1
|
Behrens S, Lillemoe HA, Dineen SP, Russell MC, Visser B, Berman RS, Farma JM, Grubbs E, Davis JL. ASO Visual Abstract: Perceptions of Readiness for Practice After Complex General Surgical Oncology Fellowship: A Survey Study. Ann Surg Oncol 2024; 31:1204. [PMID: 38036928 DOI: 10.1245/s10434-023-14667-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Shay Behrens
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Heather A Lillemoe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sean P Dineen
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Maria C Russell
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Brendan Visser
- Department of General Surgery, Stanford Hospital, Stanford, CA, USA
| | - Russell S Berman
- Division of Surgical Oncology, Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Elizabeth Grubbs
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeremy L Davis
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
| |
Collapse
|
2
|
Behrens S, Lillemoe HA, Dineen SP, Russell MC, Visser B, Berman RS, Farma JM, Grubbs E, Davis JL. Perceptions of Readiness for Practice After Complex General Surgical Oncology Fellowship: A Survey Study. Ann Surg Oncol 2024; 31:31-41. [PMID: 37936022 PMCID: PMC10695882 DOI: 10.1245/s10434-023-14524-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/16/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Surgical subspecialty training aims to meet the needs of practicing surgeons and their communities. This study investigates career preparedness of Complex General Surgical Oncology (CGSO) fellowship graduates, identifies factors associated with practice readiness, and explores potential opportunities to improve the current training model. METHODS The Society of Surgical Oncology partnered with the National Cancer Institute to conduct a 36-question survey of CGSO fellowship graduates from 2012 to 2022. RESULTS The overall survey response rate was 38% (221/582) with a slight male predominance (63%). Forty-six percent of respondents completed their fellowship after 2019. Factors influencing fellowship program selection include breadth of cancer case exposure (82%), mentor influence (66%), and research opportunities (38%). Overall, graduates reported preparedness for practice; however, some reported unpreparedness in research (18%) and in specific clinical areas: thoracic (43%), hyperthermic intraperitoneal chemotherapy (HIPEC) (15%), and hepato-pancreato-biliary (15%) surgery. Regarding technical preparedness, 70% reported being "very prepared". Respondents indicated lack of preparedness in robotic (63%) and laparoscopic (33%) surgery approaches. Suggestions for training improvement included increased autonomy and case volumes, program development, and research infrastructure. Current practice patterns by graduates demonstrated discrepancies between ideal contracts and actual practice breakdowns, particularly related to the practice of general surgery. CONCLUSIONS This study of CGSO fellowship graduates demonstrates potential gaps between trainee expectations and the realities of surgical oncology practice. Although CGSO fellowship appears to prepare surgeons for careers in surgical oncology, there may be opportunities to refine the training model to better align with the needs of practicing surgical oncologists.
Collapse
Affiliation(s)
- Shay Behrens
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Heather A Lillemoe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sean P Dineen
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Maria C Russell
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Brendan Visser
- Department of General Surgery, Stanford Hospital, Stanford, CA, USA
| | - Russell S Berman
- Division of Surgical Oncology, Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Elizabeth Grubbs
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeremy L Davis
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
| |
Collapse
|
3
|
Rompen IF, Levine J, Habib JR, Sereni E, Mughal N, Hewitt DB, Sacks GD, Welling TH, Simeone DM, Kaplan B, Berman RS, Cohen SM, Wolfgang CL, Javed AA. Progression of Site-Specific Recurrence of Pancreatic Cancer and Implications for Treatment. Ann Surg 2023:00000658-990000000-00687. [PMID: 37870253 DOI: 10.1097/sla.0000000000006142] [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: 10/24/2023]
Abstract
OBJECTIVE This study aimed to analyze post-recurrence progression in context of recurrence sites and assess implications for post-recurrence treatment. BACKGROUND Most patients with resected pancreatic ductal adenocarcinoma (PDAC) recur within two years. Different survival outcomes for location-specific patterns of recurrence are reported, highlighting their prognostic value. However, a lack of understanding of post-recurrence progression and survival remains. METHODS This retrospective analysis included surgically treated PDAC patients at the NYU-Langone Health (2010-2021). Sites of recurrence were identified at time of diagnosis and further follow-up. Kaplan-Meier curves, log-rank test, and Cox-regression analyses were applied to assess survival outcomes. RESULTS Recurrence occurred in 57.3% (196/342) patients with a median time to recurrence of 11.3 months (95%CI:12.6 to 16.5). First site of recurrence was local in 43.9% patients, liver in 23.5%, peritoneal in 8.7%, lung in 3.6%, while 20.4% had multiple sites of recurrence. Progression to secondary sites was observed in 11.7%. Only lung involvement was associated with significantly longer survival after recurrence compared to other sites (16.9 months vs. 8.49 months, P=0.003). In local recurrence, 21 (33.3%) patients were alive after one year without progression to secondary sites. This was associated with a CA19-9 of <100U/ml at time of primary diagnosis (P=0.039), nodal negative disease (P=0.023), and well-moderate differentiation (P=0.042) compared to patients with progression. CONCLUSION Except for lung recurrence, post-recurrence survival after PDAC resection is associated with poor survival. A subset of patients with local-only recurrence do not quickly succumb to systemic spread. This is associated with markers for favorable tumor biology, making them candidates for potential curative re-resections when feasible.
Collapse
Affiliation(s)
- Ingmar F Rompen
- Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jonah Levine
- Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Joseph R Habib
- Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Elisabetta Sereni
- Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Nabiha Mughal
- Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - D Brock Hewitt
- Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Greg D Sacks
- Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Theodore H Welling
- Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Diane M Simeone
- Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Brian Kaplan
- Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Russell S Berman
- Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Steven M Cohen
- Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Christopher L Wolfgang
- Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Ammar A Javed
- Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, the Netherlands
| |
Collapse
|
4
|
Kaslow SR, Sacks GD, Berman RS, Lee AY, Correa-Gallego C. Natural History of Stage IV Pancreatic Cancer. Identifying Survival Benchmarks for Curative-intent Resection in Patients With Synchronous Liver-only Metastases. Ann Surg 2023; 278:e798-e804. [PMID: 36353987 DOI: 10.1097/sla.0000000000005753] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate long-term oncologic outcomes of patients with stage IV pancreatic ductal adenocarcinoma and to identify survival benchmarks for comparison when considering resection in these patients. BACKGROUND Highly selected cohorts of patients with liver-oligometastatic pancreas cancer have reported prolonged survival after resection. The long-term impact of surgery in this setting remains undefined because of a lack of appropriate control groups. METHODS We identified patients with clinical stage IV pancreatic ductal adenocarcinoma with synchronous liver metastases within our cancer registry. We estimated overall survival (OS) among various patient subgroups using the Kaplan-Meier method. To mitigate immortal time bias, we analyzed long-term outcomes of patients who survived beyond 12 months (landmark time) from diagnosis. RESULTS We identified 241 patients. Median OS was 7 months (95% CI, 5-9), both overall and for patients with liver-only metastasis (n=144). Ninety patients (38% of liver only; 40% of whole cohort) survived at least 12 months; those who received chemotherapy in this subgroup had a median OS of 26 months (95% CI, 17-39). Of these patients, those with resectable or borderline resectable primary tumors and resectable liver-only metastasis (n=9, 4%) had a median OS of 39 months (95% CI, 13-NR). CONCLUSIONS The 4% of our cohort that were potentially eligible for surgery experienced a prolonged survival compared with all-comers with stage IV disease. Oncologic outcomes of patients undergoing resection of metastatic pancreas cancer should be assessed in the context of the expected survival of patients potentially eligible for surgery and not relative to all patients with stage IV disease.
