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Opitz I, Bille A, Dafni U, Nackaerts K, Ampollini L, de Perrot M, Brcic L, Nadal E, Syrigos K, Gray SG, Aerts J, Curioni-Fontecedro A, Rüschoff JH, Monkhorst K, Weynand B, Silini EM, Bavaghar-Zaeimi F, Jakopovic M, Llatjos R, Tsimpoukis S, Finn SP, von der Thüsen J, Marti N, Dimopoulou G, Kammler R, Peters S, Stahel RA, Falcoz PE, Brunelli A, Baas P. European Epidemiology of Pleural Mesothelioma-Real-Life Data From a Joint Analysis of the Mesoscape Database of the European Thoracic Oncology Platform and the European Society of Thoracic Surgery Mesothelioma Database. J Thorac Oncol 2023; 18:1233-1247. [PMID: 37356802 DOI: 10.1016/j.jtho.2023.06.011] [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: 08/12/2022] [Revised: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Pleural mesothelioma (PM) is an aggressive malignancy with increasing prevalence and poor prognosis. Real-life data are a unique approach to reflect the reality of PM epidemiology, treatment, and prognosis in Europe. METHODS A joint analysis of the European Thoracic Oncology Platform Mesoscape and the European Society of Thoracic Surgeons (ESTS) databases was performed to better understand the characteristics and epidemiology of PM, including histologic subtype, staging, and treatment. Overall survival (OS) was assessed, adjusting for parameters of clinical interest. RESULTS The analysis included 2766 patients (Mesoscape: 497/10 centers/ESTS: 2269/77 centers). The primary histologic subtype was epithelioid (71%), with 57% patients on stages III to IV. Within Mesoscape, the patients received either multimodality (59%) or palliative intention treatment (41%). The median follow-up was 47.2 months, on the basis of 1103 patients (Mesoscape: 491/ESTS: 612), with 823 deaths, and median OS was 17.4 months. In multivariable analysis, female sex, epithelioid subtype, and lower stage were associated with longer OS, when stratifying by cohort, age, and Eastern Cooperative Oncology Group Performance Status. Within Mesoscape, multimodality treatment including surgery was predictive of longer OS (hazard ratio = 0.56, 95% confidence interval: 0.45-0.69), adjusting for sex, histologic subtype, and Eastern Cooperative Oncology Group Performance Status. Overall, surgical candidates with a macroscopic complete resection had a significantly longer median OS compared with patients with R2 (25.2 m versus 16.4 m; log-rank p < 0.001). CONCLUSIONS This combined European Thoracic Oncology Platform/ESTS database analysis offers one of the largest databases with detailed clinical and pathologic outcome. Our finding reflects a benefit for selected patients that undergo multimodality treatment, including macroscopic complete resection, and represents a valuable resource to inform the epidemiology and treatment options for individual patients.
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Affiliation(s)
- Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
| | - Andrea Bille
- Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Urania Dafni
- ETOP IBCSG Partners Foundation Statistical Center, Frontier Science Foundation-Hellas & University of Athens, Athens, Greece
| | - Kristiaan Nackaerts
- Department of Respiratory Oncology, University Hospitals KU Leuven, Leuven, Belgium
| | - Luca Ampollini
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Marc de Perrot
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Luka Brcic
- Institute of Pathology, Medical Faculty University of Zagreb, Zagreb, Croatia; Current: Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Ernest Nadal
- Department of Medical Oncology, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet, Barcelona, Spain
| | - Konstantinos Syrigos
- Medical School of Athens, National and Kapodistrian University, Sotiria General Hospital, Athens, Greece
| | - Steven G Gray
- Thoracic Oncology, St James's Hospital and Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Joachim Aerts
- Thoracic Oncology Department, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Jan H Rüschoff
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Kim Monkhorst
- Division of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Birgit Weynand
- Department of Pathology, University Hospitals KU Leuven, Leuven, Belgium
| | | | - Fatemeh Bavaghar-Zaeimi
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marko Jakopovic
- Department for Lung Diseases, University Hospital Centre Zagreb & University of Zagreb, Zagreb, Croatia
| | - Roger Llatjos
- Department of Pathology, Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain
| | - Sotirios Tsimpoukis
- Medical School of Athens, National and Kapodistrian University, Sotiria General Hospital, Athens, Greece
| | - Stephen P Finn
- Department of Histopathology and Cancer Molecular Diagnostics, St James's Hospital and Trinity College, Dublin, Ireland
| | - Jan von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nesa Marti
- Translational Research Coordination, ETOP IBCSG Partners Foundation Coordinating Center, Bern, Switzerland
| | - Georgia Dimopoulou
- ETOP IBCSG Partners Foundation Statistical Center, Frontier Science Foundation-Hellas, Athens, Greece
| | - Roswitha Kammler
- Translational Research Coordination, ETOP IBCSG Partners Foundation Coordinating Center, Bern, Switzerland
| | - Solange Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV) and Lausanne University, Lausanne, Switzerland
| | | | | | - Alessandro Brunelli
- European Society of Thoracic Surgeons and Department of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom
| | - Paul Baas
- Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Akhoundova D, Haberecker M, Fritsch R, Höller S, Kiessling MK, Rechsteiner M, Rüschoff JH, Curioni-Fontecedro A. Targeting ALK in Neuroendocrine Tumors of the Lung. Front Oncol 2022; 12:911294. [PMID: 35756632 PMCID: PMC9214311 DOI: 10.3389/fonc.2022.911294] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background Anaplastic lymphoma kinase (ALK) rearrangements are known oncogenic drivers in non-small cell lung cancer (NSCLC). Few case reports described the occurrence of such rearrangements in large cell neuroendocrine carcinomas (LCNECs) of the lung without information on clinical responses to ALK tyrosine kinase inhibitors (TKIs) in these cases. Currently, neuroendocrine tumors of the lungs are not screened for ALK rearrangements. Methods To illustrate the clinical impact of molecular characterization in LCNECs, we report the disease course in three patients with ALK-rearranged metastatic LCNEC from our clinical routine, as well as their treatment response to ALK TKIs (index cases). To gain insight into the prevalence of ALK rearrangements in neuroendocrine tumors of the lung, we analyzed a retrospective cohort of 436 tumor biopsies including LCNEC (n = 61), small cell lung cancer (SCLC) (n = 206), typical (n = 91) and atypical (n = 69) carcinoids, and mixed histology (n = 9) for the presence of ALK rearrangements using a sequential diagnostic algorithm. ALK immunohistochemistry (IHC) was evaluable in 362 cases; fluorescence in situ hybridization (FISH) was evaluable in 28 out of the 35 IHC-positive cases, followed by next-generation sequencing (NGS) that was available in 12 cases. Results Within the retrospective cohort, ALK IHC was positive in 35 out of 362 (9.7%) evaluable samples. FISH was positive in 3 out of the 28 (10.7%) evaluable cases: 2 with atypical carcinoids and 1 with LCNEC. Additionally, the 3 index cases showed positive ALK IHC, which was confirmed by NGS. Within the retrospective cohort, NGS confirmed the presence of an ALK genomic rearrangement in one FISH-positive atypical carcinoid where material was sufficient for sequencing. Two out of three patients with metastatic ALK-rearranged LCNEC received up-front treatment with the ALK TKI alectinib and showed rapid tumor response at all metastatic sites, including multiple brain metastases. Conclusions ALK rearrangements represent rare but targetable oncogenic driver alterations in LCNEC. Contrarily to NSCLC, the detection of ALK rearrangements in neuroendocrine tumors of the lung is challenging, since ALK IHC can lead to false-positive results and therefore needs confirmation by FISH or NGS. Up-front comprehensive molecular profiling with NGS should be performed in metastatic LCNEC in order not to miss actionable genomic alterations.
