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Huang J, Faisal W, Brand M, Smith S, Alexander M, Briggs L, Conron M, Duffy M, John T, Langton D, Lesage J, MacManus M, Mitchell P, Olesen I, Parente P, Philip J, Samuel E, Torres J, Underhill CR, Zalcberg JR, Harden S, Stirling R. Patterns of care for people with small cell lung cancer in Victoria, 2011-19: a retrospective, population-based registry data study. Med J Aust 2023; 219:120-126. [PMID: 37365486 DOI: 10.5694/mja2.52017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES To report stage-specific patterns of treatment and the influence of management and treatment type on survival rates for people newly diagnosed with small cell lung cancer (SCLC). DESIGN Cross-sectional patterns of care study; analysis of data prospectively collected for the Victorian Lung Cancer Registry (VLCR). SETTING, PARTICIPANTS All people diagnosed with SCLC in Victoria during 1 April 2011 - 18 December 2019. MAIN OUTCOME MEASURES Stage-specific management and treatment of people with SCLC; median survival time. RESULTS During 2011-19, 1006 people were diagnosed with SCLC (10.5% of all lung cancer diagnoses in Victoria); their median age was 69 years (interquartile range [IQR], 62-77 years), 429 were women (43%), and 921 were current or former smokers (92%). Clinical stage was defined for 896 people (89%; TNM stages I-III, 268 [30%]; TNM stage IV, 628 [70%]) and ECOG performance status at diagnosis for 663 (66%; 0 or 1, 489 [49%]; 2-4, 174 [17%]). The cases of 552 patients had been discussed at multidisciplinary meetings (55%), 377 people had received supportive care screening (37%), and 388 had been referred for palliative care (39%). Active treatment was received by 891 people (89%): chemotherapy, 843 (84%); radiotherapy, 460 (46%); chemotherapy and radiotherapy, 419 (42%); surgery, 23 (2%). Treatment had commenced within fourteen days of diagnosis for 632 of 875 patients (72%). Overall median survival time from diagnosis was 8.9 months (IQR, 4.2-16 months; stage I-III: 16.3 [IQR, 9.3-30] months; stage IV: 7.2 [IQR, 3.3-12] months). Multidisciplinary meeting presentation (hazard ratio [HR], 0.66; 95% CI, 0.58-0.77), multimodality treatment (HR, 0.42; 95% CI, 0.36-0.49), and chemotherapy within fourteen days of diagnosis (HR, 0.68; 95% CI, 0.48-0.94) were each associated with lower mortality during follow-up. CONCLUSION Rates of supportive care screening, multidisciplinary meeting evaluation, and palliative care referral for people with SCLC could be improved. A national registry of SCLC-specific management and outcomes data could improve the quality and safety of care.
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Affiliation(s)
| | | | | | | | - Marliese Alexander
- Peter MacCallum Cancer Institute, Melbourne, VIC
- The University of Melbourne, Melbourne, VIC
| | | | - Matthew Conron
- The University of Melbourne, Melbourne, VIC
- St Vincent's Hospital Melbourne, Melbourne, VIC
| | - Mary Duffy
- Peter MacCallum Cancer Institute, Melbourne, VIC
| | - Thomas John
- Peter MacCallum Cancer Institute, Melbourne, VIC
| | - David Langton
- Monash University, Melbourne, VIC
- Peninsula Health, Melbourne, VIC
| | | | | | - Paul Mitchell
- Olivia Newton-John Cancer Centre at Austin Health, Melbourne, VIC
| | - Inger Olesen
- Andrew Love Cancer Centre, Barwon Health, Geelong, VIC
| | - Phillip Parente
- Eastern Health Clinical School, Monash University, Melbourne, VIC
- Eastern Health, Melbourne, VIC
| | | | - Evangeline Samuel
- Alfred Health, Melbourne, VIC
- Latrobe Regional Hospital, Traralgon, VIC
| | | | - Craig R Underhill
- Albury Wodonga Health, Wodonga, NSW
- The University of New South Wales, Sydney, NSW
| | - John R Zalcberg
- Alfred Health, Melbourne, VIC
- Monash University, Melbourne, VIC
| | - Susan Harden
- Monash University, Melbourne, VIC
- Peter MacCallum Cancer Institute, Melbourne, VIC
| | - Rob Stirling
- Alfred Health, Melbourne, VIC
- Monash University, Melbourne, VIC
- Monash University Central Clinical School, Melbourne, VIC
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Malsem E, Yeoh H, Harrap B, McCann K, Faisal W. 212P Impact of COVID-19 on the timeliness to care in a rapid access lung lesions clinic in a large Australian cancer centre. J Thorac Oncol 2023. [PMCID: PMC10066600 DOI: 10.1016/s1556-0864(23)00465-3] [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: 04/03/2023]