Collapse
Affiliation(s)
- Sarah R Kaslow
- Department of Surgery, New York University Grossman School of Medicine, New York City, NY
| | - Greg D Sacks
- Department of Surgery, New York University Grossman School of Medicine, New York City, NY
| | - Russell S Berman
- Department of Surgery, New York University Grossman School of Medicine, New York City, NY
| | - Ann Y Lee
- Department of Surgery, New York University Grossman School of Medicine, New York City, NY
| | - Camilo Correa-Gallego
- Department of Surgery, New York University Grossman School of Medicine, New York City, NY
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY
| |
Collapse
|
5
|
Escobar N, Keshinro A, Hambrecht A, Frangos S, Berman RS, DiMaggio C, Joseph KA, Bukur M, Klein MJ, Ude-Welcome A, Berry C. A Call to Action to Train Underrepresented Minorities in Surgical Subspecialties and Fellowships. J Am Coll Surg 2023; 237:109-116. [PMID: 36946471 DOI: 10.1097/xcs.0000000000000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND With each succession along the surgical career pathway, from medical school to faculty, the percentage of those who identify as underrepresented in medicine (URiM) decreases. We sought to evaluate the demographic trend of surgical fellowship applicants, matriculants, and graduates over time. STUDY DESIGN The Electronic Residency Application Service and the Graduate Medical Education Survey for general surgery fellowships in colorectal surgery, surgical oncology, pediatric surgery, thoracic surgery, and vascular surgery were retrospectively analyzed (2005 to 2020). The data were stratified by race and gender, descriptive statistics were performed, and time series were evaluated. Race/ethnicity groups included White, Asian, other, and URiM, which is defined as Black/African American, Hispanic/Latino(a), Alaskan or Hawaiian Native, and Native American. RESULTS From 2005 to 2020, there were 5,357 Electronic Residency Application Service applicants, 4,559 matriculants, and 4,178 graduates to surgery fellowships. Whites, followed by Asians, represented the highest percentage of applicants (62.7% and 22.3%, respectively), matriculants (65.4% and 23.8% respectively), and graduates (65.4% and 24.0%, respectively). For URiMs, the applicants (13.4%), matriculants (9.1%), and graduates (9.1%) remained significantly low (p < 0.001). When stratified by both race and gender, only 4.6% of the applicants, 2.7% of matriculants, and 2.4% of graduates identified as both URiM and female compared to White female applicants (20.0%), matriculants (17.9%), and graduates (16.5%, p < 0.001). CONCLUSIONS Significant disparities exist for URiMs in general surgery subspecialty fellowships. These results serve as a call to action to re-examine and improve the existing processes to increase the number of URiMs in the surgery subspecialty fellowship training pathway.
Collapse
Affiliation(s)
- Natalie Escobar
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
| | - Ajaratu Keshinro
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
| | - Amanda Hambrecht
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
| | - Spiros Frangos
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
| | - Russell S Berman
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
| | - Charles DiMaggio
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
| | - Kathie-Ann Joseph
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
- the New York University Langone Health Institute for Excellence in Health Equity, New York, NY (Joseph)
| | - Marko Bukur
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
| | - Michael J Klein
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
| | - Akuezunkpa Ude-Welcome
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
| | - Cherisse Berry
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
| |
Collapse
|
6
|
Broman KK, Hughes TM, Bredbeck BC, Sun J, Kirichenko D, Carr MJ, Sharma A, Bartlett EK, Nijhuis AAG, Thompson JF, Hieken TJ, Kottschade L, Downs J, Gyorki DE, Stahlie E, van Akkooi A, Ollila DW, O'shea K, Song Y, Karakousis G, Moncrieff M, Nobes J, Vetto J, Han D, Hotz M, Farma JM, Deneve JL, Fleming MD, Perez M, Baecher K, Lowe M, Bagge RO, Mattsson J, Lee AY, Berman RS, Chai H, Kroon HM, Teras J, Teras RM, Farrow NE, Beasley GM, Hui JYC, Been L, Kruijff S, Sinco B, Sarnaik AA, Sondak VK, Zager JS, Dossett LA. International Center-Level Variation in Utilization of Completion Lymph Node Dissection and Adjuvant Systemic Therapy for Sentinel Lymph Node-Positive Melanoma at Major Referral Centers. Ann Surg 2023; 277:e1106-e1115. [PMID: 35129464 PMCID: PMC10097464 DOI: 10.1097/sla.0000000000005370] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine overall trends and center-level variation in utilization of completion lymph node dissection (CLND) and adjuvant systemic therapy for sentinel lymph node (SLN)-positive melanoma. SUMMARY BACKGROUND DATA Based on recent clinical trials, management options for SLN-positive melanoma now include effective adjuvant systemic therapy and nodal observation instead of CLND. It is unknown how these findings have shaped practice or how these contemporaneous developments have influenced their respective utilization. METHODS We performed an international cohort study at 21 melanoma referral centers in Australia, Europe, and the United States that treated adults with SLN-positive melanoma and negative distant staging from July 2017 to June 2019. We used generalized linear and multinomial logistic regression models with random intercepts for each center to assess center-level variation in CLND and adjuvant systemic treatment, adjusting for patient and disease-specific characteristics. RESULTS Among 1109 patients, performance of CLND decreased from 28% to 8% and adjuvant systemic therapy use increased from 29 to 60%. For both CLND and adjuvant systemic treatment, the most influential factors were nodal tumor size, stage, and location of treating center. There was notable variation among treating centers in management of stage IIIA patients and use of CLND with adjuvant systemic therapy versus nodal observation alone for similar risk patients. CONCLUSIONS There has been an overall decline in CLND and simultaneous adoption of adjuvant systemic therapy for patients with SLN-positive melanoma though wide variation in practice remains. Accounting for differences in patient mix, location of care contributed significantly to the observed variation.
Collapse
Affiliation(s)
- Kristy K Broman
- Moffitt Cancer Center, Tampa, FL
- University of South Florida Morsani College of Medicine, Tampa, FL
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | | | | | | | - Amanda A G Nijhuis
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | | | | | | | | | - Emma Stahlie
- Netherlands Cancer institute, Amsterdam, The Netherlands
| | | | | | | | - Yun Song
- University of Gothenburg, Gothenburg, Sweden
| | | | - Marc Moncrieff
- Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Jenny Nobes
- Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - John Vetto
- Oregon Health & Science University, Portland, OR
| | - Dale Han
- Oregon Health & Science University, Portland, OR
| | | | | | | | | | | | | | | | | | - Jan Mattsson
- University Medical Center, Groningen, Netherlands
| | | | | | - Harvey Chai
- Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
| | - Hidde M Kroon
- Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
| | - Juri Teras
- North Estonia Medical Centre Foundation, Tallinn, Estonia
| | - Roland M Teras
- North Estonia Medical Centre Foundation, Tallinn, Estonia
| | | | | | | | | | | | | | - Amod A Sarnaik
- Moffitt Cancer Center, Tampa, FL
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - Vernon K Sondak
- Moffitt Cancer Center, Tampa, FL
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - Jonathan S Zager
- Moffitt Cancer Center, Tampa, FL
- University of South Florida Morsani College of Medicine, Tampa, FL
| | | |
Collapse
|
7
|
Kaslow SR, Hani L, Cohen SM, Wolfgang CL, Sacks GD, Berman RS, Lee AY, Correa-Gallego C. Outcomes after primary tumor resection of metastatic pancreatic neuroendocrine tumors: An analysis of the National Cancer Database. J Surg Oncol 2023. [PMID: 37042430 DOI: 10.1002/jso.27280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/20/2023] [Accepted: 03/26/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION There is no consensus regarding the role of primary tumor resection for patients with metastatic pancreatic neuroendocrine tumors (panNET). We assessed surgical treatment patterns and evaluated the survival impact of primary tumor resection in patients with metastatic panNET. METHODS Patients with synchronous metastatic nonfunctional panNET in the National Cancer Database (2004-2016) were categorized based on whether they underwent primary tumor resection. We used logistic regressions to assess associations with primary tumor resection. We performed survival analyses with Kaplan-Meier survival functions, log-rank test, and Cox proportional hazard regression within a propensity score matched cohort. RESULTS In the overall cohort of 2613 patients, 68% (n = 839) underwent primary tumor resection. The proportion of patients who underwent primary tumor resection decreased over time from 36% (2004) to 16% (2016, p < 0.001). After propensity score matching on age at diagnosis, median income quartile, tumor grade, size, liver metastasis, and hospital type, primary tumor resection was associated with longer median overall survival (OS) (65 vs. 24 months; p < 0.001) and was associated with lower hazard of mortality (HR: 0.39, p < 0.001). CONCLUSION Primary tumor resection was significantly associated with improved OS, suggesting that, if feasible, surgical resection can be considered for well-selected patients with panNET and synchronous metastasis.
