lo SN. Development and Validation of Nomograms to Predict Local, Regional, and Distant Recurrence in Patients With Thin (T1) Melanomas. J Clin Oncol 2021; 39:1243-1252. [PMID: 33600211 DOI: 10.1200/jco.20.02446] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Although the prognosis of patients with thin primary cutaneous melanomas (T1, ≤ 1.0 mm) is generally excellent, some develop recurrence. We sought to develop and validate a model predicting recurrences in patients with thin melanomas. METHODS A Dutch population-based cohort (n = 25,930, development set) and a cohort from an Australian melanoma treatment center (n = 2,968, validation set) were analyzed (median follow-up 6.7 and 12.0 years, respectively). Multivariable Cox models were generated for local, regional, and distant recurrence-free survival (RFS). Discrimination was assessed using Harrell's C-statistic for each outcome. Each nomogram performance was evaluated using calibration plots defining low-risk and high-risk groups as the lowest and top 5% of the nomogram risk score, respectively. The nomograms' C-statistics were compared with those of a model including the current American Joint Committee on Cancer staging parameters (T-stage and sentinel node status). RESULTS Local, regional, and distant recurrences were found in 209 (0.8%), 503 (1.9%), and 203 (0.8%) Dutch patients, respectively, and 23 (0.8%), 61 (2.1%), and 75 (2.5%) Australian patients, respectively. C-statistics of 0.79 (95% CI, 0.75 to 0.82) for local RFS, 0.77 (95% CI, 0.75 to 0.78) for regional RFS, and 0.80 (95% CI, 0.77 to 0.83) for distant RFS were obtained for the development model. External validation showed C-statistics of 0.80 (95% CI, 0.69 to 0.90), 0.76 (95% CI, 0.70 to 0.82), and 0.74 (95% CI, 0.69 to 0.80), respectively. Calibration plots showed a good match between predicted and observed rates. Using the nomogram, the C-statistic was increased by 9%-12% for the development cohort and by 11%-15% for the validation cohort, compared with a model including only T-stage and sentinel node status. CONCLUSION Most patients with thin melanomas have an excellent prognosis, but some develop recurrence. The presented nomograms can accurately identify a subgroup at high risk. An online calculator is available at www.melanomarisk.org.au.
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Affiliation(s)
- Mary-Ann El Sharouni
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Tasnia Ahmed
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexander H R Varey
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Plastic Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Arjen J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Vigfús Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Karijn P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Cancer Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Willeke A M Blokx
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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46
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Wijnands AM, de Jong ME, Lutgens MWMD, Hoentjen F, Elias SG, Oldenburg B. Prognostic Factors for Advanced Colorectal Neoplasia in Inflammatory Bowel Disease: Systematic Review and Meta-analysis. Gastroenterology 2021; 160:1584-1598. [PMID: 33385426 DOI: 10.1053/j.gastro.2020.12.036] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [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: 06/17/2020] [Revised: 11/12/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer (CRC). We performed a systematic review and meta-analysis to identify all prognostic factors for advanced colorectal neoplasia (aCRN, high-grade dysplasia, or CRC) in patients with IBD. METHODS A systematic literature search was conducted according to the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Risk of bias was assessed using the Quality in Prognostic Studies tool. Random-effects models were created separately for odds and hazard ratios, different study designs, and univariable or multivariable data. The evidence for all prognostic factors was categorized as "weak", "moderate", or "strong", based on estimate of effect sizes, heterogeneity, and risk of bias. RESULTS A total of 164 studies were included, allowing pooled analysis of 31 potential prognostic factors. In the univariable analysis, the evidence for extensive disease was classified as strong while evidence for low-grade dysplasia, strictures, primary sclerosing cholangitis, post-inflammatory polyps, family history of CRC, and ulcerative colitis versus Crohn's disease was considered moderate. Evidence for any dysplasia, colon segment resection, aneuploidy, male sex, and age was classified as weak. In addition, histologic inflammation was identified as a risk factor in multivariable analysis (weak evidence). The evidence for the protective factors colonoscopic surveillance, 5-Aminosalicylic Acid, thiopurines, and smoking was moderate in univariable analysis. Multivariable analysis provided weak evidence for statin use. CONCLUSIONS In this systematic review and meta-analysis, we identified 13 risk factors and 5 protective factors for aCRN in IBD patients, based on univariable and/or multivariable pooled analyses. These findings might lay the groundwork for an improved CRC risk stratification-based surveillance in IBD.
