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Luu HY, Nguyen TC. Nuanced Questions Provoke Nuanced Answers. Ann Thorac Surg 2023; 116:1203-1204. [PMID: 36841499 DOI: 10.1016/j.athoracsur.2023.02.040] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/27/2023]
Affiliation(s)
- Hubert Y Luu
- Department of Surgery, University of California San Francisco, 500 Parnassus Ave, MUW 405, Box 0118, San Francisco, CA 94143
| | - Tom C Nguyen
- Department of Surgery, University of California San Francisco, 500 Parnassus Ave, MUW 405, Box 0118, San Francisco, CA 94143.
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Luu HY, Santos J, Isaza E, Brzezinski M, Kukreja J. Management of primary graft dysfunction after lung transplantation with extracorporeal life support: an evidence-based review. J Thorac Dis 2023; 15:4090-4100. [PMID: 37559633 PMCID: PMC10407492 DOI: 10.21037/jtd-22-1387] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 06/25/2023] [Indexed: 08/11/2023]
Abstract
Primary graft dysfunction (PGD) is a complex inflammatory syndrome that can lead to respiratory failure after lung transplantation (LTx). The pathogenesis of PGD is multifactorial and can be driven by attributes of both the donor and recipient, perioperative characteristics, and technical handling of the graft. Despite significant advancements in patient and donor selection, perioperative management and surgical technique, PGD is still a major contributor to morbidity and mortality after lung transplant. Although there are no known durable treatment options for PGD after LTx, an increasing body of evidence and experience in high-volume lung transplant centers show that extracorporeal life support (ECLS) is a reliable option for both preventing PGD and supporting critically ill patients with PGD. Both veno-venous (V-V) ECLS and veno-arterial (V-A) ECLS are proven and feasible strategies for mitigating the morbidity and mortality associated with post-LTx PGD. In this evidence-based review, we provide an overview of the epidemiology and physiology of PGD as well as a growing body of data that supports ECLS as a major tool to manage PGD. We describe the role of ECMO in PGD prevention and management, worldwide outcomes of LTx with ECLS support, and outline our step-wise approach to managing this complex respiratory syndrome leading up to institution of ECLS.
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Affiliation(s)
- Hubert Y. Luu
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jesse Santos
- Department of Surgery, University of California San Francisco East Bay, Oakland, CA, USA
| | - Erin Isaza
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Marek Brzezinski
- Department of Anesthesia, University of California San Francisco, San Francisco, CA, USA
| | - Jasleen Kukreja
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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Greenberg AL, Karimzada MM, Brian R, Yap A, Luu HY, Ahmed S, Huang CY, Waits SA, Hirose R, Alseidi A, Rapp JH, O’Sullivan PS, Chern H, Syed SM. Assessment of Surgeon Performance of Advanced Open Surgical Skills Using a Microskills-Based Novel Curriculum. JAMA Netw Open 2022; 5:e2229787. [PMID: 36053533 PMCID: PMC9440404 DOI: 10.1001/jamanetworkopen.2022.29787] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The increase in minimally invasive surgical procedures has eroded exposure of general surgery residents to open operations. High-fidelity simulation, together with deliberate instruction, is needed for advanced open surgical skill (AOSS) development. OBJECTIVE To collect validity evidence for AOSS tools to support a shared model for instruction. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included postresidency surgeons (PRSs) and second-year general surgery residents (R2s) at a single academic medical center who completed simulated tasks taught within the AOSS curriculum between June 1 and October 31, 2021. EXPOSURES The AOSS curriculum includes 6 fine-suture and needle handling tasks, including deep suture tying (with and without needles) and continuous suturing using the pitch-and-catch and push-push-pull techniques (both superficial and deep). Teaching and assessment are based on specific microskills using a 3-dimensional printed iliac fossa model. MAIN OUTCOMES AND MEASURES The PRS group was timed and scored (5-point Likert scale) on 10 repetitions of each task. Six months after receiving instruction on the AOSS tasks, the R2 group was similarly timed and scored. RESULTS The PRS group included 14 surgeons (11 male [79%]; 8 [57%] attending surgeons) who completed the simulation; the R2 group, 9 surgeons (5 female [55%]) who completed the simulation. Score and time variability were greater for the R2s compared with the PRSs for all tasks. The R2s scored lower and took longer on (1) deep pitch-and-catch suturing (69% of maximum points for a mean [SD] of 142.0 [31.7] seconds vs 77% for a mean [SD] of 95.9 [29.4] seconds) and deep push-push-pull suturing (63% of maximum points for a mean [SD] of 284.0 [72.9] seconds vs 85% for a mean [SD] of 141.4 [29.1] seconds) relative to the corresponding superficial tasks; (2) suture tying with a needle vs suture tying without a needle (74% of maximum points for a mean [SD] of 64.6 [19.8] seconds vs 90% for a mean [SD] of 54.4 [15.6] seconds); and (3) the deep push-push-pull vs pitch-and-catch techniques (63% of maximum points for a mean [SD] of 284.0 [72.9] seconds vs 69% of maximum points for a mean [SD] of 142.0 [31.7] seconds). For the PRS group, time was negatively associated with score for the 3 hardest tasks: superficial push-push-pull (ρ = 0.60; P = .02), deep pitch-and-catch (ρ = 0.73; P = .003), and deep push-push-pull (ρ = 0.81; P < .001). For the R2 group, time was negatively associated with score for the 2 easiest tasks: suture tying without a needle (ρ = 0.78; P = .01) and superficial pitch-and-catch (ρ = 0.79; P = .01). CONCLUSIONS AND RELEVANCE The findings of this cohort study offer validity evidence for a novel AOSS curriculum; reveal differential difficulty of tasks that can be attributed to specific microskills; and suggest that position on the surgical learning curve may dictate the association between competency and speed. Together these findings suggest specific, actionable opportunities to guide instruction of AOSS, including which microskills to focus on, when individual rehearsal vs guided instruction is more appropriate, and when to focus on speed.
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Affiliation(s)
| | | | - Riley Brian
- Department of Surgery, University of California, San Francisco
| | - Ava Yap
- Department of Surgery, University of California, San Francisco
| | - Hubert Y. Luu
- Department of Surgery, University of California, San Francisco
| | - Saira Ahmed
- Department of Surgery, University of Illinois at Chicago
| | - Chiung-Yu Huang
- Department of Surgery, University of California, San Francisco
| | - Seth A. Waits
- Department of Surgery, University of Michigan, Ann Arbor
| | - Ryutaro Hirose
- Department of Surgery, University of California, San Francisco
| | - Adnan Alseidi
- Department of Surgery, University of California, San Francisco
| | - Joseph H. Rapp
- Department of Surgery, University of California, San Francisco
| | | | - Hueylan Chern
- Department of Surgery, University of California, San Francisco
| | - Shareef M. Syed
- Department of Surgery, University of California, San Francisco
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Gomez A, Wisneski AD, Luu HY, Hirose K, Roberts JP, Hirose R, Freise CE, Nakakura EK, Corvera CU. Contemporary Management of Hepatic Cyst Disease: Techniques and Outcomes at a Tertiary Hepatobiliary Center. J Gastrointest Surg 2021; 25:77-84. [PMID: 33083858 PMCID: PMC7850990 DOI: 10.1007/s11605-020-04821-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/01/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hepatic cyst disease is often asymptomatic, but treatment is warranted if patients experience symptoms. We describe our management approach to these patients and review the technical nuances of the laparoscopic approach. METHODS Medical records were reviewed for operative management of hepatic cysts from 2012 to 2019 at a single, tertiary academic medical center. RESULTS Fifty-three patients (39 female) met the inclusion criteria with median age at presentation of 65 years. Fifty cases (94.3%) were performed laparoscopically. Fourteen patients carried diagnosis of polycystic liver disease. Dominant cyst diameter was median 129 mm and located within the right lobe (30), left lobe (17), caudate (2), or was bilobar (4). Pre-operative concern for biliary cystadenoma/cystadenocarcinoma existed for 7 patients. Operative techniques included fenestration (40), fenestration with decapitation (7), decapitation alone (3), and excision (2). Partial hepatectomy was performed in conjunction with fenestration/decapitation for 15 cases: right sided (7), left sided (7), and central (1). One formal left hepatectomy was performed in a polycystic liver disease patient. Final pathology yielded simple cyst (52) and one biliary cystadenoma. Post-operative complications included bile leak (2), perihepatic fluid collection (1), pleural effusion (1), and ascites (1). At median 7.1-month follow-up, complete resolution of symptoms occurred for 34/49 patients (69.4%) who had symptoms preoperatively. Reintervention for cyst recurrence occurred for 5 cases (9.4%). CONCLUSIONS Outcomes for hepatic cyst disease are described with predominantly laparoscopic approach, approach with minimal morbidity, and excellent clinical results.