Collapse
Affiliation(s)
- Sarah R Kaslow
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Leena Hani
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Steven M Cohen
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Christopher L Wolfgang
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Greg D Sacks
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Russell S Berman
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Ann Y Lee
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Camilo Correa-Gallego
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
8
|
Kaslow SR, He Y, Sacks GD, Berman RS, Lee AY, Correa-Gallego C. Time to Curative-Intent Surgery in Gastric Cancer Shows a Bimodal Relationship with Overall Survival. J Gastrointest Surg 2023; 27:855-865. [PMID: 36650415 DOI: 10.1007/s11605-023-05585-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Time to treatment (TTT) varies widely for patients with gastric cancer. We aimed to evaluate relationships between time to treatment, overall survival (OS), and other surgical outcomes in patients with stage I-III gastric cancer. METHODS We identified patients with clinical stage I-III gastric cancer who underwent curative-intent gastrectomy within the National Cancer Database (2006-2015) and grouped them by treatment sequence: neoadjuvant chemotherapy or surgery upfront. We defined TTT as weeks from diagnosis to treatment initiation (neoadjuvant chemotherapy or definitive surgical procedure, respectively). Survival differences were assessed by Kaplan-Meier estimate, Cox proportional hazard regression, and log rank test. RESULTS Among the 22,846 patients with stage I-III gastric cancer, most (56%) received surgery upfront. Median TTT was 5 weeks (IQR 4-7) and 6 weeks (IQR 3-9) for patients in the neoadjuvant and surgery upfront groups, respectively. In the neoadjuvant group, increasing TTT was significantly associated with increasing median OS up to TTT of 5 weeks, with no change in median OS when TTT was > 5 weeks. In the surgery group, increasing TTT was significantly associated with increasing median OS up to 6 weeks; however, increasing TTT between 14 and 21 weeks was associated with decreasing median OS. CONCLUSIONS The relationship between time to treatment and survival outcomes is non-linear. Among patients who underwent surgery upfront, the relationship between time to treatment and OS was bimodal, suggesting that deferring definitive surgery, up to 14 weeks, is not associated with worse OS or oncologic outcomes. The relationship between time to treatment and overall survival among patients was bimodal, suggesting that deferring definitive surgery up to 14 weeks is not associated with worse OS.
Collapse
Affiliation(s)
- Sarah R Kaslow
- Department of Surgery, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
| | - Yanjie He
- Department of Surgery, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Greg D Sacks
- Department of Surgery, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Russell S Berman
- Department of Surgery, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Ann Y Lee
- Department of Surgery, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Camilo Correa-Gallego
- Department of Surgery, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| |
Collapse
|
9
|
Kaslow SR, Hani L, Sacks GD, Lee AY, Berman RS, Correa-Gallego C. Regional Patterns of Hospital-Level Guideline Adherence in Gastric Cancer: An Analysis of the National Cancer Database. Ann Surg Oncol 2023; 30:300-308. [PMID: 36123415 DOI: 10.1245/s10434-022-12549-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/17/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Adherence to evidence-based guidelines for gastric cancer is low, particularly at the hospital level, despite a strong association with improved overall survival (OS). We aimed to evaluate patterns of hospital and regional adherence to National Comprehensive Cancer Network guidelines for gastric cancer. METHODS Using the National Cancer Database (2004-2015), we identified patients with stage I-III gastric cancer. Hospital-level guideline adherence was calculated by dividing the patients who received guideline adherent care by the total patients treated at that hospital. OS was estimated for each hospital. Associations between adherence, region, and survival were compared using mixed-effects, hierarchical regression. RESULTS Among 576 hospitals, the median hospital guideline adherence rate was 25% (range 0-76%) and varied significantly by region (p = 0.001). Adherence was highest in the Middle Atlantic (29%) and lowest in the East South Central region (19%); hospitals in the New England, Middle Atlantic, and East North Central regions were more likely to be guideline adherent than those in the East South Central region (all p < 0.05), after adjusting for patient and hospital mix. Most (35%) of the adherence variation was attributable to the hospital. Median 2-year OS varied significantly by region. After adjusting for hospital and patient mix, hazard of mortality was 17% lower in the Middle Atlantic (hazard ratio 0.82, 95% confidence interval 0.74-0.90) relative to the East South Central region, with most of the variation (54%) attributable to patient-level factors. CONCLUSIONS Hospital-level guideline adherence for gastric cancer demonstrated significant regional variation and was associated with longer OS, suggesting that efforts to improve guideline adherence should be directed toward lower-performing hospitals.
Collapse
Affiliation(s)
- Sarah R Kaslow
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA.
| | - Leena Hani
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Greg D Sacks
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Ann Y Lee
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Russell S Berman
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | | |
Collapse
|
10
|
Kaslow SR, Hani L, Sacks GD, Lee AY, Berman RS, Correa-Gallego C. ASO Visual Abstract: Regional Patterns of Hospital-Level Guideline Adherence in Gastric Cancer-An Analysis of the National Cancer Database. Ann Surg Oncol 2023; 30:311-312. [PMID: 36245050 DOI: 10.1245/s10434-022-12651-5] [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: 12/13/2022]
Affiliation(s)
- Sarah R Kaslow
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA.
| | - Leena Hani
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Greg D Sacks
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Ann Y Lee
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Russell S Berman
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | | |
Collapse
|
11
|
Chang GA, Robinson E, Wiggins JM, Zhang Y, Tadepalli JS, Schafer CN, Darvishian F, Berman RS, Shapiro R, Shao Y, Osman I, Polsky D. Associations between TERT Promoter Mutations and Survival in Superficial Spreading and Nodular Melanomas in a Large Prospective Patient Cohort. J Invest Dermatol 2022; 142:2733-2743.e9. [PMID: 35469904 PMCID: PMC9509439 DOI: 10.1016/j.jid.2022.03.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 03/04/2022] [Accepted: 03/21/2022] [Indexed: 01/19/2023]
Abstract
Survival outcomes in melanoma and their association with mutations in the telomerase reverse transcriptase gene TERT promoter remain uncertain. In addition, few studies have examined whether these associations are affected by a nearby common germline polymorphism or vary on the basis of melanoma histopathological subtype. We analyzed 408 primary tumors from a prospective melanoma cohort for somatic TERT-124[C>T] and TERT-146[C>T] mutations, the germline polymorphism rs2853669, and BRAFV600 and NRASQ61 mutations. We tested the associations between these variants and clinicopathologic factors and survival outcomes. TERT-124[C>T] was associated with thicker tumors, ulceration, mitoses (>0/mm2), nodular histotype, and CNS involvement. In a multivariable model controlling for the American Joint Committee on Cancer stage, TERT-124[C>T] was an independent predictor of shorter recurrence-free survival (hazard ratio = 2.58, P = 0.001) and overall survival (hazard ratio = 2.47, P = 0.029). Patients with the germline variant and TERT-124[C>T]-mutant melanomas had significantly shorter recurrence-free survival than those lacking either or both sequence variants (P < 0.04). The impact of the germline variant appeared to be more pronounced in superficial spreading than in nodular melanoma. No associations were found between survival and TERT-146[C>T], BRAF, or NRAS mutations. These findings strongly suggest that TERT-124[C>T] mutation is a biomarker of aggressive primary melanomas, an effect that may be modulated by rs2853669.