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Affiliation(s)
- Anouk M Wijnands
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Michiel E de Jong
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Maurice W M D Lutgens
- Department of Gastroenterology and Hepatology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Frank Hoentjen
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Bas Oldenburg
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, the Netherlands.
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47
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Aleksandrova K, Reichmann R, Kaaks R, Jenab M, Bueno-de-Mesquita HB, Dahm CC, Eriksen AK, Tjønneland A, Artaud F, Boutron-Ruault MC, Severi G, Hüsing A, Trichopoulou A, Karakatsani A, Peppa E, Panico S, Masala G, Grioni S, Sacerdote C, Tumino R, Elias SG, May AM, Borch KB, Sandanger TM, Skeie G, Sánchez MJ, Huerta JM, Sala N, Gurrea AB, Quirós JR, Amiano P, Berntsson J, Drake I, van Guelpen B, Harlid S, Key T, Weiderpass E, Aglago EK, Cross AJ, Tsilidis KK, Riboli E, Gunter MJ. Development and validation of a lifestyle-based model for colorectal cancer risk prediction: the LiFeCRC score. BMC Med 2021; 19:1. [PMID: 33390155 PMCID: PMC7780676 DOI: 10.1186/s12916-020-01826-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/23/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Nutrition and lifestyle have been long established as risk factors for colorectal cancer (CRC). Modifiable lifestyle behaviours bear potential to minimize long-term CRC risk; however, translation of lifestyle information into individualized CRC risk assessment has not been implemented. Lifestyle-based risk models may aid the identification of high-risk individuals, guide referral to screening and motivate behaviour change. We therefore developed and validated a lifestyle-based CRC risk prediction algorithm in an asymptomatic European population. METHODS The model was based on data from 255,482 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study aged 19 to 70 years who were free of cancer at study baseline (1992-2000) and were followed up to 31 September 2010. The model was validated in a sample comprising 74,403 participants selected among five EPIC centres. Over a median follow-up time of 15 years, there were 3645 and 981 colorectal cancer cases in the derivation and validation samples, respectively. Variable selection algorithms in Cox proportional hazard regression and random survival forest (RSF) were used to identify the best predictors among plausible predictor variables. Measures of discrimination and calibration were calculated in derivation and validation samples. To facilitate model communication, a nomogram and a web-based application were developed. RESULTS The final selection model included age, waist circumference, height, smoking, alcohol consumption, physical activity, vegetables, dairy products, processed meat, and sugar and confectionary. The risk score demonstrated good discrimination overall and in sex-specific models. Harrell's C-index was 0.710 in the derivation cohort and 0.714 in the validation cohort. The model was well calibrated and showed strong agreement between predicted and observed risk. Random survival forest analysis suggested high model robustness. Beyond age, lifestyle data led to improved model performance overall (continuous net reclassification improvement = 0.307 (95% CI 0.264-0.352)), and especially for young individuals below 45 years (continuous net reclassification improvement = 0.364 (95% CI 0.084-0.575)). CONCLUSIONS LiFeCRC score based on age and lifestyle data accurately identifies individuals at risk for incident colorectal cancer in European populations and could contribute to improved prevention through motivating lifestyle change at an individual level.
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Affiliation(s)
- Krasimira Aleksandrova
- Nutrition, Immunity and Metabolism Senior Scientist Group, Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany.
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany.