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Affiliation(s)
- Axel Gomez
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Andrew D Wisneski
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Hubert Y Luu
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Kenzo Hirose
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - John P Roberts
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Ryutaro Hirose
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Christopher E Freise
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Eric K Nakakura
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Carlos U Corvera
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA.
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Luu HY, Nguyen TC. Commentary: 10,000 hours or 10,000 cases? An argument for regionalization of coronary and cardiac valve surgery in the new era. J Thorac Cardiovasc Surg 2020; 164:1804-1805. [PMID: 33454093 DOI: 10.1016/j.jtcvs.2020.11.104] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Hubert Y Luu
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, Calif.
| | - Tom C Nguyen
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, Calif
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Luu HY, Pulcrano ME, Hua HT. Surgical management of middle aortic syndrome in an adult. J Vasc Surg Cases Innov Tech 2020; 6:38-40. [PMID: 32072084 PMCID: PMC7016340 DOI: 10.1016/j.jvscit.2019.10.008] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/28/2019] [Indexed: 11/21/2022]
Abstract
Middle aortic syndrome (MAS), a coarctation of the lower thoracic and/or abdominal aorta, is typically diagnosed and treated in the pediatric population. We present a 48-year-old patient with a long-standing history of hypertension who was lost to follow-up owing to a lack of insurance coverage. After two myocardial infarcts owing to severe hypertension, a vascular workup including a computed tomography angiogram revealed a diagnosis of MAS. He underwent open vascular reconstruction with a thoracoabdominal Dacron bypass graft. He was discharged within 1 week with no hypertension or claudication. Adult patients diagnosed with MAS should undergo open or endovascular surgical repair with close follow-up.
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Affiliation(s)
- Hubert Y. Luu
- Department of Surgery, University of California San Francisco, San Francisco, Calif
| | - Marisa E. Pulcrano
- Department of Surgery, University of California San Francisco, San Francisco, Calif
- Correspondence: Marisa E. Pulcrano, MD, Resident Physician, Department of Surgery, University of California San Francisco, San Francisco, California, 513 Parnassus Ave, S-321, San Francisco, CA 94143
| | - Hong Ton Hua
- Department of Vascular Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, Calif
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Chen F, Jimenez RJ, Sharma K, Luu HY, Hsu BY, Ravindranathan A, Stohr BA, Willenbring H. Broad Distribution of Hepatocyte Proliferation in Liver Homeostasis and Regeneration. Cell Stem Cell 2019; 26:27-33.e4. [PMID: 31866223 DOI: 10.1016/j.stem.2019.11.001] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/06/2019] [Accepted: 11/07/2019] [Indexed: 12/30/2022]
Abstract
Hepatocyte proliferation is the principal mechanism for generating new hepatocytes in liver homeostasis and regeneration. Recent studies have suggested that this ability is not equally distributed among hepatocytes but concentrated in a small subset of hepatocytes acting like stem cells, located around the central vein or distributed throughout the liver lobule and exhibiting active WNT signaling or high telomerase activity, respectively. These findings were obtained by utilizing components of these growth regulators as markers for genetic lineage tracing. Here, we used random lineage tracing to localize and quantify clonal expansion of hepatocytes in normal and injured liver. We found that modest proliferation of hepatocytes distributed throughout the lobule maintains the hepatocyte mass and that most hepatocytes proliferate to regenerate it, with diploidy providing a growth advantage over polyploidy. These results show that the ability to proliferate is broadly distributed among hepatocytes rather than limited to a rare stem cell-like population.
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Affiliation(s)
- Feng Chen
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA 94143, USA.
| | - Robert J Jimenez
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Khushbu Sharma
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA 94143, USA; College of Arts and Sciences, University of San Francisco, San Francisco, CA 94117, USA
| | - Hubert Y Luu
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA 94143, USA; Division of General Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Bernadette Y Hsu
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA 94143, USA; Biomedical Sciences Graduate Program, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Ajay Ravindranathan
- Division of Surgical Pathology, Department of Pathology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Bradley A Stohr
- Division of Surgical Pathology, Department of Pathology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Holger Willenbring
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA 94143, USA; Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA 94143, USA; Liver Center, University of California, San Francisco, San Francisco, CA 94143, USA.