Collapse
Affiliation(s)
- Gregory A Chang
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA; Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | - Eric Robinson
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA; Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | - Jennifer M Wiggins
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA; Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | - Yilong Zhang
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA; Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA; Merck, Kenilworth, New Jersey, USA
| | - Jyothirmayee S Tadepalli
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA; Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | - Christine N Schafer
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA; Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | - Farbod Darvishian
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA; Department of Pathology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA
| | - Russell S Berman
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA; Division of Surgical Oncology, Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA
| | - Richard Shapiro
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA; Division of Surgical Oncology, Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA
| | - Yongzhao Shao
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA; Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA
| | - Iman Osman
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA; Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | - David Polsky
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA; Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA; Department of Pathology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA.
| |
Collapse
|
12
|
Leder Macek AJ, Wang A, Turgeon MK, Lee RM, Russell MC, Porembka MR, Alterio R, Ju M, Kronenfeld J, Goel N, Datta J, Maker AV, Fernandez M, Richter H, Berman RS, Correa-Gallego C, Lee AY. Diagnostic laparoscopy is underutilized in the staging of gastric adenocarcinoma regardless of hospital type: An US safety net collaborative analysis. J Surg Oncol 2022; 126:649-657. [PMID: 35699351 PMCID: PMC10029827 DOI: 10.1002/jso.26972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/12/2022] [Accepted: 05/22/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Diagnostic laparoscopy (DL) is a key component of staging for locally advanced gastric adenocarcinoma (GA). We hypothesized that utilization of DL varied between safety net (SNH) and affiliated tertiary referral centers (TRCs). METHODS Patients diagnosed with primary GA eligible for DL were identified from the US Safety Net Collaborative database (2012-2014). Clinicopathologic factors were analyzed for association with use of DL and findings on DL. Overall survival (OS) was analyzed by Kaplan-Meier method. RESULTS Among 233 eligible patients, 69 (30%) received DL, of which 24 (35%) were positive for metastatic disease. Forty percent of eligible SNH patients underwent DL compared to 21.5% at TRCs. Lack of insurance was significantly associated with decreased use of DL (OR 0.48, p < 0.01), while African American (OR 6.87, p = 0.02) and Asian race (OR 3.12, p ≤ 0.01), signet ring cells on biopsy (OR 3.14, p < 0.01), and distal tumors (OR 1.62, p < 0.01) were associated with increased use. Median OS of patients with a negative DL was better than those without DL or a positive DL (not reached vs. 32 vs. 12 months, p < 0.005, Figure 1). CONCLUSIONS Results from DL are a strong predictor of OS in GA; however, the procedure is underutilized. Patients from racial minority groups were more likely to undergo DL, which likely accounts for higher DL rates among SNH patients.
Collapse
Affiliation(s)
- Aleeza J. Leder Macek
- Department of Surgery, Division of Surgical Oncology, NYU Langone Health, New York, New York, USA
| | - Annie Wang
- Department of Surgery, Division of Surgical Oncology, NYU Langone Health, New York, New York, USA
| | - Michael K. Turgeon
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Rachel M. Lee
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Maria C. Russell
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Matthew R. Porembka
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Rodrigo Alterio
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Michelle Ju
- Department of Surgery, Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida, USA
| | - Joshua Kronenfeld
- Department of Surgery, Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida, USA
| | - Neha Goel
- Department of Surgery, Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida, USA
| | - Jashodeep Datta
- Department of Surgery, Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida, USA
| | - Ajay V. Maker
- Department of Surgery, Division of Surgical Oncology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Manuel Fernandez
- Department of Surgery, Division of Surgical Oncology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Harry Richter
- Department of Surgery, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Russell S. Berman
- Department of Surgery, Division of Surgical Oncology, NYU Langone Health, New York, New York, USA
| | - Camilo Correa-Gallego
- Department of Surgery, Division of Surgical Oncology, NYU Langone Health, New York, New York, USA
| | - Ann Y. Lee
- Department of Surgery, Division of Surgical Oncology, NYU Langone Health, New York, New York, USA
| |
Collapse
|
13
|
Kaslow SR, Ma Z, Hani L, Prendergast K, Vitiello G, Lee AY, Berman RS, Goldberg JD, Correa-Gallego C. Adherence to guidelines at the patient- and hospital-levels is associated with improved overall survival in patients with gastric cancer. J Surg Oncol 2022; 126:479-489. [PMID: 35471731 PMCID: PMC9339461 DOI: 10.1002/jso.26895] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/14/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Adherence to evidence-based guidelines in gastric cancer is low. We aimed to evaluate adherence to National Comprehensive Cancer Network (NCCN) Guidelines for gastric cancer at both patient- and hospital-levels and examine associations between guideline adherence and treatment outcomes, including overall survival (OS). METHODS We applied stage-specific, annual NCCN Guidelines (2004-2015) to patients with gastric cancer treated with curative-intent within the National Cancer Database and compared characteristics of patients who did and did not receive guideline-adherent care. Hospitals were evaluated by guideline adherence rate. We identified associations with OS through multivariable Cox regression. RESULTS Of 37 659 patients included, 32% received NCCN Guideline-adherent treatment. OS was significantly associated with both guideline adherence (51 months for patients receiving guideline-adherent treatment vs. 22 for patients receiving nonadherent treatment, p < 0.001). Treatment at a hospital with higher adherence was associated with longer OS (21 months for patients treated at lowest adherence quartile hospitals vs. 37 months at highest adherence quartile hospitals, p < 0.001), regardless of type of treatment received. CONCLUSIONS Guideline-adherent treatment was strongly associated with longer median OS. Guideline adherence should be used as a benchmark for focused quality improvement for physicians taking care of patients with gastric cancer and institutions at large.
Collapse
Affiliation(s)
| | - Zhongyang Ma
- Division of Biostatistics, Departments of Population Health and Environmental Medicine, NYU Grossman School of Medicine
| | - Leena Hani
- Department of Surgery, NYU Grossman School of Medicine
| | | | | | - Ann Y Lee
- Department of Surgery, NYU Grossman School of Medicine
| | | | - Judith D Goldberg
- Division of Biostatistics, Departments of Population Health and Environmental Medicine, NYU Grossman School of Medicine
| | | |
Collapse
|
14
|
Eroglu Z, Broman KK, Thompson JF, Nijhuis A, Hieken TJ, Kottschade L, Farma JM, Hotz M, Deneve J, Fleming M, Bartlett EK, Sharma A, Dossett L, Hughes T, Gyorki DE, Downs J, Karakousis G, Song Y, Lee A, Berman RS, van Akkooi A, Stahlie E, Han D, Vetto J, Beasley G, Farrow NE, Hui JYC, Moncrieff M, Nobes J, Baecher K, Perez M, Lowe M, Ollila DW, Collichio FA, Bagge RO, Mattsson J, Kroon HM, Chai H, Teras J, Sun J, Carr MJ, Tandon A, Babacan NA, Kim Y, Naqvi M, Zager J, Khushalani NI. Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection. J Immunother Cancer 2022; 10:jitc-2021-004417. [PMID: 36002183 PMCID: PMC9413295 DOI: 10.1136/jitc-2021-004417] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/08/2022] Open
Abstract
Until recently, most patients with sentinel lymph node-positive (SLN+) melanoma underwent a completion lymph node dissection (CLND), as mandated in published trials of adjuvant systemic therapies. Following multicenter selective lymphadenectomy trial-II, most patients with SLN+ melanoma no longer undergo a CLND prior to adjuvant systemic therapy. A retrospective analysis of clinical outcomes in SLN+ melanoma patients treated with adjuvant systemic therapy after July 2017 was performed in 21 international cancer centers. Of 462 patients who received systemic adjuvant therapy, 326 patients received adjuvant anti-PD-1 without prior immediate (IM) CLND, while 60 underwent IM CLND. With median follow-up of 21 months, 24-month relapse-free survival (RFS) was 67% (95% CI 62% to 73%) in the 326 patients. When the patient subgroups who would have been eligible for the two adjuvant anti-PD-1 clinical trials mandating IM CLND were analyzed separately, 24-month RFS rates were 64%, very similar to the RFS rates from those studies. Of these no-CLND patients, those with SLN tumor deposit >1 mm, stage IIIC/D and ulcerated primary had worse RFS. Of the patients who relapsed on adjuvant anti-PD-1, those without IM CLND had a higher rate of relapse in the regional nodal basin than those with IM CLND (46% vs 11%). Therefore, 55% of patients who relapsed without prior CLND underwent surgery including therapeutic lymph node dissection (TLND), with 30% relapsing a second time; there was no difference in subsequent relapse between patients who received observation vs secondary adjuvant therapy. Despite the increased frequency of nodal relapses, adjuvant anti-PD-1 therapy may be as effective in SLN+ pts who forego IM CLND and salvage surgery with TLND at relapse may be a viable option for these patients.