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Affiliation(s)
- Dilara Akhoundova
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland.,Department of Medical Oncology, Inselspital, University Hospital of Bern, Bern, Switzerland.,Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Martina Haberecker
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Ralph Fritsch
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Sylvia Höller
- Institute of Pathology, Stadtspital Zurich Triemli, Zurich, Switzerland
| | - Michael K Kiessling
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland.,Department of Internal Medicine-Oncology, See Spital Horgen, Horgen, Switzerland
| | - Markus Rechsteiner
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Jan H Rüschoff
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
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Laudicella R, Rüschoff JH, Ferraro DA, Brada MD, Hausmann D, Mebert I, Maurer A, Hermanns T, Eberli D, Rupp NJ, Burger IA. Infiltrative growth pattern of prostate cancer is associated with lower uptake on PSMA PET and reduced diffusion restriction on mpMRI. Eur J Nucl Med Mol Imaging 2022; 49:3917-3928. [PMID: 35435496 PMCID: PMC9399036 DOI: 10.1007/s00259-022-05787-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/29/2022] [Indexed: 01/21/2023]
Abstract
Purpose Recently, a significant association was shown between novel growth patterns on histopathology of prostate cancer (PCa) and prostate-specific membrane antigen (PSMA) uptake on [68Ga]PSMA-PET. It is the aim of this study to evaluate the association between these growth patterns and ADC (mm2/1000 s) values in comparison to [68Ga]PSMA uptake on PET/MRI. Methods We retrospectively evaluated patients who underwent [68Ga]PSMA PET/MRI for staging or biopsy guidance, followed by radical prostatectomy at our institution between 07/2016 and 01/2020. The dominant lesion per patient was selected based on histopathology and correlated to PET/MRI in a multidisciplinary meeting, and quantified using SUVmax for PSMA uptake and ADCmean for diffusion restriction. PCa growth pattern was classified as expansive (EXP) or infiltrative (INF) according to its properties of forming a tumoral mass or infiltrating diffusely between benign glands by two independent pathologists. Furthermore, the corresponding WHO2016 ISUP tumor grade was evaluated. The t test was used to compare means, Pearson’s test for categorical correlation, Cohen’s kappa test for interrater agreement, and ROC curve to determine the best cutoff. Results Sixty-two patients were included (mean PSA 11.7 ± 12.5). The interrater agreement between both pathologists was almost perfect with κ = 0.81. While 25 lesions had an EXP-growth with an ADCmean of 0.777 ± 0.109, 37 showed an INF-growth with a significantly higher ADCmean of 1.079 ± 0.262 (p < 0.001). We also observed a significant difference regarding PSMA SUVmax for the EXP-growth (19.2 ± 10.9) versus the INF-growth (9.4 ± 6.2, p < 0.001). Within the lesions encompassing the EXP- or the INF-growth, no significant correlation between the ISUP groups and ADCmean could be observed (p = 0.982 and p = 0.861, respectively). Conclusion PCa with INF-growth showed significantly lower SUVmax and higher ADCmean values compared to PCa with EXP-growth. Within the growth groups, ADCmean values were independent from ISUP grading. Supplementary information The online version contains supplementary material available at 10.1007/s00259-022-05787-9.
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Affiliation(s)
- Riccardo Laudicella
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 10, 8091, Zurich, Switzerland
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Jan H Rüschoff
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniela A Ferraro
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 10, 8091, Zurich, Switzerland
- Department of Radiology and Oncology, Faculdade de Medicina, FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Muriel D Brada
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Hausmann
- Department of Radiology, Kantonsspital Baden, Baden, Switzerland
- Department of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Iliana Mebert
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 10, 8091, Zurich, Switzerland
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexander Maurer
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 10, 8091, Zurich, Switzerland
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Niels J Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Irene A Burger
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 10, 8091, Zurich, Switzerland.
- Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland.
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Alijaj N, Pavlovic B, Martel P, Rakauskas A, Cesson V, Saba K, Hermanns T, Oechslin P, Veit M, Provenzano M, Rüschoff JH, Brada MD, Rupp NJ, Poyet C, Derré L, Valerio M, Banzola I, Eberli D. Identification of Urine Biomarkers to Improve Eligibility for Prostate Biopsy and Detect High-Grade Prostate Cancer. Cancers (Basel) 2022; 14:cancers14051135. [PMID: 35267445 PMCID: PMC8909910 DOI: 10.3390/cancers14051135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary The screening of prostate cancer (PCa), based on the serum prostate specific antigen (PSA), is characterized by a high number of false positives, leading to overdiagnosis of healthy men and overtreatment of indolent PCa. This clinical problem severely affects the quality of life of patients, who would benefit from more specific risk stratification models. By performing a mass spectrometry (MS) screening on urine samples collected prior to prostate biopsy, we identified novel biomarkers and validated them by ELISA. Here, we show that an upfront urine test, based on quantitative biomarkers and patient age, has a higher performance compared to PSA (AUC = 0.6020) and is a feasible method to improve the eligibility criteria for prostate biopsy, to detect healthy men (AUC = 0.8196) and clinically significant PCa, thereby reducing the number of unnecessary prostate biopsies. Abstract PCa screening is based on the measurements of the serum prostate specific antigen (PSA) to select men with higher risks for tumors and, thus, eligible for prostate biopsy. However, PSA testing has a low specificity, leading to unnecessary biopsies in 50–75% of cases. Therefore, more specific screening opportunities are needed to reduce the number of biopsies performed on healthy men and patients with indolent tumors. Urine samples from 45 patients with elevated PSA were collected prior to prostate biopsy, a mass spectrometry (MS) screening was performed to identify novel biomarkers and the best candidates were validated by ELISA. The urine quantification of PEDF, HPX, CD99, CANX, FCER2, HRNR, and KRT13 showed superior performance compared to PSA. Additionally, the combination of two biomarkers and patient age resulted in an AUC of 0.8196 (PSA = 0.6020) and 0.7801 (PSA = 0.5690) in detecting healthy men and high-grade PCa, respectively. In this study, we identified and validated novel urine biomarkers for the screening of PCa, showing that an upfront urine test, based on quantitative biomarkers and patient age, is a feasible method to reduce the number of unnecessary prostate biopsies and detect both healthy men and clinically significant PCa.
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Affiliation(s)
- Nagjie Alijaj
- Department of Urology, University Hospital of Zürich and University of Zürich, 8006 Zürich, Switzerland; (N.A.); (B.P.)
| | - Blaz Pavlovic
- Department of Urology, University Hospital of Zürich and University of Zürich, 8006 Zürich, Switzerland; (N.A.); (B.P.)
| | - Paul Martel
- Department of Urology, Urology Research Unit and Urology Biobank, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (P.M.); (A.R.); (V.C.); (L.D.); (M.V.)
| | - Arnas Rakauskas
- Department of Urology, Urology Research Unit and Urology Biobank, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (P.M.); (A.R.); (V.C.); (L.D.); (M.V.)
| | - Valérie Cesson
- Department of Urology, Urology Research Unit and Urology Biobank, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (P.M.); (A.R.); (V.C.); (L.D.); (M.V.)
| | - Karim Saba
- Department of Urology, University Hospital of Zürich, 8091 Zürich, Switzerland; (K.S.); (T.H.); (P.O.); (M.V.); (M.P.); (C.P.); (D.E.)
| | - Thomas Hermanns
- Department of Urology, University Hospital of Zürich, 8091 Zürich, Switzerland; (K.S.); (T.H.); (P.O.); (M.V.); (M.P.); (C.P.); (D.E.)
| | - Pascal Oechslin
- Department of Urology, University Hospital of Zürich, 8091 Zürich, Switzerland; (K.S.); (T.H.); (P.O.); (M.V.); (M.P.); (C.P.); (D.E.)
| | - Markus Veit
- Department of Urology, University Hospital of Zürich, 8091 Zürich, Switzerland; (K.S.); (T.H.); (P.O.); (M.V.); (M.P.); (C.P.); (D.E.)
| | - Maurizio Provenzano
- Department of Urology, University Hospital of Zürich, 8091 Zürich, Switzerland; (K.S.); (T.H.); (P.O.); (M.V.); (M.P.); (C.P.); (D.E.)
| | - Jan H. Rüschoff
- Department of Pathology and Molecular Pathology, University Hospital of Zürich, 8091 Zürich, Switzerland; (J.H.R.); (M.D.B.); (N.J.R.)
| | - Muriel D. Brada
- Department of Pathology and Molecular Pathology, University Hospital of Zürich, 8091 Zürich, Switzerland; (J.H.R.); (M.D.B.); (N.J.R.)
| | - Niels J. Rupp
- Department of Pathology and Molecular Pathology, University Hospital of Zürich, 8091 Zürich, Switzerland; (J.H.R.); (M.D.B.); (N.J.R.)