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Luu HY, Zobel MJ, Jonzzon S, Lin M, Lee D, Eichler C, Lin MYC. Predictors and Outcomes of Paramedian Incisional Hernia After Anterior Spine Exposure. J Surg Res 2019; 247:380-386. [PMID: 31753554 DOI: 10.1016/j.jss.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/22/2019] [Accepted: 10/01/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Anterior exposures for lumbar spine surgery are increasingly common for treating various spinal pathologies. A retroperitoneal approach via a paramedian incision has grown rapidly in popularity, but little is known about the risk of incisional hernia development with this technique. We sought to assess the incidence of paramedian incisional hernia development and identify risk factors that are associated with occurrence. MATERIALS AND METHODS We conducted a retrospective review of all patients who underwent anterior lumbar spine exposure by a paramedian approach between 2012 and 2017 at a single, tertiary medical center. The primary outcome was the development of postoperative paramedian incisional hernia. RESULTS Of the 735 patients included in the study, 445 (60.5%) were women, and the mean (standard deviation) age of all patients was 60 y (12.4). Nearly all (97.4%) paramedian approaches were performed with a vascular surgeon present. Median follow-up time was 10 mo (interquartile range 3.5-19.9). Postoperative paramedian hernia developed in 20 patients (2.7%), of which 14 underwent repair. The mean (standard deviation) size of the hernia was 13.5 cm (5.5); 9 of 14 (64%) were repaired with synthetic mesh, whereas 3 of 14 (21%) required bowel resection. On multivariate analysis, risk factors associated with hernia development were male gender (0.045), higher American Society of Anesthesiologists class (0.039), history of abdominal surgery (P = 0.013), and postoperative intensive care unit admission (P = 0.02). CONCLUSIONS A paramedian approach for anterior lumbar spine exposure resulted in a low rate of incisional hernia with minimal morbidity. Surgeons involved in these collaborative procedures should consider the risk factors that predispose patients to develop these hernias.
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Affiliation(s)
- Hubert Y Luu
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Michael J Zobel
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Soren Jonzzon
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Michele Lin
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Danny Lee
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Charles Eichler
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, California
| | - Matthew Y C Lin
- Division of General Surgery and Minimally Invasive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California.
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Klempner SJ, Bhangoo MS, Luu HY, Kim ST, Chao J, Kim KM, Lee J. Low ATM expression and progression-free and overall survival in advanced gastric cancer patients treated with first-line XELOX chemotherapy. J Gastrointest Oncol 2018; 9:1198-1206. [PMID: 30603142 PMCID: PMC6286926 DOI: 10.21037/jgo.2018.09.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 07/08/2018] [Accepted: 08/14/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Gastric cancer (GC) is a leading cause of cancer-specific mortality with limited biologically informed treatments. The ataxia telangiectasia mutated (ATM) gene is critically involved in the repair of double-stranded DNA breaks and a component of DNA damage repair (DDR) pathways. Platinum salts are hypothesized to have increased efficacy in tumors deficient in DDR pathways. We sought to investigate an association between ATM status and response to XELOX in a homogenous first line GC patient cohort. METHODS A clinically annotated cohort of 137 Korean patients with advanced GC treated with first-line XELOX was retrospectively examined for ATM status by immunohistochemistry. Correlation between ATM expression and clinicopathologic variables was performed by two-tailed, unpaired t-tests and Fisher's exact tests. Kaplan-Meier survival analysis curves and Cox proportional hazards models were used to evaluate for independent predictors of disease-free survival (DFS) and overall survival (OS). RESULTS Low ATM expression was observed in 19.0% (26/137) of patients and was not associated with clinicopathologic features or response rate to XELOX. Univariate, but not multivariable, logistic regression and Cox analysis identified ATM as an independent risk factor influencing OS and DFS. A higher ECOG score independently predicted worse survival [hazard ratio (HR) 2.96, P=0.016] and complete surgical resection independently protected against progression of disease (HR 0.69, P=0.007). CONCLUSIONS Low ATM expression was not associated with increased response rates to XELOX in a single-institution cohort of advanced GC patients. Similarly, ATM status did not predict DFS or OS after platinum-based chemotherapy.