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
| | - Robin Reichmann
- Nutrition, Immunity and Metabolism Senior Scientist Group, Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mazda Jenab
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - H Bas Bueno-de-Mesquita
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | | | | | | | - Fanny Artaud
- CESP, Faculté de Medicine, Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
| | | | - Gianluca Severi
- CESP, Faculté de Medicine, Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
- Dipartimento di Statistica, Informatica e Applicazioni "G. Parenti" (DISIA), University of Florence, Florence, Italy
| | - Anika Hüsing
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece
| | | | - Salvatore Panico
- EPIC Centre of Naples, Dipartimento di Medicina Clinica e Chirurgia, University of Naples Federico II, Naples, Italy
| | - Giovanna Masala
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Sara Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP), Ragusa, Italy
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kristin B Borch
- Department of Community Medicine, Health Faculty, UiT-the Arctic university of Norway, Tromsø, Norway
| | - Torkjel M Sandanger
- Department of Community Medicine, Health Faculty, UiT-the Arctic university of Norway, Tromsø, Norway
| | - Guri Skeie
- Department of Community Medicine, Health Faculty, UiT-the Arctic university of Norway, Tromsø, Norway
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universidad de Granada, Granada, Spain
| | - José María Huerta
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Núria Sala
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Translational Research Laboratory, Catalan Institute of Oncology (ICO), Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Aurelio Barricarte Gurrea
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | | | - Pilar Amiano
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Ministry of Health of the Basque Government, Public Health Division of Gipuzkoa, Biodonostia Health Research Institute, Donostia-San Sebastian, Spain
| | - Jonna Berntsson
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Isabel Drake
- Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
| | - Bethany van Guelpen
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Sophia Harlid
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Tim Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Elom K Aglago
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Marc J Gunter
- International Agency for Research on Cancer, World Health Organization, Lyon, France
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Dang H, van Pelt GW, Haasnoot KJC, Backes Y, Elias SG, Seerden TCJ, Schwartz MP, Spanier BWM, de Vos tot Nederveen Cappel WH, van Bergeijk JD, Kessels K, Geesing JMJ, Groen JN, ter Borg F, Wolfhagen FHJ, Seldenrijk CA, Raicu MG, Milne AN, van Lent AUG, Brosens LAA, Johan A. Offerhaus G, Siersema PD, Tollenaar RAEM, Hardwick JCH, Hawinkels LJAC, Moons LMG, Lacle MM, Mesker WE, Boonstra JJ. Tumour-stroma ratio has poor prognostic value in non-pedunculated T1 colorectal cancer: A multi-centre case-cohort study. United European Gastroenterol J 2020; 9:2050640620975324. [PMID: 33210982 PMCID: PMC8259249 DOI: 10.1177/2050640620975324] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/28/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Current risk stratification models for early invasive (T1) colorectal cancer are not able to discriminate accurately between prognostic favourable and unfavourable tumours, resulting in over-treatment of a large (>80%) proportion of T1 colorectal cancer patients. The tumour-stroma ratio (TSR), which is a measure for the relative amount of desmoplastic tumour stroma, is reported to be a strong independent prognostic factor in advanced-stage colorectal cancer, with a high stromal content being associated with worse prognosis and survival. We aimed to investigate whether the TSR predicts clinical outcome in patients with non-pedunculated T1 colorectal cancer. METHODS Hematoxylin and eosin (H&E)-stained tumour tissue slides from a retrospective multi-centre case cohort of patients with non-pedunculated surgically treated T1 colorectal cancer were assessed for TSR by two independent observers who were blinded for clinical outcomes. The primary end point was adverse outcome, which was defined as the presence of lymph node metastasis in the resection specimen or colorectal cancer recurrence during follow-up. RESULTS All 261 patients in the case cohort had H&E slides available for TSR scoring. Of these, 183 were scored as stroma-low, and 78 were scored as stroma-high. There was moderate inter-observer agreement (κ = 0.42). In total, 41 patients had lymph node metastasis, 17 patients had recurrent cancer and five had both. Stroma-high tumours were not associated with an increased risk for an adverse outcome (adjusted hazard ratio = 0.66, 95% confidence interval 0.37-1.18; p = 0.163). CONCLUSIONS Our study emphasises that existing prognosticators may not be simply extrapolated to T1 colorectal cancers, even though their prognostic value has been widely validated in more advanced-stage tumours.