- Faculty of Medicine, University of Zürich, 8032 Zürich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital of Zürich, 8091 Zürich, Switzerland; (K.S.); (T.H.); (P.O.); (M.V.); (M.P.); (C.P.); (D.E.)
| | - Laurent Derré
- Department of Urology, Urology Research Unit and Urology Biobank, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (P.M.); (A.R.); (V.C.); (L.D.); (M.V.)
| | - Massimo Valerio
- Department of Urology, Urology Research Unit and Urology Biobank, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (P.M.); (A.R.); (V.C.); (L.D.); (M.V.)
| | - Irina Banzola
- Department of Urology, University Hospital of Zürich and University of Zürich, 8006 Zürich, Switzerland; (N.A.); (B.P.)
- Correspondence: ; Tel.: +41762503737
| | - Daniel Eberli
- Department of Urology, University Hospital of Zürich, 8091 Zürich, Switzerland; (K.S.); (T.H.); (P.O.); (M.V.); (M.P.); (C.P.); (D.E.)
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Arvaniti E, Fricker KS, Moret M, Rupp N, Hermanns T, Fankhauser C, Wey N, Wild PJ, Rüschoff JH, Claassen M. Author Correction: Automated Gleason grading of prostate cancer tissue microarrays via deep learning. Sci Rep 2021; 11:23032. [PMID: 34815456 PMCID: PMC8611014 DOI: 10.1038/s41598-021-02195-1] [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] [Indexed: 11/24/2022] Open
Affiliation(s)
- Eirini Arvaniti
- Institute for Molecular Systems Biology, ETH Zurich, Zurich, Switzerland.,Swiss Institute of Bioinformatics (SIB), Zurich, Switzerland
| | - Kim S Fricker
- Department of Pathology and Molecular Pathology, University of Zurich, Zurich, Switzerland
| | - Michael Moret
- Institute for Molecular Systems Biology, ETH Zurich, Zurich, Switzerland
| | - Niels Rupp
- Department of Pathology and Molecular Pathology, University of Zurich, Zurich, Switzerland
| | - Thomas Hermanns
- Department of Urology, University of Zurich, Zurich, Switzerland
| | | | - Norbert Wey
- Department of Pathology and Molecular Pathology, University of Zurich, Zurich, Switzerland
| | - Peter J Wild
- Department of Pathology and Molecular Pathology, University of Zurich, Zurich, Switzerland.,Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Frankfurt, Germany
| | - Jan H Rüschoff
- Department of Pathology and Molecular Pathology, University of Zurich, Zurich, Switzerland.
| | - Manfred Claassen
- Institute for Molecular Systems Biology, ETH Zurich, Zurich, Switzerland. .,Swiss Institute of Bioinformatics (SIB), Zurich, Switzerland.
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Rüschoff JH, Stratton S, Roberts E, Clark S, Sebastiao N, Fankhauser CD, Eberli D, Moch H, Wild PJ, Rupp NJ. A novel 5x multiplex immunohistochemical staining reveals PSMA as a helpful marker in prostate cancer with low p504s expression. Pathol Res Pract 2021; 228:153667. [PMID: 34717149 DOI: 10.1016/j.prp.2021.153667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/24/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022]
Abstract
The ability to combine multiple immunohistochemical (IHC) markers within a single tissue section facilitates the evaluation and detection of co-expressions, while saving tissue. A newly developed 5x multiplex (MPX) IHC staining of five different IHC markers (Basal cell cocktail (34βE12 + p63), p504s (SP116), ERG (EPR3864), Ki-67 (30-9), PSMA (EP192)) was applied on whole sections of n = 37 radical prostatectomies (RPE) including normal and cancerous tissue. Four different colors including brown, magenta, yellow and teal coded for different stainings, whereas magenta was used twice for nuclear Ki-67 and cytosolic / membranous PSMA. The staining of multiplex IHC was compared to single stains of ERG, PSMA and p504s. The proper staining of the basal cell cocktail and Ki-67 could be assessed by internal positive controls in the multiplex staining. The proportion of PSMA and p504s expression revealed a significant correlation between multiplex and single stains (p < 0.01) as well as a concordant staining pattern for ERG (n = 14 prostate cancers were identified ERG positive with both methods). Our proof of concept study demonstrates a robust staining pattern of all five different antibodies with this newly developed 5x MPX IHC. This approach facilitates the recognition of prostate cancer, in particular by adding PSMA in cases with low p504s expression.
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Affiliation(s)
- Jan H Rüschoff
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | | | | | | | | | - Christian D Fankhauser
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich; Department of Urology, The Christie NHS Foundation Trusts, Manchester, UK
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Peter J Wild
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Frankfurt am Main, Germany; Frankfurt Institute for Advanced Studies (FIAS), Frankfurt am Main, Germany
| | - Niels J Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Lobo J, Ohashi R, Helmchen BM, Rupp NJ, Rüschoff JH, Moch H. The Morphological Spectrum of Papillary Renal Cell Carcinoma and Prevalence of Provisional/Emerging Renal Tumor Entities with Papillary Growth. Biomedicines 2021; 9:1418. [PMID: 34680535 PMCID: PMC8533532 DOI: 10.3390/biomedicines9101418] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 09/17/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 12/11/2022] Open
Abstract
Renal cell carcinoma (RCC) represents a heterogeneous disease, encompassing an increasing number of tumor subtypes. Post-2016, the World Health Organization (WHO) classification recognized that the spectrum of papillary renal cell carcinoma is evolving and has long surpassed the dichotomic simplistic "type 1 versus type 2" classification. The differential diagnosis of pRCC includes several new provisional/emerging entities with papillary growth. Type 2 tumors have been cleared out of several confounding entities, now regarded as independent tumors with specific clinical and molecular backgrounds. In this work we describe the prevalence and characteristics of emerging papillary tumor entities in two renal tumor cohorts (one consisting of consecutive papillary tumors from a single institute, the other consisting of consultation cases from several centers). After a review of 154 consecutive pRCC cases, 58% remained type 1 pRCC, and 34% type 2 pRCC. Papillary renal neoplasm with reversed polarity (1.3%), biphasic hyalinizing psammomatous RCC (1.3%), and biphasic squamoid/alveolar RCC (4.5%) were rare. Among 281 consultation cases, 121 (43%) tumors had a dominant papillary growth (most frequently MiT family translocation RCCs, mucinous tubular and spindle cell carcinoma and clear cell papillary RCC). Our data confirm that the spectrum of RCCs with papillary growth represents a major diagnostical challenge, frequently requiring a second expert opinion. Papillary renal neoplasm with reversed polarity, biphasic hyalinizing psammomatous RCC, and biphasic squamoid/alveolar RCC are rarely sent out for a second opinion, but correct classification and knowledge of these variants will improve our understanding of the clinical behavior of renal tumors with papillary growth.