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Donnelly J, Appathurai A, Yeoh HL, Driscoll K, Faisal W. Vitamin E in Cancer Treatment: A Review of Clinical Applications in Randomized Control Trials. Nutrients 2022; 14:nu14204329. [PMID: 36297013 PMCID: PMC9611110 DOI: 10.3390/nu14204329] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Vitamin E, along with other vitamins and micronutrients play a range of physiologic roles in the homeostasis of the body. Moreover, they also have postulated therapeutic roles that are often incompletely studied and understood. In this scoping review, we explored the recent randomized control trials (RCTs) of Vitamin E in the context of cancer, to investigate whether Vitamin E has a therapeutic role. We searched major bibliographic electronic databases to identify sixteen RCTs studying the role of Vitamin E in cancer management that have been published in the last ten years. These studies had different methodological qualities, including some that used Vitamin E in combination with other treatments. Furthermore, due to the heterogenous results, it is difficult to make a consensus statement on the effectiveness of Vitamin E in cancer therapeutics. In some cases, there were even suggestion of detriment with Vitamin E supplementation. Therefore, well designed, large, prospective RCTs are needed studying pure isoforms of Vitamin E to establish the safety and efficacy of this dietary supplement.
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Affiliation(s)
- Jennifer Donnelly
- Department of Cardiothoracic Surgery, St.Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia
- Nutrition Department, St.Vincent’s Private Hospital, Fitzroy, VIC 3065, Australia
- Correspondence:
| | - Amanda Appathurai
- Department of Infectious Diseases, The University of Melbourne, Parkville, VIC 3000, Australia
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - Hui-Ling Yeoh
- Department of Medical Oncology, Frankston Hospital, Peninsula Health, Frankston, VIC 3199, Australia
| | - Kate Driscoll
- Department of Nutrition and Dietetics, Peninsula Health, Frankston, VIC 3199, Australia
| | - Wasek Faisal
- Department of Medical Oncology, Ballarat Regional Integrated Cancer Centre (BRICC), Grampians Health, Ballarat Central, VIC 3350, Australia
- School of Health, La Trobe University, Melbourne, VIC 3000, Australia
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McLean LS, Faisal W, Parakh S, Kao SC, Lewis CR, Chin MT, Voskoboynik M, Itchins MJ, Jennens RR, Broad AR, Morris TA, Solomon BJ. Standard-Dose Osimertinib in EGFR-Mutated Non-Small-Cell Lung Adenocarcinoma With Leptomeningeal Disease. JCO Precis Oncol 2022; 5:561-568. [PMID: 34994604 DOI: 10.1200/po.20.00464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Leptomeningeal disease (LMD) in epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma is associated with a poor prognosis and limited treatment options. Osimertinib is a potent third-generation EGFR tyrosine kinase inhibitor with confirmed CNS penetration. This study reports on outcomes of patients with EGFR-mutated non-small-cell lung cancer who developed LMD and were subsequently treated with osimertinib. METHODS We identified patients treated with osimertinib 80 mg PO daily under a compassionate access scheme across nine tertiary Australian institutes between July 2017 and July 2020. Patient demographics, tumor characteristics, and treatment history were collected. Median overall survival, median progression-free survival, disease control rates (DCR), and overall response rates (ORR) were assessed. Kaplan-Meier analysis was performed and descriptive statistics were used. RESULTS Thirty-nine patients were analyzed of which 74% were female. Exon 19 deletions (49%) and L858R point mutations (41%) were the most common EGFR mutations. Forty-nine percentage of patients were Eastern Cooperative Oncology Group 1. The median duration of osimertinib therapy was 6 months. The extracranial DCR and ORR were 60% and 54%, and the intracranial DCR and ORR were 68% and 53%, respectively. Median overall survival was 10.5 months (95% CI, 8.17 to 15.05 months). CONCLUSION There are limited treatment options for LMD in EGFR-positive lung cancer, and osimertinib at a dose of 80 mg daily is an active therapeutic option for these patients.
