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Jafari P, Evaristo G, Du XA, Sharma AE, Marcus V, Liu X, Zhao L, Westerhoff M, Hart J. Portosinusoidal Vascular Disorder: A Heretofore Unrecognized Manifestation of Sickle Cell Disease? Mod Pathol 2024; 37:100351. [PMID: 37820763 DOI: 10.1016/j.modpat.2023.100351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/10/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023]
Abstract
Portosinusoidal vascular disorder (PSVD) is a recently proposed histopathologic entity that encompasses a spectrum of often subtle hepatic microvascular lesions and related microarchitectural abnormalities. Clinical manifestations may arise years after histologic diagnosis and include extrahepatic portal vein thrombosis and portal hypertension. While the histopathologic features of PSVD have been associated with numerous clinical conditions, most notably prothrombotic/vasculopathic disorders, PSVD has not yet been described in sickle cell disease. This gap is striking given the central role of microvascular dysfunction in sickle cell disease and well-described patterns of hepatic injury and dysfunction in this population. This case series is the first to explore the prevalence and pathogenesis of PSVD in sickle cell disease. Forty-one diagnostically adequate liver biopsies from patients with sickle cell disease were identified across the archives of 5 tertiary medical centers. All biopsies exhibited at least 1 histopathologic feature associated with PSVD (mean 3.8 features/case). Overall, 90.2% of patients met the criteria for a diagnosis of PSVD based on the presence of specific histopathologic and/or clinical findings. Immunohistochemical stains for von Willebrand factor, CD34, and glutamine synthetase were performed on 36 cases (87.8%). Aberrant (centrilobular sinusoidal) CD34 and von Willebrand factor staining was present in 97.2% and 86.1% of cases, respectively. Glutamine synthetase reactivity was at least mildly decreased in zone 3 hepatocytes in 52.8% of cases. We posit that chronic erythrocyte sickling results in dysfunction and remodeling of the portal microvasculature, culminating in regression of zone 3 hepatocytes. The presence of PSVD may explain, at least in part, the hepatic dysfunction observed in this patient population. These patients may also benefit from extended clinical surveillance for portal hypertension and other complications. While subtle and prone to overdiagnosis, the features of PSVD should be carefully considered when interpreting liver biopsies from patients with sickle cell disease.
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Affiliation(s)
- Pari Jafari
- Department of Pathology, University of Chicago Medicine, The University of Chicago, Chicago, Illinois.
| | - Gertruda Evaristo
- Department of Pathology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Xiaotang Alison Du
- Department of Pathology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Aarti E Sharma
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Victoria Marcus
- Department of Pathology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Xiuli Liu
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Lei Zhao
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maria Westerhoff
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - John Hart
- Department of Pathology, University of Chicago Medicine, The University of Chicago, Chicago, Illinois
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Alenezi T, Marcus V, Bessissow T. A Case Report and Literature Review of a Rare Jejunal Solitary Peutz-Jeghers-Type Polyp Resected Endoscopically in an Elderly Patient Presenting with Subacute Gastrointestinal Bleeding. Case Rep Gastrointest Med 2023; 2023:2391602. [PMID: 38146326 PMCID: PMC10749718 DOI: 10.1155/2023/2391602] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/07/2023] [Accepted: 12/07/2023] [Indexed: 12/27/2023] Open
Abstract
Solitary Peutz-Jeghers-type polyp (SPJP) is a rare hamartomatous lesion. It is considered a different entity from Peutz-Jeghers syndrome despite similar histopathological findings. It can be found in the GI tract but rarely in the jejunum. Jejunal SPJP is susceptible to necrosis, ulceration, and intussusception, resulting in GI bleeding or small bowel obstruction. We describe a case of subacute gastrointestinal bleeding secondary to jejunal SPJP to share our approach to this challenging case using therapeutic endoscopy. An 81-year-old male patient with a history of atrial fibrillation on warfarin with stable therapeutic INR levels presented with a 1-week history of melena, generalized fatigue, and shortness of breath on exertion and was found to have profound iron deficiency anemia. Esophageal gastroduodenoscopy and colonoscopy failed to identify the source of bleeding; however, single-balloon enteroscopy detected a 4 cm polyp with a stalk in the proximal jejunum. Endoscopic polypectomy was performed, and the whole polyp was removed. Histopathological examination was consistent with Peutz-Jeghers polyp. The genetic analysis was negative for STK11 mutation. Follow-up magnetic resonance enterography and video capsule endoscopy did not reveal any other polypoid lesion in the GI tract. The patient's symptoms resolved gradually, and his hemoglobin level returned back to normal levels within 6 months. To our knowledge, this is the first case of endoscopic polypectomy during balloon-assisted enteroscopy for jejunal SPJP.
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Affiliation(s)
- Talal Alenezi
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC, Canada
| | - Victoria Marcus
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada
| | - Talat Bessissow
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC, Canada
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Alharbi E, Rajaram A, Côté K, Farag M, Maleki F, Gao ZH, Maedler-Kron C, Marcus V, Fiset PO. A Deep Learning-Based Approach to Estimate Paneth Cell Granule Area in Celiac Disease. Arch Pathol Lab Med 2023:496481. [PMID: 37852171 DOI: 10.5858/arpa.2023-0074-oa] [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] [Accepted: 08/10/2023] [Indexed: 10/20/2023]
Abstract
CONTEXT.— Changes in Paneth cell numbers can be associated with chronic inflammatory diseases of the gastrointestinal tract. So far, no consensus has been achieved on the number of Paneth cells and their relevance to celiac disease (CD). OBJECTIVES.— To compare crypt and Paneth cell granule areas between patients with CD and without CD (non-CD) using an artificial intelligence-based solution. DESIGN.— Hematoxylin-eosin-stained sections of duodenal biopsies from 349 patients at the McGill University Health Centre were analyzed. Of these, 185 had a history of CD and 164 were controls. Slides were digitized and NoCodeSeg, a code-free workflow using open-source software (QuPath, DeepMIB), was implemented to train deep learning models to segment crypts and Paneth cell granules. The total area of the entire analyzed tissue, epithelium, crypts, and Paneth cell granules was documented for all slides, and comparisons were performed. RESULTS.— A mean intersection-over-union score of 88.76% and 91.30% was achieved for crypt areas and Paneth cell granule segmentations, respectively. On normalization to total tissue area, the crypt to total tissue area in CD was increased and Paneth cell granule area to total tissue area decreased when compared to non-CD controls. CONCLUSIONS.— Crypt hyperplasia was confirmed in CD compared to non-CD controls. The area of Paneth cell granules, an indirect measure of Paneth cell function, decreased with increasing severity of CD. More importantly, our study analyzed complete hematoxylin-eosin slide sections using an efficient and easy to use coding-free artificial intelligence workflow.
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Affiliation(s)
- Ebtihal Alharbi
- From the Department of Pathology, McGill University, Montreal, Quebec, Canada (Alharbi, Rajaram, Côté, Farag, Gao, Maedler-Kron, Marcus, Fiset)
- Department of Pathology, Faculty of Medicine in Rabigh, King Abdulaziz University, Saudi Arabia (Alharbi)
| | - Ajay Rajaram
- From the Department of Pathology, McGill University, Montreal, Quebec, Canada (Alharbi, Rajaram, Côté, Farag, Gao, Maedler-Kron, Marcus, Fiset)
| | - Kevin Côté
- From the Department of Pathology, McGill University, Montreal, Quebec, Canada (Alharbi, Rajaram, Côté, Farag, Gao, Maedler-Kron, Marcus, Fiset)
| | - Mina Farag
- From the Department of Pathology, McGill University, Montreal, Quebec, Canada (Alharbi, Rajaram, Côté, Farag, Gao, Maedler-Kron, Marcus, Fiset)
| | - Farhad Maleki
- Augmented Intelligence & Precision Health Laboratory, Research Institute and Department of Radiology, McGill University Health Centre, Montreal, Quebec, Canada (Maleki)
- Department of Computer Science, University of Calgary, Calgary, Alberta, Canada (Maleki)
| | - Zu-Hua Gao
- From the Department of Pathology, McGill University, Montreal, Quebec, Canada (Alharbi, Rajaram, Côté, Farag, Gao, Maedler-Kron, Marcus, Fiset)
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada (Gao)
| | - Chelsea Maedler-Kron
- From the Department of Pathology, McGill University, Montreal, Quebec, Canada (Alharbi, Rajaram, Côté, Farag, Gao, Maedler-Kron, Marcus, Fiset)
- Research Institute of McGill University Health Center, Montreal, Quebec, Canada (Maedler-Kron, Fiset)
| | - Victoria Marcus
- From the Department of Pathology, McGill University, Montreal, Quebec, Canada (Alharbi, Rajaram, Côté, Farag, Gao, Maedler-Kron, Marcus, Fiset)
| | - Pierre Olivier Fiset
- From the Department of Pathology, McGill University, Montreal, Quebec, Canada (Alharbi, Rajaram, Côté, Farag, Gao, Maedler-Kron, Marcus, Fiset)
- Research Institute of McGill University Health Center, Montreal, Quebec, Canada (Maedler-Kron, Fiset)
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Duffy SC, Lupien A, Elhaji Y, Farag M, Marcus V, Behr MA. Establishment of persistent enteric mycobacterial infection following streptomycin pre-treatment. Gut Pathog 2023; 15:46. [PMID: 37789445 PMCID: PMC10546655 DOI: 10.1186/s13099-023-00573-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/21/2023] [Indexed: 10/05/2023] Open
Abstract
Mycobacterium avium subsp. paratuberculosis (MAP) is the causative agent of paratuberculosis, a chronic gastrointestinal disease affecting ruminants. This disease remains widespread in part due to the limitations of available diagnostics and vaccines. A representative small animal model of disease could act as a valuable tool for studying its pathogenesis and to develop new methods for paratuberculosis control, but current models are lacking. Streptomycin pre-treatment can reduce colonization resistance and has previously been shown to improve enteric infection in a Salmonella model. Here, we investigated whether streptomycin pre-treatment of mice followed by MAP gavage could act as a model of paratuberculosis which mimics the natural route of infection and disease development in ruminants. The infection outcomes of MAP were compared to M. avium subsp. hominissuis (MAH), an environmental mycobacterium, and M. bovis and M. orygis, two tuberculous mycobacteria. Streptomycin pre-treatment was shown to consistently improve bacterial infection post-oral inoculation. This model led to chronic MAP infection of the intestines and mesenteric lymph nodes (MLNs) up to 24-weeks post-gavage, however there was no evidence of inflammation or disease. These infection outcomes were found to be specific to MAP. When the model was applied to a bacterium of lesser virulence MAH, the infection was comparatively transient. Mice infected with bacteria of greater virulence, M. bovis or M. orygis, developed chronic intestinal and MLN infection with pulmonary disease similar to zoonotic TB. Our findings suggest that a streptomycin pre-treatment mouse model could be applied to future studies to improve enteric infection with MAP and to investigate other modifications underlying MAP enteritis.
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Affiliation(s)
- Shannon C Duffy
- Department of Microbiology and Immunology, McGill University, Montreal, QC, Canada
- McGill International TB Centre, Montreal, QC, Canada
- The Infectious Diseases and Immunity in Global Health Program, The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Andréanne Lupien
- Department of Microbiology and Immunology, McGill University, Montreal, QC, Canada
- McGill International TB Centre, Montreal, QC, Canada
- The Infectious Diseases and Immunity in Global Health Program, The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Youssef Elhaji
- Diagnostic Genomic Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Mina Farag
- Department of Pathology, McGill University, Montreal, QC, Canada
- Department of Laboratory Medicine, Division of Pathology, McGill University Health Center, Montreal, QC, Canada
| | - Victoria Marcus
- Department of Pathology, McGill University, Montreal, QC, Canada
- Department of Laboratory Medicine, Division of Pathology, McGill University Health Center, Montreal, QC, Canada
| | - Marcel A Behr
- Department of Microbiology and Immunology, McGill University, Montreal, QC, Canada.
- McGill International TB Centre, Montreal, QC, Canada.
- The Infectious Diseases and Immunity in Global Health Program, The Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
- Department of Medicine, McGill University, Montreal, QC, Canada.
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Alenezi T, Bessissow T, Marcus V. A236 ENDOSCOPIC MANAGEMENT OF RARE JEJUNAL SOLITARY PEUTZ-JEGHERS-TYPE POLYP IN AN ELDERLY PATIENT WITHOUT A POLYPOSIS SYNDROME: A CASE REPORT AND REVIEW OF THE LITERATURE. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991120 DOI: 10.1093/jcag/gwac036.236] [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: 03/09/2023] Open
Abstract
Background Solitary Peutz-Jeghers-type polyp (SPJP) is a rare hamartomatous lesion. It is considered as a different entity from Peutz-Jeghers syndrome despite similar histopathological findings. It can be found in the GI tract but rarely in the jejunum. Jejunal SPJP are susceptible to necrosis, ulceration, and intussusception, resulting in GI bleeding or small bowel obstruction. Purpose We describe a case of subacute gastrointestinal bleeding secondary to jejunal SPJP to share our approach to this challenging case using therapeutic endoscopy Method An 81-year-old male patient with a history of atrial fibrillation on warfarin with stable therapeutic INR levels, who presented with 1-week history of melena, generalized fatigue and shortness of breath on exertion and was found to have profound iron deficiency anemia. Esophageal gastroduodenoscopy and colonoscopy failed to identify the source of bleeding; however, double balloon enteroscopy detected a 4 cm polyp with stalk in the proximal jejunum. Endoscopic polypectomy was performed and the whole polyp was removed. Histopathological examination was consistent with Peutz-Jeghers polyp. The oropharyngeal and skin examination was negative for mucocutaneous hyperpigmented macules and the genetic analysis was negative for STK11 mutation. Follow up magnetic resonance enterography and video capsule endoscopy did not reveal any other polypoid lesion in the GI tract. The patient’s symptoms resolved gradually, and his hemoglobin level returned back to normal levels within 6 months. Result(s) To our knowledge this is the first case of endoscopic polypectomy during balloon-assisted enteroscopy for jejunal SPJP. Conclusion(s) Conclusion Solitary Peutz-Jeghers hamartomas are a rare occurrence but should be part of the differential diagnosis for abdominal pain from intussusception, or small bowel bleeding even in elderly patient. Balloon assisted enteroscopy is a valuable technique for the management of solitary small bowel lesions. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared LIVER AND BILIARY DISEASE
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Affiliation(s)
| | | | - V Marcus
- Pathology, McGill University Health centre, Montreal, Canada
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Evaristo G, Katz A, Ramírez-GarcíaLuna JL, Issac MSM, Sangwan V, Thai DV, Bertos N, Guiot MC, Camilleri-Broët S, Marcus V, Mueller C, Cools-Lartigue J, Fiset PO, Ferri LE. Relation between mismatch repair status, chemoresponse, survival and anatomic location in gastroesophageal adenocarcinoma. Can J Surg 2023; 66:E79-E87. [PMID: 36792128 PMCID: PMC9943547 DOI: 10.1503/cjs.017021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND It has recently been reported that mismatch repair (MMR) status and microsatellite instability (MSI) status in gastroesophageal carcinomas predict surgical, chemotherapeutic and immunotherapeutic outcomes; however, there is extensive variability in the reported incidence and clinical implications of MMR/MSI status in gastroesophaegal adenocarcinomas. We characterized a Canadian surgical patient cohort with respect to MMR status, clinicopathologic correlates and anatomic tumour location. METHODS We investigated MMR and BRAF V600E status of gastroesophaegal adenocarcinomas in patients who underwent gastrectomy or esophagectomy with extended (D2) lymphadenectomy at a single centre between 2011 and 2019. We correlated patterns of MMR expression in the overall cohort and in anatomic location-defined subgroups with treatment response and overall survival using multivariate analysis. RESULTS In all, 226 cases of gastroesophaegal adenocarcinoma (63 esophageal, 98 gastroesophageal junctional and 65 gastric) were included. The MMR-deficient (dMMR) immunophenotype was found in 28 tumours (12.3%) (15 junctional [15.3%], 13 gastric [20.0%] and none of the esophageal). The majority (25 [89%]) of dMMR cases showed MLH1/PMS2 loss without concurrent BRAF V600E mutation. Two MSH2/ MSH6-deficient gastric tumours and 1 MSH6-deficient junctional tumour were detected. The pathologic response to preoperative chemotherapy was comparable in the dMMR and MMR-proficient (pMMR) cohorts. However, dMMR status was associated with significantly longer median overall survival than pMMR status (5.8 yr v. 2.4 yr, hazard ratio [HR] 1.91, 95% confidence interval [CI] 1.06-3.46), particularly in junctional tumours (4.6 yr v. 1.9 yr, HR 2.97, 95% CI 1.27-6.94). CONCLUSION Our study shows that MMR status has at least prognostic value, which supports the need for biomarker testing in gastroesophageal adenocarcinomas, including junctional adenocarcinomas. This highlights the clinical significance of determining the MMR status in all adenocarcinomas of the upper gastrointestinal tract. Response to induction chemotherapy, however, was not influenced by MMR status.