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Affiliation(s)
- João Lobo
- Department of Pathology, Portuguese Oncology Institute of Porto (IPOP), R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal;
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC), R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
- Department of Pathology and Molecular Immunology, ICBAS—School of Medicine and Biomedical Sciences, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, 4050-513 Porto, Portugal
| | - Riuko Ohashi
- Histopathology Core Facility, Faculty of Medicine, Niigata University, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata 951-8510, Japan;
- Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata 951-8510, Japan
| | - Birgit M. Helmchen
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland; (B.M.H.); (N.J.R.); (J.H.R.)
| | - Niels J. Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland; (B.M.H.); (N.J.R.); (J.H.R.)
| | - Jan H. Rüschoff
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland; (B.M.H.); (N.J.R.); (J.H.R.)
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland; (B.M.H.); (N.J.R.); (J.H.R.)
- Faculty of Medicine, University of Zurich, Rämistrasse 71, 8006 Zurich, Switzerland
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8
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Rüschoff JH, Ferraro DA, Muehlematter UJ, Laudicella R, Hermanns T, Rodewald AK, Moch H, Eberli D, Burger IA, Rupp NJ. What's behind 68Ga-PSMA-11 uptake in primary prostate cancer PET? Investigation of histopathological parameters and immunohistochemical PSMA expression patterns. Eur J Nucl Med Mol Imaging 2021; 48:4042-4053. [PMID: 34386839 PMCID: PMC8484204 DOI: 10.1007/s00259-021-05501-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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: 04/24/2021] [Accepted: 07/18/2021] [Indexed: 02/07/2023]
Abstract
Purpose Prostate-specific membrane antigen (PSMA-) PET has become a promising tool in staging and restaging of prostate carcinoma (PCa). However, specific primary tumour features might impact accuracy of PSMA-PET for PCa detection. We investigated histopathological parameters and immunohistochemical PSMA expression patterns on radical prostatectomy (RPE) specimens and correlated them to the corresponding 68Ga-PSMA-11-PET examinations. Methods RPE specimens of 62 patients with preoperative 68Ga-PSMA-11-PET between 2016 and 2018 were analysed. WHO/ISUP grade groups, growth pattern (expansive vs. infiltrative), tumour area and diameter as well as immunohistochemical PSMA heterogeneity, intensity and negative tumour area (PSMA%neg) were correlated with spatially corresponding SUVmax on 68Ga-PSMA-11-PET in a multidisciplinary analysis. Results All tumours showed medium to strong membranous (2–3 +) and weak to strong cytoplasmic (1–3 +) PSMA expression. Heterogeneously expressed PSMA was found in 38 cases (61%). Twenty-five cases (40%) showed at least 5% and up to 80% PSMA%neg. PSMA%neg, infiltrative growth pattern, smaller tumour area and diameter and WHO/ISUP grade group 2 significantly correlated with lower SUVmax values. A ROC curve analysis revealed 20% PSMA%neg as an optimal cutoff with the highest sensitivity and specificity (89% and 86%, AUC 0.923) for a negative PSMA-PET scan. A multiple logistic regression model revealed tumoural PSMA%neg (p < 0.01, OR = 9.629) and growth pattern (p = 0.0497, OR = 306.537) as significant predictors for a negative PSMA-PET scan. Conclusions We describe PSMA%neg, infiltrative growth pattern, smaller tumour size and WHO/ISUP grade group 2 as parameters associated with a lower 68Ga-PSMA-11 uptake in prostate cancer. These findings can serve as fundament for future biopsy-based biomarker development to enable an individualized, tumour-adapted imaging approach. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05501-1.
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Affiliation(s)
- Jan H Rüschoff
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniela A Ferraro
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Urs J Muehlematter
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Riccardo Laudicella
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ann-Katrin Rodewald
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Irene A Burger
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland
| | - Niels J Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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9
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Charmpi K, Guo T, Zhong Q, Wagner U, Sun R, Toussaint NC, Fritz CE, Yuan C, Chen H, Rupp NJ, Christiansen A, Rutishauser D, Rüschoff JH, Fankhauser C, Saba K, Poyet C, Hermanns T, Oehl K, Moore AL, Beisel C, Calzone L, Martignetti L, Zhang Q, Zhu Y, Martínez MR, Manica M, Haffner MC, Aebersold R, Wild PJ, Beyer A. Convergent network effects along the axis of gene expression during prostate cancer progression. Genome Biol 2020; 21:302. [PMID: 33317623 PMCID: PMC7737297 DOI: 10.1186/s13059-020-02188-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023] Open
Abstract
Background Tumor-specific genomic aberrations are routinely determined by high-throughput genomic measurements. It remains unclear how complex genome alterations affect molecular networks through changing protein levels and consequently biochemical states of tumor tissues. Results Here, we investigate the propagation of genomic effects along the axis of gene expression during prostate cancer progression. We quantify genomic, transcriptomic, and proteomic alterations based on 105 prostate samples, consisting of benign prostatic hyperplasia regions and malignant tumors, from 39 prostate cancer patients. Our analysis reveals the convergent effects of distinct copy number alterations impacting on common downstream proteins, which are important for establishing the tumor phenotype. We devise a network-based approach that integrates perturbations across different molecular layers, which identifies a sub-network consisting of nine genes whose joint activity positively correlates with increasingly aggressive tumor phenotypes and is predictive of recurrence-free survival. Further, our data reveal a wide spectrum of intra-patient network effects, ranging from similar to very distinct alterations on different molecular layers. Conclusions This study uncovers molecular networks with considerable convergent alterations across tumor sites and patients. It also exposes a diversity of network effects: we could not identify a single sub-network that is perturbed in all high-grade tumor regions.
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Affiliation(s)
- Konstantina Charmpi
- CECAD, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne, Cologne, Germany
| | - Tiannan Guo
- Department of Biology, Institute of Molecular Systems Biology, ETH Zurich, Zurich, Switzerland. .,Zhejiang Provincial Laboratory of Life Sciences and Biomedicine, Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, 310024, China. .,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, 310024, China.
| | - Qing Zhong
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,ProCan®, Children's Medical Research Institute, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, Australia
| | - Ulrich Wagner
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rui Sun
- Zhejiang Provincial Laboratory of Life Sciences and Biomedicine, Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, 310024, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, 310024, China
| | - Nora C Toussaint
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,NEXUS Personalized Health Technologies, ETH Zurich, Zurich, Switzerland.,Swiss Institute of Bioinformatics, Zurich, Switzerland
| | - Christine E Fritz
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Chunhui Yuan
- Zhejiang Provincial Laboratory of Life Sciences and Biomedicine, Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, 310024, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, 310024, China
| | - Hao Chen
- Zhejiang Provincial Laboratory of Life Sciences and Biomedicine, Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, 310024, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, 310024, China
| | - Niels J Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ailsa Christiansen
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dorothea Rutishauser
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan H Rüschoff
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian Fankhauser
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Karim Saba
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Cedric Poyet
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kathrin Oehl
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ariane L Moore
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
| | - Christian Beisel
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
| | | | | | - Qiushi Zhang
- Zhejiang Provincial Laboratory of Life Sciences and Biomedicine, Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, 310024, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, 310024, China
| | - Yi Zhu
- Department of Biology, Institute of Molecular Systems Biology, ETH Zurich, Zurich, Switzerland.,Zhejiang Provincial Laboratory of Life Sciences and Biomedicine, Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, 310024, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, 310024, China
| | | | | | | | - Ruedi Aebersold
- Department of Biology, Institute of Molecular Systems Biology, ETH Zurich, Zurich, Switzerland. .,Faculty of Science, University of Zurich, Zurich, Switzerland.
| | - Peter J Wild
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Germany.
| | - Andreas Beyer
- CECAD, University of Cologne, Cologne, Germany. .,Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne, Cologne, Germany.