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Affiliation(s)
- Luke S McLean
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Wasek Faisal
- Department of Medical Oncology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Sagun Parakh
- Department of Medical Oncology, Austin Health, Melbourne, Victoria, Australia
| | - Steven C Kao
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Craig R Lewis
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Melvin T Chin
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Voskoboynik
- Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Malinda J Itchins
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Ross R Jennens
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Medical Oncology, Epworth Health, Melbourne, Victoria, Australia
| | - Adam R Broad
- Department of Medical Oncology, Andrew Love Cancer Centre, Geelong, Victoria, Australia
| | - Tessa A Morris
- Southern Blood and Cancer Service, Dunedin, New Zealand.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Benjamin J Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
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Webster R, Mccann K, Facey M, Faisal W. P60.04 TTF1 Expression in Advanced Lung Adenocarcinoma and Survival Outcome: An Observational Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chan DLH, Espinoza D, Chan J, Lee A, Faisal W, Segelov E, Pavlakis N. Adjuvant anti-VEGF therapy for overall survival and relapse-free survival in patients with resected non-metastatic colorectal cancer. Hippokratia 2020. [DOI: 10.1002/14651858.cd012460.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David Lok Hang Chan
- Royal North Shore Hospital; Department of Medical Oncology; Kolling Institute Sydney New South Wales Australia 2065
| | - David Espinoza
- University of Sydney; NHMRC Clinical Trials Centre; 92-94 Parramatta Road Camperdown NSW Australia 2050
| | - Joseph Chan
- University of Sydney; Department of Medicine; Northern Sydney Cancer Centre Level 1, ASB, Royal North Shore Hospital St Leonards NSW Australia 2065
| | - Adrian Lee
- Royal North Shore Hospital; Department of Medical Oncology; Kolling Institute Sydney New South Wales Australia 2065
| | - Wasek Faisal
- Royal North Shore Hospital; Department of Medical Oncology; St Leonards New South Wales Australia 2065
| | - Eva Segelov
- Monash University and Monash Health; Department of Oncology; Lvl 7, MHTP building, Monash Health 240 Clayton Rd Clayton Victoria Australia 3168
| | - Nick Pavlakis
- Royal North Shore Hospital; Department of Medical Oncology; St Leonards New South Wales Australia 2065
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McCann K, Faisal W. Invasive diagnostic investigation-related complications and its impact on treatment initiation in lung cancer patients in a rapid access lung lesion clinic in regional Australia. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz070.009] [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: 11/13/2022] Open
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Abstract
Metastatic gastric cancer is associated with a poor prognosis and novel treatment options are desperately needed. The development of targeted therapies heralded a new era for the management of metastatic gastric cancer, however results from clinical trials of numerous targeted agents have been mixed. The advent of immune checkpoint inhibitors has yielded similar promise and results from early trials are encouraging. This review provides an overview of the systemic treatment options evaluated in metastatic gastric cancer, with a focus on recent evidence from clinical trials for targeted therapies and immune checkpoint inhibitors. The failure to identify appropriate predictive biomarkers has hampered the success of many targeted therapies in gastric cancer, and a deeper understanding of specific molecular subtypes and genomic alterations may allow for more precision in the application of novel therapies. Identifying appropriate biomarkers for patient selection is essential for future clinical trials, for the most effective use of novel agents and in combination approaches to account for growing complexity of treatment options.