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Affiliation(s)
- Samuel J. Klempner
- The Angeles Clinic and Research Institute, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Hubert Y. Luu
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Seung Tae Kim
- Department of Medicine, Samsung Medical Center, Seoul, Korea
| | - Joseph Chao
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Kyoung-Mee Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Seoul, Korea
| | - Jeeyun Lee
- Department of Medicine, Samsung Medical Center, Seoul, Korea
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Bhangoo MS, Luu HY, Kim ST, Lee J, Chao J, Klempner SJ. Abstract 5543: Low ATM expression is associated with improved progression-free and overall survival in advanced gastric cancer patients treated with platinum-based chemotherapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-5543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Platinum-based combination chemotherapy regimens represent standard approaches for locally advanced and metastatic gastric adenocarcinoma. Ataxia-teleangiectasia mutated protein (ATM) plays a critical role in repairing DNA damage to double-stand breaks. Tumors deficient in ATM (defined as pathologic loss measured by IHC) are hypothesized to demonstrate increased susceptibility platinum chemotherapy.
Methods: We retrospectively reviewed patients from a single center (Samsung Medical Center, Seoul, South Korea) with advanced, unresectable gastric cancer (stage 3b or higher) receiving capecitabine/oxaliplatin (XELOX) from 2013-2017. Clinicopathologic data, treatment response, progression-free survival (PFS), and overall survival (OS) were analyzed according to level of ATM expression by immunohistochemistry (IHC). Low-expression of ATM was defined as greater than 50% loss by IHC. Two-tailed, unpaired t-tests and Fisher's exact tests were used to compare outcomes between patients with preserved ATM versus low ATM expression. Kaplan-Meier survival analysis was used to compare disease-free survival and overall survival; the log-rank test was used to determine statistical significance.
Results: During the study period, 138 patients underwent treatment with XELOX for a diagnosis of advanced gastric cancer. Median (IQR) follow-up time was 11.8 mo. (6.8-17.3). Between patients with ATMintact or ATMlow, there were no significant differences in mean age, sex, final pathologic diagnosis, or mean number of cycles of chemotherapy received. Kaplan-Meier analysis demonstrated that patients with ATM low were associated with a longer PFS (ATMlow 14.9 mo versus ATMintact 6.8 mo.) (HR 0.24, [0.18-0.34, 95% CI], p<0.0001), and longer OS (ATMlow 30.0 mo. versus ATMintact 14.7) (HR 0.23, [0.17-0.33, 95% CI], p<0.0001). There was no difference in response rates between the two groups.
Conclusions: This retrospective, case-control study in patients with advanced gastric cancer shows improved survival in patients with ATMlow tumors compared with ATMintact tumors after treatment with platinum-based chemotherapy. Findings are suggestive and require prospective validation in cohorts of patients with ATMlow/ATMintact tumors.
Citation Format: Munveer S. Bhangoo, Hubert Y. Luu, Seung Tae Kim, Jeeyun Lee, Joseph Chao, Samuel J. Klempner. Low ATM expression is associated with improved progression-free and overall survival in advanced gastric cancer patients treated with platinum-based chemotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5543.
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Affiliation(s)
| | - Hubert Y. Luu
- 2University of California, San Francisco, San Francisco, CA
| | | | - Jeeyun Lee
- 3Samsung Medical Center, Seoul, Republic of Korea
| | | | - Samuel J. Klempner
- 5The Angeles Clinic and Research Institute; Cedars-Sinai Medical Center, Los Angeles, CA
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Luu HY, Bhangoo MS, Lin MYC. A Rare Cause of Small-Bowel Ischemia. JAMA Surg 2018; 153:81-82. [PMID: 29188271 DOI: 10.1001/jamasurg.2017.4595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Hubert Y Luu
- Department of Surgery, University of California, San Francisco
| | - Munveer S Bhangoo
- Division of Hematology-Oncology, Scripps Clinic, La Jolla, California
| | - Matthew Y C Lin
- Department of Surgery, University of California, San Francisco
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Luu HY, Ulloa JG, Roll GR, Freise CE. Emesis following laparoscopic left donor nephrectomy. Am J Transplant 2014; 14:1701; quiz 1700, 1702. [PMID: 24954467 DOI: 10.1111/ajt.12685] [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: 01/25/2023]
Affiliation(s)
- H Y Luu
- Department of Surgery, University of California, San Francisco, San Francisco, CA
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