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10
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Ferraro DA, Rüschoff JH, Muehlematter UJ, Kranzbühler B, Müller J, Messerli M, Husmann L, Hermanns T, Eberli D, Rupp NJ, Burger IA. Immunohistochemical PSMA expression patterns of primary prostate cancer tissue are associated with the detection rate of biochemical recurrence with 68Ga-PSMA-11-PET. Theranostics 2020; 10:6082-6094. [PMID: 32483440 PMCID: PMC7255040 DOI: 10.7150/thno.44584] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/19/2020] [Indexed: 12/19/2022] Open
Abstract
Prostate-specific membrane antigen (PSMA) targeted PET has a high detection rate for biochemical recurrence (BCR) of prostate cancer (PCa). Nevertheless, even at high prostate-specific antigen (PSA) levels (> 3 ng/ml), a relevant number of PSMA-PET scans are negative, mainly due to PSMA-negative PCa. Our objective was to investigate whether PSMA-expression patterns of the primary tumour on immunohistochemistry (IHC) are associated with PSMA-PET detection rate of recurrent PCa. Methods: Retrospective institutional review board approved single-centre analysis of patients who had undergone 68Ga-PSMA-11-PET for BCR after radical prostatectomy (RPE) between 04/2016 and 07/2019, with tumour specimens available for PSMA-IHC. Clinical information (age, PSA-level, ongoing androgen deprivation therapy (ADT), Gleason score) and PSMA-IHC of the primary tumour were collected and their relationship to results from PSMA-PET (positive/negative) was investigated using a multiple logistic regression analysis. Results: 120 PSMA-PET scans in 74 patients were available for this analysis. Overall detection rate was 62% (74/120 scans), with a mean PSA value at scan time of 0.99 ng/ml (IQR 0.32-4.27). Of the clinical factors, only PSA-level and ADT were associated with PSMA-PET positivity. The percentage of PSMA-negative tumour area on IHC (PSMA%neg) had a significant association to PSMA-PET negativity (OR = 2.88, p < 0.001), while membranous PSMA-expression showed no association (p = 0.73). The positive predictive value of PSMA%neg ≥ 50% for a negative PSMA-PET was 85% (13/11) and for a PSMA%neg of 80% or more, 100% (9/9). Conclusions: PSMA-negative tumour area on IHC exhibited the strongest association with negative PSMA-PET scans, beside PSA-level and ADT. Even at very high PSA levels, PSMA-PET scans were negative in most of the patients with PSMA%neg ≥ 50%.
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11
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Muehlematter UJ, Burger IA, Becker AS, Schawkat K, Hötker AM, Reiner CS, Müller J, Rupp NJ, Rüschoff JH, Eberli D, Donati OF. Diagnostic Accuracy of Multiparametric MRI versus 68Ga-PSMA-11 PET/MRI for Extracapsular Extension and Seminal Vesicle Invasion in Patients with Prostate Cancer. Radiology 2019; 293:350-358. [PMID: 31502937 DOI: 10.1148/radiol.2019190687] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Recent studies have reported the additive value of combined gallium 68 (68Ga)-labeled Glu-urea-Lys (Ahx)-HBED-CC ligand targeting the prostate-specific membrane antigen (PSMA) (hereafter called 68Ga-PSMA-11) PET/MRI for the detection and localization of primary prostate cancer compared with multiparametric MRI. Purpose To compare the diagnostic accuracy and interrater agreement of multiparametric MRI and 68Ga-PSMA-11 PET/MRI for the detection of extracapsular extension (ECE) and seminal vesicle infiltration (SVI) in patients with prostate cancer. Materials and Methods Retrospective analysis of 40 consecutive men who underwent multiparametric MRI and 68Ga-PSMA-11 PET/MRI within 6 months for suspected prostate cancer followed by radical prostatectomy between April 2016 and July 2018. Four readers blinded to clinical and histopathologic findings rated the probability of ECE and SVI at multiparametric MRI and PET/MRI by using a five-point Likert-type scale. The prostatectomy specimen served as the reference standard. Accuracy was assessed with a multireader multicase analysis and by calculating reader-average areas under the receiver operating characteristics curve (AUCs), sensitivity, and specificity for ordinal and dichotomized data in a region-specific and patient-specific approach. Interrater agreement was assessed with the Fleiss multirater κ. Results For multiparametric MRI versus PET/MRI in ECE detection, respectively, AUC, sensitivity, and specificity in the region-specific analysis were 0.67 and 0.75 (P = .07), 28% (21 of 76) and 47% (36 of 76) (P = .09), and 94% (529 of 564) and 90% (509 of 564) (P = .007). For the patient-specific analysis, AUC, sensitivity, and specificity were 0.66 and 0.73 (P = .19), 46% (22 of 48) and 69% (33 of 48) (P = .04), and 75% (84 of 112) and 67% (75 of 112) (P = .19), respectively. For multiparametric MRI versus PET/MRI in SVI detection, respectively, AUC, sensitivity, and specificity of the region-specific analysis were 0.66 and 0.74 (P = .21), 35% (seven of 20) and 50% (10 of 20) (P = .25), and 98% (295 of 300) and 94% (282 of 300) (P < .001). For the patient-specific analysis, AUC, sensitivity, and specificity were 0.65 and 0.79 (P = .25), 35% (seven of 20) and 55% (11 of 20) (P = .20), and 98% (137 of 140) and 94% (131 of 140) (P = .07), respectively. Interrater reliability for multiparametric MRI versus PET/MRI did not differ for ECE (κ, 0.46 vs 0.40; P = .24) and SVI (κ, 0.23 vs 0.33; P = .39). Conclusion Our results suggest that gallium 68 (68Ga)-labeled Glu-urea-Lys (Ahx)-HBED-CC ligand targeting the prostate-specific membrane antigen (PSMA) (68Ga-PSMA-11) PET/MRI and multiparametric MRI perform similarly for local staging of prostate cancer in patients with intermediate-to-high-risk prostate cancer. The increased sensitivity of 68Ga-PSMA-11 PET/MRI for the detection of extracapsular disease comes at the cost of a slightly reduced specificity. © RSNA, 2019.
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Affiliation(s)
- Urs J Muehlematter
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Irene A Burger
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Anton S Becker
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Khoschy Schawkat
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Andreas M Hötker
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Cäcilia S Reiner
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Julian Müller
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Niels J Rupp
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Jan H Rüschoff
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Daniel Eberli
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Olivio F Donati
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
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12
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Rüschoff JH, Gradhand E, Kahraman A, Rees H, Ferguson JL, Curioni-Fontecedro A, Zoche M, Moch H, Vrugt B. STRN -ALK Rearranged Malignant Peritoneal Mesothelioma With Dramatic Response Following Ceritinib Treatment. JCO Precis Oncol 2019; 3:1900048. [PMID: 32914035 PMCID: PMC7446511 DOI: 10.1200/po.19.00048] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2019] [Indexed: 12/27/2022] Open
Affiliation(s)
| | - Elise Gradhand
- Dr Senckenberg Institute of Pathology, University Hospital Frankfurt, Germany
| | | | - Helen Rees
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Jane L Ferguson
- Royal Devon and Exeter National Health Service Foundation Trust, Exeter, United Kingdom
| | | | | | - Holger Moch
- University Hospital Zurich, Zurich, Switzerland
| | - Bart Vrugt
- University Hospital Zurich, Zurich, Switzerland
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13
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Bihr S, Ohashi R, Moore AL, Rüschoff JH, Beisel C, Hermanns T, Mischo A, Corrò C, Beyer J, Beerenwinkel N, Moch H, Schraml P. Expression and Mutation Patterns of PBRM1, BAP1 and SETD2 Mirror Specific Evolutionary Subtypes in Clear Cell Renal Cell Carcinoma. Neoplasia 2019; 21:247-256. [PMID: 30660076 PMCID: PMC6355619 DOI: 10.1016/j.neo.2018.12.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/14/2018] [Accepted: 12/22/2018] [Indexed: 12/16/2022] Open
Abstract
Bi-allelic inactivation of the VHL gene on chromosome 3p is the characteristic feature in most clear cell renal cell carcinomas (ccRCC). Frequent gene alterations were also identified in SETD2, BAP1 and PBRM1, all of which are situated on chromosome 3p and encode histone/chromatin regulators. The relationship between gene mutation, loss of protein expression and the correlations with clinicopathological parameters is important for the understanding of renal cancer progression. We analyzed PBRM1 and BAP1 protein expression as well as the tri-methylation state of H3K36 as a surrogate marker for SETD2 activity in more than 700 RCC samples. In ccRCC loss of nuclear PBRM1 (68%), BAP1 (40%) and H3K36me3 (47%) expression was significantly correlated with each other, advanced tumor stage, poor tumor differentiation (P < .0001 each), and necrosis (P < .005) Targeted next generation sequencing of 83 ccRCC samples demonstrated a significant association of genetic mutations in PBRM1, BAP1, and SETD2 with absence of PBRM1, BAP1, and HEK36me3 protein expression (P < .05, each). By assigning the protein expression patterns to evolutionary subtypes, we revealed similar clinical phenotypes as suggested by TRACERx Renal. Given their important contribution to tumor suppression, we conclude that combined functional inactivation of PBRM1, BAP1, SETD2 and pVHL is critical for ccRCC progression.