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Affiliation(s)
- Gertruda Evaristo
- From the Department of Pathology, McGill University Health Centre, Montréal, Que. (Evaristo, Thai, Guiot, Camilleri-Broët, Marcus, Fiset); the Cancer Research Program and the LD MacLean Surgical Research Laboratories, Department of Surgery, Research Institute of the McGill University Health Centre, Montréal, Que. (Katz, Ramírez-GarcíaLuna, Sangwan, Mueller, Cools-Lartigue, Ferri); the Research Institute of the McGill University Health Centre, Montréal, Que. (Issac, Bertos); and the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que. (Sangwan, Mueller, Cools-Lartigue, Ferri)
| | - Amit Katz
- From the Department of Pathology, McGill University Health Centre, Montréal, Que. (Evaristo, Thai, Guiot, Camilleri-Broët, Marcus, Fiset); the Cancer Research Program and the LD MacLean Surgical Research Laboratories, Department of Surgery, Research Institute of the McGill University Health Centre, Montréal, Que. (Katz, Ramírez-GarcíaLuna, Sangwan, Mueller, Cools-Lartigue, Ferri); the Research Institute of the McGill University Health Centre, Montréal, Que. (Issac, Bertos); and the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que. (Sangwan, Mueller, Cools-Lartigue, Ferri)
| | - José L Ramírez-GarcíaLuna
- From the Department of Pathology, McGill University Health Centre, Montréal, Que. (Evaristo, Thai, Guiot, Camilleri-Broët, Marcus, Fiset); the Cancer Research Program and the LD MacLean Surgical Research Laboratories, Department of Surgery, Research Institute of the McGill University Health Centre, Montréal, Que. (Katz, Ramírez-GarcíaLuna, Sangwan, Mueller, Cools-Lartigue, Ferri); the Research Institute of the McGill University Health Centre, Montréal, Que. (Issac, Bertos); and the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que. (Sangwan, Mueller, Cools-Lartigue, Ferri)
| | - Marianne S M Issac
- From the Department of Pathology, McGill University Health Centre, Montréal, Que. (Evaristo, Thai, Guiot, Camilleri-Broët, Marcus, Fiset); the Cancer Research Program and the LD MacLean Surgical Research Laboratories, Department of Surgery, Research Institute of the McGill University Health Centre, Montréal, Que. (Katz, Ramírez-GarcíaLuna, Sangwan, Mueller, Cools-Lartigue, Ferri); the Research Institute of the McGill University Health Centre, Montréal, Que. (Issac, Bertos); and the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que. (Sangwan, Mueller, Cools-Lartigue, Ferri)
| | - Veena Sangwan
- From the Department of Pathology, McGill University Health Centre, Montréal, Que. (Evaristo, Thai, Guiot, Camilleri-Broët, Marcus, Fiset); the Cancer Research Program and the LD MacLean Surgical Research Laboratories, Department of Surgery, Research Institute of the McGill University Health Centre, Montréal, Que. (Katz, Ramírez-GarcíaLuna, Sangwan, Mueller, Cools-Lartigue, Ferri); the Research Institute of the McGill University Health Centre, Montréal, Que. (Issac, Bertos); and the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que. (Sangwan, Mueller, Cools-Lartigue, Ferri)
| | - Duc-Vinh Thai
- From the Department of Pathology, McGill University Health Centre, Montréal, Que. (Evaristo, Thai, Guiot, Camilleri-Broët, Marcus, Fiset); the Cancer Research Program and the LD MacLean Surgical Research Laboratories, Department of Surgery, Research Institute of the McGill University Health Centre, Montréal, Que. (Katz, Ramírez-GarcíaLuna, Sangwan, Mueller, Cools-Lartigue, Ferri); the Research Institute of the McGill University Health Centre, Montréal, Que. (Issac, Bertos); and the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que. (Sangwan, Mueller, Cools-Lartigue, Ferri)
| | - Nicholas Bertos
- From the Department of Pathology, McGill University Health Centre, Montréal, Que. (Evaristo, Thai, Guiot, Camilleri-Broët, Marcus, Fiset); the Cancer Research Program and the LD MacLean Surgical Research Laboratories, Department of Surgery, Research Institute of the McGill University Health Centre, Montréal, Que. (Katz, Ramírez-GarcíaLuna, Sangwan, Mueller, Cools-Lartigue, Ferri); the Research Institute of the McGill University Health Centre, Montréal, Que. (Issac, Bertos); and the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que. (Sangwan, Mueller, Cools-Lartigue, Ferri)
| | - Marie-Christine Guiot
- From the Department of Pathology, McGill University Health Centre, Montréal, Que. (Evaristo, Thai, Guiot, Camilleri-Broët, Marcus, Fiset); the Cancer Research Program and the LD MacLean Surgical Research Laboratories, Department of Surgery, Research Institute of the McGill University Health Centre, Montréal, Que. (Katz, Ramírez-GarcíaLuna, Sangwan, Mueller, Cools-Lartigue, Ferri); the Research Institute of the McGill University Health Centre, Montréal, Que. (Issac, Bertos); and the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que. (Sangwan, Mueller, Cools-Lartigue, Ferri)
| | - Sophie Camilleri-Broët
- From the Department of Pathology, McGill University Health Centre, Montréal, Que. (Evaristo, Thai, Guiot, Camilleri-Broët, Marcus, Fiset); the Cancer Research Program and the LD MacLean Surgical Research Laboratories, Department of Surgery, Research Institute of the McGill University Health Centre, Montréal, Que. (Katz, Ramírez-GarcíaLuna, Sangwan, Mueller, Cools-Lartigue, Ferri); the Research Institute of the McGill University Health Centre, Montréal, Que. (Issac, Bertos); and the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que. (Sangwan, Mueller, Cools-Lartigue, Ferri)
| | - Victoria Marcus
- From the Department of Pathology, McGill University Health Centre, Montréal, Que. (Evaristo, Thai, Guiot, Camilleri-Broët, Marcus, Fiset); the Cancer Research Program and the LD MacLean Surgical Research Laboratories, Department of Surgery, Research Institute of the McGill University Health Centre, Montréal, Que. (Katz, Ramírez-GarcíaLuna, Sangwan, Mueller, Cools-Lartigue, Ferri); the Research Institute of the McGill University Health Centre, Montréal, Que. (Issac, Bertos); and the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que. (Sangwan, Mueller, Cools-Lartigue, Ferri)
| | - Carmen Mueller
- From the Department of Pathology, McGill University Health Centre, Montréal, Que. (Evaristo, Thai, Guiot, Camilleri-Broët, Marcus, Fiset); the Cancer Research Program and the LD MacLean Surgical Research Laboratories, Department of Surgery, Research Institute of the McGill University Health Centre, Montréal, Que. (Katz, Ramírez-GarcíaLuna, Sangwan, Mueller, Cools-Lartigue, Ferri); the Research Institute of the McGill University Health Centre, Montréal, Que. (Issac, Bertos); and the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que. (Sangwan, Mueller, Cools-Lartigue, Ferri)
| | - Jonathan Cools-Lartigue
- From the Department of Pathology, McGill University Health Centre, Montréal, Que. (Evaristo, Thai, Guiot, Camilleri-Broët, Marcus, Fiset); the Cancer Research Program and the LD MacLean Surgical Research Laboratories, Department of Surgery, Research Institute of the McGill University Health Centre, Montréal, Que. (Katz, Ramírez-GarcíaLuna, Sangwan, Mueller, Cools-Lartigue, Ferri); the Research Institute of the McGill University Health Centre, Montréal, Que. (Issac, Bertos); and the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que. (Sangwan, Mueller, Cools-Lartigue, Ferri)
| | - Pierre O Fiset
- From the Department of Pathology, McGill University Health Centre, Montréal, Que. (Evaristo, Thai, Guiot, Camilleri-Broët, Marcus, Fiset); the Cancer Research Program and the LD MacLean Surgical Research Laboratories, Department of Surgery, Research Institute of the McGill University Health Centre, Montréal, Que. (Katz, Ramírez-GarcíaLuna, Sangwan, Mueller, Cools-Lartigue, Ferri); the Research Institute of the McGill University Health Centre, Montréal, Que. (Issac, Bertos); and the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que. (Sangwan, Mueller, Cools-Lartigue, Ferri)
| | - Lorenzo E Ferri
- From the Department of Pathology, McGill University Health Centre, Montréal, Que. (Evaristo, Thai, Guiot, Camilleri-Broët, Marcus, Fiset); the Cancer Research Program and the LD MacLean Surgical Research Laboratories, Department of Surgery, Research Institute of the McGill University Health Centre, Montréal, Que. (Katz, Ramírez-GarcíaLuna, Sangwan, Mueller, Cools-Lartigue, Ferri); the Research Institute of the McGill University Health Centre, Montréal, Que. (Issac, Bertos); and the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que. (Sangwan, Mueller, Cools-Lartigue, Ferri)
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Biswas K, Couillard M, Cavallone L, Burkett S, Stauffer S, Martin BK, Southon E, Reid S, Plona TM, Baugher RN, Mellott SD, Pike KM, Albaugh ME, Maedler-Kron C, Hamel N, Tessarollo L, Marcus V, Foulkes WD, Sharan SK. A novel mouse model of PMS2 founder mutation that causes mismatch repair defect due to aberrant splicing. Cell Death Dis 2021; 12:838. [PMID: 34489406 PMCID: PMC8421400 DOI: 10.1038/s41419-021-04130-8] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/10/2021] [Accepted: 08/18/2021] [Indexed: 11/09/2022]
Abstract
Hereditary non-polyposis colorectal cancer, now known as Lynch syndrome (LS) is one of the most common cancer predisposition syndromes and is caused by germline pathogenic variants (GPVs) in DNA mismatch repair (MMR) genes. A common founder GPV in PMS2 in the Canadian Inuit population, NM_000535.5: c.2002A>G, leads to a benign missense (p.I668V) but also acts as a de novo splice site that creates a 5 bp deletion resulting in a truncated protein (p.I668*). Individuals homozygous for this GPV are predisposed to atypical constitutional MMR deficiency with a delayed onset of first primary malignancy. We have generated mice with an equivalent germline mutation (Pms2c.1993A>G) and demonstrate that it results in a splicing defect similar to those observed in humans. Homozygous mutant mice are viable like the Pms2 null mice. However, unlike the Pms2 null mice, these mutant mice are fertile, like humans homozygous for this variant. Furthermore, these mice exhibit a significant increase in microsatellite instability and intestinal adenomas on an Apc mutant background. Rectification of the splicing defect in human and murine fibroblasts using antisense morpholinos suggests that this novel mouse model can be valuable in evaluating the efficacy aimed at targeting the splicing defect in PMS2 that is highly prevalent among the Canadian Inuits.
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Affiliation(s)
- Kajal Biswas
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - Martin Couillard
- The Lady Davis Institute of the Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Luca Cavallone
- The Lady Davis Institute of the Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Sandra Burkett
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - Stacey Stauffer
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - Betty K Martin
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
- Leidos Biomedical Research, Inc. Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA
| | - Eileen Southon
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
- Leidos Biomedical Research, Inc. Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA
| | - Susan Reid
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - Teri M Plona
- CLIA Molecular Diagnostics Laboratory, Leidos Biomedical Research, Inc. Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Ryan N Baugher
- CLIA Molecular Diagnostics Laboratory, Leidos Biomedical Research, Inc. Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Stephanie D Mellott
- CLIA Molecular Diagnostics Laboratory, Leidos Biomedical Research, Inc. Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Kristen M Pike
- CLIA Molecular Diagnostics Laboratory, Leidos Biomedical Research, Inc. Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Mary E Albaugh
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
- Leidos Biomedical Research, Inc. Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA
| | | | - Nancy Hamel
- Department of Oncology, McGill University, Montreal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Lino Tessarollo
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - Victoria Marcus
- Department of Pathology, McGill University, Montreal, QC, Canada
| | - William D Foulkes
- The Lady Davis Institute of the Jewish General Hospital, McGill University, Montreal, QC, Canada
- Department of Oncology, McGill University, Montreal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Department of Medical Genetics, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
- Department of Medical Genetics and Cancer Research Program, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, H4A 3JI, Canada
| | - Shyam K Sharan
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA.
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8
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Alcindor T, Opu T, Elkrief A, Khosrow-Khavar F, Mueller CL, Cools-Lartigue J, Hickeson M, Artho G, Evaristo G, Marcus V, Camilleri-Broët S, Fiset PO, Spatz A, Koulouris Z, Ferri L. Phase II trial of perioperative chemotherapy + avelumab in locally advanced gastroesophageal adenocarcinoma: Preliminary results. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4046] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4046 Background: Perioperative chemotherapy improves cure rate in locally advanced gastroesophageal adenocarcinoma (GEA), and immune checkpoint inhibitors are active at the metastatic stage. This trial tests the hypothesis that the addition of avelumab to perioperative chemotherapy will increase the major pathologic response (MPR) rate in comparison with historical controls. Methods: Phase II study of avelumab + chemotherapy (docetaxel, cisplatin and 5-FU or mDCF) given every 2 weeks for 4 cycles before and after surgery. Main inclusion criteria: GEA, cT3 and/or cN+, M0, WHO PS 0-1. Main exclusion criteria: use of immunosuppressants, serious autoimmune disease, daily intake >10 mg prednisone. Staging studies: CT, PET-CT, endoscopic ultrasound, diagnostic laparoscopy. Surgical resection: D2 lymphadenectomy, en-bloc esophagectomy for type I/II gastroesophageal junction (GEJ) tumors. Aim of the study: MPR as defined as tumor regression grades 0-1 (modified Ryan scheme); as per hypothesis, this experimental regimen will result in a 20% rate of MPR, compared with 7% with chemotherapy alone. Simon 2-stage design: if less than 2 MPR are seen in the first 16 patients, the study will be closed. The study hypothesis cannot be rejected if at least 6 MPR are seen in the first 50 patients. All adverse effects are prospectively recorded per CTCAE guidelines in patients who have received at least one treatment cycle. Survival rates are calculated with Kaplan-Meier method. Preliminary results are presented since the study has met its primary endpoint. Results: Feb 2018-Feb 2020: 28 patients enrolled (25 M/3 F, age 45-78). Location: GEJ (23), stomach (5). Staging: cT3 (25), cT4 (1), cN+ (20). Biomarkers expression: mismatch repair (MMR) protein loss (3/28); PD-L1(clone 73-10) expression in 1% (TPS) or more of tumor cells seen in 12/28 samples, and >10% in 6 patients. Grade 3 toxicity: stomatitis (2/28); nausea (2/28); vomiting (1/28); diarrhea (1/28); hypothyroidism (1/28); arthralgia (3/28); neutropenia (1/28). Grade 4 toxicity: pneumonia (1/28); neutropenia (2/28). Postoperative 30-day mortality: 0%. One patient was excluded from efficacy analyses for M1 staging; 27 patients underwent surgery, 26 with R0 (96%). Six cases (22%) show MPR: 3 grade 0 (11%) and 3 grade 1 (11%) tumor regressions. No correlation was seen between MMR proteins or PD-L1 expression and tumor regression. With a median follow-up of 1.5 years (range 0.4-2.5), the disease-free survival rate is projected to be 0.92 (95% CI 0.83-1.00) at 12 months and 0.77 (95% CI 0.58-1.00) at 24 months. Conclusions: The combination of mDCF chemotherapy with Avelumab demonstrates a promising safety and activity profile. Ongoing laboratory investigations are underway to correlate our findings with tumor molecular features before exposure to treatment. Clinical trial information: NCT03288350.
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Affiliation(s)
| | - Touhid Opu
- Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Arielle Elkrief
- University of Montreal Research Center (CRCHUM), Montréal, QC, Canada
| | | | - Carmen L. Mueller
- Division of Thoracic and Upper GI Surgery, McGill University, Montreal, QC, Canada
| | | | - Marc Hickeson
- McGill University Health Centre, Montréal, QC, Canada
| | | | | | | | | | | | - Alan Spatz
- Jewish General Hospital, Lady Davis Institute, McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Zoe Koulouris
- McGill University Health Centre, Montréal, QC, Canada
| | - Lorenzo Ferri
- Division of Thoracic and Upper GI Surgery, McGill University, Montreal, QC, Canada
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9
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Kennedy ED, Simunovic M, Jhaveri K, Kirsch R, Brierley J, Drolet S, Brown C, Vos PM, Xiong W, MacLean T, Kanthan S, Stotland P, Raphael S, Chow G, O'Brien CA, Cho C, Streutker C, Wong R, Schmocker S, Liberman S, Reinhold C, Kopek N, Marcus V, Bouchard A, Lavoie C, Morin S, Périgny M, Wright A, Neumann K, Clarke S, Patil NG, Arnason T, Williams L, McLeod R, Brown G, Mathieson A, Pooni A, Baxter NN. Safety and Feasibility of Using Magnetic Resonance Imaging Criteria to Identify Patients With "Good Prognosis" Rectal Cancer Eligible for Primary Surgery: The Phase 2 Nonrandomized QuickSilver Clinical Trial. JAMA Oncol 2020; 5:961-966. [PMID: 30973610 DOI: 10.1001/jamaoncol.2019.0186] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Chemoradiotherapy (CRT), followed by surgery, is the recommended approach for stage II and III rectal cancer. While CRT decreases the risk of local recurrence, it does not improve survival and leads to poorer functional outcomes than surgery alone. Therefore, new approaches to better select patients for CRT are important. Objective To conduct a phase 2 study to evaluate the safety and feasibility of using magnetic resonance imaging (MRI) criteria to select patients with "good prognosis" rectal tumors for primary surgery. Design, Setting, and Participants Prospective nonrandomized phase 2 study at 12 high-volume colorectal surgery centers across Canada. From September 30, 2014, to October 21, 2016, a total of 82 patients were recruited for the study. Participants were patients newly diagnosed as having rectal cancer with MRI-predicted good prognosis rectal cancer. The MRI criteria for good prognosis tumors included distance to the mesorectal fascia greater than 1 mm; definite T2, T2/early T3, or definite T3 with less than 5 mm of extramural depth of invasion; and absent or equivocal extramural venous invasion. Interventions Patients with rectal cancer with MRI-predicted good prognosis tumors underwent primary surgery. Main Outcomes and Measures The primary outcome was the proportion of patients with a positive circumferential resection margin (CRM) rate. Assuming a 10% baseline probability of a positive CRM, a sample size of 75 was estimated to yield a 95% CI of ±6.7%. Results Eighty-two patients (74% male) participated in the study. The median age at the time of surgery was 66 years (range, 37-89 years). Based on MRI, most tumors were midrectal (65% [n = 53]), T2/early T3 (60% [n = 49]), with no suspicious lymph nodes (63% [n = 52]). On final pathology, 91% (n = 75) of tumors were T2 or greater, 29% (n = 24) were node positive, and 59% (n = 48) were stage II or III. The positive CRM rate was 4 of 82 (4.9%; 95% CI, 0.2%-9.6%). Conclusions and Relevance The use of MRI criteria to select patients with good prognosis rectal cancer for primary surgery results in a low rate of positive CRM and suggests that CRT may not be necessary for all patients with stage II and III rectal cancer. Trial Registration ISRCTN.com identifier: ISRCTN05107772.
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Affiliation(s)
- Erin D Kennedy
- Division of General Surgery, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Marko Simunovic
- Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kartik Jhaveri
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Toronto, Ontario, Canada.,Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Richard Kirsch
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jim Brierley
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Sébastien Drolet
- Department of Surgery, Centre Hospitalier Universitaire (CHU) de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Carl Brown
- Department of Surgery, St Paul's Hospital, Providence Health Care, Vancouver, British Columbia, Canada
| | - Patrick M Vos
- Department of Radiology, St Paul's Hospital, Providence Health Care, Vancouver, British Columbia, Canada
| | - Wei Xiong
- Department of Pathology & Laboratory Medicine, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Tony MacLean
- Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Selliah Kanthan
- Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Peter Stotland
- Department of Surgery, North York General Hospital, Toronto, Ontario, Canada
| | - Simon Raphael
- Department of Pathology and Laboratory Medicine, North York General Hospital, Toronto, Ontario, Canada
| | - Gil Chow
- Department of Medical Imaging, North York General Hospital, Toronto, Ontario, Canada
| | | | - Charles Cho
- Department of Radiation Oncology, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Cathy Streutker
- Department of Pathology and Laboratory Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Raimond Wong
- Department of Radiation Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Selina Schmocker
- Division of General Surgery, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Sender Liberman
- Department of Surgery, McGill University Health Centre (MUHC)-Montreal General Hospital, Montreal, Quebec, Canada
| | - Caroline Reinhold
- Department of Diagnostic Radiology, MUHC-Montreal General Hospital, Montreal, Quebec, Canada
| | - Neil Kopek
- Department of Radiation Oncology, MUHC-Montreal General Hospital, Montreal, Quebec, Canada
| | - Victoria Marcus
- Department of Pathology and Laboratory Medicine, MUHC-Montreal General Hospital, Montreal, Quebec, Canada
| | - Alexandre Bouchard
- Department of Surgery, CHU de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Caroline Lavoie
- Department of Radiation Oncology, CHU de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Stanislas Morin
- Department of Medical Imaging, CHU de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Martine Périgny
- Department of Pathology and Laboratory Medicine, CHU de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Ann Wright
- Department of Surgery, Centre Hospitalier Universitaire (CHU) de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Katerina Neumann
- Department of Surgery, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Sharon Clarke
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Nikhilesh G Patil
- Department of Radiation Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Thomas Arnason
- Department of Pathology & Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Lara Williams
- Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Robin McLeod
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Gina Brown
- Department of Radiology, The Royal Marsden Hospital National Health Service (NHS) Foundation Trust, Surrey, England, United Kingdom
| | - Alex Mathieson
- Department of Surgery, Eastern Health Authority, Memorial University, St John's, Newfoundland, Canada
| | - Amandeep Pooni
- Division of General Surgery, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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10
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Kaufman E, de Castro C, Williamson T, Lessard B, Munoz M, Mayrand MH, Burchell AN, Klein MB, Charest L, Auger M, Marcus V, Coutlée F, de Pokomandy A. Acceptability of anal cancer screening tests for women living with HIV in the EVVA study. ACTA ACUST UNITED AC 2020; 27:19-26. [PMID: 32218656 DOI: 10.3747/co.27.5401] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Anal cancer is potentially preventable through screening. For screening to be implemented, the screening procedures must be acceptable to the affected population. The objective of the present study was to measure the acceptability of currently available anal cancer screening tests in a population of women living with hiv who had experienced the tests. Methods The evva study ("Evaluation of Human Immunodeficiency Virus, Human Papillomavirus, and Anal Intraepithelial Neoplasia in Women") is a prospective cohort study of adult women living with hiv in Montreal, Quebec. Participants were screened with cervical or anal hpv testing and cervical or anal cytology every 6 months for 2 years. High-resolution anoscopy (hra) and digital anal rectal examination (dare) were also performed systematically, with biopsies, at baseline and at 2 years. An acceptability questionnaire was administered at the final visit or at study withdrawal. Results Of 124 women who completed the acceptability questionnaire, most considered screening "an absolute necessity" in routine care for all women living with hiv [77%; 95% confidence interval (ci): 69% to 84%]. Yearly anal cytology or anal hpv testing was considered very acceptable by 81% (95% ci: 73% to 88%); hra every 2 years was considered very acceptable by 84% (95% ci: 77% to 90%); and yearly dare was considered very acceptable by 87% (95% ci: 79% to 92%). Acceptability increased to more than 95% with a longer proposed time interval. Pain was the main reason for lower acceptability. Conclusions Most participating women considered anal cancer screening necessary and very acceptable. Longer screening intervals and adequate pain management could further increase the acceptability of repeated screening.
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Affiliation(s)
- E Kaufman
- Department of Family Medicine, McGill University, Montreal, QC.,Cumming School of Medicine, University of Calgary, Calgary, AB
| | - C de Castro
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC
| | - T Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - B Lessard
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC
| | - M Munoz
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC
| | - M H Mayrand
- Départements d'obstétrique-gynécologie et de médecine sociale et préventive, Centre hospitalier de l'Université de Montréal and Université de Montréal, Montreal, QC
| | - A N Burchell
- Department of Family and Community Medicine and Centre for Urban Health Solutions, St. Michael's Hospital, and Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON.,Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, BC
| | - M B Klein
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC.,Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, BC
| | - L Charest
- Clinique médicale l'Actuel, Montreal, QC
| | - M Auger
- Department of Pathology, McGill University, and McGill University Health Centre, Montreal, QC
| | - V Marcus
- Department of Pathology, McGill University, and McGill University Health Centre, Montreal, QC
| | - F Coutlée
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC.,Département de microbiologie, infectiologie, et immunologie, Centre hospitalier de l'Université de Montréal and Université de Montréal, Montreal, QC
| | - A de Pokomandy
- Department of Family Medicine, McGill University, Montreal, QC.,Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC.,Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, BC
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11
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Hart L, Chavannes M, Kherad O, Maedler C, Mourad N, Marcus V, Afif W, Bitton A, Lakatos PL, Brassard P, Bessissow T. Faecal Calprotectin Predicts Endoscopic and Histological Activity in Clinically Quiescent Ulcerative Colitis. J Crohns Colitis 2020; 14:46-52. [PMID: 31314884 DOI: 10.1093/ecco-jcc/jjz107] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Faecal calprotectin [FC] is a reliable surrogate marker for disease activity in ulcerative colitis [UC]; however, there are no consensus cut-off values for remission. The study aim was to correlate FC with Mayo Endoscopic Score [MES] and histological disease activity of UC patients in clinical remission. METHODS Our study recruited adult UC patients at the McGill IBD Center between 2013 and 2017. Patients in clinical remission [partial Mayo score ≤2], undergoing endoscopy for disease activity or dysplasia surveillance, were enrolled. Before bowel preparation, FC was collected. MES was documented during colonoscopy. Biopsies were taken; histological activity was assessed using Geboes score and the presence of basal plasmacytosis. RESULTS A total of 185 patients were recruited. The area under the curve [AUC] in receiver operating characteristic [ROC] analysis to predict MES 1-3 [from 0] was 0.743 [95% CI 0.67-0.82; p <0.001] with an FC cut-off value 170 µg/g [64% sensitivity, 74% specificity], and to predict MES 2-3 [from 0-1] was 0.722 [95% CI 0.61-0.83; p <0.001] with an FC cut-off value 170 µg/g [69% sensitivity, 65% specificity]. To differentiate MES 0 from MES 1, an FC value 130 µg/g yields a 70% sensitivity and 68% specificity. The AUC in ROC analysis to predict Geboes <3.1 was 0.627 [95% CI 0.55-0.71; p = 0.003], with an FC value 135 µg/g [54% sensitivity, 69% specificity]. CONCLUSIONS In this large study, FC ≥170 µg/g predicts endoscopic activity and FC ≥135 µg/g predicts histological activity. Therefore in clinical practice, lower faecal calprotectin thresholds can be chosen to optimise identification of patients with ongoing endoscopic and histological disease activity.