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Affiliation(s)
- Aaron C. Tan
- Northern Sydney Cancer Centre, Royal North Shore
Hospital, Sydney, NSW, Australia/National Cancer Centre Singapore,
Singapore
| | - David L. Chan
- Northern Sydney Cancer Centre, Royal North Shore
Hospital, Sydney, NSW, Australia/Northern Clinical School, University of
Sydney, NSW, Australia
| | - Wasek Faisal
- Ballarat Regional Integrated Cancer Centre,
Ballarat, VIC, Australia
| | - Nick Pavlakis
- Northern Sydney Cancer Centre, Royal North Shore
Hospital, Reserve Road, St. Leonards, NSW 2065, Australia
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Lim L, Faisal W, Wuttke M, Chong G. Causes of death in a cohort of early stage colorectal cancer patients at a regional centre in Australia. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.287] [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: 11/14/2022] Open
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Chowdhury A, Ahmed K, Faisal W. Survey of patients’ knowledge relating to their cancer and its concordance with the treating medical teams. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx676.022] [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: 11/12/2022] Open
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Faisal W, Jacques J. Role of Ketamine and Methadone as Adjunctive Therapy in Complex Pain Management: A Case Report and Literature Review. Indian J Palliat Care 2017; 23:100-103. [PMID: 28216871 PMCID: PMC5294428 DOI: 10.4103/0973-1075.197956] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Assessment and management of complex cancer pain always remains a major challenge for any palliative care team, given its heterogeneity of underlying pathophysiology and limitations of any pharmacotherapy. Here, we present a case of complex pain management in a young patient with a life-limiting illness, highlighting the issues of organic and nonorganic contributors of pain and provide some insight into the role of ketamine and methadone as adjunctive therapy to opioid analgesics. A brief literature review is also done to provide the context of use of these adjunctive drugs in this setting.
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Affiliation(s)
- Wasek Faisal
- Department of Medical Oncology, Ballarat Regional Integrated Cancer Centre, Ballarat, Victoria, Australia
| | - Judith Jacques
- Department of Palliative Care, Central Coast Cancer Centre, Gosford, NSW, Australia
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12
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Chan DLH, Espinoza D, Chan J, Lee A, Faisal W, Segelov E, Pavlakis N. Adjuvant anti-VEGF therapy for overall survival and relapse-free survival in patients with resected non-metastatic colorectal cancer. Hippokratia 2016. [DOI: 10.1002/14651858.cd012460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- David Lok Hang Chan
- Royal North Shore Hospital; Department of Medical Oncology; St Leonards New South Wales Australia 2065
| | - David Espinoza
- University of Sydney; NHMRC Clinical Trials Centre; 92-94 Parramatta Road Camperdown NSW Australia 2050
| | - Joseph Chan
- University of Sydney; Department of Medicine; Northern Sydney Cancer Centre Level 1, ASB, Royal North Shore Hospital St Leonards NSW Australia 2065
| | - Adrian Lee
- Royal North Shore Hospital; Department of Medical Oncology; St Leonards New South Wales Australia 2065
| | - Wasek Faisal
- Royal North Shore Hospital; Department of Medical Oncology; St Leonards New South Wales Australia 2065
| | - Eva Segelov
- St Vincent's Hospital; Medical Oncology; Suite 708/438 Victoria Street Darlinghurst NSW Australia 2010
| | - Nick Pavlakis
- Royal North Shore Hospital; Department of Medical Oncology; St Leonards New South Wales Australia 2065
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Affiliation(s)
- Wasek Faisal
- , Ballarat Regional Integrated Cancer Centre, Ballarat, Victoria; , Tamworth Hospital, Tamworth; and , Central Coast Cancer Centre, Gosford, New South Wales, Australia
| | - Hoi-Mun Tang
- , Ballarat Regional Integrated Cancer Centre, Ballarat, Victoria; , Tamworth Hospital, Tamworth; and , Central Coast Cancer Centre, Gosford, New South Wales, Australia
| | - Susan Tiley
- , Ballarat Regional Integrated Cancer Centre, Ballarat, Victoria; , Tamworth Hospital, Tamworth; and , Central Coast Cancer Centre, Gosford, New South Wales, Australia
| | - Craig Kukard
- , Ballarat Regional Integrated Cancer Centre, Ballarat, Victoria; , Tamworth Hospital, Tamworth; and , Central Coast Cancer Centre, Gosford, New South Wales, Australia
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Faisal W, Burnton G, Imlay-Gillespie L, Robilliard J. Cerebral Abscesses and Septic Pulmonary Emboli due to Serratia marcescens Infection Arising from a Portacath. Journal of Microbiology, Immunology and Infection 2010; 43:538-41. [DOI: 10.1016/s1684-1182(10)60083-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 03/04/2009] [Accepted: 05/21/2009] [Indexed: 10/18/2022]