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Affiliation(s)
- Svenja Bihr
- Department of Oncology, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - Riuko Ohashi
- Histopathology Core Facility, Niigata University Faculty of Medicine, Niigata, Japan
| | - Ariane L Moore
- Department of Biosystems Science and Engineering, ETH, Zurich, Basel, Switzerland
| | - Jan H Rüschoff
- Department of Pathology and Molecular Pathology, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - Christian Beisel
- Department of Biosystems Science and Engineering, ETH, Zurich, Basel, Switzerland
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - Axel Mischo
- Department of Oncology, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - Claudia Corrò
- Department of Pathology and Molecular Pathology, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - Jörg Beyer
- Department of Oncology, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - Niko Beerenwinkel
- Department of Biosystems Science and Engineering, ETH, Zurich, Basel, Switzerland
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - Peter Schraml
- Department of Pathology and Molecular Pathology, University Hospital Zurich and University Zurich, Zurich, Switzerland.
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14
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Arvaniti E, Fricker KS, Moret M, Rupp N, Hermanns T, Fankhauser C, Wey N, Wild PJ, Rüschoff JH, Claassen M. Automated Gleason grading of prostate cancer tissue microarrays via deep learning. Sci Rep 2018; 8:12054. [PMID: 30104757 PMCID: PMC6089889 DOI: 10.1038/s41598-018-30535-1] [Citation(s) in RCA: 203] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/19/2018] [Indexed: 12/31/2022] Open
Abstract
The Gleason grading system remains the most powerful prognostic predictor for patients with prostate cancer since the 1960s. Its application requires highly-trained pathologists, is tedious and yet suffers from limited inter-pathologist reproducibility, especially for the intermediate Gleason score 7. Automated annotation procedures constitute a viable solution to remedy these limitations. In this study, we present a deep learning approach for automated Gleason grading of prostate cancer tissue microarrays with Hematoxylin and Eosin (H&E) staining. Our system was trained using detailed Gleason annotations on a discovery cohort of 641 patients and was then evaluated on an independent test cohort of 245 patients annotated by two pathologists. On the test cohort, the inter-annotator agreements between the model and each pathologist, quantified via Cohen’s quadratic kappa statistic, were 0.75 and 0.71 respectively, comparable with the inter-pathologist agreement (kappa = 0.71). Furthermore, the model’s Gleason score assignments achieved pathology expert-level stratification of patients into prognostically distinct groups, on the basis of disease-specific survival data available for the test cohort. Overall, our study shows promising results regarding the applicability of deep learning-based solutions towards more objective and reproducible prostate cancer grading, especially for cases with heterogeneous Gleason patterns.
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Affiliation(s)
- Eirini Arvaniti
- Institute for Molecular Systems Biology, ETH Zurich, Zurich, Switzerland.,Swiss Institute of Bioinformatics (SIB), Zurich, Switzerland
| | - Kim S Fricker
- Department of Pathology and Molecular Pathology, University of Zurich, Zurich, Switzerland
| | - Michael Moret
- Institute for Molecular Systems Biology, ETH Zurich, Zurich, Switzerland
| | - Niels Rupp
- Department of Pathology and Molecular Pathology, University of Zurich, Zurich, Switzerland
| | - Thomas Hermanns
- Department of Urology, University of Zurich, Zurich, Switzerland
| | | | - Norbert Wey
- Department of Pathology and Molecular Pathology, University of Zurich, Zurich, Switzerland
| | - Peter J Wild
- Department of Pathology and Molecular Pathology, University of Zurich, Zurich, Switzerland.,Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Frankfurt, Germany
| | - Jan H Rüschoff
- Department of Pathology and Molecular Pathology, University of Zurich, Zurich, Switzerland.
| | - Manfred Claassen
- Institute for Molecular Systems Biology, ETH Zurich, Zurich, Switzerland. .,Swiss Institute of Bioinformatics (SIB), Zurich, Switzerland.
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15
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Zhong Q, Guo T, Rechsteiner M, Rüschoff JH, Rupp N, Fankhauser C, Saba K, Mortezavi A, Poyet C, Hermanns T, Zhu Y, Moch H, Aebersold R, Wild PJ. A curated collection of tissue microarray images and clinical outcome data of prostate cancer patients. Sci Data 2017; 4:170014. [PMID: 28291248 PMCID: PMC5349242 DOI: 10.1038/sdata.2017.14] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 01/05/2017] [Indexed: 01/13/2023] Open
Abstract
Microscopy image data of human cancers provide detailed phenotypes of spatially and morphologically intact tissues at single-cell resolution, thus complementing large-scale molecular analyses, e.g., next generation sequencing or proteomic profiling. Here we describe a high-resolution tissue microarray (TMA) image dataset from a cohort of 71 prostate tissue samples, which was hybridized with bright-field dual colour chromogenic and silver in situ hybridization probes for the tumour suppressor gene PTEN. These tissue samples were digitized and supplemented with expert annotations, clinical information, statistical models of PTEN genetic status, and computer source codes. For validation, we constructed an additional TMA dataset for 424 prostate tissues, hybridized with FISH probes for PTEN, and performed survival analysis on a subset of 339 radical prostatectomy specimens with overall, disease-specific and recurrence-free survival (maximum 167 months). For application, we further produced 6,036 image patches derived from two whole slides. Our curated collection of prostate cancer data sets provides reuse potential for both biomedical and computational studies.
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Affiliation(s)
- Qing Zhong
- Department of Pathology and Molecular Pathology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Tiannan Guo
- Department of Biology, Institute of Molecular Systems Biology, ETH Zurich, 8093 Zurich, Switzerland
| | - Markus Rechsteiner
- Department of Pathology and Molecular Pathology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Jan H Rüschoff
- Department of Pathology and Molecular Pathology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Niels Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, 8091 Zurich, Switzerland
| | | | - Karim Saba
- Department of Urology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Ashkan Mortezavi
- Department of Urology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Yi Zhu
- Department of Biology, Institute of Molecular Systems Biology, ETH Zurich, 8093 Zurich, Switzerland
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Ruedi Aebersold
- Department of Biology, Institute of Molecular Systems Biology, ETH Zurich, 8093 Zurich, Switzerland.,Faculty of Science, University of Zurich, 8057 Zurich, Switzerland
| | - Peter J Wild
- Department of Pathology and Molecular Pathology, University Hospital Zurich, 8091 Zurich, Switzerland.,University of Zurich, 8006 Zurich, Switzerland
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16
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Zhong Q, Rüschoff JH, Guo T, Gabrani M, Schüffler PJ, Rechsteiner M, Liu Y, Fuchs TJ, Rupp NJ, Fankhauser C, Buhmann JM, Perner S, Poyet C, Blattner M, Soldini D, Moch H, Rubin MA, Noske A, Rüschoff J, Haffner MC, Jochum W, Wild PJ. Image-based computational quantification and visualization of genetic alterations and tumour heterogeneity. Sci Rep 2016; 6:24146. [PMID: 27052161 PMCID: PMC4823793 DOI: 10.1038/srep24146] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/22/2016] [Indexed: 12/31/2022] Open
Abstract
Recent large-scale genome analyses of human tissue samples have uncovered a high degree of genetic alterations and tumour heterogeneity in most tumour entities, independent of morphological phenotypes and histopathological characteristics. Assessment of genetic copy-number variation (CNV) and tumour heterogeneity by fluorescence in situ hybridization (ISH) provides additional tissue morphology at single-cell resolution, but it is labour intensive with limited throughput and high inter-observer variability. We present an integrative method combining bright-field dual-colour chromogenic and silver ISH assays with an image-based computational workflow (ISHProfiler), for accurate detection of molecular signals, high-throughput evaluation of CNV, expressive visualization of multi-level heterogeneity (cellular, inter- and intra-tumour heterogeneity), and objective quantification of heterogeneous genetic deletions (PTEN) and amplifications (19q12, HER2) in diverse human tumours (prostate, endometrial, ovarian and gastric), using various tissue sizes and different scanners, with unprecedented throughput and reproducibility.