Collapse
Affiliation(s)
- Zeynep Eroglu
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA .,University of South Florida, Tampa, Florida, USA
| | - Kristy K Broman
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA,University of South Florida, Tampa, Florida, USA
| | - John F Thompson
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | - Amanda Nijhuis
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, New York, USA
| | - Lisa Kottschade
- Department of Surgery, Mayo Clinic, Rochester, New York, USA
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Meghan Hotz
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Jeremiah Deneve
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Martin Fleming
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Edmund K Bartlett
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Avinash Sharma
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lesly Dossett
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Tasha Hughes
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jennifer Downs
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Giorgos Karakousis
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yun Song
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ann Lee
- Department of Surgery, New York University, New York, New York, USA
| | - Russell S Berman
- Department of Surgery, New York University, New York, New York, USA
| | - Alexander van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Emma Stahlie
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dale Han
- Division of Surgical Oncology, Oregon Health and Science University, Portland, Oregon, USA
| | - John Vetto
- Division of Surgical Oncology, Oregon Health and Science University, Portland, Oregon, USA
| | - Georgia Beasley
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Norma E Farrow
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | | | | | - Jenny Nobes
- Norfolk and Norwich University Hospital, Norwich, UK
| | - Kirsten Baecher
- Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - Matthew Perez
- Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - Michael Lowe
- Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - David W Ollila
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Frances A Collichio
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Roger Olofsson Bagge
- Department of Surgery, Sahlgrenska Center for Cancer Research, University of Gothenburg, Gothenburg, Sweden
| | - Jan Mattsson
- Department of Surgery, Sahlgrenska Center for Cancer Research, University of Gothenburg, Gothenburg, Sweden
| | - Hidde M Kroon
- Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Harvey Chai
- Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Jyri Teras
- North Estonia Medical Centre Foundation, Tallinn, Estonia
| | - James Sun
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Michael J Carr
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Nalan Akgul Babacan
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Younchul Kim
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | - Mahrukh Naqvi
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jonathan Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA,University of South Florida, Tampa, Florida, USA
| | - Nikhil I Khushalani
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA,University of South Florida, Tampa, Florida, USA
| |
Collapse
|
15
|
Nohria A, Kaslow SR, Hani L, He Y, Sacks GD, Berman RS, Lee AY, Correa-Gallego C. Outcomes After Surgical Palliation of Patients With Gastric Cancer. J Surg Res 2022; 279:304-311. [PMID: 35809355 DOI: 10.1016/j.jss.2022.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/06/2022] [Accepted: 06/13/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Surgery is an option for symptom palliation in patients with metastatic gastric cancer. Operative outcomes after palliative interventions are largely unknown. Herein, we assess the trends of surgical palliation use for patients with gastric cancer and describe outcomes of patients undergoing surgical palliation compared to nonsurgical palliation. METHODS Patients with clinical Stage IV gastric cancer in the National Cancer Database (2004-2015) who received surgical or nonsurgical palliation were selected. We identified factors associated with palliative surgery. Survival differences were assessed by Kaplan-Meier estimate, Cox proportional hazard regression, and log rank test. RESULTS Six thousand eight hundred twenty nine patients received palliative care for gastric cancer. Most patients (87%, n = 5944) received nonsurgical palliation: 29% radiation therapy, 57% systemic treatment, and 14% pain management. The number of patients receiving palliative care increased between 2004 and 2015; however, use of surgical palliation declined significantly (22% in 2004, 8% in 2015; P < 0.001). Median overall survival (OS) for the cohort was 5.65 mo (95% confidence interval 5.45-5.85); 1-year and 2-year OS were 24% and 9%, respectively. Older age at diagnosis and diagnosis between 2004 and 2006 were significantly associated with undergoing surgical palliation. Patients who underwent surgical palliation had significantly shorter median OS and a 20% higher hazard of mortality than those who received nonsurgical palliation. CONCLUSIONS Patients with metastatic gastric cancer experience very short survival. While palliative surgery is used infrequently, the observed association with shorter median OS underscores the importance of careful patient selection. Palliative surgery should be offered judiciously and expectations about outcomes clearly established.
Collapse
Affiliation(s)
- Ambika Nohria
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Sarah R Kaslow
- Department of Surgery, New York University Grossman School of Medicine, New York, New York.
| | - Leena Hani
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Yanjie He
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Greg D Sacks
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Russell S Berman
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Ann Y Lee
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Camilo Correa-Gallego
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| |
Collapse
|
16
|
Holmberg CJ, Ny L, Hieken TJ, Block MS, Carr MJ, Sondak VK, Örtenwall C, Katsarelias D, Dimitriou F, Menzies AM, Saw RPM, Rogiers A, Straker RJ, Karakousis G, Applewaite R, Pallan L, Han D, Vetto JT, Gyorki DE, Tie EN, Vitale MG, Ascierto PA, Dummer R, Cohen J, Hui JYC, Schachter J, Asher N, Helgadottir H, Chai H, Kroon H, Coventry B, Rothermel LD, Sun J, Carlino MS, Duncan Z, Broman K, Weber J, Lee AY, Berman RS, Teras J, Ollila DW, Long GV, Zager JS, van Akkooi A, Olofsson Bagge R. The efficacy of immune checkpoint blockade for melanoma in-transit with or without nodal metastases - A multicenter cohort study. Eur J Cancer 2022; 169:210-222. [PMID: 35644725 PMCID: PMC9975793 DOI: 10.1016/j.ejca.2022.03.041] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/16/2022] [Accepted: 03/31/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Guidelines addressing melanoma in-transit metastasis (ITM) recommend immune checkpoint inhibitors (ICI) as a first-line treatment option, despite the fact that there are no efficacy data available from prospective trials for exclusively ITM disease. The study aims to analyze the outcome of patients with ITM treated with ICI based on data from a large cohort of patients treated at international referral clinics. METHODS A multicenter retrospective cohort study of patients treated between January 2015 and December 2020 from Australia, Europe, and the USA, evaluating treatment with ICI for ITM with or without nodal involvement (AJCC8 N1c, N2c, and N3c) and without distant disease (M0). Treatment was with PD-1 inhibitor (nivolumab or pembrolizumab) and/or CTLA-4 inhibitor (ipilimumab). The response was evaluated according to the RECIST criteria modified for cutaneous lesions. RESULTS A total of 287 patients from 21 institutions in eight countries were included. Immunotherapy was first-line treatment in 64 (22%) patients. PD-1 or CTLA-4 inhibitor monotherapy was given in 233 (81%) and 23 (8%) patients, respectively, while 31 (11%) received both in combination. The overall response rate was 56%, complete response (CR) rate was 36%, and progressive disease (PD) rate was 32%. Median PFS was ten months (95% CI 7.4-12.6 months) with a one-, two-, and five-year PFS rate of 48%, 33%, and 18%, respectively. Median MSS was not reached, and the one-, two-, and five-year MSS rates were 95%, 83%, and 71%, respectively. CONCLUSION Systemic immunotherapy is an effective treatment for melanoma ITM. Future studies should evaluate the role of systemic immunotherapy in the context of multimodality therapy, including locoregional treatments such as surgery, intralesional therapy, and regional therapies.