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Affiliation(s)
- Lara Hart
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Mallory Chavannes
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Omar Kherad
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal, QC, Canada.,Department of Internal Medicine, Hôpital de la Tour and University of Geneva, Geneva, Switzerland
| | - Chelsea Maedler
- Department of Pathology, McGill University, Montreal, QC, Canada
| | - Nathalie Mourad
- Department of Pathology, McGill University, Montreal, QC, Canada
| | - Victoria Marcus
- Department of Pathology, McGill University, Montreal, QC, Canada
| | - Waqqas Afif
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Alain Bitton
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Peter L Lakatos
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal, QC, Canada.,Division of Gastroenterology, Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Paul Brassard
- Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Talat Bessissow
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal, QC, Canada
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12
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Alcindor T, Opu T, Mueller C, Marcus V, Fiset PO, Camilleri-Broet S, Artho G, Asselah J, Vanhuyse M, Hickeson M, Awan A, Koulouris Z, Ferri L. Interim analysis of a phase II trial of perioperative chemotherapy plus avelumab in esophagogastric and gastric adenocarcinoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Smith AL, Wong C, Cuggia A, Borgida A, Holter S, Hall A, Connor AA, Bascuñana C, Asselah J, Bouganim N, Poulin V, Jolivet J, Vafiadis P, Le P, Martel G, Lemay F, Beaudoin A, Rafatzand K, Chaudhury P, Barkun J, Metrakos P, Marcus V, Omeroglu A, Chong G, Akbari MR, Foulkes WD, Gallinger S, Zogopoulos G. Reflex Testing for Germline BRCA1, BRCA2, PALB2, and ATM Mutations in Pancreatic Cancer: Mutation Prevalence and Clinical Outcomes From Two Canadian Research Registries. JCO Precis Oncol 2018; 2:1-16. [DOI: 10.1200/po.17.00098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose We investigated the translational value of reflex testing for germline mutations in four homology-directed DNA repair predisposition genes ( BRCA1, BRCA2, PALB2, and ATM) in consecutive patients with pancreatic adenocarcinoma. Methods One hundred fifty patients with French-Canadian (FC) ancestry were evaluated for founder mutations, and 114 patients were subsequently assessed by full gene sequencing and multiplex ligation-dependent probe amplification for nonfounder mutations. Two hundred thirty-six patients unselected for ancestry were also assessed for mutations by full gene sequencing. Results The FC founder mutation prevalence among the 150 patients was 5.3% (95% CI, 2.6% to 10.3%), and the nonfounder mutation prevalence across the four genes among the 114 patients tested was 2.6% (95% CI, 0.6% to 7.8%). In the case series unselected for ancestry, 10.0% (95% CI, 2.7% to 26.4%) of patients reporting Ashkenazi Jewish (AJ) ancestry carried an AJ founder mutation, with no nonfounder mutations identified. The mutation prevalence among patients without FC/AJ ancestry was 4.9% (95% CI, 2.6% to 8.8%). Mutations were more frequent in patients diagnosed at ≤ 50 years of age ( P = .03) and in patients with either two or more first- or second-degree relatives with pancreas, breast, ovarian or prostate cancer, or one such relative and a second primary of one of these cancer types ( P < .001). BRCA1, BRCA2, and PALB2 carriers with late-stage (III or IV) disease had an overall survival advantage ( P = .049), particularly if treated with platinum-based chemotherapies ( P = .030). Conclusion Considering these results, we recommend reflex founder mutation testing of patients with FC/AJ ancestry and full gene sequencing of patients who are ≤ 50 years or meet the identified family history criteria. Reflex testing of all incident patients for these four genes may become justified as full gene sequencing costs decline.
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Affiliation(s)
- Alyssa L. Smith
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Cavin Wong
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Adeline Cuggia
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Ayelet Borgida
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Spring Holter
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Anita Hall
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Ashton A. Connor
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Claire Bascuñana
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Jamil Asselah
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Nathaniel Bouganim
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Véronique Poulin
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Jacques Jolivet
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Petro Vafiadis
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Philippe Le
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Guillaume Martel
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Frédéric Lemay
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Annie Beaudoin
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Khashayar Rafatzand
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Prosanto Chaudhury
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Jeffrey Barkun
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Peter Metrakos
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Victoria Marcus
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Atilla Omeroglu
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - George Chong
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Mohammad R. Akbari
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - William D. Foulkes
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Steven Gallinger
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - George Zogopoulos
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
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de Pokomandy A, de Pokomandy A, Lessard B, Mayrand MH, Charest L, Marcus V, Burchell A, Rodrigues-Coutlée S, Coutlée F. Two-years persistence of anal high-risk HPV infections in women living with HIV, results from the EVVA study. Papillomavirus Research 2018. [DOI: 10.1016/j.pvr.2018.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gao B, Yu T, Xue D, Sun B, Shao Q, Choudhry H, Marcus V, Ragoussis J, Zhang Y, Zhang W, Gao ZH. A multidimensional integration analysis reveals potential bridging targets in the process of colorectal cancer liver metastasis. PLoS One 2017. [PMID: 28628609 PMCID: PMC5476238 DOI: 10.1371/journal.pone.0178760] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Approximately 9% of cancer-related deaths are caused by colorectal cancer. Liver metastasis is a major factor for the high colorectal cancer mortality rate. However, the molecular mechanism underlying colorectal cancer liver metastasis remains unclear. Using a global and multidimensional integration approach, we studied sequencing data, protein-protein interactions, and regulation of transcription factor and non-coding RNAs in primary tumor samples and liver metastasis samples to unveil the potential bridging molecules and the regulators that functionally link different stages of colorectal cancer liver metastasis. Primary tumor samples and liver metastasis samples had modules with significant overlap and crosstalk from which we identified several bridging genes (e.g. KNG1 and COX5B), transcription factors (e.g. E2F4 and CDX2), microRNAs (e.g. miR-590-3p and miR-203) and lncRNAs (e.g. lincIRX5 and lincFOXF1) that may play an important role in the process of colorectal cancer liver metastasis. This study enhances our understanding of the genetic alterations and transcriptional regulation that drive the metastatic process, but also provides the methodology to guide the studies on other metastatic cancers.
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Affiliation(s)
- Bo Gao
- Department of General Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
- Department of Pathology, The Research Institute of McGill University Health Center, Montreal, Québec, Canada
| | - Tian Yu
- Section of Immunity, Infection and Inflammation, Division of Applied Medicine, School of Medicine and Dentistry, Institute of Medical Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Dongbo Xue
- Department of General Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Boshi Sun
- Department of General Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qin Shao
- Department of Pathology, The Research Institute of McGill University Health Center, Montreal, Québec, Canada
| | - Hani Choudhry
- Department of Biochemistry, Faculty of Science, Cancer and Mutagenesis Unit, King Fahd Center for Medical Research, Center of Innovation in Personalized Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Victoria Marcus
- Department of Pathology, The Research Institute of McGill University Health Center, Montreal, Québec, Canada
| | - Jiannis Ragoussis
- McGill University and Genome Quebec Innovation Centre, Montreal, Québec, Canada
| | - Yuguo Zhang
- Department of Traditional and Western Medical Hepatology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Weihui Zhang
- Department of General Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zu-hua Gao
- Department of Pathology, The Research Institute of McGill University Health Center, Montreal, Québec, Canada
- * E-mail:
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Shi Y, Dong K, Zhang YG, Michel RP, Marcus V, Wang YY, Chen Y, Gao ZH. Sinusoidal endotheliitis as a histological parameter for diagnosing acute liver allograft rejection. World J Gastroenterol 2017; 23:792-799. [PMID: 28223723 PMCID: PMC5296195 DOI: 10.3748/wjg.v23.i5.792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 12/18/2016] [Accepted: 01/11/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigated the feasibility of using sinusoidal endotheliitis (SE) as a histological marker for liver allograft rejection.
METHODS We compared the histological features of 88 liver allograft biopsies with acute cellular rejection (ACR) and 59 cases with no evidence of ACR. SE was scored as: (1) focal linear lifting up of the endothelial cells by lymphocytes with no obvious damage to adjacent hepatocytes; (2) focal disruption of the endothelial lining by a cluster of subendothelial lymphocytes (a group of > 3 lymphocytes); and (3) severe confluent endotheliitis with hemorrhage and adjacent hepatocyte loss.
RESULTS The sensitivity and specificity of SE was 81% and 85%, respectively. Using SE as the only parameter, the positive predictive value for ACR (PPV) was 0.89, whereas the negative predictive value for ACR (NPV) was 0.75. The correlation between RAI and SE was moderate (R = 0.44, P < 0.001) (Figure 3A), whereas it became strong (R = 0.65, P < 0.001) when correlating SE with the venous endotheliitis activity index only.
CONCLUSION Our data suggest that SE scoring could be a reliable and reproducible supplemental parameter to the existing Banff schema for diagnosing acute liver allograft rejection.
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Gao B, Shao Q, Choudhry H, Marcus V, Dong K, Ragoussis J, Gao ZH. [Corrigendum] Weighted gene co-expression network analysis of colorectal cancer liver metastasis genome sequencing data and screening of anti-metastasis drugs. Int J Oncol 2016; 50:339. [PMID: 27748802 PMCID: PMC5182005 DOI: 10.3892/ijo.2016.3722] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/03/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- Bo Gao
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Qin Shao
- Department of Pathology, The Research Institute of McGill University Health Center, Montreal, Québec H4A 3J1, Canada
| | - Hani Choudhry
- McGill University and Genome Quebec Innovation Centre, Montreal, Québec H3B 1S6, Canada
| | - Victoria Marcus
- Department of Pathology, The Research Institute of McGill University Health Center, Montreal, Québec H4A 3J1, Canada
| | - Kung Dong
- Department of Pathology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, P.R. China
| | - Jiannis Ragoussis
- McGill University and Genome Quebec Innovation Centre, Montreal, Québec H3B 1S6, Canada
| | - Zu-Hua Gao
- Department of Pathology, The Research Institute of McGill University Health Center, Montreal, Québec H4A 3J1, Canada
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Gao B, Shao Q, Choudhry H, Marcus V, Dong K, Ragoussis J, Gao ZH. Weighted gene co-expression network analysis of colorectal cancer liver metastasis genome sequencing data and screening of anti-metastasis drugs. Int J Oncol 2016; 49:1108-18. [PMID: 27571956 DOI: 10.3892/ijo.2016.3591] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/03/2016] [Indexed: 11/06/2022] Open
Abstract
Approximately 9% of cancer-related deaths are caused by colorectal cancer (CRC). CRC patients are prone to liver metastasis, which is the most important cause for the high CRC mortality rate. Understanding the molecular mechanism of CRC liver metastasis could help us to find novel targets for the effective treatment of this deadly disease. Using weighted gene co-expression network analysis on the sequencing data of CRC with and with metastasis, we identified 5 colorectal cancer liver metastasis related modules which were labeled as brown, blue, grey, yellow and turquoise. In the brown module, which represents the metastatic tumor in the liver, gene ontology (GO) analysis revealed functions including the G-protein coupled receptor protein signaling pathway, epithelial cell differentiation and cell surface receptor linked signal transduction. In the blue module, which represents the primary CRC that has metastasized, GO analysis showed that the genes were mainly enriched in GO terms including G-protein coupled receptor protein signaling pathway, cell surface receptor linked signal transduction, and negative regulation of cell differentiation. In the yellow and turquoise modules, which represent the primary non-metastatic CRC, 13 downregulated CRC liver metastasis-related candidate miRNAs were identified (e.g. hsa-miR-204, hsa-miR-455, etc.). Furthermore, analyzing the DrugBank database and mining the literature identified 25 and 12 candidate drugs that could potentially block the metastatic processes of the primary tumor and inhibit the progression of metastatic tumors in the liver, respectively. Data generated from this study not only furthers our understanding of the genetic alterations that drive the metastatic process, but also guides the development of molecular-targeted therapy of colorectal cancer liver metastasis.
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Affiliation(s)
- Bo Gao
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Qin Shao
- Department of Pathology, The Research Institute of McGill University Health Center, Montreal, Québec H4A 3J1, Canada
| | - Hani Choudhry
- McGill University and Genome Quebec Innovation Centre, Montreal, Québec H3B 1S6, Canada
| | - Victoria Marcus
- Department of Pathology, The Research Institute of McGill University Health Center, Montreal, Québec H4A 3J1, Canada
| | - Kung Dong
- Department of Pathology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, P.R. China
| | - Jiannis Ragoussis
- McGill University and Genome Quebec Innovation Centre, Montreal, Québec H3B 1S6, Canada
| | - Zu-Hua Gao
- Department of Pathology, The Research Institute of McGill University Health Center, Montreal, Québec H4A 3J1, Canada
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Bhat M, Skill N, Marcus V, Deschenes M, Tan X, Bouteaud J, Negi S, Awan Z, Aikin R, Kwan J, Amre R, Tabaries S, Hassanain M, Seidah NG, Maluccio M, Siegel P, Metrakos P. Decreased PCSK9 expression in human hepatocellular carcinoma. BMC Gastroenterol 2015; 15:176. [PMID: 26674961 PMCID: PMC4682218 DOI: 10.1186/s12876-015-0371-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 10/08/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The management of hepatocellular carcinoma (HCC) is limited by the lack of adequate screening biomarkers and chemotherapy. In response, there has been much interest in tumor metabolism as a therapeutic target. PCSK9 stimulates internalization of the LDL-receptor, decreases cholesterol uptake into hepatocytes and affects liver regeneration. Thus, we investigated whether PCSK9 expression is altered in HCC, influencing its ability to harness cholesterol metabolism. METHODS Thirty-nine patients undergoing partial hepatectomy or liver transplantation for HCC were consented for use of HCC tissue to construct a tissue microarray (TMA). The TMA was immunostained for PCSK9. Imagescope software was used to objectively determine staining, and assess for pathological and clinical correlations. PCSK9 and LDL receptor mRNA levels in flash-frozen HCC and adjacent liver tissue were determined by quantitative RT-PCR. Serum PCSK9 levels were determined by ELISA. RESULTS By immunohistochemistry, there was significantly lower expression of PCSK9 in HCC as compared to adjacent cirrhosis (p-value < 0.0001, wilcoxon signed-rank test). Significantly greater staining of PCSK9 was present in cirrhosis compared to HCC (p value <0.0001), and positivity (percentage of positive cells) was significantly greater in cirrhosis compared to HCC (p-value < 0.0001). Conversely, significantly higher expression of LDL-R was present in HCC as compared to the adjacent cirrhosis (p-value < 0.0001). There was no significant correlation of PCSK9 staining with grade of tumor, but there were significant correlations between PCSK9 staining and stage of fibrosis, according to spearman correlation test. PCSK9 mRNA levels were relatively less abundant within HCC compared to adjacent liver tissue (p-value =0.08) and normal control tissue (p-value =0.02). In contrast, serum PCSK9 levels were significantly increased among patients with HCC compared to those with chronic liver disease without HCC (p-value =0.029). LDL receptor mRNA was consistantly greater in HCC when compared to normal control tissue (p-value = 0.06) and, in general, was significantly greater in HCC when compared to adjacent liver (p-value = 0.04). CONCLUSIONS The decreased expression of PCSK9 and conversely increased LDL-R expression in HCC suggests that HCC modulates its local microenvironment to enable a constant energy supply. Larger-scale studies should be conducted to determine whether PCSK9 could be a therapeutic target for HCC.
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Affiliation(s)
- Mamatha Bhat
- Division of Gastroenterology, McGill University Health Centre, 687 Pine Avenue West, Montreal, H3A1A1, Canada.
| | - Nicolas Skill
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Victoria Marcus
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada.
| | - Marc Deschenes
- Division of Gastroenterology, McGill University Health Centre, 687 Pine Avenue West, Montreal, H3A1A1, Canada.
| | - Xianming Tan
- Biostatistics Core Facility, Research Institute, McGill University Health Centre, Montreal, QC, Canada.
| | - Jeanne Bouteaud
- Hepatopancreatobiliary and Multi-Organ Transplant Surgery, McGill University Health Centre, Montreal, QC, Canada.
| | - Sarita Negi
- Hepatopancreatobiliary and Multi-Organ Transplant Surgery, McGill University Health Centre, Montreal, QC, Canada.
| | - Zuhier Awan
- Department of Medical Biochemistry, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Reid Aikin
- Hepatopancreatobiliary and Multi-Organ Transplant Surgery, McGill University Health Centre, Montreal, QC, Canada.
| | - Janet Kwan
- Hepatopancreatobiliary and Multi-Organ Transplant Surgery, McGill University Health Centre, Montreal, QC, Canada.
| | - Ramila Amre
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Sebastien Tabaries
- Department of Medicine, Goodman Cancer Research Centre, Montreal, QC, Canada.
| | - Mazen Hassanain
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada.
- Department of Surgery, King Saud University, Riyadh, Saudi Arabia.
| | - Nabil G Seidah
- Department of Medical Biochemistry, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Mary Maluccio
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Peter Siegel
- Department of Medicine, Goodman Cancer Research Centre, Montreal, QC, Canada.
| | - Peter Metrakos
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada.
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Lobatón T, Bessissow T, De Hertogh G, Lemmens B, Maedler C, Van Assche G, Vermeire S, Bisschops R, Rutgeerts P, Bitton A, Afif W, Marcus V, Ferrante M. The Modified Mayo Endoscopic Score (MMES): A New Index for the Assessment of Extension and Severity of Endoscopic Activity in Ulcerative Colitis Patients. J Crohns Colitis 2015; 9:846-52. [PMID: 26116558 DOI: 10.1093/ecco-jcc/jjv111] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [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: 03/09/2015] [Accepted: 06/01/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Current endoscopic activity scores for ulcerative colitis (UC) do not take into account the extent of mucosal inflammation. We have developed a simple endoscopic index for UC that takes into account the severity and distribution of mucosal inflammation. METHODS In this multicentre trial, UC patients undergoing colonoscopy were prospectively enrolled. For the Modified Score (MS), the sum of Mayo Endoscopic Subscores (MESs) for five colon segments (ascending, transverse, descending, sigmoid and rectum) was calculated. The Extended Modified Score (EMS) was obtained by multiplying the MS by the maximal extent of inflammation. The Modified Mayo Endoscopic Score (MMES) was obtained by dividing the EMS by the number of segments with active inflammation. Colon biopsies were obtained from the rectum and sigmoid, as well as from all inflamed segments, by standard methods. Clinical activity was scored according to the Partial Mayo Score (PMS). Biological activity was scored according to C-reactive protein (CRP) and faecal calprotectin (FC) levels. Histological activity was scored according to the Geboes Score (GS). RESULTS One hundred and seventy-one UC patients (38% female, median age 47 years, median disease duration 13 years) were included. The MMES correlated significantly with the PMS (r = 0.535), CRP (r = 0.238), FC (r = 0.730) and GS (r = 0.615) (all p < 0.001). Median MMES scores were significantly higher in patients with clinical, biological or histological activity (all p ≤ 0.001) CONCLUSIONS: The MMES is an easy to use endoscopic index for UC that combines the severity analysis of the MES with disease extent, and correlates very well with clinical, biological and histological disease activity.
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Affiliation(s)
- Triana Lobatón
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Talat Bessissow
- Department of Gastroenterology, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Bart Lemmens
- Department of Pathology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Chelsea Maedler
- Department of Pathology, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Gert Van Assche
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Séverine Vermeire
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Raf Bisschops
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Paul Rutgeerts
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Alain Bitton
- Department of Gastroenterology, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Waqqas Afif
- Department of Gastroenterology, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Victoria Marcus
- Department of Pathology, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Marc Ferrante
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
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21
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Sun C, Zargham R, Shao Q, Gui X, Marcus V, Lazaris A, Salman A, Metrakos P, Qu X, Gao Z. Association of CD98, integrin β1, integrin β3 and Fak with the progression and liver metastases of colorectal cancer. Pathol Res Pract 2014; 210:668-74. [PMID: 25041835 DOI: 10.1016/j.prp.2014.06.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/12/2014] [Accepted: 06/19/2014] [Indexed: 11/29/2022]
Abstract
CD98-mediated β1 and β3 integrins activation can induce Fak phosphorylation which eventually promotes cell survival, proliferation, and migration. We evaluated the expression of CD98, integrin β1, integrin β3 and Fak in 45 cases of matched colorectal cancer (CRC) and liver metastases as well as 35 cases of CRC without liver metastases. There was a gradual increase of the expression of CD98, integrin β1, integrin β3 and Fak as tumor progressed from normal colon to carcinoma to budding tumor cells at the invasive front and to liver metastases. The expression of CD98 and integrin β1 in CRC with liver metastases was significantly higher than that in CRC without liver metastases. Furthermore, for those liver metastases with desmoplastic growth pattern, expression of CD98, integrin β1, integrin β3 and Fak at the metastases center was as strong as that at the metastases periphery. For those liver metastases with pushing or replacement growth patterns, more intense expression of these markers was found at the metastases center than the periphery. Overexpression of CD98, integrin β1, integrin β3 and Fak is associated with the progression and liver metastases of CRC. Overexpression of these markers in liver metastases requires direct contact between tumor cells and the stroma.
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Affiliation(s)
- Cuicui Sun
- Department of Pharmacology, Key Laboratory of Chemical Biology, School of Pharmaceutical Sciences, Shandong University, Jinan, China
| | - Ramin Zargham
- Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Qin Shao
- Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Xianyong Gui
- Department of Pathology, University of Calgary, Calgary, Alberta, Canada
| | - Victoria Marcus
- Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Anthoula Lazaris
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Ayat Salman
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Peter Metrakos
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Xianjun Qu
- Department of Pathology, Beijing You An Hospital, Capital Medical University, Beijing, China.
| | - Zuhua Gao
- Department of Pathology, McGill University, Montreal, Quebec, Canada; Department of Pathology, Beijing You An Hospital, Capital Medical University, Beijing, China.