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Affiliation(s)
- Hao Dang
- Department of Gastroenterology and HepatologyLeiden University Medical CentreLeidenThe Netherlands
| | - Gabi W. van Pelt
- Department of SurgeryLeiden University Medical CentreLeidenThe Netherlands
| | - Krijn J. C. Haasnoot
- Department of Gastroenterology and HepatologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Yara Backes
- Department of Gastroenterology and HepatologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Sjoerd G. Elias
- Julius Centre for Health Sciences and Primary CareUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Tom C. J. Seerden
- Department of Gastroenterology and HepatologyAmphia HospitalBredaThe Netherlands
| | - Matthijs P. Schwartz
- Department of Gastroenterology and HepatologyMeander Medical CentreAmersfoortThe Netherlands
| | | | | | | | - Koen Kessels
- Department of Gastroenterology and HepatologySint Antonius HospitalNieuwegeinThe Netherlands
| | - Joost M. J. Geesing
- Department of Gastroenterology and HepatologyDiakonessenhuisUtrechtThe Netherlands
| | - John N. Groen
- Department of Gastroenterology and HepatologySint JansdalHarderwijkThe Netherlands
| | - Frank ter Borg
- Department of Gastroenterology and HepatologyDeventer HospitalDeventerThe Netherlands
| | - Frank H. J. Wolfhagen
- Department of Gastroenterology and HepatologyAlbert Schweitzer HospitalDordrechtThe Netherlands
| | | | | | - Anya N. Milne
- Pathology DNASint Antonius HospitalNieuwegeinThe Netherlands
| | - Anja U. G. van Lent
- Department of Gastroenterology and HepatologyOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
| | - Lodewijk A. A. Brosens
- Department of PathologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - G. Johan A. Offerhaus
- Department of PathologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Peter D. Siersema
- Department of Gastroenterology and HepatologyRadboud University Medical CentreNijmegenThe Netherlands
| | | | - James C. H. Hardwick
- Department of Gastroenterology and HepatologyLeiden University Medical CentreLeidenThe Netherlands
| | - Lukas J. A. C. Hawinkels
- Department of Gastroenterology and HepatologyLeiden University Medical CentreLeidenThe Netherlands
| | - Leon M. G. Moons
- Department of Gastroenterology and HepatologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Miangela M. Lacle
- Department of PathologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Wilma E. Mesker
- Department of SurgeryLeiden University Medical CentreLeidenThe Netherlands
| | - Jurjen J. Boonstra
- Department of Gastroenterology and HepatologyLeiden University Medical CentreLeidenThe Netherlands
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van Roekel C, Jongen JMJ, Smits MLJ, Elias SG, Koopman M, Kranenburg O, Borel Rinkes IHM, Lam MGEH. Mode of progression after radioembolization in patients with colorectal cancer liver metastases. EJNMMI Res 2020; 10:107. [PMID: 32960390 PMCID: PMC7509032 DOI: 10.1186/s13550-020-00697-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background Radioembolization is an established treatment modality in colorectal cancer patients with liver-dominant disease in a salvage setting. Selection of patients who will benefit most is of vital importance. The aim of this study was to assess response (and mode of progression) at 3 months after radioembolization and the impact of baseline characteristics. Methods Three months after radioembolization with either yttrium-90 resin/glass or holmium-166, anatomic response, according to RECIST 1.1, was evaluated in 90 patients. Correlations between baseline characteristics and efficacy were evaluated. For more detailed analysis of progressive disease as a dismal clinical entity, distinction was made between intra- and extrahepatic progression, and between progression of existing metastases and new metastases. Results Forty-two patients (47%) had extrahepatic disease (up to five ≥ 1 cm lung nodules, and ≤ 2 cm lymph nodes) at baseline. No patients showed complete response, 5 (5.5%) patients had partial response, 16 (17.8%) had stable disease, and 69 (76.7%) had progressive disease. Most progressive patients (67/69; 97%) had new metastases (intra-hepatic N = 11, extrahepatic N = 32; or both N = 24). Significantly fewer patients had progressive disease in the group of patients presenting without extrahepatic metastases at baseline (63% versus 93%; p = 0.0016). Median overall survival in patients with extrahepatic disease was 6.5 months, versus 10 months in patients without extrahepatic disease at baseline (hazard ratio 1.79, 95%CI 1.24–2.57). Conclusions Response at 3-month follow-up and survival were heavily influenced by new metastases. Patients with extrahepatic disease at baseline had a worse outcome compared to patients without.