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Kaye PV, Haider SA, Ilyas M, James PD, Soomro I, Faisal W, Catton J, Parsons SL, Ragunath K. Barrett's dysplasia and the Vienna classification: reproducibility, prediction of progression and impact of consensus reporting and p53 immunohistochemistry. Histopathology 2009; 54:699-712. [PMID: 19438745 DOI: 10.1111/j.1365-2559.2009.03288.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AIMS The Vienna classification is used to classify dysplasia in Barrett's oesophagus (BO), but reproducibility and value of diagnosis of lower grades in particular are often questioned. The aim was to test the diagnostic variability and correlation with patient outcome and to attempt to define histological features causing discrepant diagnoses, as well as to test the impact of adding p53 immunohistochemistry on reproducibility and prediction of outcome. METHODS AND RESULTS One hundred and forty-three patients with 154 sets of biopsy specimens originally diagnosed with Barrett's dysplasia were retrieved from the pathology records of Nottingham University Hospital. Thirty-two Barrett's patients without dysplasia were added. Anonymized slides were graded independently by five pathologists without and with p53-stained slides. Interobserver variation, correlation with outcome and diagnostic accuracy were determined. Weighted kappa scores between pairs of pathologists showed substantial agreement and improved after p53 immunohistochemistry. Agreement with the original diagnosis was substantially lower. Fourteen of 34 low-grade dysplasias (LGD) and 27 of 30 high-grade dysplasias on consensus progressed within 10 years compared with 18/94 and 28/39 of original diagnoses. Progression correlated with p53 positivity. CONCLUSION The Vienna classification is useful and reproducible in BO. Consensus diagnosis by gastrointestinal pathologists produces high specificity and predictive value, even for LGD. p53 immunohistochemistry assists in diagnosis in difficult cases and predicts progression.
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Affiliation(s)
- Philip V Kaye
- Department of Cellular Pathology, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, UK.
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Faisal W, Symonds P, Panjwani S, Heng Y, Murray JC. Cell-surface associated p43/endothelial-monocyte-activating-polypeptide-II in hepatocellular carcinoma cells induces apoptosis in T-lymphocytes. Asian J Surg 2007; 30:13-22. [PMID: 17337366 DOI: 10.1016/s1015-9584(09)60122-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The novel, proinflammatory cytokine endothelial-monocyte-activating-polypeptide-II (EMAP-II) was first found in tumour cell supernatants and is closely related or identical to the p43 component of the mammalian multisynthetase complex. In its secreted form, EMAP-II has multiple cytokine-like activities in vitro, including chemotactic, procoagulant and antiangiogenic properties. We recently showed that neoplastic but not normal hepatocytes expresses the 34-kDa molecule on the cell surface in vitro and the cell-surface expression is upregulated by treatment with tumour necrosis factor (TNF)-alpha/interferon (IFN)-gamma and/or hypoxia. We hypothesized an immune-regulatory role of EMAP-II within neoplastic tissues and investigated its effects on lymphocytes. METHODS To study the role of EMAP-II in tumour cell-induced lymphocyte killing, Jurkat T-cells were co-cultured with a range of hepatocellular carcinoma (HCC) cell monolayers (HuH-7, HepG2 and Alexander cells), which were either untreated or treated with TNF-alpha/IFN-gamma under normoxic and hypoxic conditions over a period of 16-24 hours. Flow cytometric analysis of apoptosis in Jurkat cells was performed using the annexin-V-FITC/propidium iodide technique. RESULTS rEMAP-II caused a dose-dependent apoptosis in Jurkat T-cells. Co-culture of Jurkat cells with HCC cell monolayers induced significant apoptosis of the Jurkat cells. In general, under normoxic conditions, cytokine-treated HCC cell monolayer caused more apoptosis than untreated cells. This effect was enhanced by hypoxia. Critically, native EMAP-II expressed on the surface of the HCC cells also induced activation of caspase-8 and apoptosis in Jurkat cells, which was partially but significantly blocked by addition of polyclonal antibodies against EMAP-II to the incubation mixture. CONCLUSION Our data suggest that membrane-bound EMAP-II is cytotoxic to lymphocytes and, therefore, might constitute a component of a novel, immunosuppressive pathway by which HCC cells may eliminate attacking T-cells and evade the immune system. The mechanism by which it does so is currently under investigation.
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Affiliation(s)
- Wasek Faisal
- Wolfson Digestive Diseases Centre, University Hospital, University of Nottingham, Nottingham, UK.
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