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22
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Spicer J, Benay C, Lee L, Rousseau M, Andalib A, Kushner Y, Marcus V, Ferri L. Diagnostic accuracy and utility of intraoperative microscopic margin analysis of gastric and esophageal adenocarcinoma. Ann Surg Oncol 2014; 21:2580-6. [PMID: 24806114 DOI: 10.1245/s10434-014-3669-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Positive resection margins are amongst the strongest predictors of cancer-related mortality for adenocarcinoma of the stomach and esophagus. Although intraoperative pathology consultation with frozen section of margins can predict final permanent section pathology, the accuracy of this approach is not known. We sought to determine the diagnostic accuracy of frozen section margin analysis in esophagogastric adenocarcinoma and the impact that it had on surgical therapy. METHODS Patients with resection of esophagogastric adenocarcinoma at a single centre from 1998 to 2008 were identified. Clinicopathologic data were collected. Frozen section results were compared to permanent section assessment, and sensitivity, specificity, positive, and negative predictive values were calculated. Patients with positive margins by frozen section were reviewed to assess the impact on surgical decision-making. RESULTS Of 220 patients who underwent surgery for adenocarcinoma of the esophagus and stomach (esophagus: 34/220, EGJ: 106/220, stomach 80/220), 56 % had an intraoperative consultation. Of these 122 patients, 66 % underwent frozen section. All errors on frozen section occurred on the interpretation of the proximal margin. The diagnostic accuracy of frozen section at the proximal margin was 93 % with sensitivity = 67 %, specificity = 100 %, positive predictive value = 100 %, and negative predictive value = 91 %. Signet ring cells were present in 83 % of false-negative readings. Surgical management was altered in 10 of the 13 of patients who had a true positive frozen section and 9 of these patients were converted to R0 resections. CONCLUSIONS Although very specific, negative results on frozen section require greater caution when signet ring cells are present. For esophagogastric adenocarcinoma, frozen section alters management and may increase the rate of complete resection.
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Affiliation(s)
- Jonathan Spicer
- Division of Thoracic Surgery, David Mulder Chair of Thoracic Surgery, McGill University Health Centre, The Montreal General Hospital, Montreal, QC, Canada,
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23
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Ndao M, Nath-Chowdhury M, Sajid M, Marcus V, Mashiyama ST, Sakanari J, Chow E, Mackey Z, Land KM, Jacobson MP, Kalyanaraman C, McKerrow JH, Arrowood MJ, Caffrey CR. A cysteine protease inhibitor rescues mice from a lethal Cryptosporidium parvum infection. Antimicrob Agents Chemother 2013; 57:6063-73. [PMID: 24060869 PMCID: PMC3837922 DOI: 10.1128/aac.00734-13] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/16/2013] [Indexed: 02/06/2023] Open
Abstract
Cryptosporidiosis, caused by the protozoan parasite Cryptosporidium parvum, can stunt infant growth and can be lethal in immunocompromised individuals. The most widely used drugs for treating cryptosporidiosis are nitazoxanide and paromomycin, although both exhibit limited efficacy. To investigate an alternative approach to therapy, we demonstrate that the clan CA cysteine protease inhibitor N-methyl piperazine-Phe-homoPhe-vinylsulfone phenyl (K11777) inhibits C. parvum growth in mammalian cell lines in a concentration-dependent manner. Further, using the C57BL/6 gamma interferon receptor knockout (IFN-γR-KO) mouse model, which is highly susceptible to C. parvum, oral or intraperitoneal treatment with K11777 for 10 days rescued mice from otherwise lethal infections. Histologic examination of untreated mice showed intestinal inflammation, villous blunting, and abundant intracellular parasite stages. In contrast, K11777-treated mice (210 mg/kg of body weight/day) showed only minimal inflammation and no epithelial changes. Three putative protease targets (termed cryptopains 1 to 3, or CpaCATL-1, -2, and -3) were identified in the C. parvum genome, but only two are transcribed in infected mammals. A homology model predicted that K11777 would bind to cryptopain 1. Recombinant enzymatically active cryptopain 1 was successfully targeted by K11777 in a competition assay with a labeled active-site-directed probe. K11777 exhibited no toxicity in vitro and in vivo, and surviving animals remained free of parasites 3 weeks after treatment. The discovery that a cysteine protease inhibitor provides potent anticryptosporidial activity in an animal model of infection encourages the investigation and development of this biocide class as a new, and urgently needed, chemotherapy for cryptosporidiosis.
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Affiliation(s)
- Momar Ndao
- National Reference Centre for Parasitology, Research Institute of the McGill University Health Center, Montreal, Canada
| | - Milli Nath-Chowdhury
- National Reference Centre for Parasitology, Research Institute of the McGill University Health Center, Montreal, Canada
| | - Mohammed Sajid
- Center for Discovery and Innovation in Parasitic Diseases and Department of Pathology, California Institute for Quantitative Biosciences, University of California, San Francisco, San Francisco, California, USA
- Leiden University Medical Center, Leiden, Netherlands
| | - Victoria Marcus
- Department of Pathology, McGill University Health Centre, Montreal General Hospital, Montreal, Canada
| | - Susan T. Mashiyama
- Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Judy Sakanari
- Center for Discovery and Innovation in Parasitic Diseases and Department of Pathology, California Institute for Quantitative Biosciences, University of California, San Francisco, San Francisco, California, USA
| | - Eric Chow
- Center for Discovery and Innovation in Parasitic Diseases and Department of Pathology, California Institute for Quantitative Biosciences, University of California, San Francisco, San Francisco, California, USA
| | - Zachary Mackey
- Center for Discovery and Innovation in Parasitic Diseases and Department of Pathology, California Institute for Quantitative Biosciences, University of California, San Francisco, San Francisco, California, USA
| | - Kirkwood M. Land
- Center for Discovery and Innovation in Parasitic Diseases and Department of Pathology, California Institute for Quantitative Biosciences, University of California, San Francisco, San Francisco, California, USA
- Department of Biological Sciences, University of the Pacific, Stockton, California, USA
| | - Matthew P. Jacobson
- Departments of Pharmaceutical Sciences
- Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Chakrapani Kalyanaraman
- Departments of Pharmaceutical Sciences
- Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California, USA
| | - James H. McKerrow
- Center for Discovery and Innovation in Parasitic Diseases and Department of Pathology, California Institute for Quantitative Biosciences, University of California, San Francisco, San Francisco, California, USA
| | - Michael J. Arrowood
- Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Conor R. Caffrey
- Center for Discovery and Innovation in Parasitic Diseases and Department of Pathology, California Institute for Quantitative Biosciences, University of California, San Francisco, San Francisco, California, USA
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Alain T, Morita M, Fonseca BD, Yanagiya A, Siddiqui N, Bhat M, Zammit D, Marcus V, Metrakos P, Voyer LA, Gandin V, Liu Y, Topisirovic I, Sonenberg N. eIF4E/4E-BP ratio predicts the efficacy of mTOR targeted therapies. Cancer Res 2012; 72:6468-76. [PMID: 23100465 DOI: 10.1158/0008-5472.can-12-2395] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Active-site mTOR inhibitors (asTORi) hold great promise for targeting dysregulated mTOR signaling in cancer. Because of the multifaceted nature of mTORC1 signaling, identification of reliable biomarkers for the sensitivity of tumors to asTORi is imperative for their clinical implementation. Here, we show that cancer cells acquire resistance to asTORi by downregulating eukaryotic translation initiation factor (eIF4E)-binding proteins (4E-BPs-EIF4EBP1, EIF4EBP2). Loss of 4E-BPs or overexpression of eIF4E renders neoplastic growth and translation of tumor-promoting mRNAs refractory to mTOR inhibition. Conversely, moderate depletion of eIF4E augments the anti-neoplastic effects of asTORi. The anti-proliferative effect of asTORi in vitro and in vivo is therefore significantly influenced by perturbations in eIF4E/4E-BP stoichiometry, whereby an increase in the eIF4E/4E-BP ratio dramatically limits the sensitivity of cancer cells to asTORi. We propose that the eIF4E/4E-BP ratio, rather than their individual protein levels or solely their phosphorylation status, should be considered as a paramount predictive marker for forecasting the clinical therapeutic response to mTOR inhibitors.
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Affiliation(s)
- Tommy Alain
- Department of Biochemistry, SMBD-Jewish General Hospital, Montreal, Quebec, Canada
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25
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Cools-Lartigue J, Chang SY, Mckendy K, Mayrand S, Marcus V, Fried GM, Ferri LE. Pattern of esophageal eosinophilic infiltration in patients with achalasia and response to Heller myotomy and Dor fundoplication. Dis Esophagus 2012; 26:766-75. [PMID: 22891632 DOI: 10.1111/j.1442-2050.2012.01385.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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] [Indexed: 12/11/2022]
Abstract
Eosinophilic esophagitis (EoE) is now recognized as a common cause of dysphagia. Eosinophilic infiltration of the esophagus has also been associated with other conditions, such as gastroesophageal reflux disease (GERD); however, the incidence, pattern, and clinical significance of eosinophilic infiltration in achalasia are poorly documented. We sought to characterize this histological finding in patients undergoing Heller myotomy (HM) for achalasia. Ninety-six patients undergoing laparoscopic HM for primary achalasia between 1999 and 2008 were identified from a prospective database. Serial mid and distal per-endoscopic esophageal biopsies taken from patients before and after surgery were assessed for the presence of elevated intraepithelial eosinophils (EIEs). Slides from patients with reports suggestive of EIE were reviewed independently by two pathologists, and the highest eosinophil count/high-power field (eos/hpf) was recorded. Dysphagia scores (0 = none to 5 = severe dysphagia), GERD health-related quality of life scores (0 = best to 45 = worst), and 24-hour pH results were compared before and 3 months after surgery. We related the highest eos to the symptoms and response to HM. Data are presented as median (range). Paired t-test and Wilcoxon signed-rank test determined significance, *P < 0.05. Of 96 patients with achalasia, 50 had undergone pre-HM biopsies revealing EIE in 17/50 (34%), with a median of 3 eos/hpf (1-21). Two patients were found to have superimposed esophageal candidiasis. One patient met the pathologic criteria for EoE. Twenty-five of 50 (50%) postoperative biopsies demonstrated a median of 5 eos/hpf (1-62) for a total of 28/50 patients (56%) with EIE in either the preoperative or postoperative period. Four patients (8%) met the pathologic criteria for EoE, and two demonstrated persistent esophageal candidiasis. A decrease in eosinophils was found in 6/28 patients (21%) from 3/hpf (1-21) to 0.5/hpf (0-4). Increase in eosinophils was found in 22/28 patients (79%) from 0.5/hpf (0-8) to 5/hpf (1-62). Preoperative and postoperative dysphagia scores were available in 23 patients. Dysphagia scores improved in 22/23 patients. (3 [0-5] to 0 [0-2])*. Preoperative and postoperative GERD scores were available in 21 patients. GERD scores improved in 20/21 patients (10 [3-38] to 2 [2-14])*. Four of 13 patients (30.7%) demonstrated significant reflux in the postoperative period. No difference in clinical response to HM was detected between patients with preoperative EIE compared with patients with no EIE. No correlation between postoperative esophageal pH and eos was observed. A significant number of patients with achalasia demonstrate esophageal eosinophilic infiltration even at numbers demonstrable in patients with EoE (8% 4/50). While the interaction between achalasia and esophageal eosinophilic infiltration needs further investigation, this does not represent a distinct clinical entity. Thus, the presence of esophageal eosinophils in patients presenting with dysphagia should not preclude further work-up for other etiologies, including achalasia.
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Affiliation(s)
- J Cools-Lartigue
- Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada Department of Pathology, McGill University Health Center, Montreal, Quebec, Canada Department of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada Steinberg-Bernstein Center for Minimally Invasive Surgery, Montreal, Quebec, Canada
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26
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Fayez R, AlMuntashery A, Bodie G, Almamar A, Gill R, Raîche I, Mueller C, AlMuntashery A, Fayez R, AlMuntashery A, Moustarah F, Khokhotva M, Anvari M, Kwong J, Elkassem S, Bonrath E, Zevin B, Sockalingam S, Smith C, Smith C, Whitlock K, Gill R, Suri M, Palter V, Wakeam E, Khan R, Martelli V, Malik A, Young P, Daigle C, McCreery G, Seth R, Paskar D, Sudarshan M, Richardson D, Haggar F, Davis V, Rivard J, Agzarian J, Racz J, Winocour J, Zilbert N, Decker C, Neumann K, Gosney J, Wissanji H, Chadi S, Alhabboubi M, Partridge E, Alhabboubi M, Olszewski M, Chan R, Nadler A, Hameed U, Brotherhood H, Menezes A, MacDonald B, Rakovich G, Hilsden R, Merani S, Davis P, Davis P, Cools-Lartigue J, Ojah J, Julien F, Carter D, Pitt D, Banks B, Rudovics A, Ravichandran P, Anantha R, Aad I, Kholdebarin R, Aird L, Wong S, Payne J, Hallet J, Farries L, Raiche I, Botkin C, Morency D, Berger-Richardson D, Isa A, Dupuis I, Schweigert M, Koubi S, Ernjakovic M, Grant K, Cools-Lartigue J, Carrott P, Stafford T, Malthaner R, Sudarshan M, Hanna W, Lee L, Markar S, Razzak R, Bharadwaj S, Ashrafi A, Ouellette D, Fergusson D, Forster A, Boushey R, Porter G, Johnson P, Gomes T, Chan B, Auer R, Moloo H, Mamdani M, Markar S, Al-Omran M, Al-Obaid O, Boushey R, Lim DR, Min BS, Baik SH, Gordon P, Kim NK, Lo A, Pinsk I, Bottoni D, Brown C, Raval M, Cheng H, Wong C, Johnston N, Farrokhyar F, Stephen W, Kelly S, Lindsay L, Forbes S, Knickle C, Bouchard A, Parry N, Leslie K, Ott M, Coughlin S, Gazala S, Gazala S, Donahoe L, Walker K, Li C, Alnasser S, Schweigert M, Schweigert M, Zhuruk A, Hanouf A, Vanounou T, Karanicolas P, Aubin JM, Yeung J, Dumitra S, Simoneau E, Vanounou T, Howe B, Hawel J, Jang JH, Bertens K, Rekman J, Wei A, Dumitra S, Koubi S, Ouellet JF, Wei A, Covelli A, Maniar R, Sun S, Davis V, Brackstone M, Boissonneault R, Kim S, Baliski C, Gazala S, Hameed U, Sudarshan M, Arnaout A, Wedman D, Nostedt M, Hebbard P, Shetty S, Dixon M, Wei A, Dixon M, Kazazian K, Lemke M, Wells B, Musselman R, Zih FSW, Menezes A, Nassif M, Leon-Carlyle M, Wei A, Krotneva S, Bradley N, Trabulsi N, Trabulsi N, Chin-Lenn L, Cheng H, Petrucci A, Sandhu L, Neville A, Lee L, Li C, Yang I, Prabhu KL, Melich G, Knowles S, Richardson D, Borowiec A, Hallet J, Boissonneault R, Kolozsvari N, Hallet J, Tuttle P, VanHouwelingen L, Haggar F, Boulanger-Gobeil C, Chan B, Chan B, Richardson D, Musselman R, Melich G, Phang P, Goldstein L, Wen C, Lebrun A, Chadi S, Roy M, Villeneuve S, AlMuntashery A, Demyttenaere S, Christou N, Court O, Fayez R, Demyttenaere S, Christou N, Court O, Bonrath E, Hagen J, Okrainec A, Sullivan P, Grantcharov T, Sharma A, Karmali S, Birch D, Majumdar S, Wang X, Tuepah R, Klarenbach S, Birch D, Karmali S, Sharma A, Padwal R, Smith C, Haggar F, Moloo H, Poulin E, Martel G, Yelle JD, Mamazza J, Jackson T, Penner T, Pitzul K, Urbach D, Okrainec A, Villeneuve S, Roy M, Fayez R, Demyttenaere S, Christou N, Court O, Roy M, Villeneuve S, AlMuntashery A, Demyttenaere S, Christou N, Court O, Fayez R, Demyttenaere S, Court O, Christou N, Biertho L, Hould FS, Lebel S, Lescelleur O, Marceau S, Marceau P, Biron S, Grantcharov T, Sharma A, Yusuf S, Okrainec A, Pitzul K, Urbach D, Jackson T, Lindsay D, Sullivan P, Smith L, Zevin B, Dedy N, Grantcharov T, Bonrath E, Aggarwal R, Grantcharov T, Cassin S, Crawford S, Pitzul K, Khan A, Hawa R, Jackson T, Okrainec A, Brar B, Mamazza J, Raîche I, Yelle JD, Haggar F, Moloo H, Brar B, Haggar F, Dent R, Mamazza J, Raîche I, Moloo H, Gill R, Ali T, Shi X, Birch D, Karmali S, Whitlock K, Shi X, Sarkhosh K, Birch D, Karmali S, Turner J, Nation P, Wizzard P, Brubaker P, Gisalet D, Wales P, Grantcharov T, Tien H, Spencer F, Brenneman F, Kowal J, Wiseman S, Fraser S, Vedel I, Deban M, Holcroft C, Monette M, Monette J, Bergman S, Bell C, Stukel T, Urbach D, Mueller T, Lucykx V, Lukowski C, Compston C, Churchill T, Khadaroo R, Grantcharov T, Vogt K, Dubois L, Gray D, Ananth A, Tai LH, Lam T, Falls T, Souza C, Bell J, Auer R, Crawford S, Parry N, Leslie K, Alhabboubi M, St-Louis E, Deckelbaum D, Razek T, Feldman L, Khwaja K, Porter G, Johnson P, Boushey R, Moloo H, Raiche I, Mamazza J, Schiller D, Eurich D, Sawyer M, Vergis A, Unger B, Hardy K, Andrew C, Gillman L, Park J, Prodger J, Kelly W, Kelly S, Prodger D, Ewara E, Martin J, Sarma S, Chu M, Schlachta C, Zaric G, Al-Ali K, Briggs K, George R, Murnaghan M, Leung A, Regehr G, Moulton CA, Mahmud S, Metcalfe J, McKay A, Park J, Hochman D, Burkle F, Redmond A, McQueen K, Desrosiers E, Gilbert A, Leslie K, Ott M, Sudarshan M, Jessula S, Alburakan A, Deckelbaum D, Razek T, Iqbal S, Khwaja K, Aikins C, Sudarshan M, Deckelbaum D, Iqbal S, Khwaja K, Razek T, Roberts N, Moulton CA, Murnaghan M, Cil T, Marshall J, Pederson K, Erichsen S, White J, Aarts MA, Okrainec A, Victor J, Pearsall E, McLeod R, Jackson T, Okrainec A, Penner T, Urbach D, Karimuddin A, Hall C, Bawan S, Malik S, Hayashi A, Gill R, McAlister C, Zhang N, DesRosiers E, Mills A, Crozier M, Lee L, Maxwell J, Partridge E, Chad S, Steigerwald S, Mapiour D, Roberts D, MacPherson C, Donahoe L, Mercer D, Hopman W, Latulippe JF, Knowles S, Moffat B, Parry N, Leslie K, Switzer N, Khadaroo R, Tul Y, Widder S, Molinari M, Levy A, Johnson P, Bailey J, Molinari M, Hayden J, Johnson P, Benlolo S, Marcus V, Ferri L, Finley R, Anderson D, Gagné JP, Chan S, Wong S, Li J, Michael A, Choi D, Liu E, Hoogenes J, Dath D, Aubin JM, Mew D, McConnell Y, Classen D, Kanthan S, Croome K, Kovacs M, Lazo-Langner A, Hernandez-Alejandro R, Vogt K, Crawford S, Parry N, Leslie K, Khoshgoo N, Iwasiow B, Keijzer R, Brown C, Isa D, Pace D, Widder S, Tul Y, Primrose M, Hudson D, Khadaroo R, Lauzier F, Mailloux O, Trottier V, ARchambault P, Zarychanski R, Turgeon A, Mailloux O, Hardy P, Muirhead R, Masters J, Haggar F, Poulin HME, Martel G, Mamazza J, Milbrandt C, Keijzer R, Sideris L, Grenier-Vallée P, Latulippe JF, Dubé P, Kurashima Y, Kaneva P, Feldman L, Fried G, Vassiliou M, Kwan AL, Fraser S, Solymosi N, Rauh N, Dubecz A, Renz M, Ofner D, Stein H, Borgaonkar M, Crystal P, Easson A, Escallon J, Reedijk M, Cil T, Leong W, McCready D, Clifton J, Mayo J, Finley R, Noreau-Nguyen M, Mulder D, Ferri L, Markar S, Hong J, Low D, Maslow A, Davignon K, Ng T, Tan L, Aruranian J, Kosa S, Ferri L, Murphy G, Allison F, Moshonov H, Darling G, Waddell T, De Perrot M, Cypel M, Yasufuku K, Keshavjee S, Paul N, Pierre A, Darling G, Pedneault C, Marcus V, Mulder D, Ferri L, Low D, Roa W, Löbenberg R, McEwan S, Bédard E, Louie B, Farivar A, McHugh S, Aye R, Tan-Tam C, De Vera M, Bond R, Ong S, Johal B, Schellenberg D, Po M, Nissar S, Lund C, Ahmadi S, Wakil N, Rakovich G, Beauchamps G, Preston S, Baker C, Low D, Campbell G, Malthaner R, Bethune D, Henteleff H, Johnston M, Buduhan G, Coughlin HE, Roth L, Bhandari M, Malthaner R, Johnson J, Kutsogiannis J, Bédard E, Rammohan K, Stewart K, Bédard E, Buduhan G, Gruchy J, Xu Z, Buduhan G, Ferri L, Mulder D, Ncuti A, Neville A, Kaneva P, Watson D, Vassiliou M, Carli F, Feldman L, Av R, Mayrand S, Franco E, Ferri L, Dubecz A, Renz M, Stadlhuber R, Ofner D, Stein H, Renz M, Dubecz A, Solymosi N, Thumfart L, Ofner D, Stein H, Croome K, Leeper R, Hernandez R, Livingstone S, Sapp J, Woodhall D, Alwayn I, Bergman S, Lam-McCulloch J, Balaa F, Jayaraman S, Quan D, Wei A, Guyatt G, Rekman J, Fairfull-Smith R, Mimeault R, Balaa F, Martel G, Boehnert M, Bazerbachi F, Knaak J, Selzner N, McGilvray I, Rotstein O, Adeyi O, Levy G, Keshavjee S, Grant D, Selzner M, Khalil JA, Jamal M, Chaudhury P, Zogopoulos G, Petrakos P, Tchervenkov J, Barkun J, Jamal M, Hassanain M, Chaudhury P, Wong S, Salman A, Tran T, Metrakos P, Groeschl R, Geller D, Marsh J, Gamblin T, Croome K, Croome K, Quan D, Hernandez R, Kim P, Greig PD, Gallinger S, Moulton CA, Wei A, Fischer S, Cleary S, Vogt K, Hernandez-Alejandro R, Gray D, Aubin J, Fairfull-Smith J, Mimeault R, Balaa F, Martel G, Devitt K, Ramjaun A, Gallingher S, Alabbad S, Constantinos D, Hassanein M, Barkun J, Metrakos P, Paraskevas S, Chaudhury P, Tchervenkov J, Borgaonkar M, Tanyingoh D, Dixon E, Kaplan G, Myers R, Howard T, Sutherland F, Zyromski N, Ball C, Coburn N, Moulton CA, Cleary S, Law C, Greig P, Steven G, Baxter N, Fitch M, Wright F, Hochman D, Wirtzfeld D, McKay A, Yaffe C, Yip B, Silverman R, Park J, McConnell Y, Temple W, Mack L, Schiller D, Bathe O, Sawyer M, Scott L, Vandenberg T, Perera F, Potvin K, Chambers A, Loungnarath R, DeBroux É, Lavertu S, Donath D, Ayoub JP, Tehfé M, Richard C, Cornacchi S, Heller B, Farrokhyar F, Babra M, Lovrics P, Liberto C, Ghosh S, McLean R, Schiller D, Jackson T, Okrainec A, Penner T, Urbach D, Dumitra S, Duplisea J, Wexler S, Seely J, Smylie J, Knight K, Robertson S, Watters J, Zhang T, Arneout A, Hochman D, Wirtzfeld D, McKay A, Yip B, Yaffe C, Silverman R, Park J, Baxter N, Yun L, Rakovitch E, Wright F, Warner E, McCready D, Hodgson N, Quan M, Natarajan B, Govindarajan V, Thomas P, Loggie B, Brar S, Mahar A, Law C, Coburn N, Devitt K, Wiebe M, Bathe O, McLeod R, Baxter N, Gagliardi A, Kennedy E, Urbach D, Brar S, Mahar A, Law C, Coburn N, Zih F, Rosario C, Dennis J, Gingras AC, Swallow C, Ko YJ, Rowsell C, Law C, Saskin R, Quan ML, Xie M, McLaughlin K, Marginean C, Moyana T, Moloo H, Boushey R, Auer R, Razik R, Haase E, Mathieson A, Smith A, Swallow C, Barnes A, Scheer A, Moloo H, Boushey R, Sabri E, Auer R, Reidel K, Trabulsi N, Meterissian S, Tamblyn R, Mayo N, Meguerditchian A, Brown J, Hamm J, Phang P, Raval M, Brown C, Devitt K, Wiebe M, Bathe O, McLeod R, Taylor B, Urbach D, Reidel K, Mayo N, Tamblyn R, Meguerditchian A, Hamm J, Wiseman S, Patakfalvi L, Nassif M, Turcotte R, Nichols A, Meguerditchian A, Riedel K, Winslade N, Grégoire JP, Meterissian S, Abrahamovicz M, Megueerditchian A, Pasieka J, McMillan C, Lipa J, Snell L, Sudarshan M, Dumitra S, Duplisea J, Wexler S, Meterissian S, Tomlinson G, Kennedy E, Wei A, Baxter N, Urbach D, Liberman A, Charlebois P, Stein B, Ncuti A, Vassiliou M, Fried G, Feldman L, Capretti G, Power A, Liberman A, Charlebois P, Stein B, Kaneva P, Carli F, Fried G, Feldman L, Carli F, Charlebois P, Stein B, Liberman A, Kaneva P, Augustin B, Gamsa A, Kim DJ, Vassiliou M, Feldman L, Boushey R, Moloo H, Vu L, Chan S, Phang P, Gown A, Jones S, Wiseman S, Jeong DH, Hur H, Baik SH, Kim NK, Faria J, Min BS, Lumb K, Colquhoun P, Porter G, Johnson P, Baxter N, Schmocker S, Huang H, Victor J, Krzyzanowska MK, Brierley J, McLeod R, Kennedy E, Milot H, Desrosiers E, Lebrun A, Drolet S, Bouchard A, Grégoire R, Vuong T, Loungnarath R, DeBroux