Collapse
Affiliation(s)
- Carl-Jacob Holmberg
- Sahlgrenska Center for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden,Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Ny
- Sahlgrenska Center for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tina J. Hieken
- Department of Surgery, Mayo Clinic, Rochester, USA,Mayo Clinic Cancer Center, Rochester, USA
| | - Matthew S. Block
- Mayo Clinic Cancer Center, Rochester, USA,Department of Oncology, Mayo Clinic, Rochester, USA
| | - Michael J. Carr
- Department of Cutaneous Oncology Moffitt Cancer Center, Tampa, USA
| | - Vernon K. Sondak
- Department of Cutaneous Oncology Moffitt Cancer Center, Tampa, USA
| | - Christoffer Örtenwall
- Sahlgrenska Center for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dimitrios Katsarelias
- Sahlgrenska Center for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Florentia Dimitriou
- Melanoma Institute Australia, The University of Sydney, Sydney Australia,Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland
| | - Alexander M. Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney Australia,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia,Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Robyn PM. Saw
- Melanoma Institute Australia, The University of Sydney, Sydney Australia,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia,Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Aljosja Rogiers
- Melanoma Institute Australia, The University of Sydney, Sydney Australia
| | - Richard J. Straker
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Giorgos Karakousis
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Rona Applewaite
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lalit Pallan
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dale Han
- Division of Surgical Oncology, Department of Surgery, Oregon Health & Science University, Portland, USA
| | - John T. Vetto
- Division of Surgical Oncology, Department of Surgery, Oregon Health & Science University, Portland, USA
| | - David E. Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre and Sir Peter MacCallum Department, University of Melbourne, Melbourne, Australia
| | - Emilia Nan Tie
- Division of Cancer Surgery, Peter MacCallum Cancer Centre and Sir Peter MacCallum Department, University of Melbourne, Melbourne, Australia
| | - Maria Grazia Vitale
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Paulo A. Ascierto
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland
| | - Jade Cohen
- Department of Surgery, University of Minnesota, Minneapolis, USA
| | - Jane YC. Hui
- Department of Surgery, University of Minnesota, Minneapolis, USA
| | - Jacob Schachter
- The Ella Lemelbaum Institite for Immuno-oncology, Sheba Medical Center, Tel Aviv, Israel
| | - Nethanel Asher
- The Ella Lemelbaum Institite for Immuno-oncology, Sheba Medical Center, Tel Aviv, Israel
| | - H. Helgadottir
- Theme Cancer, Karolinska University Hospital, Stockholm, Sweden,Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Harvey Chai
- Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Hidde Kroon
- Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Brendon Coventry
- Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Luke D. Rothermel
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA,Case Western Reserve University, Cleveland, USA
| | - James Sun
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA,Case Western Reserve University, Cleveland, USA
| | - Matteo S. Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney Australia,Department of Medical Oncology, Westmead and Blacktown Hospitals, The Crown Princess Mary Cancer Centre, Sydney, Australia
| | - Zoey Duncan
- University of Alabama at Birmingham, Birmingham, USA
| | - Kristy Broman
- University of Alabama at Birmingham, Birmingham, USA
| | - Jeffrey Weber
- Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, New York, USA
| | - Ann Y. Lee
- Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, New York, USA,NYU Grossman School of Medicine, Department of Surgery, New York, USA
| | - Russell S. Berman
- Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, New York, USA,NYU Grossman School of Medicine, Department of Surgery, New York, USA
| | - Jüri Teras
- North Estonian Medical Centre Foundation, Tallinn, Estonia
| | - David W. Ollila
- Division of Surgical Oncology and Endocrine Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, Sydney Australia,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia,Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Jonathan S. Zager
- Department of Cutaneous Oncology Moffitt Cancer Center, Tampa, USA,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Alexander van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Roger Olofsson Bagge
- Sahlgrenska Center for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
| |
Collapse
|
17
|
Kaslow SR, Prendergast K, Vitiello GA, Hani L, Berman RS, Lee AY, Correa-Gallego C. Systemic therapy for duodenal adenocarcinoma: An analysis of the National Cancer Database (NCDB). Surgery 2022; 172:358-364. [DOI: 10.1016/j.surg.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/21/2022] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
|
18
|
Kaslow SR, Vitiello GA, Prendergast K, Hani L, Cohen SM, Wolfgang C, Berman RS, Lee AY, Correa-Gallego C. Surgical Treatment of Patients with Poorly Differentiated Pancreatic Neuroendocrine Carcinoma: An NCDB Analysis. Ann Surg Oncol 2022; 29:3522-3531. [PMID: 35246811 DOI: 10.1245/s10434-022-11477-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/08/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Consensus guidelines discourage resection of poorly differentiated pancreatic neuroendocrine carcinoma (panNEC) given its association with poor long-term survival. This study assessed treatment patterns and outcomes for this rare malignancy using the National Cancer Database (NCDB). METHODS Patients with non-functional pancreatic neuroendocrine tumors in the NCDB (2004-2016) were categorized based on pathologic differentiation. Logistic and Cox proportional hazard regressions identified associations with resection and overall survival (OS). Survival was compared using Kaplan-Meier and log-rank tests. RESULTS Most patients (83%) in the cohort of 8560 patients had well-differentiated tumors (panNET). The median OS was 47 months (panNET, 63 months vs panNEC, 17 months; p < 0.001). Surgery was less likely for older patients (odds ratio [OR], 0.97), patients with panNEC (OR, 0.27), and patients with metastasis at diagnosis (OR, 0.08) (all p < 0.001). After propensity score-matching of these factors, surgical resection was associated with longer OS (82 vs 29 months; p < 0.001) and a decreased hazard of mortality (hazard ratio [HR], 0.37; p < 0.001). Surgery remained associated with longer OS when stratified by differentiation (98 vs 41 months for patients with panNET and 36 vs 8 months for patients with panNEC). Overall survival did not differ between patients with panNEC who underwent surgery and patients with panNET who did not (both 39 months; p = 0.294). CONCLUSIONS Poorly differentiated panNEC exhibits poorer survival than well-differentiated panNET. In the current cohort, surgical resection was strongly and independently associated with improved OS, suggesting that patients with panNEC who are suitable operative candidates should be considered for multimodality therapy, including surgery.
Collapse
Affiliation(s)
- Sarah R Kaslow
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Gerardo A Vitiello
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Katherine Prendergast
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Leena Hani
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Steven M Cohen
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Christopher Wolfgang
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Russell S Berman
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Ann Y Lee
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Camilo Correa-Gallego
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA.