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Affiliation(s)
- Qing Zhong
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Jan H Rüschoff
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Tiannan Guo
- Institute of Molecular Systems Biology, ETH, Zurich, Switzerland
| | - Maria Gabrani
- Zurich Labouratory, IBM Research-Zurich, Rueschlikon, Switzerland
| | | | - Markus Rechsteiner
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Yansheng Liu
- Institute of Molecular Systems Biology, ETH, Zurich, Switzerland
| | - Thomas J Fuchs
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Niels J Rupp
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Christian Fankhauser
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | | | - Sven Perner
- Department of Prostate Cancer Research, Institute of Pathology, University Hospital of Bonn, Bonn, Germany
| | - Cédric Poyet
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Miriam Blattner
- Institute for Precision Medicine and Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University and New York-Presbyterian Hospital, New York, NY, USA
| | - Davide Soldini
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Holger Moch
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Mark A Rubin
- Institute for Precision Medicine and Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University and New York-Presbyterian Hospital, New York, NY, USA
| | - Aurelia Noske
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Josef Rüschoff
- Targos Molecular Pathology, Pathology Nordhessen, Kassel, Germany
| | - Michael C Haffner
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Wolfram Jochum
- Institute of Pathology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Peter J Wild
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
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17
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Rupp NJ, Schüffler PJ, Zhong Q, Falkner F, Rechsteiner M, Rüschoff JH, Fankhauser C, Drach M, Largo R, Tremp M, Poyet C, Sulser T, Kristiansen G, Moch H, Buhmann J, Müntener M, Wild PJ. Oxygen supply maps for hypoxic microenvironment visualization in prostate cancer. J Pathol Inform 2016; 7:3. [PMID: 26955501 PMCID: PMC4763504 DOI: 10.4103/2153-3539.175376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/26/2015] [Indexed: 12/04/2022] Open
Abstract
Background: Intratumoral hypoxia plays an important role with regard to tumor biology and susceptibility to radio- and chemotherapy. For further investigation of hypoxia-related changes, areas of certain hypoxia must be reliably detected within cancer tissues. Pimonidazole, a 2-nitroimindazole, accumulates in hypoxic tissue and can be easily visualized using immunohistochemistry. Materials and Methods: To improve detection of highly hypoxic versus normoxic areas in prostate cancer, immunoreactivity of pimonidazole and a combination of known hypoxia-related proteins was used to create computational oxygen supply maps of prostate cancer. Pimonidazole was intravenously administered before radical prostatectomy in n = 15 patients, using the da Vinci robot-assisted surgical system. Prostatectomy specimens were immediately transferred into buffered formaldehyde, fixed overnight, and completely embedded in paraffin. Pimonidazole accumulation and hypoxia-related protein expression were visualized by immunohistochemistry. Oxygen supply maps were created using the normalized information from pimonidazole and hypoxia-related proteins. Results: Based on pimonidazole staining and other hypoxia.related proteins (osteopontin, hypoxia-inducible factor 1-alpha, and glucose transporter member 1) oxygen supply maps in prostate cancer were created. Overall, oxygen supply maps consisting of information from all hypoxia-related proteins showed high correlation and mutual information to the golden standard of pimonidazole. Here, we describe an improved computer-based ex vivo model for an accurate detection of oxygen supply in human prostate cancer tissue. Conclusions: This platform can be used for precise colocalization of novel candidate hypoxia-related proteins in a representative number of prostate cancer cases, and improve issues of single marker correlations. Furthermore, this study provides a source for further in situ tests and biochemical investigations
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Affiliation(s)
- Niels J Rupp
- Institute of Surgical Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
| | - Peter J Schüffler
- Department of Computer Science, ETH Zurich, Universitaetstr 6, 8092 Zurich, Switzerland
| | - Qing Zhong
- Institute of Surgical Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
| | - Florian Falkner
- Institute of Pathology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Markus Rechsteiner
- Institute of Surgical Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
| | - Jan H Rüschoff
- Institute of Surgical Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
| | - Christian Fankhauser
- Institute of Surgical Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
| | - Matthias Drach
- Institute of Surgical Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
| | - Remo Largo
- Department of Urology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Mathias Tremp
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Cedric Poyet
- Department of Urology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Tullio Sulser
- Department of Urology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Glen Kristiansen
- Institute of Pathology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Holger Moch
- Institute of Surgical Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
| | - Joachim Buhmann
- Department of Computer Science, ETH Zurich, Universitaetstr 6, 8092 Zurich, Switzerland
| | - Michael Müntener
- Department of Urology, City Hospital Triemli, Birmensdorferstrasse 497, 8063 Zurich, Switzerland
| | - Peter J Wild
- Institute of Surgical Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
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18
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Rothermundt C, Hayoz S, Templeton AJ, Winterhalder R, Strebel RT, Bärtschi D, Pollak M, Lui L, Endt K, Schiess R, Rüschoff JH, Cathomas R, Gillessen S. Metformin in chemotherapy-naive castration-resistant prostate cancer: a multicenter phase 2 trial (SAKK 08/09). Eur Urol 2014; 66:468-74. [PMID: 24412228 DOI: 10.1016/j.eururo.2013.12.057] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/23/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is evidence linking metformin to improved prostate cancer (PCa)-related outcomes. OBJECTIVE To evaluate treatment with metformin in patients with castration-resistant PCa (CRPC) and the effect of the treatment on progression-free survival (PFS) and PSA doubling time (PSA DT). DESIGN, SETTING, AND PARTICIPANTS Forty-four men with progressive metastatic CRPC from 10 Swiss centers were included in this single-arm phase 2 trial between December 2010 and December 2011. INTERVENTION Patients received metformin 1000 mg twice daily until disease progression. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary end point was the absence of disease progression at 12 wk. Simon two-stage optimal design was applied. With a 5% significance level and 90% power, 44 patients were required to test PFS at 12 wk ≤ 15% (H0) compared with ≥ 35% (H1). RESULTS AND LIMITATIONS Thirty-six percent of patients were progression-free at 12 wk, 9.1% were progression-free at 24 wk, and in two patients a confirmed ≥ 50% prostate-specific antigen (PSA) decline was demonstrated. In 23 patients (52.3%) we observed a prolongation of PSA DT after starting metformin. The homeostatic model assessment index fell by 26% from baseline to 12 wk, indicating an improvement in insulin sensitivity. There was a significant change in insulin-like growth factor-1 and insulin-like growth factor binding protein 3 from baseline to 12 wk. Sample size and lack of a control arm are the limitations of this trial; analyses are therefore exploratory. CONCLUSIONS Treatment with metformin is safe in nondiabetic patients, and it yields objective PSA responses and may induce disease stabilization. The activity of metformin in PCa, along with its low cost, favorable toxicity profile, and positive effect on metabolic parameters, suggests that further investigation of metformin as therapy for patients with PCa is of interest. PATIENT SUMMARY In this trial we assessed the use of the diabetes mellitus drug metformin in patients with advanced prostate cancer. We found disease stabilization and prolongation of prostate-specific antigen doubling time in some patients as well as effects on metabolic parameters. TRIAL REGISTRATION This study is registered with ClinicalTrials.gov with the identifier NCT01243385. PREVIOUS PRESENTATION The study was presented at ESMO 2012 (abstract 1460).