E, Liberman A, Charlebois P, Stein B, Richard C, Capretti G, Kaneva P, Neville A, Carli F, Liberman S, Charlebois P, Stein B, Vassiliou M, Fried G, Feldman L, Milot H, Drolet S, Bouchard A, Grégoire R, Powell R, Fowler A, Mathieson A, Martin K, Vogt K, Ott M, Pereira G, Einarsdottir K, Moloo H, Boushey R, Mamazza J, Bouchard A, Gagné J, Grégoire R, Thibault C, Bouchard P, Gomes T, Musselman R, Auer R, Moloo H, Mamdani M, Al-Omran M, Boushey R, AlObeed O, Armstrong J. Canadian Surgery Forum1 Is laparoscopic sleeve gastrectomy a reasonable stand-alone procedure for super morbidly obese patients?2 Postoperative monitoring requirements of patients with obstructive sleep apnea undergoing bariatric surgery3 Role of relaparoscopy in the diagnosis and treatment of bariatric complications in the early postoperative period4 Changes of active and total ghrelin, GLP-1 and PYY following restrictive bariatric surgery and their impact on satiety: comparison of sleeve gastrectomy and adjustable gastric banding5 Prioritization and willingness to pay for bariatric surgery: the patient perspective6 Ventral hernia at the time of laparoscopic gastric bypass surgery: Should it be repaired?7 Linear stapled gastrojejunostomy with transverse handsewn enterotomy closure significantly reduces strictures for laparoscopic Roux-en-Y bypass8 Laparoscopic biliopancreatic diversion with duodenal switch as second stage for super super morbidly obese patients. Do all patients benefit?9 Sleeve gastrectomy in the super super morbidly obese (BMI > 60 kg/m2): a Canadian experience10 Laparoscopic gastric bypass for the treatment of refractory idiopathic gastroparesis: a report of 2 cases11 Duodeno-ileal switch as a primary bariatric and metabolic surgical option for the severely obese patient with comorbidities: review of a single-institution case series of duodeno-ileal intestinal bypass12 Management of large paraesophageal hernias in morbidly obese patients with laparoscopic sleeve gastrectomy: a case series13 Early results of the Ontario bariatric surgical program: using the bariatric registry14 Improving access to bariatric surgical care: Is universal health care the answer?15 Early and liberal postoperative exploration can reduce morbidity and mortality in patients undergoing bariatric surgery16 Withdrawn17 Identification and assessment of technical errors in laparoscopic Roux-en-Y gastric bypass18 A valid and reliable tool for assessment of surgical skill in laparoscopic Roux-en-Y gastric bypass19 Psychiatric predictors of presurgery drop-out following suitability assessment for bariatric surgery20 Predictors of outcomes following Roux-en-Y gastric bypass surgery at The Ottawa Hospital21 Prophylactic management of cholelithiasis in bariatric patients: Is routine cholecystectomy warranted?22 Early outcomes of Roux-en-Y gastric bypass in a publicly funded obesity program23 Similar incidence of gastrojejunal anastomotic stricture formation with hand-sewn and 21 mm circular stapler techniques during Roux-en-Y gastric bypass24 (CAGS Basic Science Award) Exogenous glucagon-like peptide-1 improves clinical, morphological and histological outcomes of intestinal adaptation in a distal-intestinal resection piglet model of short bowel syndrome25 (CAGS Clinical Research Award) Development and validation of a comprehensive curriculum to teach an advanced minimally invasive procedure: a randomized controlled trial26 Negative-pressure wound therapy (iVAC) on closed, high-risk incisions following abdominal wall reconstruction27 The impact of seed granting on research in the University of British Columbia Department of Surgery28 Quality of surgical care is inadequate for elderly patients29 Recurrence of inguinal hernia in general and hernia specialty hospitals in Ontario, Canada30 Oncostatin M receptor deficiency results in increased mortality in an intestinal ischemia reperfusion model in mice31 Laparoscopic repair of large paraesophageal hernias with anterior gastropexy: a multicentre trial32 Response to preoperative medical therapy predicts success of laparoscopic splenectomy for immune thrombocytopenic purpura33 Perioperative sepsis, but not hemorrhagic shock, promotes the development of cancer metastases in a murine model34 Measuring the impact of implementing an acute care surgery service on the management of acute biliary disease35 Patient flow and efficiency in an acute care surgery service36 The relationship between treatment factors and postoperative complications after radical surgery for rectal cancer37 Risk of ventral hernia after laparoscopic colon surgery38 Urinary metabolomics as a tool for early detection of Barrett’s and esophageal cancer39 Construct validity of individual and summary performance metrics associated with a computer-based laparo-scopic simulator40 Impact of a city-wide health system reorganization on emergency department visits in hospitals in surrounding communities41 Transcatheter aortic valve implantation for the nonoperative management of aortic stenosis: a cost-effectiveness analysis42 Breast cancer: racial differences in age of onset. A potential confounder in Canadian screening recommendations43 Risk taking in surgery: in and out of the comfort zone44 A tumour board in the office: Track those cancer patients!45 Increased patient BMI is not associated with advanced colon cancer stage or grade on presentation: a retrospective chart review46 Consensus statements regarding the multidisciplinary care of limb amputation patients in disasters or humanitarian emergencies. Report of the 2011 Humanitarian Action Summit Surgical Working Group on amputations following disasters or conflict47 Learning the CanMEDS role of professional: a pilot project of supervised discussion groups addressing the hidden curriculum48 Assessing the changing scope of training in Canadian general surgery programs: expected versus actual experience49 Predicting need for surgical management for massive gastrointestinal hemorrhage50 International health care experience: using CanMEDS to evaluate learning outcomes following a surgical mission in Mampong, Ghana51 The open abdomen: risk factors for mortality and rates of closure52 How surgeons think: an exploration of mental practice in surgical preparation53 The surgery wiki: a novel method for delivery of under-graduate surgical education54 Understanding surgical residents’ postoperative practices before implementing an enhanced recovery after surgery (ERAS) guideline at the University of Toronto55 From laparoscopic transabdominal to posterior retroperitoneal adrenalectomy: a paradigm shift in operative approach56 A retrospective audit of outcomes in patients over the age of 80 undergoing acute care abdominal surgery57 Canadian general surgery residents’ perspectives on work-hour regulations58 Timing of surgical intervention and its outcomes in acute appendicitis59 Preparing surgical trainees to deal with adverse events. An outline of learning issues60 Acute care surgical service: surgeon agreement at the time of handover61 Predicting discharge of elderly patients to prehospitalization residence following emergency general surgery62 Morbidity and mortality after emergency abdominal surgery in octo- and nonagenarians63 The impact of acute abdominal illness and urgent admission to hospital on the living situation of elderly patients64 A comparison of laparoscopic versus open subtotal gastrectomy for antral gastric adenocarcinoma: a North American perspective65 Minimally invasive excision of ectopic mediastinal parathyroid adenomas66 Perioperative outcomes of laparoscopic hernia repair in a tertiary care centre: a single institution’s experience67 Evaluation of a student-run, practical and didactic curriculum for preclerkship medical students68 Joseph Lister: Father of Modern Surgery69 Comparisons of melanoma sentinel lymph node biopsy prediction nomograms in a cohort of Canadian patients70 Local experience with myocutaneous flaps after extensive pelvic surgery71 The treatment of noncirrhotic splanchnic vein thrombosis: Is anticoagulation enough?72 Implementation of an acute care surgery service does not affect wait-times for elective cancer surgeries: an institutional experience73 Use of human collagen mesh for closure of a large abdominal wall defect, after colon cancer surgery, a case report74 The role of miR-200b in pulmonary hypoplasia associated with congenital diaphragmatic hernia75 Systematic review and meta-analysis of electrocautery versus scalpel for incising epidermis and dermis76 Accuracy of sentinel lymph node biopsy for early breast cancer in the community setting in St. John’s, New-foundland: results of a retrospective review77 Acute surgical outcomes in the 80 plus population78 The liberal use of platelets transfusions in the acute phase of trauma resuscitation: a systematic review79 Implementation of an acute care surgical on call program in a Canadian community hospital80 Short-term outcomes following paraesophageal hernia repair in the elderly patient81 First experience with single incision surgery: feasibility in the pediatric population and cost evaluation82 The impact of the establishment of an acute care surgery unit on the outcomes of appendectomies and cholecystectomies83 Description and preliminary evaluation of a low-cost simulator for training and evaluation of flexible endoscopic skills84 Tumour lysis syndrome in metastatic colon cancer: a case report85 Acute care surgery service model implementation study at a single institution86 Colonic disasters approached by emergent subtotal and total colectomy: lessons learned from 120 consecutive cases87 Acellular collagen matrix stent to protect bowel anastomoses88 Lessons we learned from preoperative MRI-guided wire localization of breast lesions: the University Health Network (UHN) experience89 Interim cost comparison for the use of platinum micro-coils in the operative localization of small peripheral lung nodules90 Routine barium esophagram has minimal impact on the postoperative management of patients undergoing esophagectomy for esophageal cancer91 Iron deficiency anemia is a common presenting issue with giant paraesophageal hernia and resolves following repair92 A randomized comparison of different ventilation strategies during thoracotomy and lung resection93 The Canadian Lung Volume Reduction Surgery study: an 8-year follow-up94 A comparison of minimally invasive versus open Ivor-Lewis esophagectomy95 A new paradigm in the follow-up after curative resection for lung cancer: minimal-dose CT scan allows for early detection of asymptomatic cancer activity96 Predictors of lymph node metastasis in early esophageal adenocarcinoma: Is endoscopic resection worth the risk?97 How well can thoracic surgery residents operate? Comparing resident and program director opinions98 The impact of extremes of age on short- and long-term outcomes following surgical resection of esophageal malignancy99 Epidermal growth factor receptor targeted gold nanoparticles for the enhanced radiation treatment of non–small cell lung cancer100 Laparoscopic Heller myotomy results in excellent outcomes in all subtypes of achalasia as defined by the Chicago classification101 Neoadjuvant chemoradiation versus surgery in managing esophageal cancer102 Quality of life postesophagectomy for cancer!103 The implementation, evolution and translocation of standardized clinical pathways can improve perioperative outcomes following surgical treatment of esophageal cancer104 A tissue-mimicking phantom for applications in thoracic surgical simulation105 Sublobar resection compared with lobectomy for early stage non–small cell lung cancer: a single institution study106 Not all reviews are equal: the quality of systematic reviews and meta-analyses in thoracic surgery107 Do postoperative complications affect health-related quality of life after video-assisted thoracoscopic lobectomy for patients with lung cancer? A cohort study108 Thoracoscopic plication for palliation of dyspnea secondary to unilateral diaphragmatic paralysis: A worthwhile venture?109 Thoracic surgery experience in Canadian general surgery residency programs110 Perioperative morbidity and pathologic response rates following neoadjuvant chemotherapy and chemoradiation for locally advanced esophageal carcinoma111 An enhanced recovery pathway reduces length of stay after esophagectomy112 Predictors of dysplastic and neoplastic progression of Barrett’s esophagus113 Recurrent esophageal cancer complicated by tracheoesophageal fistula: management by means of palliative airway stenting114 Pancreaticopleural fistula-induced empyema thoracis: principles and results of surgical management115 Prognostic factors of early postoperative mortality following right extended hepatectomy116 Optimizing steatotic livers for transplantation using a cell-penetrating peptide CPP-fused heme oxygenase117 Video outlining the technical steps for a robot-assisted laparoscopic pancreaticoduodenectomy118 Establishment of a collaborative group to conduct innovative clinical trials in Canada119 Hepatic resection for metastatic malignant melanoma: a systematic review and meta-analysis120 Acellular normothermic ex vivo liver perfusion for donor liver preservation121 Pancreatic cancer and predictors of survival: comparing the CA 19–9/bilirubin ratio with the McGill Brisbane Scoring System122 Staged liver resections for bilobar hepatic colorectal metastases: a single centre experience123 Economic model of observation versus immediate resection of hepatic adenomas124 Resection of colorectal liver metastasis in the elderly125 Acceptable long-term survival in patients undergoing liver resection for metastases from noncolorectal, non-neuroendocrine, nonsarcoma malignancies126 Patient and clinicopathological features and prognosis of CK19+ hepatocellular carcinomas: a case–control study127 The management of blunt hepatic trauma in the age of angioembolization: a single centre experience128 Liver resections for noncolorectal and non-neuroendocrine metastases: an evaluation of oncologic outcomes129 Developing an evidence-based clinical pathway for patients undergoing pancreaticoduodenectomy130 Hepatitis C infection and hepatocellular carcinoma in liver transplant: a 20 year experience131 The effect of medication on the risk of post-ERCP pancreatitis132 Temporal trends in the use of diagnostic imaging for patients with hepato-pancreato-biliary (HPB) conditions: How much ionizing radiation are we really using?196 A phase II study of aggressive metastasectomy for intra-and extrahepatic metastases from colorectal cancer133 Why do women choose mastectomy for breast cancer treatment? A conceptual framework for understanding surgical decision-making in early-stage breast cancer134 Synoptic operative reporting: documentation of quality of care data for rectal cancer surgery135 Learning curve analysis for cytoreductive surgery: a useful application of the cumulative sum (CUSUM) method136 Pancreatic cancer is strongly associated with a unique urinary metabolomic signature137 Concurrent neoadjuvant chemo/radiation in locally advanced breast cancer138 Impact of positron emission tomography on clinical staging of newly diagnosed rectal cancer: a specialized single centre retrospective study139 An evaluation of intraoperative Faxitron microradiography versus conventional specimen radiography for the excision of nonpalpable breast lesions140 Comparison of breast cancer treatment wait-times in the Southern Interior of British Columbia in 2006 and 2010141 Factors affecting lymph nodes harvest in colorectal carcinoma142 Laparoscopic adrenalectomy for metastases143 You have a message! Social networking as a motivator for fundamentals of laparoscopic surgery (FLS) training144 The evaluation and validation of a rapid diagnostic and support clinic for women assessment for breast cancer145 Oncoplastic breast surgery: oncologic benefits and limitations146 A qualitative study on rectal cancer patients’ preferences for location of surgical care147 The effect of surgery on local recurrence in young women with breast cancer148 Elevated IL-6 and IL-8 levels in tumour microenvironment is not associated with increased serum levels in humans with Pseudomyxoma peritonei and peritoneal mesothelioma149 Conversion from laparoscopic to open approach during gastrectomy: a population-based analysis150 A scoping review of surgical process improvement tools (SPITs) in cancer surgery151 Splenectomy during gastric cancer surgery: a population-based study152 Defining the polo-like kinase 4 (Plk4) interactome in cancer cell protrusions153 Neoadjuvant imatinib mesylate for locally advanced gastrointestinal stromal tumours154 Implementing results from ACOSOG Z0011: Practice-changing or practice-affirming?155 Should lymph node retrieval be a surgical quality indicator in colon cancer?156 Long-term outcomes following resection of retroperitoneal recurrence of colorectal cancer157 Clinical research in surgical oncology: an analysis of clinicaltrials.gov158 Radiation therapy after breast conserving surgery: When are we missing the mark?159 The accuracy of endorectal ultrasound in staging rectal lesions in patients undergoing transanal endoscopic microsurgery160 Quality improvement in gastrointestinal cancer surgery: expert panel recommendations for priority research areas161 Factors influencing the quality of local management of ductal carcinoma in situ: a cohort study162 Papillary thyroid microcarcinoma: Does size matter?163 Hyperthermic isolated limb perfusion for extremity soft tissue sarcomas: systematic review of clinical efficacy and quality assessment of reported trials164 Adherence to antiestrogen therapy in seniors with breast cancer: How well are we doing?165 Parathyroid carcinoma: Challenging the surgical dogma?166 A qualitative assessment of the journey to delayed breast reconstruction195 The role of yoga therapy in breast cancer patients167 Outcomes reported in comparative studies of surgical interventions168 Enhanced recovery pathways decrease length of stay following colorectal surgery, but how quickly do patients actually recover?169 The impact of complications on bed utilization after elective colorectal resection170 Impact of trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study171 Complex fistula-in-ano: Should the plug be abandoned in favour of the LIFT or BioLIFT?172 Prognostic utility of cyclooxygenase-2 expression by colon and rectal cancer173 Laparoscopic right hemicolectomy with complete mesocolic excision provides acceptable perioperative outcomes but is complex and time-consuming: analysis of learning curves for a novice minimally invasive surgeon174 Intraoperative quality assessment following double stapled circular colorectal anastomosis175 Improving patient outcomes through quality assessment of rectal cancer care176 Are physicians willing to accept a decrease in treatment effectiveness for improved functional outcomes for low rectal cancer?177 Turnbull-Cutait delayed coloanal anastomosis for the treatment of distal rectal cancer: a prospective cohort study178 Preoperative high-dose rate brachytherapy in preparation for sphincter preservation surgery for patients with advanced cancer of the lower rectum179 Impact of an enhanced recovery program on short-term outcomes after scheduled laparoscopic colon resection180 The clinical results of the Turnbull-Cutait delayed coloanal anastomosis: a systematic review181 Is a vertical rectus abdominus flap (VRAM) necessary? An analysis of perineal wound complications182 Fistula plug versus endorectal anal advancement flap for the treatment of high transsphincteric cryptoglandular anal fistulas: a systematic review and meta-analysis183 Maternal and neonatal outcomes following colorectal cancer surgery184 Transanal drainage to treat anastomotic leaks after low anterior resection for rectal cancer: a valuable option185 Trends in colon cancer in Ontario: 2002–2009186 Validation of electronically derived short-term outcomes in colorectal surgery187 A population-based assessment of transanal and endoscopic resection for adenocarcinoma of the rectum188 Laparoscopic colorectal surgery in the emergency setting: trends in the province of Ontario from 2002 to 2009189 Prevention of perineal hernia after laparoscopic and robotic abdominoperineal resection: review with case series of internal hernia through pelvic mesh which was placed in attempt to prevent perineal hernia190 Effect of rectal cancer treatments on quality of life191 The use of antibacterial sutures as an adjunctive preventative strategy for surgical site infection in Canada: an economic analysis192 Impact of socioeconomic status on colorectal cancer screening and stage at presentation: preliminary results of a population-based study from an urban Canadian centre193 Initial perioperative results of the first transanal endoscopic microsurgery (TEM) program in the province of Quebec194 Use of negative pressure wound therapy decreases perineal wound infections following abdominal perineal resection. Can J Surg 2012; 55:S63-S135. [DOI: 10.1503/cjs.016712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Bhat M, Ghali P, Wong P, Marcus V, Michel R, Cantarovich M, Metrakos P, Deschenes M. Immunosuppression with budesonide for liver transplant recipients with severe infections. Liver Transpl 2012; 18:262-3. [PMID: 22006869 DOI: 10.1002/lt.22453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Alcindor T, Ferri L, Ades S, Andalib A, Al-Baimani K, Hickeson M, Artho G, Chasen MR, Marcus V, Thirlwell MP. Perioperative chemotherapy for upper gastrointestinal cancer: Correlation between response to treatment and outcome. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
95 Background: Perioperative chemotherapy improves outcomes of surgery for upper GI cancer. Some patients have rapid recurrence. We hypothesized that any type of response to chemotherapy would predict better disease-free survival (DFS). Methods: From May 2007 to Sep 2009, 43 patients with operable adenocarcinoma of the esophagus, stomach or gastroesophageal junction went on a multicenter phase II trial. 3 cycles of docetaxel/cisplatin/5FU were given pre and post surgery. We compared DFS between responders and nonresponders after 3 cycles. Clinical response was defined as improvement of ≥ 2 points on a dysphagia score (0: normal swallowing, to 4: total obstruction), metabolic response as ≥ 35% reduction of maximum SUV by PET scan. Lack of nodal involvement or significant histologic regression (less than 50% viable tumor) was considered pathologic response. Log-rank test was used for univariate analysis, Cox regression model for multivariate analysis. All p values are double sided, median follow-up from surgery is 808 days. Results: Clinical response data for 29/40 patients: 26 responses (90%). Median DFS was 405 days for clinical responders vs. 210 days for nonresponders (p= 0.018). Metabolic response data for 28/40 patients : 22 responses (70%). Median DFS was 276 days in metabolic nonresponders, and has not been reached in responders (p = 0.009). 14 patients had no nodal involvement at resection (N0) and had longer DFS (median not reached) than the 26 with N+, who had median DFS of 562 days (p = 0.045). A nonsignificant trend (p = 0.192) was seen in favor of the 20 with significant tumor regression (DFS 565 days) compared to the 20se without it (median DFS not reached). All results were supported by multivariate analysis. Conclusions: These preliminary results indicate that clinical, metabolic and pathologic responses may be individually predictive of longer DFS in patients receiving perioperative chemotherapy for upper GI adenocarcinoma. This requires confirmation in larger datasets. The optimal management of nonresponders is unclear at present. Acknowledgements: Biostatistics Unit (McGill University Health Centre) and Cedars Cancer Institute (Henry R Shibata Fellowship to Dr Alcindor).