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Affiliation(s)
- Caren van Roekel
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, University Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Jennifer M J Jongen
- Department of Surgical Oncology, Endocrine and GI Surgery, Cancer Center, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Maarten L J Smits
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, University Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Onno Kranenburg
- Division of Biomedical Genetics, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Inne H M Borel Rinkes
- Department of Surgical Oncology, Endocrine and GI Surgery, Cancer Center, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, University Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Spijkers S, Littooij AS, Kwee TC, Tolboom N, Beishuizen A, Bruin MCA, Elias SG, van de Brug T, Enríquez G, Sábado C, Miller E, Granata C, de Lange C, Verzegnassi F, Greer MLC, de Keizer B, Nievelstein RAJ. Whole-body MRI versus an FDG-PET/CT-based reference standard for staging of paediatric Hodgkin lymphoma: a prospective multicentre study. Eur Radiol 2020; 31:1494-1504. [PMID: 32880696 PMCID: PMC7880958 DOI: 10.1007/s00330-020-07182-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/02/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022]
Abstract
Objectives To assess the concordance of whole-body MRI (WB-MRI) and an FDG-PET/CT-based reference standard for the initial staging in children with Hodgkin lymphoma (HL) Methods Children with newly diagnosed HL were included in this prospective, multicentre, international study and underwent WB-MRI and FDG-PET/CT at staging. Two radiologists and a nuclear medicine physician independently evaluated all images. Discrepancies between WB-MRI and FDG-PET/CT were assessed by an expert panel. All FDG-PET/CT errors were corrected to derive the FDG-PET/CT-based reference standard. The expert panel corrected all reader errors in the WB-MRI DWI dataset to form the intrinsic MRI data. Inter-observer agreement for WB-MRI DWI was calculated using overall agreement, specific agreements and kappa statistics. Concordance for correct classification of all disease sites and disease stage between WB-MRI (without DWI, with DWI and intrinsic WB-MRI DWI) and the reference standard was calculated as primary outcome. Secondary outcomes included positive predictive value, negative predictive value and kappa statistics. Clustering within patients was accounted for using a mixed-effect logistic regression model with random intercepts and a multilevel kappa analysis. Results Sixty-eight children were included. Inter-observer agreement between WB-MRI DWI readers was good for disease stage (κ = 0.74). WB-MRI DWI agreed with the FDG-PET/CT-based reference standard for determining disease stage in 96% of the patients versus 88% for WB-MRI without DWI. Agreement between WB-MRI DWI and the reference standard was excellent for both nodal (98%) and extra-nodal (100%) staging. Conclusions WB-MRI DWI showed excellent agreement with the FDG-PET/CT-based reference standard. The addition of DWI to the WB-MRI protocol improved the staging agreement. Key Points • This study showed excellent agreement between WB-MRI DWI and an FDG-PET/CT-based reference standard for staging paediatric HL. • Diffusion-weighted imaging is a useful addition to WB-MRI in staging paediatric HL. • Inter-observer agreement for WB-MRI DWI was good for both nodal and extra-nodal staging and determining disease stage. Electronic supplementary material The online version of this article (10.1007/s00330-020-07182-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Suzanne Spijkers
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Annemieke S Littooij
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, Department of Radiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Nelleke Tolboom
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | - Auke Beishuizen
- Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands.,Department of Paediatric Oncology/Haematology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marrie C A Bruin
- Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tim van de Brug
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
| | | | - Constantino Sábado
- Department of Paediatric Oncology and Haematology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Elka Miller
- Department of Medical Imaging, CHEO, University of Ottawa, Ottawa, Canada
| | - Claudio Granata
- Department of Paediatric Radiology, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Charlotte de Lange
- Department of Diagnostic Imaging and Intervention, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Federico Verzegnassi
- Oncohematology Unit, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | - Rutger A J Nievelstein
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
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