| |
Collapse
|
19
|
Kaslow SR, Vitiello GA, Prendergast K, Hani L, Cohen SM, Wolfgang C, Berman RS, Lee AY, Correa-Gallego C. ASO Visual Abstract: Surgical Treatment of Patients with Poorly Differentiated Pancreatic Neuroendocrine Carcinoma—An NCDB Analysis. Ann Surg Oncol 2022. [DOI: 10.1245/s10434-022-11526-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
20
|
Kolla AM, Vitiello GA, Friedman EB, Sun J, Potdar A, Daou H, Farrow NE, Farley CR, Vetto JT, Han D, Tariq M, Beasley GM, Contreras CM, Lowe M, Zager JS, Osman I, Berman RS, Liebman TN, Stein JA, Lee AY. Acral Lentiginous Melanoma: A United States Multi-Center Substage Survival Analysis. Cancer Control 2021; 28:10732748211053567. [PMID: 34752172 PMCID: PMC8581784 DOI: 10.1177/10732748211053567] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Acral lentiginous melanoma is associated with worse survival than other subtypes of melanoma. Understanding prognostic factors for survival and recurrence can help better inform follow-up care. Objectives To analyze the clinicopathologic features, melanoma-specific survival, and recurrence-free survival by substage in a large, multi-institutional cohort of primary acral lentiginous melanoma patients. Methods Retrospective review of the United States Melanoma Consortium database, a multi-center prospectively collected database of acral lentiginous melanoma patients treated between January 2000 and December 2017. Results Of the 433 primary acral lentiginous melanoma patients identified (median [range] age: 66 [8–97] years; 53% female, 83% white), 66% presented with stage 0–2 disease and the median time of follow-up for the 392 patients included in the survival analysis was 32.5 months (range: 0–259). The 5-year melanoma-specific survivals by stage were 0 = 100%, I = 93.8%, II = 76.2%, III = 63.4%, IIIA = 80.8%, and IV = 0%. Thicker Breslow depth ((HR) = 1.13; 95% CI = 1.05–1.21; P < .001)) and positive nodal status ((HR) = 1.79; 95% CI = 1.00–3.22; P = .050)) were independent prognostic factors for melanoma-specific survival. Breslow depth ((HR = 1.13; 95% CI = 1.07–1.20; P < .001), and positive nodal status (HR = 2.12; 95% CI = 1.38–3.80; P = .001) were also prognostic factors for recurrence-free survival. Conclusion In this cohort of patients, acral lentiginous melanoma was associated with poor outcomes even in early stage disease, consistent with prior reports. Stage IIB and IIC disease were associated with particularly low melanoma-specific and recurrence-free survival. This suggests that studies investigating adjuvant therapies in stage II patients may be especially valuable in acral lentiginous melanoma patients.
Collapse
Affiliation(s)
- Avani M Kolla
- The Ronald O. Perelman Department of Dermatology, 12297NYU Langone Health, New York, NY, USA
| | | | - Erica B Friedman
- Department of Surgery, 12297NYU Langone Health, New York, NY, USA
| | - James Sun
- Department of Cutaneous Oncology, 25301Moffitt Cancer Center, Tampa, FL, USA
| | - Aishwarya Potdar
- Department of Cutaneous Oncology, 25301Moffitt Cancer Center, Tampa, FL, USA.,Department of Surgery, 33697University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Hala Daou
- Department of Cutaneous Oncology, 25301Moffitt Cancer Center, Tampa, FL, USA.,Department of Surgery, 33697University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Norma E Farrow
- Department of Surgery, 3065Duke University, Durham, NC, USA
| | - Clara R Farley
- Department of Surgery, 1371Emory University, Atlanta, GA, USA
| | - John T Vetto
- Department of Surgery, 6684Oregon Health & Science University, Portland, OR, USA
| | - Dale Han
- Department of Surgery, 6684Oregon Health & Science University, Portland, OR, USA
| | - Marvi Tariq
- Department of Surgery, 1371Emory University, Atlanta, GA, USA
| | | | - Carlo M Contreras
- Department of Surgery, 2647The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Michael Lowe
- Department of Surgery, 1371Emory University, Atlanta, GA, USA
| | - Jonathan S Zager
- Department of Cutaneous Oncology, 25301Moffitt Cancer Center, Tampa, FL, USA.,Department of Surgery, 33697University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Iman Osman
- The Ronald O. Perelman Department of Dermatology, 12297NYU Langone Health, New York, NY, USA
| | - Russell S Berman
- Department of Surgery, 12297NYU Langone Health, New York, NY, USA
| | - Tracey N Liebman
- The Ronald O. Perelman Department of Dermatology, 12297NYU Langone Health, New York, NY, USA
| | - Jennifer A Stein
- The Ronald O. Perelman Department of Dermatology, 12297NYU Langone Health, New York, NY, USA
| | - Ann Y Lee
- Department of Surgery, 12297NYU Langone Health, New York, NY, USA
| |
Collapse
|
21
|
Abstract
Noncutaneous melanomas are rare subtypes of melanoma with high rates of metastatic disease and poor overall survival. One-third to one-half of cases are amelanotic, which may contribute to a delay in diagnosis. Immunohistochemistry staining with typical melanoma markers helps confirm the diagnosis. There is no standard staging system across mucosal melanomas. Elective nodal dissection is not recommended and there is a paucity of data to support use of sentinel lymph node biopsy. Mutational analysis should be routinely performed. Systemic therapy options include targeted inhibitors, immunotherapy, and cytotoxic chemotherapy, although further studies are needed to confirm their efficacy.
Collapse
Affiliation(s)
- Ann Y Lee
- Department of Surgery, NYU Langone Health, 550 1st Avenue, NBV 15N1, New York, NY 10016, USA.
| | - Russell S Berman
- Department of Surgery, NYU Langone Health, 550 1st Avenue, NBV 15N1, New York, NY 10016, USA. https://twitter.com/bermar01
| |
Collapse
|
22
|
Lee AY, Friedman EB, Sun J, Potdar A, Daou H, Farrow NE, Farley CR, Vetto JT, Han D, Tariq M, Shapiro R, Beasley G, Contreras CM, Osman I, Lowe M, Zager JS, Berman RS. Correction to: The Devil's in the Details: Discrepancy Between Biopsy Thickness and Final Pathology in Acral Melanoma. Ann Surg Oncol 2021; 28:876. [PMID: 33893602 DOI: 10.1245/s10434-021-10047-5] [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: 11/18/2022]
Affiliation(s)
- Ann Y Lee
- Department of Surgery, NYU Langone Health, 462 First Ave, NBV 15S6, New York, NY, 10016, USA.
| | - Erica B Friedman
- Department of Surgery, NYU Langone Health, 462 First Ave, NBV 15S6, New York, NY, 10016, USA
| | - James Sun
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Aishwarya Potdar
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Hala Daou
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Clara R Farley
- Department of Surgery, Emory University, Atlanta, GA, USA
| | - John T Vetto
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Dale Han
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Marvi Tariq
- Department of Surgery, Emory University, Atlanta, GA, USA
| | - Richard Shapiro
- Department of Surgery, NYU Langone Health, 462 First Ave, NBV 15S6, New York, NY, 10016, USA
| | | | - Carlo M Contreras
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Iman Osman
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, NY, USA
| | - Michael Lowe
- Department of Surgery, Emory University, Atlanta, GA, USA
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Russell S Berman
- Department of Surgery, NYU Langone Health, 462 First Ave, NBV 15S6, New York, NY, 10016, USA
| |
Collapse
|
23
|
Broman KK, Hughes T, Dossett L, Sun J, Kirichenko D, Carr MJ, Sharma A, Bartlett EK, Nijhuis AAG, Thompson JF, Hieken TJ, Kottschade L, Downs J, Gyorki DE, Stahlie E, van Akkooi A, Ollila DW, Frank J, Song Y, Karakousis G, Moncrieff M, Nobes J, Vetto J, Han D, Farma JM, Deneve JL, Fleming MD, Perez MC, Lowe MC, Olofsson Bagge R, Mattsson J, Lee AY, Berman RS, Chai H, Kroon HM, Teras J, Teras RM, Farrow NE, Beasley G, Hui JYC, Been L, Kruijff S, Kim Y, Naqvi SMH, Sarnaik AA, Sondak VK, Zager JS. Active surveillance of patients who have sentinel node positive melanoma: An international, multi-institution evaluation of adoption and early outcomes after the Multicenter Selective Lymphadenectomy Trial II (MSLT-2). Cancer 2021; 127:2251-2261. [PMID: 33826754 DOI: 10.1002/cncr.33483] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND For patients with sentinel lymph node (SLN)-positive cutaneous melanoma, the Second Multicenter Selective Lymphadenectomy trial demonstrated equivalent disease-specific survival (DSS) with active surveillance using nodal ultrasound versus completion lymph node dissection (CLND). Adoption and outcomes of active surveillance in clinical practice and in adjuvant therapy recipients are unknown. METHODS In a retrospective cohort of SLN-positive adults treated at 21 institutions in Australia, Europe, and the United States from June 2017 to November 2019, the authors evaluated the impact of active surveillance and adjuvant therapy on all-site recurrence-free survival (RFS), isolated nodal RFS, distant metastasis-free survival (DMFS), and DSS using Kaplan-Meier curves and Cox proportional hazard models. RESULTS Among 6347 SLN biopsies, 1154 (18%) were positive and had initial negative distant staging. In total, 965 patients (84%) received active surveillance, 189 (16%) underwent CLND. Four hundred thirty-nine patients received adjuvant therapy (surveillance, 38%; CLND, 39%), with the majority (83%) receiving anti-PD-1 immunotherapy. After a median follow-up of 11 months, 220 patients developed recurrent disease (surveillance, 19%; CLND, 22%), and 24 died of melanoma (surveillance, 2%; CLND, 4%). Sixty-eight patients had an isolated nodal recurrence (surveillance, 6%; CLND, 4%). In patients who received adjuvant treatment without undergoing prior CLND, all isolated nodal recurrences were resectable. On risk-adjusted multivariable analyses, CLND was associated with improved isolated nodal RFS (hazard ratio [HR], 0.36; 95% CI, 0.15-0.88), but not all-site RFS (HR, 0.68; 95% CI, 0.45-1.02). Adjuvant therapy improved all-site RFS (HR, 0.52; 95% CI, 0.47-0.57). DSS and DMFS did not differ by nodal management or adjuvant treatment. CONCLUSIONS Active surveillance has been adopted for most SLN-positive patients. At initial assessment, real-world outcomes align with randomized trial findings, including in adjuvant therapy recipients. LAY SUMMARY For patients with melanoma of the skin and microscopic spread to lymph nodes, monitoring with ultrasound is an alternative to surgically removing the remaining lymph nodes. The authors studied adoption and real-world outcomes of ultrasound monitoring in over 1000 patients treated at 21 centers worldwide, finding that most patients now have ultrasounds instead of surgery. Although slightly more patients have cancer return in the lymph nodes with this strategy, typically, it can be removed with delayed surgery. Compared with up-front surgery, ultrasound monitoring results in the same overall risk of melanoma coming back at any location or of dying from melanoma.