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Affiliation(s)
- Thierry Alcindor
- McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada; Fletcher Allen Health Care/University of Vermont College of Medicine, Burlington, VT; McGill University, Montreal, QC, Canada; McGill University Department of Medicine, Montreal, QC, Canada; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Montreal General Hospital, Montreal, QC, Canada
| | - Lorenzo Ferri
- McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada; Fletcher Allen Health Care/University of Vermont College of Medicine, Burlington, VT; McGill University, Montreal, QC, Canada; McGill University Department of Medicine, Montreal, QC, Canada; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Montreal General Hospital, Montreal, QC, Canada
| | - Steven Ades
- McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada; Fletcher Allen Health Care/University of Vermont College of Medicine, Burlington, VT; McGill University, Montreal, QC, Canada; McGill University Department of Medicine, Montreal, QC, Canada; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Montreal General Hospital, Montreal, QC, Canada
| | - Amin Andalib
- McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada; Fletcher Allen Health Care/University of Vermont College of Medicine, Burlington, VT; McGill University, Montreal, QC, Canada; McGill University Department of Medicine, Montreal, QC, Canada; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Montreal General Hospital, Montreal, QC, Canada
| | - Khalid Al-Baimani
- McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada; Fletcher Allen Health Care/University of Vermont College of Medicine, Burlington, VT; McGill University, Montreal, QC, Canada; McGill University Department of Medicine, Montreal, QC, Canada; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Montreal General Hospital, Montreal, QC, Canada
| | - Marc Hickeson
- McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada; Fletcher Allen Health Care/University of Vermont College of Medicine, Burlington, VT; McGill University, Montreal, QC, Canada; McGill University Department of Medicine, Montreal, QC, Canada; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Montreal General Hospital, Montreal, QC, Canada
| | - Giovanni Artho
- McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada; Fletcher Allen Health Care/University of Vermont College of Medicine, Burlington, VT; McGill University, Montreal, QC, Canada; McGill University Department of Medicine, Montreal, QC, Canada; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Montreal General Hospital, Montreal, QC, Canada
| | - Martin Robert Chasen
- McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada; Fletcher Allen Health Care/University of Vermont College of Medicine, Burlington, VT; McGill University, Montreal, QC, Canada; McGill University Department of Medicine, Montreal, QC, Canada; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Montreal General Hospital, Montreal, QC, Canada
| | - Victoria Marcus
- McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada; Fletcher Allen Health Care/University of Vermont College of Medicine, Burlington, VT; McGill University, Montreal, QC, Canada; McGill University Department of Medicine, Montreal, QC, Canada; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Montreal General Hospital, Montreal, QC, Canada
| | - Michael P. Thirlwell
- McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada; Fletcher Allen Health Care/University of Vermont College of Medicine, Burlington, VT; McGill University, Montreal, QC, Canada; McGill University Department of Medicine, Montreal, QC, Canada; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Montreal General Hospital, Montreal, QC, Canada
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Ferri LE, Ades S, Alcindor T, Chasen M, Marcus V, Hickeson M, Artho G, Thirlwell MP. Perioperative docetaxel, cisplatin, and 5-fluorouracil (DCF) for locally advanced esophageal and gastric adenocarcinoma: a multicenter phase II trial. Ann Oncol 2011; 23:1512-7. [PMID: 22039085 DOI: 10.1093/annonc/mdr465] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although perioperative chemotherapy for esophagogastric adenocarcinoma (ADC) improves survival, the overall poor prognosis suggests that further refinement of treatment is required. Docetaxel, cisplatin, and 5-fluorouracil (5-FU) (DCF) is effective for metastatic ADC of the upper gastrointestinal (GI) tract; we thus sought to investigate the efficacy of this regimen in patients with resectable disease. PATIENTS AND METHODS Patients with resectable ADC of the upper GI tract received DCF [docetaxel (Taxotere) 75 mg/m(2) I.V. day 1, cisplatin 75 mg/m(2) I.V. day 1, 5-FU 750 mg/m(2) continuous infusion for 120 h, every 3 weeks] for three cycles before and after resection. Primary end point was complete resection; secondary end points were response, toxicity, surgical morbidity, and overall survival. RESULTS Forty-three patients with ADC of the esophagus (11), gastroesophageal junction (25), or stomach (7) started treatment and 86% completed all preoperative cycles with grade 3-4 toxicity arising in 47%. Metabolic response to chemotherapy (reduction in maximal standard uptake value >35%) was achieved in 25/33 (76%) patients. Surgery was carried out in 41/43 and complete resection was achieved in all 41 patients with pathologic complete response in 4/41. Postoperative chemotherapy was started in 29 patients and completed in 24. Three-year overall survival was 60%. CONCLUSION Perioperative DCF is a tolerable and highly effective regimen for the treatment of esophagogastric ADC.
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Affiliation(s)
- L E Ferri
- Department of Surgery, University of Vermont, Burlington, VT, USA.
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Bhat M, Laneuville P, Marliss EB, Costea F, Marcus V, Seidman EG, Bitton A. Secondary intestinal lymphangiectasia due to multiple myeloma. Gastrointest Endosc 2011; 74:718-20. [PMID: 21092952 DOI: 10.1016/j.gie.2010.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 09/07/2010] [Indexed: 02/08/2023]
Affiliation(s)
- Mamatha Bhat
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
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Almadi MA, Aljebreen AM, Sanai FM, Marcus V, Almeghaiseeb ES, Ghosh S. New insights into gastrointestinal and hepatic granulomatous disorders. Nat Rev Gastroenterol Hepatol 2011; 8:455-66. [PMID: 21818145 DOI: 10.1038/nrgastro.2011.115] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [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: 12/12/2022]
Abstract
Numerous diseases that involve the gastrointestinal tract reveal the presence of granulomas on histological analysis. Granulomatous diseases can be either primary or secondary to environmental factors. Granulomas are dynamic structures composed of organized collections of activated macrophages, including epithelioid and multinucleated giant cells, surrounded by lymphocytes. The formation of granulomas is usually in response to antigenic stimulation and is orchestrated through cytokines, immune cells and host genetics. In this Review, the pathogenesis and etiologies of granulomas of the gastrointestinal tract and liver are discussed, as are the available diagnostic tools to help differentiate their various underlying etiologies. In addition, the role of granulomas in harboring latent tuberculosis is reviewed. The effects of tumor necrosis factor antagonists and interferon-α on the development of granulomas are also discussed.
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Affiliation(s)
- Majid A Almadi
- Department of Medicine, Gastroenterology Division, King Khalid University Hospital, King Saud University, PO Box 231494, Riyadh 11321, Saudi Arabia.
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Van Der Kraak L, Meunier C, Turbide C, Jothy S, Gaboury L, Marcus V, Chang SY, Beauchemin N, Gros P. A two-locus system controls susceptibility to colitis-associated colon cancer in mice. Oncotarget 2010; 1:436-446. [PMID: 21311099 PMCID: PMC3248117 DOI: 10.18632/oncotarget.177] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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: 08/30/2010] [Accepted: 10/10/2010] [Indexed: 11/25/2022] Open
Abstract
We have previously shown that the differential susceptibility of A/J (susceptible) and C57BL/6J (B6, resistant) mouse strains to azoxymethane (AOM)-induced colorectal cancer (CRC) is controlled by the chromosome 3 locus, Ccs3. We report that A/J and B6 mice also show differential susceptibility to colitis-associated colorectal cancer (CA-CRC) induced by combined administration of AOM and dextran sulfate. This differential susceptibility is not controlled by Ccs3, but is under distinct genetic control. Linkage analyses in (A/J x B6)F2 mice detected a major CA-CRC susceptibility locus on chromosome 9 (Ccs4) which controls tumor multiplicity and tumor surface area. Susceptibility alleles at Ccs4 are inherited in a recessive fashion, with A/J alleles being associated with susceptibility. We also detected a second locus on chromosome 14 that acts in an additive fashion with Ccs4. Strikingly, F2 mice homozygous for A/J alleles at both loci (Ccs4 and chromosome 14) are as susceptible to CA-CRC as the A/J controls while mice homozygous for B6 alleles are as resistant as the B6 controls, thus supporting the role of two interacting loci in this CA-CRC model. This indicates that susceptibility to chemically-induced CRC and susceptibility to CA-CRC are under distinct genetic control in mice, and probably involve distinct cellular pathways.
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Affiliation(s)
- Lauren Van Der Kraak
- Department of Biochemistry, McGill University, Montreal, Quebec, Canada
- Goodman Cancer Research Centre, McGill University, Montreal, Quebec, Canada
| | - Charles Meunier
- Department of Biochemistry, McGill University, Montreal, Quebec, Canada
- Goodman Cancer Research Centre, McGill University, Montreal, Quebec, Canada
| | - Claire Turbide
- Goodman Cancer Research Centre, McGill University, Montreal, Quebec, Canada
| | - Serge Jothy
- Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Louis Gaboury
- Institut de Recherche en Immunologie et en Cancérologie, Université de Montréal, Montreal, Quebec, Canada
| | - Victoria Marcus
- Department of Pathology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sing Yun Chang
- Department of Pathology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nicole Beauchemin
- Department of Biochemistry, McGill University, Montreal, Quebec, Canada
- Goodman Cancer Research Centre, McGill University, Montreal, Quebec, Canada
- Departments of Medicine and Oncology, McGill University, Montreal, Quebec, Canada
| | - Philippe Gros
- Department of Biochemistry, McGill University, Montreal, Quebec, Canada
- Goodman Cancer Research Centre, McGill University, Montreal, Quebec, Canada
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Ferri LE, Ades S, Alcindor T, Marcus V, Hickeson M, Artho G, Chasen MR, Thirlwell MP. Perioperative docetaxel, cisplatin, and 5-fluorouracil (DCF) for locally advanced esophageal and gastric adenocarcinoma: Safety and response results from a multicenter phase II trial. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chan G, Hassanain M, Chaudhury P, Vrochides D, Neville A, Cesari M, Kavan P, Marcus V, Metrakos P. Pathological response grade of colorectal liver metastases treated with neoadjuvant chemotherapy. HPB (Oxford) 2010; 12:277-84. [PMID: 20590898 PMCID: PMC2873651 DOI: 10.1111/j.1477-2574.2010.00170.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND The complete resection of liver metastases from colorectal cancer is the major determinant of longterm survival. The effectiveness of current chemotherapy regimens has made treatment algorithms more flexible and resulted in many different options. Recently, the pathological response to chemotherapy has emerged as another important prognostic marker. Different systems have been used to grade the pathological response in these patients. METHODS This study prospectively evaluates the prognostic value of the pathological response grade (PRG) in liver metastases treated with neoadjuvant chemotherapy. RESULTS Between 2002 and 2006, 50 patients were treated with a sandwich chemotherapy regimen and underwent liver resection. Complete resection was achieved in 45 patients (90%). A strong pathological response to chemotherapy (<10% viable tumour cells in all lesions) was seen in 17 patients (34%). It was associated with a statistically significant longer overall survival (P= 0.019) and was also identified on multivariate analysis as an independent predictor of survival (odds ratio = 243). CONCLUSIONS This pilot study demonstrates the prognostic potential of the PRG, which could be used clinically to select patients for an aggressive multimodal adjuvant algorithm. Larger multicentre studies are required to validate this particular grading system. The keys to longterm survival are resectability and chemo-responsiveness.
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Affiliation(s)
- Gabriel Chan
- Department of Surgery, Maisonneuve-Rosemont Hospital (Hôpital Maisonneuve-Rosemont)Montreal, Quebec, Canada
| | - Mazen Hassanain
- Division of Hepatobiliary and Transplant Surgery, McGill University Health CentreMontreal, Quebec, Canada
| | - Prosanto Chaudhury
- Division of Hepatobiliary and Transplant Surgery, McGill University Health CentreMontreal, Quebec, Canada
| | - Dionisios Vrochides
- Division of Hepatobiliary and Transplant Surgery, McGill University Health CentreMontreal, Quebec, Canada
| | - Amy Neville
- Division of Hepatobiliary and Transplant Surgery, McGill University Health CentreMontreal, Quebec, Canada
| | - Matthew Cesari
- Department of Pathology, McGill University Health CentreMontreal, Quebec, Canada
| | - Petr Kavan
- Department of Oncology, McGill University Health CentreMontreal, Quebec, Canada,Department of Oncology, Jewish General Hospital (Hôpital Général Juif)Montreal, Quebec, Canada
| | - Victoria Marcus
- Department of Pathology, McGill University Health CentreMontreal, Quebec, Canada
| | - Peter Metrakos
- Division of Hepatobiliary and Transplant Surgery, McGill University Health CentreMontreal, Quebec, Canada
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Chong G, Jarry J, Marcus V, Thiffault I, Winocour S, Monczak Y, Drouin R, Latreille J, Australie K, Bapat B, Gordon PH, Giguère Y, Gologan A, Galiatsatos P, Jass JR, Wong N, Zaor S, Palma L, Kasprzak L, Tischkowitz M, Foulkes WD. High frequency of exon deletions and putative founder effects in French Canadian Lynch syndrome families. Hum Mutat 2009; 30:E797-812. [PMID: 19459153 DOI: 10.1002/humu.21056] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lynch syndrome is one of the most common autosomal dominantly inherited cancer syndromes. Mutations in MLH1, MSH2, MSH6, and PMS2 account for greater than 98% of reported mutations in Lynch syndrome families. It has been reported that large genomic deletions in MLH1 and MSH2 are a frequent cause of Lynch syndrome in certain populations. Using a multimodal approach, we have identified mutations in MLH1, MSH2, and MSH6 in French Canadian families fulfilling the Amsterdam criteria for Lynch syndrome and who displayed abnormal staining for at least one of the Lynch syndrome proteins. Mutations were identified in 28 of our 29 French Canadian probands (97%). A total of 18 distinct mutations (nine in MLH1, seven in MSH2, two in MSH6) were identified, of which six (33%) were genomic exon deletions. Another four (22%) resulted in exon deletions in cDNA alone. Three (17%) are novel mutations. Five of these 18 mutations were detected in more than one distinct family (four in MLH1, one in MSH2) and haplotype analysis suggests the possibility of founder effects. Fifteen of the 29 (52%) families carried one of these five putative founder mutations. These findings may simplify genetic testing for Lynch syndrome in French Canadians.