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Affiliation(s)
| | | | - Arnoud J Templeton
- Cantonal Hospital St. Gallen, St. Gallen, Switzerland; SAKK Coordinating Center Bern, Bern, Switzerland
| | | | | | | | - Michael Pollak
- Lady Davis Institute for Medical Research Jewish General Hospital Montréal, Montréal, Canada
| | - Lillianne Lui
- Lady Davis Institute for Medical Research Jewish General Hospital Montréal, Montréal, Canada
| | | | | | - Jan H Rüschoff
- Institute of Surgical Pathology University Hospital Zurich, Zurich, Switzerland
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19
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Rössle M, Sigg M, Rüschoff JH, Wild PJ, Moch H, Weber A, Rechsteiner MP. Ultra-deep sequencing confirms immunohistochemistry as a highly sensitive and specific method for detecting BRAF V600E mutations in colorectal carcinoma. Virchows Arch 2013; 463:623-31. [PMID: 24085553 DOI: 10.1007/s00428-013-1492-3] [Citation(s) in RCA: 24] [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] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 09/19/2013] [Accepted: 09/20/2013] [Indexed: 10/26/2022]
Abstract
The activating BRAF (V600) mutation is a well-established negative prognostic biomarker in metastatic colorectal carcinoma (CRC). A recently developed monoclonal mouse antibody (clone VE1) has been shown to detect reliably BRAF (V600E) mutated protein by immunohistochemistry (IHC). In this study, we aimed to compare the detection of BRAF (V600E) mutations by IHC, Sanger sequencing (SaS), and ultra-deep sequencing (UDS) in CRC. VE1-IHC was established in a cohort of 68 KRAS wild-type CRCs. The VE1-IHC was only positive in the three patients with a known BRAF (V600E) mutation as assessed by SaS and UDS. The test cohort consisted of 265 non-selected, consecutive CRC samples. Thirty-nine out of 265 cases (14.7%) were positive by VE1-IHC. SaS of 20 randomly selected IHC negative tumors showed BRAF wild-type (20/20). Twenty-four IHC-positive cases were confirmed by SaS (24/39; 61.5%) and 15 IHC-positive cases (15/39; 38.5%) showed a BRAF wild-type by SaS. UDS detected a BRAF (V600E) mutation in 13 of these 15 discordant cases. In one tumor, the mutation frequency was below our threshold for UDS positivity, while in another case, UDS could not be performed due to low DNA amount. Statistical analysis showed sensitivities of 100% and 63% and specificities of 95 and 100% for VE1-IHC and SaS, respectively, compared to combined results of SaS and UDS. Our data suggests that there is high concordance between UDS and IHC using the anti-BRAF(V600E) (VE1) antibody. Thus, VE1 immunohistochemistry is a highly sensitive and specific method in detecting BRAF (V600E) mutations in colorectal carcinoma.
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Affiliation(s)
- Matthias Rössle
- Institute of Surgical Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland,
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20
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Rechsteiner M, von Teichman A, Rüschoff JH, Fankhauser N, Pestalozzi B, Schraml P, Weber A, Wild P, Zimmermann D, Moch H. KRAS, BRAF, and TP53 Deep Sequencing for Colorectal Carcinoma Patient Diagnostics. J Mol Diagn 2013; 15:299-311. [DOI: 10.1016/j.jmoldx.2013.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 01/07/2013] [Accepted: 02/07/2013] [Indexed: 12/12/2022] Open
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21
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Templeton AJ, Dutoit V, Cathomas R, Rothermundt C, Bärtschi D, Dröge C, Gautschi O, Borner M, Fechter E, Stenner F, Winterhalder R, Müller B, Schiess R, Wild PJ, Rüschoff JH, Thalmann G, Dietrich PY, Aebersold R, Klingbiel D, Gillessen S. Phase 2 trial of single-agent everolimus in chemotherapy-naive patients with castration-resistant prostate cancer (SAKK 08/08). Eur Urol 2013; 64:150-8. [PMID: 23582881 DOI: 10.1016/j.eururo.2013.03.040] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 03/24/2013] [Indexed: 01/15/2023]
Abstract
BACKGROUND The phosphatase and tensin homolog (PTEN) tumor suppressor gene is deregulated in many advanced prostate cancers, leading to activation of the phosphatidylinositol 3-kinase (PI3K)-Akt-mammalian target of rapamycin (mTOR) pathway and thus increased cell survival. OBJECTIVE To evaluate everolimus, an inhibitor of mTOR, in patients with metastatic castration-resistant prostate cancer (mCRPC), and to explore potentially predictive serum biomarkers by proteomics, the significance of PTEN status in tumor tissue, and the impact of everolimus on immune cell subpopulations and function. DESIGN, SETTING, AND PARTICIPANTS A total of 37 chemotherapy-naive patients with mCRPC and progressive disease were recruited to this single-arm phase 2 trial (ClinicalTrials.gov identifier NCT00976755). INTERVENTION Everolimus was administered continuously at a dose of 10mg daily. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary end point was progression-free survival (PFS) at 12 wk defined as the absence of prostate-specific antigen (PSA), radiographic progression, or clinical progression. Groups were compared using Wilcoxon rank-sum tests or Fisher exact tests for continuous and discrete variables, respectively. Time-to-event end points were analyzed using the Kaplan-Meier method and univariate Cox regression. RESULTS AND LIMITATIONS A total of 13 patients (35%; 95% confidence interval, 20-53) met the primary end point. Confirmed PSA response ≥50% was seen in two (5%), and four further patients (11%) had a PSA decline ≥30%. Higher serum levels of carboxypeptidase M and apolipoprotein B were predictive for reaching the primary end point. Deletion of PTEN was associated with longer PFS and response. Treatment was associated with a dose-dependent decrease of CD3, CD4, and CD8 T lymphocytes and CD8 proliferation and an increase in regulatory T cells. Small sample size was the major limitation of the study. CONCLUSIONS Everolimus activity in unselected patients with mCRPC is moderate, but PTEN deletion could be predictive for response. Several serum glycoproteins were able to predict PFS at 12 wk. Prospective validation of these potential biomarkers is warranted. TRIAL REGISTRATION This study is registered with ClinicalTrials.gov with the identifier NCT00976755. Results of this study were presented in part at the 47th Annual Meeting of the American Society of Clinical Oncology (June 3-7, 2011; Chicago, IL, USA) and the annual meeting of the German, Austrian, and Swiss Societies for Oncology and Hematology (September 30-October 4, 2011; Basel, Switzerland).
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Affiliation(s)
- Arnoud J Templeton
- Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
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22
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Rüschoff JH, Brandenburger T, Strehler EE, Filoteo AG, Heinmöller E, Aumüller G, Wilhelm B. Plasma Membrane Calcium ATPase Expression in Human Colon Multistep Carcinogenesis. Cancer Invest 2012; 30:251-7. [DOI: 10.3109/07357907.2012.657817] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jan H. Rüschoff
- Department of Anatomy and Cell Biology, Philipps-University,
Marburg, Germany,1
| | - Timo Brandenburger
- Department of Anesthesiology, University Hospital Düsseldorf,
Düsseldorf, Germany,2
| | - Emanuel E. Strehler
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine,
Rochester, USA,3
| | - Adelaida G. Filoteo
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine,
Rochester, USA,3
| | | | - Gerhard Aumüller
- Department of Anatomy and Cell Biology, Philipps-University,
Marburg, Germany,1
| | - Beate Wilhelm
- Department of Anatomy and Cell Biology, Philipps-University,
Marburg, Germany,1
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