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Affiliation(s)
- George Chong
- Departments of Medical Genetics and Oncology, Cancer Prevention Centre, Jewish General Hospital, Montreal, Quebec H3T 1E2, Canada
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Nenshi R, Kennedy E, Baxter NN, Saskin R, Sutradhar R, Urbach DR, Sroka G, Feldman LS, Vassiliou MC, Kaneva PA, Fayez R, Fried GM, Krajewski SA, Brown CJ, Hur C, McCrea PH, Mitchell A, Porter G, Grushka J, Razek T, Khwaja K, Fata P, Martel G, Moloo H, Picciano G, Boushey RP, Poulin EC, Mamazza J, Haas B, Xiong W, Brennan-Barnes M, Gomez D, Nathens AB, Yang I, Forbes SS, Stephen WJ, Loeb M, Smith R, Christoffersen EP, McLean RF, Westerholm J, Garcia-Osogobio S, Farrokhyar F, Cadeddu M, Anvari M, Ponton-Carss A, Hutchison C, Violato C, Segedi M, Mittleman M, Fisman D, Kinlin L, Rousseau M, Saleh W, Ferri LE, Feldman LS, Stanbridge DD, Mayrand S, Fried GM, Pandya A, Gagliardi A, Nathens A, Ahmed N, Tran T, Demyttenaere SV, Polyhronopoulos G, Seguin C, Artho GP, Kaneva P, Fried GM, Feldman LS, Demyttenaere SV, Bergman S, Anderson J, Mikami DJ, Melvin WS, Racz JM, Dubois L, Katchky A, Wall WJ, Faryniuk A, Hochman D, Clarkson CA, Rubiano AM, Clarkson CA, Boone D, Ball CG, Dixon E, Kirkpatrick AW, Sutherland FR, Feliciano DV, Wyrzykowski AD, Nicholas JM, Dente CJ, Ball CG, Feliciano DV, Ullah SM, McAlister VC, Malik S, Ramsey D, Pooler S, Teague B, Misra M, Cadeddu M, Anvari M, Kaminsky M, Vergis A, Gillman LM, Gillman LM, Vergis A, Altaf A, Ellsmere J, Bonjer HJ, Klassen D, Orzech N, Palter V, Aggarwal R, Okrainec A, Grantcharov TP, Ghaderi I, Feldman LS, Sroka G, Kaneva PA, Fried GM, Shlomovitz E, Reznick RK, Kucharczyk W, Lee L, Iqbal S, Barayan H, Lu Y, Fata P, Razek T, Khwaja K, Boora PS, White JS, Vogt KN, Charyk-Stewart T, Minuk L, Eckert K, Chin-Yee I, Gray D, Parry N, Humphrey RJ, Bütter A, Schmidt J, Grieci T, Gagnon R, Han V, Duhaime S, Pitt DF, Palter V, Orzech N, Aggarwal R, Okrainec A, Grantcharov TP, Dubois L, Vogt KN, Davies W, Schlachta CM, Shi X, Birch DW, Gu Y, Moser MA, Swanson TW, Schaeffer DF, Tang BQ, Rusnak CH, Amson BJ, Vogt KN, Dubois L, Hobbs A, Etemad-Rezai R, Schlachta CM, Claydon E, McAlister V, Grushka J, Sur W, Laberge JM, Tchervenkov J, Bell L, Flageole H, Labidi S, Gagné JP, Gowing R, Kahnamoui K, McAlister CC, Marble A, Coughlin S, Karanicolas P, Emmerton-Coughlin H, Kanbur B, Kanbur S, Colquhoun P, Trottier DC, Doucette S, Huynh H, Soto CM, Poulin EC, Mamazza J, Boushey RP, Jamal MH, Rousseau M, Meterissian S, Snell L, Racz JM, Davies E, Aminazadeh N, Farrokhyar F, Reid S, Naeeni A, Naeeni M, Kashfi A, Kahnamoui K, Martin K, Weir M, Taylor B, Martin KM, Girotti MJ, Parry NG, Hanna WC, Fraser S, Weissglas I, Ghitulescu G, Bilek A, Marek J, Galatas C, Bergman S, Chiu CG, Nguyen NH, Bloom SW, Wiebe S, Klassen D, Bonjer J, Lawlor D, Plowman J, Ransom T, Vallis M, Ellsmere J, Menezes AC, Karmali S, Birch DW, Forbes SS, Eskicioglu C, Brenneman FD, McLeod RS, Fraser SA, Bergman S, Garzon J, Gomez D, Lawless B, Haas B, Nathens AB, Lumb KJ, Harkness L, Williamson J, Charyk-Stewart T, Gray D, Malthaner RA, Van Koughnett JA, Vogt KN, Gray DK, Parry NG, Teague B, Cadeddu M, Anvari M, Misra M, Pooler S, Malik S, Swain P, Chackungal S, Vogt KN, Yoshy C, Etemad-Rezai R, Cunningham I, Dubois L, Schlachta CM, Scott L, Vinden C, Okrainec A, Henao O, Azzie G, Deen S, Hameed M, Ramirez V, Veillette C, Bray P, Jewett M, Okrainec A, Pagliarello G, Brenneman F, Buczkowski A, Nathens A, Razek T, Widder S, Anderson I, Klassen D, Saadia R, Johner A, Hameed SM, Qureshi AP, Vergis A, Jimenez CM, Green J, Pryor AD, Schlachta CM, Okrainec A, Perri MT, Trejos AL, Naish MD, Patel RV, Malthaner RA, Stanger J, Stewart K, Yasui Y, Cass C, Damaraju S, Graham K, Bharadwaj S, Srinathan S, Tan L, Unruh H, Finley C, Miller L, Ferri LE, Urbach DR, Darling G, Spicer J, Ergun S, McDonald B, Rousseau M, Kaneva P, Ferri LE, Spicer J, Andalib A, Benay C, Rousseau M, Kushner Y, Marcus V, Ferri LE, Hunt I, Gazala S, Razzak R, Chuck A, Valji A, Stewart K, Tsuyuki R, Bédard ELR, Bottoni DA, Campbell G, Malthaner RA, Rousseau M, Guevremont P, Chasen M, Spicer J, Eckert E, Alcindor T, Ades S, Ferri LE, McGory R, Nagpal D, Fortin D, Inculet RI, Malthaner RA, Ko M, Shargall Y, Compeau C, Razzak R, Gazala S, Hunt I, Veenstra J, Valji A, Stewart K, Bédard ELR, Davis PJ, Mancuso M, Mujoomdar AA, Gazala S, Bédard ELR, Lee L, Spicer J, Robineau C, Sirois C, Mulder D, Ferri LE, Cools-Lartigue J, Chang SY, Mayrand S, Marcus V, Fried GM, Ferri LE, Perry T, Hunt I, Allegretto M, Maguire C, Abele J, Williams D, Stewart K, Bédard ELR, Grover HS, Basi S, Chiasson P, Basi S, Gregory W, Irshad K, Schieman C, MacGregor JH, Kelly E, Gelfand G, Graham AJ, McFadden SP, Grondin SC, Croome KP, Chudzinski R, Hanto DW, Jamal MH, Doi SA, Barkun JS, Wong SL, Kwan AHL, Yang S, Law C, Luo Y, Spiers J, Forse A, Taylor W, Apriasz I, Mysliwiec B, Sarin N, Gregor J, Moulton CE, McLeod RS, Barnett H, Nhan C, Gallinger S, Demyttenaere SV, Nau P, Muscarella P, Melvin WS, Ellison EC, Wiseman SM, Melck AL, Davidge KM, Eskicioglu C, Lipa J, Ferguson P, Swallow CJ, Wright FC, Edwards JP, Kelly EJ, Lin Y, Lenders T, Ghali WA, Graham A, Francescutti V, Farrokhyar F, Tozer R, Heller B, Lovrics P, Jansz G, Kahnamoui K, Spiegle G, Schmocker S, Huang H, Victor C, Law C, Kennedy ED, McCart JA, Aslani N, Swanson T, Kennecke H, Woods R, Davis N, Klevan AE, Ramsay JA, Stephen WJ, Smith M, Plourde M, Johnson PM, Yaffe P, Walsh M, Hoskin D, Huynh HP, Trottier DC, Soto C, Auer R, Poulin EC, Mamazza J, Boushey RP, Moloo H, Huynh HP, Trottier DC, Soto C, Moloo H, Poulin EC, Mamazza J, Boushey RP, Nhan C, Driman DK, Smith AJ, Hunter A, McLeod RS, Eskicioglu C, Fenech DS, Victor C, McLeod RS, Trottier DC, Huynh H, Sabri E, Soto C, Scheer A, Zolfaghari S, Moloo H, Mamazza J, Poulin EC, Boushey RP, Hallet J, Guénette-Lemieux M, Bouchard A, Grégoire RC, Thibault C, Dionne G, Côté F, Langis P, Gagné JP, Raval MJ, Phang PT, Brown CJ, Kuzmanovic A, Planting A, Raval MJ, Phang PT, Brown CJ, Huynh HP, Trottier DC, Moloo H, Poulin EC, Mamazza J, Friedlich M, Stern HS, Boushey RP, Tang BQ, Moloo H, Bleier J, Goldberg SM, Alsharif J, Martel G, Bouchard A, Sabri E, Ramsay CR, Mamazza J, Poulin EC, Boushey RP, Richardson D, Porter G, Johnson P, Al-Sukhni E, Ridgway PF, O'Connor B, McLeod RS, Swallow CJ, Forbes SS, Urbach DR, Sutradhar R, Paszat L, Rabeneck L, Baxter NN, Chung W, Ko D, Sun C, Brown CJ, Raval M, Phang PT, Pao JS, Woods R, Raval MJ, Phang PT, Brown CJ, Power A, Francescutti V, Ramsey D, Kelly S, Stephen W, Simunovic M, Coates A, Goldsmith CH, Thabane L, Reeson D, Smith AJ, McLeod RS, DeNardi F, Whelan TJ, Levine MN, Al-Khayal KA, Buie WD, Wallace L, Sigalet D, Eskicioglu C, Gagliardi A, Fenech DS, Victor C, McLeod RS. Abstracts of presentations to the Annual Meetings of the Canadian Association of General Surgeons Canadian Association of Thoracic Surgeons Canadian Hepato-Pancreato-Biliary Society Canadian Society of Surgical Oncology Canadian Society of Colon and Rectal Surgeons: Victoria, BC Sept. 10-13, 2009. Can J Surg 2009; 52:S1-S48. [PMID: 35488397 PMCID: PMC2726442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- R Nenshi
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - E Kennedy
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - N N Baxter
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - R Saskin
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - R Sutradhar
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - D R Urbach
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - G Sroka
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - M C Vassiliou
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - P A Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - R Fayez
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - S A Krajewski
- From the Department of Surgery, University of British Columbia, Vancouver, BC, and the Institute for Technology Assessment, Massachusetts General Hospital, Boston, Mass
| | - C J Brown
- From the Department of Surgery, University of British Columbia, Vancouver, BC, and the Institute for Technology Assessment, Massachusetts General Hospital, Boston, Mass
| | - C Hur
- From the Department of Surgery, University of British Columbia, Vancouver, BC, and the Institute for Technology Assessment, Massachusetts General Hospital, Boston, Mass
| | - P H McCrea
- From the Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - A Mitchell
- From the Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - G Porter
- From the Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - J Grushka
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - T Razek
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - K Khwaja
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - P Fata
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - G Martel
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - G Picciano
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - B Haas
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - W Xiong
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - M Brennan-Barnes
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - D Gomez
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - A B Nathens
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - I Yang
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - S S Forbes
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - W J Stephen
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - M Loeb
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - R Smith
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - E P Christoffersen
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - R F McLean
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - J Westerholm
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - S Garcia-Osogobio
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - F Farrokhyar
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - M Cadeddu
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - M Anvari
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - A Ponton-Carss
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - C Hutchison
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - C Violato
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - M Segedi
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - M Mittleman
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - D Fisman
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - L Kinlin
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - M Rousseau
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - W Saleh
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - D D Stanbridge
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - S Mayrand
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - A Pandya
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Gagliardi
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Nathens
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - N Ahmed
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - T Tran
- From the Department of Surgery, McGill University, Montréal, Que
| | - S V Demyttenaere
- From the Department of Surgery, McGill University, Montréal, Que
| | | | - C Seguin
- From the Department of Surgery, McGill University, Montréal, Que
| | - G P Artho
- From the Department of Surgery, McGill University, Montréal, Que
| | - P Kaneva
- From the Department of Surgery, McGill University, Montréal, Que
| | - G M Fried
- From the Department of Surgery, McGill University, Montréal, Que
| | - L S Feldman
- From the Department of Surgery, McGill University, Montréal, Que
| | - S V Demyttenaere
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - S Bergman
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - J Anderson
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - D J Mikami
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - W S Melvin
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - J M Racz
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - L Dubois
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - A Katchky
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - W J Wall
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - A Faryniuk
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - D Hochman
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - C A Clarkson
- From the Neiva City University Hospital, Neiva, Huila, Colombia
| | - A M Rubiano
- From the Neiva City University Hospital, Neiva, Huila, Colombia
| | - C A Clarkson
- From the Department of Surgery, Memorial University of Newfoundland, St. John's, NL
| | - D Boone
- From the Department of Surgery, Memorial University of Newfoundland, St. John's, NL
| | - C G Ball
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - E Dixon
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - A W Kirkpatrick
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - F R Sutherland
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - D V Feliciano
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - A D Wyrzykowski
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - J M Nicholas
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - C J Dente
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - C G Ball
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - D V Feliciano
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - S M Ullah
- From the Division of Clinical Anatomy, Department of Anatomy and Cell Biology, Department of Surgery, University Hospital, University of Western Ontario, London, Ont
| | - V C McAlister
- From the Division of Clinical Anatomy, Department of Anatomy and Cell Biology, Department of Surgery, University Hospital, University of Western Ontario, London, Ont
| | - S Malik
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - D Ramsey
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - S Pooler
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - B Teague
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Misra
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Cadeddu
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Anvari
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Kaminsky
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine and Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Vergis
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine and Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - L M Gillman
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine and Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - L M Gillman
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine, Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Vergis
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine, Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Altaf
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - J Ellsmere
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - H J Bonjer
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - D Klassen
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - N Orzech
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - V Palter
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - R Aggarwal
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - A Okrainec
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - T P Grantcharov
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - I Ghaderi
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - G Sroka
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - P A Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - E Shlomovitz
- From the Departments of Surgery and Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - R K Reznick
- From the Departments of Surgery and Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - W Kucharczyk
- From the Departments of Surgery and Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - L Lee
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - S Iqbal
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - H Barayan
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - Y Lu
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - P Fata
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - T Razek
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - K Khwaja
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - P S Boora
- From the Department of Surgery, University of Alberta, Edmonton, Alta
| | - J S White
- From the Department of Surgery, University of Alberta, Edmonton, Alta
| | - K N Vogt
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - T Charyk-Stewart
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - L Minuk
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - K Eckert
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - I Chin-Yee
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - D Gray
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - N Parry
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - R J Humphrey
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - A Bütter
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - J Schmidt
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - T Grieci
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - R Gagnon
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - V Han
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - S Duhaime
- From the University of Ottawa, Ottawa, Ont
| | - D F Pitt
- From the University of Ottawa, Ottawa, Ont
| | - V Palter
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - N Orzech
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - R Aggarwal
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - A Okrainec
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - T P Grantcharov
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - L Dubois
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - K N Vogt
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - W Davies
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - C M Schlachta
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - X Shi
- From the Centre for the Advancement of Minimally Invasive Surgery, Edmonton, Alta
| | - D W Birch
- From the Centre for the Advancement of Minimally Invasive Surgery, Edmonton, Alta
| | - Y Gu
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask
| | - M A Moser
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask
| | - T W Swanson
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - D F Schaeffer
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - B Q Tang
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - C H Rusnak
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - B J Amson
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - K N Vogt
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - L Dubois
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - A Hobbs
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - R Etemad-Rezai
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - C M Schlachta
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - E Claydon
- From the Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont
| | - V McAlister
- From the Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont
| | - J Grushka
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - W Sur
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - J-M Laberge
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - J Tchervenkov
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - L Bell
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - H Flageole
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - S Labidi
- From the Québec Centre for Minimally Invasive Surgery, Centre hospitalier universitaire de Québec, Québec, Que
| | - J P Gagné
- From the Québec Centre for Minimally Invasive Surgery, Centre hospitalier universitaire de Québec, Québec, Que
| | - R Gowing
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - K Kahnamoui
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - C C McAlister
- From the University of Toronto, Toronto, Ont., Dalhousie University, Halifax, NS
| | - A Marble
- From the University of Toronto, Toronto, Ont., Dalhousie University, Halifax, NS
| | - S Coughlin
- From the University of Western Ontario, London, Ont
| | | | | | - B Kanbur
- From the University of Western Ontario, London, Ont
| | - S Kanbur
- From the University of Western Ontario, London, Ont
| | - P Colquhoun
- From the University of Western Ontario, London, Ont
| | - D C Trottier
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - S Doucette
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - H Huynh
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - C M Soto
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - E C Poulin
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Mamazza
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - R P Boushey
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - M H Jamal
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - M Rousseau
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - S Meterissian
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - L Snell
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - J M Racz
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - E Davies
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - N Aminazadeh
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - F Farrokhyar
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - S Reid
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - A Naeeni
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - M Naeeni
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - A Kashfi
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - K Kahnamoui
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - K Martin
- From the London Health Sciences Centre, London, Ont
| | - M Weir
- From the London Health Sciences Centre, London, Ont
| | - B Taylor
- From the London Health Sciences Centre, London, Ont
| | - K M Martin
- From the London Health Sciences Centre, Children's Hospital of Western Ontario, London, Ont
| | - M J Girotti
- From the London Health Sciences Centre, Children's Hospital of Western Ontario, London, Ont
| | - N G Parry
- From the London Health Sciences Centre, Children's Hospital of Western Ontario, London, Ont
| | - W C Hanna
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - S Fraser
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - I Weissglas
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - G Ghitulescu
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - A Bilek
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - J Marek
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - C Galatas
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - S Bergman
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - C G Chiu
- From the Richmond Hospital, Richmond, BC
| | - N H Nguyen
- From the Richmond Hospital, Richmond, BC
| | - S W Bloom
- From the Richmond Hospital, Richmond, BC
| | - S Wiebe
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - D Klassen
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - J Bonjer
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - D Lawlor
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - J Plowman
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - T Ransom
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - M Vallis
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - J Ellsmere
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - A C Menezes
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Alberta Health Services, Department of Surgery, University of Alberta, Edmonton, Alta
| | - S Karmali
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Alberta Health Services, Department of Surgery, University of Alberta, Edmonton, Alta
| | - D W Birch
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Alberta Health Services, Department of Surgery, University of Alberta, Edmonton, Alta
| | - S S Forbes
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - C Eskicioglu
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - F D Brenneman
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - S A Fraser
- From the Department of General Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montréal, Que
| | - S Bergman
- From the Department of General Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montréal, Que
| | - J Garzon
- From the Department of General Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montréal, Que
| | - D Gomez
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - B Lawless
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - B Haas
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - A B Nathens
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - K J Lumb
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - L Harkness
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - J Williamson
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - T Charyk-Stewart
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - D Gray
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - R A Malthaner
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - J A Van Koughnett
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - K N Vogt
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - D K Gray
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - N G Parry
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - B Teague
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - M Cadeddu
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - M Anvari
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - M Misra
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - S Pooler
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - S Malik
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - P Swain
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - S Chackungal
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - K N Vogt
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C Yoshy
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - R Etemad-Rezai
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - I Cunningham
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - L Dubois
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C M Schlachta
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - L Scott
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C Vinden
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - A Okrainec
- From the Toronto Western Hospital, University Health Network, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - O Henao
- From the Toronto Western Hospital, University Health Network, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - G Azzie
- From the Toronto Western Hospital, University Health Network, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - S Deen
- From the Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - M Hameed
- From the Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - V Ramirez
- From the University Health Network, University of Toronto, Toronto, Ont
| | - C Veillette
- From the University Health Network, University of Toronto, Toronto, Ont
| | - P Bray
- From the University Health Network, University of Toronto, Toronto, Ont
| | - M Jewett
- From the University Health Network, University of Toronto, Toronto, Ont
| | - A Okrainec
- From the University Health Network, University of Toronto, Toronto, Ont
| | - G Pagliarello
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - F Brenneman
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A Buczkowski
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A Nathens
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - T Razek
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - S Widder
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - I Anderson
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - D Klassen
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - R Saadia
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A Johner
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - S M Hameed
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A P Qureshi
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - A Vergis
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - C M Jimenez
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - J Green
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - A D Pryor
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - C M Schlachta
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - A Okrainec
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - M T Perri
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - A L Trejos
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - M D Naish
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - R V Patel
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - R A Malthaner
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - J Stanger
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - K Stewart
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - Y Yasui
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - C Cass
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - S Damaraju
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - K Graham
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - S Bharadwaj
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - S Srinathan
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - L Tan
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - H Unruh
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - C Finley
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - L Miller
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - L E Ferri
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - D R Urbach
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - G Darling
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - J Spicer
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - S Ergun
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - B McDonald
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - M Rousseau
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - P Kaneva
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - J Spicer
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - A Andalib
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - C Benay
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - M Rousseau
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - Y Kushner
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - V Marcus
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - I Hunt
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - S Gazala
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - R Razzak
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - A Chuck
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - A Valji
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - K Stewart
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - R Tsuyuki
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - E L R Bédard
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - D A Bottoni
- From the Division of Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - G Campbell
- From the Division of Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - R A Malthaner
- From the Division of Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - M Rousseau
- From the McGill University Health Centre, Montréal, Que
| | - P Guevremont
- From the McGill University Health Centre, Montréal, Que
| | - M Chasen
- From the McGill University Health Centre, Montréal, Que
| | - J Spicer
- From the McGill University Health Centre, Montréal, Que
| | - E Eckert
- From the McGill University Health Centre, Montréal, Que
| | - T Alcindor
- From the McGill University Health Centre, Montréal, Que
| | - S Ades
- From the McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the McGill University Health Centre, Montréal, Que
| | - R McGory
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - D Nagpal
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - D Fortin
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - R I Inculet
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - R A Malthaner
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - M Ko
- From the Division of Thoracic Surgery, St. Joseph's Health Centre, University of Toronto, Toronto, Ont
| | - Y Shargall
- From the Division of Thoracic Surgery, St. Joseph's Health Centre, University of Toronto, Toronto, Ont
| | - C Compeau
- From the Division of Thoracic Surgery, St. Joseph's Health Centre, University of Toronto, Toronto, Ont
| | - R Razzak
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - S Gazala
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - I Hunt
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - J Veenstra
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - A Valji
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - K Stewart
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - E L R Bédard
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - P J Davis
- From the Division of General Surgery, Department of Surgery, The Moncton Hospital, Moncton, NB, and Dalhousie University, Halifax, NS
| | - M Mancuso
- From the Division of General Surgery, Department of Surgery, The Moncton Hospital, Moncton, NB, and Dalhousie University, Halifax, NS
| | - A A Mujoomdar
- From the Division of General Surgery, Department of Surgery, The Moncton Hospital, Moncton, NB, and Dalhousie University, Halifax, NS
| | - S Gazala
- From the University of Alberta, Edmonton, Alta
| | | | - L Lee
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - J Spicer
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - C Robineau
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - C Sirois
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - D Mulder
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - J Cools-Lartigue
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - S-Y Chang
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - S Mayrand
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - V Marcus
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - G M Fried
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - L E Ferri
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - T Perry
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - I Hunt
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - M Allegretto
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - C Maguire
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - J Abele
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - D Williams
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - K Stewart
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - E L R Bédard
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - H S Grover
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - S Basi
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - P Chiasson
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - S Basi
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - W Gregory
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - K Irshad
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - C Schieman
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - J H MacGregor
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - E Kelly
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - G Gelfand
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - A J Graham
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - S P McFadden
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - S C Grondin
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - K P Croome
- From the Department of General Surgery, University of Western Ontario, London, Ont., Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, and the Department of Epidemiology, Harvard University, Boston, Mass
| | - R Chudzinski
- From the Department of General Surgery, University of Western Ontario, London, Ont., Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, and the Department of Epidemiology, Harvard University, Boston, Mass
| | - D W Hanto
- From the Department of General Surgery, University of Western Ontario, London, Ont., Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, and the Department of Epidemiology, Harvard University, Boston, Mass
| | - M H Jamal
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., School of Population Health, University of Queensland, Brisbane, Australia
| | - S A Doi
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., School of Population Health, University of Queensland, Brisbane, Australia
| | - J S Barkun
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., School of Population Health, University of Queensland, Brisbane, Australia
| | - S L Wong
- From the Department of Surgery, Health Science Centre, St. John's, NL
| | - A H L Kwan
- From the Department of Surgery, Health Science Centre, St. John's, NL
| | - S Yang
- From the Sunnybrook Health Sciences Centre, Toronto, Ont
| | - C Law
- From the Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Y Luo
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - J Spiers
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - A Forse
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - W Taylor
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - I Apriasz
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - B Mysliwiec
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - N Sarin
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - J Gregor
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C E Moulton
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - R S McLeod
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - H Barnett
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - C Nhan
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - S Gallinger
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - S V Demyttenaere
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - P Nau
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - P Muscarella
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - W S Melvin
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - E C Ellison
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - S M Wiseman
- From St. Paul's Hospital, Department of Surgery, University of British Columbia, Vancouver, BC
| | - A L Melck
- From St. Paul's Hospital, Department of Surgery, University of British Columbia, Vancouver, BC
| | - K M Davidge
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - C Eskicioglu
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - J Lipa
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - P Ferguson
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - C J Swallow
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - F C Wright
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - J P Edwards
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - E J Kelly
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - Y Lin
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - T Lenders
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - W A Ghali
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - A Graham
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - V Francescutti
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - F Farrokhyar
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - R Tozer
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - B Heller
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - P Lovrics
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - G Jansz
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - K Kahnamoui
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - G Spiegle
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - S Schmocker
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - H Huang
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - C Victor
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - C Law
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - E D Kennedy
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - J A McCart
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - N Aslani
- From the British Columbia Cancer Agency, Vancouver, BC
| | - T Swanson
- From the British Columbia Cancer Agency, Vancouver, BC
| | - H Kennecke
- From the British Columbia Cancer Agency, Vancouver, BC
| | - R Woods
- From the British Columbia Cancer Agency, Vancouver, BC
| | - N Davis
- From the British Columbia Cancer Agency, Vancouver, BC
| | - A E Klevan
- From the Departments of Surgery, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - J A Ramsay
- From the Departments of Surgery, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - W J Stephen
- From the Departments of Surgery, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - M Smith
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - M Plourde
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - P M Johnson
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - P Yaffe
- From the Departments of Medical Sciences, Surgery, Pathology, and Microbiology and Immunology, Dalhousie University, Halifax, NS
| | - M Walsh
- From the Departments of Medical Sciences, Surgery, Pathology, and Microbiology and Immunology, Dalhousie University, Halifax, NS
| | - D Hoskin
- From the Departments of Medical Sciences, Surgery, Pathology, and Microbiology and Immunology, Dalhousie University, Halifax, NS
| | - H P Huynh
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D C Trottier
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C Soto
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Auer
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H P Huynh
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D C Trottier
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C Soto
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C Nhan
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - D K Driman
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - A J Smith
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - A Hunter
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - R S McLeod
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - C Eskicioglu
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - D S Fenech
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - C Victor
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - D C Trottier
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - H Huynh
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - E Sabri
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - C Soto
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - A Scheer
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - S Zolfaghari
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - H Moloo
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Mamazza
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - E C Poulin
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - R P Boushey
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Hallet
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - M Guénette-Lemieux
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - A Bouchard
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - R C Grégoire
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - C Thibault
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - G Dionne
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - F Côté
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - P Langis
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - J-P Gagné
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - M J Raval
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - P T Phang
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - C J Brown
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - A Kuzmanovic
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - A Planting
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - M J Raval
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - P T Phang
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - C J Brown
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - H P Huynh
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D C Trottier
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - M Friedlich
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H S Stern
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - B Q Tang
- From the Department of Surgery, Division of General Surgery, Royal Jubilee Hospital, Vancouver Island Health Authority, Victoria, BC
| | - H Moloo
- From the Department of Colorectal Surgery, University of Minnesota, Minneapolis, Minn., the Department of Surgery, University of Ottawa, Ottawa, Ont., and the Department of Colorectal Surgery, University of Pennsylvania, Philadelphia, Pa
| | - J Bleier
- From the Department of Colorectal Surgery, University of Minnesota, Minneapolis, Minn., the Department of Surgery, University of Ottawa, Ottawa, Ont., and the Department of Colorectal Surgery, University of Pennsylvania, Philadelphia, Pa
| | - S M Goldberg
- From the Department of Colorectal Surgery, University of Minnesota, Minneapolis, Minn., the Department of Surgery, University of Ottawa, Ottawa, Ont., and the Department of Colorectal Surgery, University of Pennsylvania, Philadelphia, Pa
| | - J Alsharif
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - G Martel
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - A Bouchard
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E Sabri
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C R Ramsay
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D Richardson
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - G Porter
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - P Johnson
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - E Al-Sukhni
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - P F Ridgway
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - B O'Connor
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - C J Swallow
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - S S Forbes
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - D R Urbach
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - R Sutradhar
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - L Paszat
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - L Rabeneck
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - N N Baxter
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - W Chung
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - D Ko
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - C Sun
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - C J Brown
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - M Raval
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - P T Phang
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - J S Pao
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - R Woods
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - M J Raval
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - P T Phang
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - C J Brown
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - A Power
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - V Francescutti
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - D Ramsey
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - S Kelly
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - W Stephen
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - M Simunovic
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - A Coates
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - C H Goldsmith
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - L Thabane
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - D Reeson
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - A J Smith
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - R S McLeod
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - F DeNardi
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - T J Whelan
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - M N Levine
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - K A Al-Khayal
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - W D Buie
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - L Wallace
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - D Sigalet
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - C Eskicioglu
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Gagliardi
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - D S Fenech
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - C Victor
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Division of General Surgery, University of Toronto, Toronto, Ont
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Al-Thihli K, Palma L, Marcus V, Cesari M, Kushner YB, Barkun A, Foulkes WD. A case of Cowden's syndrome presenting with gastric carcinomas and gastrointestinal polyposis. Nat Rev Gastroenterol Hepatol 2009; 6:184-9. [PMID: 19190598 DOI: 10.1038/ncpgasthep1359] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 12/18/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND A 73-year-old white man was referred to a cancer genetics clinic for evaluation of a approximately 20-year history of mixed upper and lower gastrointestinal polyposis, including hyperplastic, inflammatory and adenomatous polyps, colonic ganglioneuromas, and associated diffuse, esophageal glycogenic acanthosis. Two synchronous gastric carcinomas had been identified before referral and the patient had undergone a total gastrectomy, omentectomy and cholecystectomy. Multiple hyperplastic polyps and small, sessile polyps were also observed in the gastrectomy specimen. INVESTIGATIONS History and physical examination, upper and lower gastrointestinal endoscopy and biopsy, genetic testing, molecular pathology investigations (immunohistochemistry), thyroid ultrasonography, fine-needle aspiration of a thyroid nodule. DIAGNOSIS Cowden's syndrome. MANAGEMENT Genetic counseling, thyroidectomy, vitamin B(12) supplementation, continued endoscopic surveillance and genetic testing of at-risk family members.
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Palma L, Marcus V, Gilbert L, Chong G, Foulkes WD. Synchronous occult cancers of the endometrium and fallopian tube in an MSH2 mutation carrier at time of prophylactic surgery. Gynecol Oncol 2008; 111:575-8. [DOI: 10.1016/j.ygyno.2008.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 07/24/2008] [Accepted: 08/01/2008] [Indexed: 11/16/2022]
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Alcindor T, Tosikyan A, Vuong T, Marcus V. Small-cell anal carcinoma and AIDS: case report and review of the literature. Int J Colorectal Dis 2008; 23:135-6. [PMID: 17279348 DOI: 10.1007/s00384-007-0283-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2007] [Indexed: 02/04/2023]
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Abstract
Poorly differentiated malignancies affecting the anal canal are uncommon but pose diagnostic difficulties because of the wide range of normal cell types that may occur within a limited anatomical region. The range of lesions that may present as poorly differentiated tumours includes squamous cell carcinoma, adenocarcinoma, small and large cell neuroendocrine carcinoma, neuroendocrine carcinoma expressing epithelial cytokeratins and other patterns of mixed differentiation, undifferentiated carcinoma, malignant melanoma, lymphoma and secondary tumours. This review discusses the differential diagnosis of these neoplasms with the aid of short illustrative case studies.
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Affiliation(s)
- B Balachandra
- Department of Pathology, McGill University, Montreal, Quebec, Canada
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Leung N, Turbide C, Olson M, Marcus V, Jothy S, Beauchemin N. Deletion of the carcinoembryonic antigen-related cell adhesion molecule 1 (Ceacam1) gene contributes to colon tumor progression in a murine model of carcinogenesis. Oncogene 2006; 25:5527-36. [PMID: 16619040 DOI: 10.1038/sj.onc.1209541] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) is a glycoprotein that is part of the carcinoembryonic antigen and the immunoglobulin superfamilies. We have shown that it functions as a tumor suppressor and that this function depends upon the presence of the longer CEACAM1 cytoplasmic domain. In this report, we describe the generation of a Ceacam1-/- mouse. The Ceacam1-/- colon exhibits increased in vivo proliferation relative to the wild-type counterpart with a corresponding decreased expression of the p21(Cip1) and p27(Kip1) Cyclin D kinase inhibitors. The colonic villi undergo decreased apoptosis. Out of 35 litters of mice, no spontaneous tumors in any tissues normally expressing CEACAM1 were found over the lifespan of the animals, suggesting that CEACAM1 may not be involved in initiation of tumor development. However, when mice are treated with azoxymethane to induce colonic tumors, we find that Ceacam1-/- mice developed a significantly greater number of tumors than their littermate controls. Moreover, the tumor size was greater in the knockout mice relative to that in the wild-type mice. These results indicate that deletion of CEACAM1 favors progression of colon tumorigenesis.
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Affiliation(s)
- N Leung
- McGill Cancer Centre, McGill University, Montreal, Quebec, Canada
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Tzimas GN, Chevet E, Jenna S, Nguyên DT, Khatib AM, Marcus V, Zhang Y, Chrétien M, Seidah N, Metrakos P. Abnormal expression and processing of the proprotein convertases PC1 and PC2 in human colorectal liver metastases. BMC Cancer 2005; 5:149. [PMID: 16293189 PMCID: PMC1310616 DOI: 10.1186/1471-2407-5-149] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Accepted: 11/17/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The family of proprotein convertases has been recently implicated in tumorigenesis and metastasis in animal models. However, these studies have not yet been completely corroborated in human tumors. METHODS Using RT PCR, immunoblot and immunohistochemistry we assessed the presence and the processing patterns of the convertases PC1 and PC2 as well as the PC2 specific chaperone 7B2 in human liver metastases originating from colorectal cancer and compared them to unaffected and normal liver. Furthermore, we assessed the presence and processing profiles of PC1, PC2 and 7B2 in primary colon cancers. RESULTS mRNA, protein expression, and protein cleavage profiles of proprotein convertases 1 and 2 are altered in liver colorectal metastasis, compared to unaffected and normal liver. Active PC1 protein is overexpressed in tumor, correlating with its mRNA profile. Moreover, the enhanced PC2 processing pattern in tumor correlates with the overexpression of its specific binding protein 7B2. These results were corroborated by immunohistochemistry. The specific and uniform convertase pattern observed in the metastases was present only in a fraction of primary colon cancers. CONCLUSION The uniformly altered proprotein convertase profile in liver metastases is observed only in a fraction of primary colon cancers, suggesting possible selection processes involving PCs during metastasis as well as an active role of PCs in liver metastasis. In addition, the exclusive presence of 7B2 in metastatic tumors may represent a new target for early diagnosis, prognosis and/or treatment.
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Affiliation(s)
- George N Tzimas
- Transplant and Hepato-pancreatobiliary Research Group, McGill University Health Center, McGill University, 687 Pine Avenue West, S.10.26, Montreal, Canada H3A1A1
- Department of Surgical Services, Kypselis General Hospital, 24 Drossopoulou Street, Athens 11257, Greece
- Organelle Signaling Laboratory, Department of Surgery, McGill University Health Center, McGill University, 687 Pine Avenue West, S.10.26, Montreal, Canada H3A1A1
| | - Eric Chevet
- Organelle Signaling Laboratory, Department of Surgery, McGill University Health Center, McGill University, 687 Pine Avenue West, S.10.26, Montreal, Canada H3A1A1
| | - Sarah Jenna
- Organelle Signaling Laboratory, Department of Surgery, McGill University Health Center, McGill University, 687 Pine Avenue West, S.10.26, Montreal, Canada H3A1A1
| | - Duc Thang Nguyên
- Organelle Signaling Laboratory, Department of Surgery, McGill University Health Center, McGill University, 687 Pine Avenue West, S.10.26, Montreal, Canada H3A1A1
| | - Abdel M Khatib
- Ottawa Health Research Institute, University of Ottawa, Ottawa, Canada Y1K 4K9
| | - Victoria Marcus
- Department of Pathology, McGill University Health Center, McGill University, 1650 Cedar Avenue, Montreal, Canada H3G 1A4
| | - Yi Zhang
- Department of Pathology, McGill University Health Center, McGill University, 1650 Cedar Avenue, Montreal, Canada H3G 1A4
| | - Michel Chrétien
- Ottawa Health Research Institute, University of Ottawa, Ottawa, Canada Y1K 4K9
| | - Nabil Seidah
- Laboratory of Biochemical Neuroendocrinology, Clinical Research Institute of Montreal, University of Montreal, Montreal, Canada H2W 1R7, QC
| | - Peter Metrakos
- Transplant and Hepato-pancreatobiliary Research Group, McGill University Health Center, McGill University, 687 Pine Avenue West, S.10.26, Montreal, Canada H3A1A1
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Arnold CN, Goel A, Compton C, Marcus V, Niedzwiecki D, Dowell JM, Wasserman L, Inoue T, Mayer RJ, Bertagnolli MM, Boland CR. Evaluation of microsatellite instability, hMLH1 expression and hMLH1 promoter hypermethylation in defining the MSI phenotype of colorectal cancer. Cancer Biol Ther 2004; 3:73-8. [PMID: 14726676 DOI: 10.4161/cbt.3.1.590] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION About 15% of all colorectal cancers (CRCs) demonstrate high levels of microsatellite instability (MSI-H) and are currently best identified by molecular analysis of microsatellite markers. Most sporadic CRCs with MSI-H are known to be associated with the methylation of the hMLH1 promoter. Promoter methylation coincided with lack of hMLH1 expression. We aimed to investigate the association between MSI status, hMLH1 protein expression and methylation status of the hMLH1 promoter, and to determine the usefulness of each method in defining the MSI phenotype in sporadic CRCs. MATERIALS AND METHODS CRCs from 173 patients from the Cancer and Leukemia Group B (CALGB) were assessed for their MSI status. An additional cohort of 18 MSI-H tumors from the University of California San Diego (UCSD) was included in the analysis of the MSI-H subgroup. MSI testing was performed by PCR using five standard MSI markers. hMLH1 promoter analysis was investigated by methylation specific PCR (MSP), and expression of the MMR genes hMLH1 and hMSH2 was examined by immunohistochemistry (IHC). RESULTS Of the 173 CALGB tumors, 111 (64%) were MSS, 35 (20%) were MSI-L and 27 (16%) MSI-H, respectively. Data on hMLH1 protein expression, hMSH2 protein expression and hMLH1 methylation are available on 128, 173 and 81 of these tumors, respectively. Presence of hMLH1 and hMSH2 protein expression was significantly associated with MSI status. Four of 45 (8.9%) MSI-H tumors and 0 of 146 (0%) MSS/MSI-L tumors did not express hMSH2 (p = 0.0028). hMLH1 protein expression was present in 107 of 108 (99%) MSS and MSI-L tumors versus 11 of 20 (55%) MSI-H tumors (p < 0.0001). Of 61 MSS and MSI-L cancers studied for methylation, 11 (18%) were methylated at the hMLH1 promoter whereas 14 of 20 (70%) MSI-H cancers were methylated (p = 0.0001). In 27 MSI-H tumors studied for hMLH1 protein expression and methylation, 93% of tumors with loss of expression (93%) were also methylated while 42% (5/12) with positive immunostaining for hMLH1 were methylated at the hMLH1 promoter (p = 0.009). CONCLUSIONS Promoter methylation and hMLH1 expression are significantly associated with the MSI-H phenotype in CRC. Promoter methylation analysis provides a useful means to screen for MSI-H tumors. Our data further suggests that hMLH1 promoter methylation analysis alone cannot replace MSI testing, as a significant number of MSI-H tumors could be potentially overseen by such an approach. We suggest that phenotypic evaluation of CRC is performed most reliably with MSI testing, although expression analysis and investigation of the promoter methylation status may complement the screening process.
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Affiliation(s)
- Christian N Arnold
- Department of Medicine and Cancer Center, University of California, San Diego, La Jolla, California, USA
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Affiliation(s)
- Vadim Sherman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Department of Surgery, McGill University Health Centre, Montreal, PQ, Canada
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Foulkes WD, Thiffault I, Gruber SB, Horwitz M, Hamel N, Lee C, Shia J, Markowitz A, Figer A, Friedman E, Farber D, Greenwood CMT, Bonner JD, Nafa K, Walsh T, Marcus V, Tomsho L, Gebert J, Macrae FA, Gaff CL, Paillerets BBD, Gregersen PK, Weitzel JN, Gordon PH, MacNamara E, King MC, Hampel H, de la Chapelle A, Boyd J, Offit K, Rennert G, Chong G, Ellis NA. The founder mutation MSH2*1906G-->C is an important cause of hereditary nonpolyposis colorectal cancer in the Ashkenazi Jewish population. Am J Hum Genet 2002; 71:1395-412. [PMID: 12454801 PMCID: PMC420003 DOI: 10.1086/345075] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2002] [Accepted: 09/19/2002] [Indexed: 01/20/2023] Open
Abstract
Hereditary nonpolyposis colorectal cancer (HNPCC) is caused by mutations in the mismatch-repair genes. We report here the identification and characterization of a founder mutation in MSH2 in the Ashkenazi Jewish population. We identified a nucleotide substitution, MSH2*1906G-->C, which results in a substitution of proline for alanine at codon 636 in the MSH2 protein. This allele was identified in 15 unrelated Ashkenazi Jewish families with HNPCC, most of which meet the Amsterdam criteria. Genotype analysis of 18 polymorphic loci within and flanking MSH2 suggested a single origin for the mutation. All colorectal cancers tested showed microsatellite instability and absence of MSH2 protein, by immunohistochemical analysis. In an analysis of a population-based incident series of 686 Ashkenazi Jews from Israel who have colorectal cancer, we identified 3 (0.44%) mutation carriers. Persons with a family history of colorectal or endometrial cancer were more likely to carry the mutation than were those without such a family history (P=.042), and those with colorectal cancer who carried the mutation were, on average, younger than affected individuals who did not carry it (P=.033). The mutation was not detected in either 566 unaffected Ashkenazi Jews from Israel or 1,022 control individuals from New York. In hospital-based series, the 1906C allele was identified in 5/463 Ashkenazi Jews with colorectal cancer, in 2/197 with endometrial cancer, and in 0/83 with ovarian cancer. When families identified by family history and in case series are included, 25 apparently unrelated Ashkenazi Jewish families have been found to harbor this mutation. Although this pathogenic mutation is not frequent in the Ashkenazi Jewish population (accounting for 2%-3% of colorectal cancer in those whose age at diagnosis is <60 years), it is highly penetrant and accounts for approximately one-third of HNPCC in Ashkenazi Jewish families that fulfill the Amsterdam criteria.
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Affiliation(s)
- W. D. Foulkes
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - I. Thiffault
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - S. B. Gruber
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - M. Horwitz
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - N. Hamel
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - C. Lee
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - J. Shia
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - A. Markowitz
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - A. Figer
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - E. Friedman
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - D. Farber
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - C. M. T. Greenwood
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - J. D. Bonner
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - K. Nafa
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - T. Walsh
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - V. Marcus
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - L. Tomsho
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - J. Gebert
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - F. A. Macrae
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - C. L. Gaff
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - B. Bressac-de Paillerets
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - P. K. Gregersen
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - J. N. Weitzel
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - P. H. Gordon
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - E. MacNamara
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - M.-C. King
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - H. Hampel
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - A. de la Chapelle
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - J. Boyd
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - K. Offit
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - G. Rennert
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - G. Chong
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
| | - N. A. Ellis
- Departments of Medicine, Oncology, Surgery, and Diagnostic Medicine, Sir Mortimer B Davis–Jewish General Hospital, Departments of Medicine, Human Genetics, Pathology, Epidemiology, and Biostatistics and Research Institute, McGill University Health Centre, and Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal; Division of Molecular Medicine and Genetics, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor; Division of Medical Genetics, Department of Medicine, University of Washington, Seattle; Departments of Medicine, Pathology and Surgery, Memorial Sloan-Kettering Cancer Center, New York; Gastrointestinal Tumor Service, Elias Sourasky Medical Center, Tel Aviv; The Susanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel; Division of Molecular Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; Family Cancer Clinic, Royal Melbourne Hospital, and Genetic Health Services Victoria, Melbourne; Institut Gustave Roussy, Paris; Center for Genomics and Human Genetics, North Shore Long Island Jewish Research Institute, Manhasset, NY; Department of Cancer Genetics, City of Hope Cancer Center, Duarte, CA ; Human Cancer Genetics Program, Ohio State University, Columbus; and Chalit Health Services Cancer Control Center, Haifa, Israel
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Abstract
BACKGROUND & AIMS Recent reports have suggested the mucosa of an ileal reservoir could be at risk of neoplasia. Risk factors may include the age of the pouch, chronic pouchitis, and previous colonic neoplasia. This study examined a group of such patients to determine the risk of dysplasia. METHODS From a cohort of 1221 patients with ileal pouches, 171 patients with possible risk factors were selected. Successful contact was made with 138 patients who were invited for endoscopy and multiple biopsies. Biopsy specimens were stained with H&E and p53, scored for inflammatory changes including villous atrophy, and analyzed by flow cytometry. RESULTS One hundred six patients took part and fell into 1 or more of the following clinical categories: chronic pouchitis (n = 34), pelvic pouch for > or =12 years (n = 42); Kock pouch for > or =14 years (n = 29), and neoplasia in colectomy specimen (n = 11). Thirty-three patients had severe villous atrophy. One patient of 106 (95% confidence interval, 0.9% +/- 1.6%) with a long-standing pouch had low-grade dysplasia that was multifocal. DNA analysis by flow cytometry showed aneuploidy in this patient and 2 others. CONCLUSIONS These data suggest that the development of dysplasia in ileal pouches performed for ulcerative colitis is probably a rare event within 15-20 years of pouch surgery.
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Affiliation(s)
- M W Thompson-Fawcett
- Department of Surgery, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto M5G 1X5 Canada
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Millar AL, Pal T, Madlensky L, Sherman C, Temple L, Mitri A, Cheng H, Marcus V, Gallinger S, Redston M, Bapat B, Narod S. Mismatch repair gene defects contribute to the genetic basis of double primary cancers of the colorectum and endometrium. Hum Mol Genet 1999; 8:823-9. [PMID: 10196371 DOI: 10.1093/hmg/8.5.823] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.7] [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: 11/14/2022] Open
Abstract
Hereditary non-polyposis colorectal cancer (HNPCC) is a dominantly inherited cancer syndrome caused by germline defects of mismatch repair (MMR) genes. Endometrial cancer is the most common extracolonic neoplasm in HNPCC and is the primary clinical manifestation of the syndrome in some families. The cumulative incidence of endometrial cancer among HNPCC mutation carriers is high, estimated to be from 22 to 43%. We hypothesized that women with double primary cancers of the colorectum and endometrium are likely to be members of HNPCC families. In order to determine how frequently HNPCC manifests in the context of double primary cancers, we examined alterations of two MMR genes, hMSH2 and hMLH1, in 40 unrelated women affected with double primary cancers. These cases were identified using hospital-based and population-based cancer registries in Ontario, Canada. MMR gene mutations were screened by single-strand conformation polymorphism analysis and confirmed by direct sequencing. Eighteen percent (seven of 40) were found to harbor mutations of one of the two MMR genes. Analysis of colorectal and/or endometrial tumors of mutation-negative probands found microsatellite instability in seven of 20 cases. Six of seven mutation-positive probands had strong family histories suggestive of HNPCC. First degree relatives of mutation-positive probands had a very high relative risk (RR) of colorectal cancer (RR = 8.1, CI 3. 5-15.9) and endometrial cancer (RR = 23.8, CI 6.4-61.0). The relative risk of mutation-negative cases was 2.8 (CI 1.7-4.5) for colorectal cancer and 5.4 (CI 2.0-11.7) for endometrial cancer. We recommend that all double primary patients with cancers at these sites should have a genetic evaluation, including molecular analysis for HNPCC where appropriate.
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Affiliation(s)
- A L Millar
- Department of Pathology and Laboratory Medicine, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
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Silverman G, Marcus V. Letter: Speech in schizophrenic patients. Br J Psychiatry 1975; 127:405-6. [PMID: 1182393 DOI: 10.1192/bjp.127.4.415-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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