Collapse
Affiliation(s)
- Kristy Kummerow Broman
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida Morsani School of Medicine, Tampa, Florida
| | - Tasha Hughes
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Lesly Dossett
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - James Sun
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Dennis Kirichenko
- Department of Oncologic Sciences, University of South Florida Morsani School of Medicine, Tampa, Florida
| | - Michael J Carr
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Avinash Sharma
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Edmund K Bartlett
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amanda A G Nijhuis
- Department of Surgery, Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - John F Thompson
- Department of Surgery, Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Tina J Hieken
- Department of Surgery, Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Lisa Kottschade
- Department of Surgery, Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Jennifer Downs
- Division of Cancer Surgery, Peter MacCallum Cancer Center, Melbourne, Australia
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Center, Melbourne, Australia
| | - Emma Stahlie
- Division of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Alexander van Akkooi
- Division of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - David W Ollila
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Jill Frank
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Yun Song
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Giorgos Karakousis
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marc Moncrieff
- Department of Plastic Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Jenny Nobes
- Department of Plastic Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - John Vetto
- Department of Surgery, Oregon Health & Science University, Portland, Oregon
| | - Dale Han
- Department of Surgery, Oregon Health & Science University, Portland, Oregon
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | - Martin D Fleming
- Department of Surgery, University of Tennessee, Memphis, Tennessee
| | | | - Michael C Lowe
- Department of Surgery, Emory University, Atlanta, Georgia
| | - Roger Olofsson Bagge
- Department of Surgery, Sahlgrenska Center for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Mattsson
- Department of Surgery, Sahlgrenska Center for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann Y Lee
- Department of Surgery, NYU Langone Health, New York, New York
| | | | - Harvey Chai
- Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia
| | - Hidde M Kroon
- Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia
| | - Juri Teras
- Surgery Clinic, North Estonia Medical Center Foundation, Tallinn, Estonia
| | - Roland M Teras
- Surgery Clinic, North Estonia Medical Center Foundation, Tallinn, Estonia
| | - Norma E Farrow
- Department of Surgery, Duke University, Durham, North Carolina
| | - Georgia Beasley
- Department of Surgery, Duke University, Durham, North Carolina
| | | | - Lukas Been
- Department of Surgical Oncology, University Medical Center, Groningen, the Netherlands
| | - Schelto Kruijff
- Department of Surgical Oncology, University Medical Center, Groningen, the Netherlands
| | - Youngchul Kim
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | | | - Amod A Sarnaik
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida Morsani School of Medicine, Tampa, Florida
| | - Vernon K Sondak
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida Morsani School of Medicine, Tampa, Florida
| | - Jonathan S Zager
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida Morsani School of Medicine, Tampa, Florida
| |
Collapse
|
24
|
Broman KK, Hughes TM, Dossett LA, Sun J, Carr MJ, Kirichenko DA, Sharma A, Bartlett EK, Nijhuis AA, Thompson JF, Hieken TJ, Kottschade L, Downs J, Gyorki DE, Stahlie E, van Akkooi A, Ollila DW, Frank J, Song Y, Karakousis G, Moncrieff M, Nobes J, Vetto J, Han D, Farma J, Deneve JL, Fleming MD, Perez M, Baecher K, Lowe M, Bagge RO, Mattsson J, Lee AY, Berman RS, Chai H, Kroon HM, Teras RM, Teras J, Farrow NE, Beasley GM, Hui JY, Been L, Kruijff S, Boulware D, Sarnaik AA, Sondak VK, Zager JS. Surveillance of Sentinel Node-Positive Melanoma Patients with Reasons for Exclusion from MSLT-II: Multi-Institutional Propensity Score Matched Analysis. J Am Coll Surg 2021; 232:424-431. [PMID: 33316427 PMCID: PMC8764869 DOI: 10.1016/j.jamcollsurg.2020.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND In sentinel lymph node (SLN)-positive melanoma, two randomized trials demonstrated equivalent melanoma-specific survival with nodal surveillance vs completion lymph node dissection (CLND). Patients with microsatellites, extranodal extension (ENE) in the SLN, or >3 positive SLNs constitute a high-risk group largely excluded from the randomized trials, for whom appropriate management remains unknown. STUDY DESIGN SLN-positive patients with any of the three high-risk features were identified from an international cohort. CLND patients were matched 1:1 with surveillance patients using propensity scores. Risk of any-site recurrence, SLN-basin-only recurrence, and melanoma-specific mortality were compared. RESULTS Among 1,154 SLN-positive patients, 166 had ENE, microsatellites, and/or >3 positive SLN. At 18.5 months median follow-up, 49% had recurrence (vs 26% in patients without high-risk features, p < 0.01). Among high-risk patients, 52 (31%) underwent CLND and 114 (69%) received surveillance. Fifty-one CLND patients were matched to 51 surveillance patients. The matched cohort was balanced on tumor, nodal, and adjuvant treatment factors. There were no significant differences in any-site recurrence (CLND 49%, surveillance 45%, p = 0.99), SLN-basin-only recurrence (CLND 6%, surveillance 14%, p = 0.20), or melanoma-specific mortality (CLND 14%, surveillance 12%, p = 0.86). CONCLUSIONS SLN-positive patients with microsatellites, ENE, or >3 positive SLN constitute a high-risk group with a 2-fold greater recurrence risk. For those managed with nodal surveillance, SLN-basin recurrences were more frequent, but all-site recurrence and melanoma-specific mortality were comparable to patients treated with CLND. Most recurrences were outside the SLN-basin, supporting use of nodal surveillance for SLN-positive patients with microsatellites, ENE, and/or >3 positive SLN.
Collapse
Affiliation(s)
- Kristy K Broman
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL; Department of Oncologic Sciences, University of South Florida, Tampa, FL; Department of Surgery, University of Alabama at Birmingham.
| | - Tasha M Hughes
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Lesly A Dossett
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - James Sun
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL; Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Michael J Carr
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL
| | | | - Avinash Sharma
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Edmund K Bartlett
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amanda Ag Nijhuis
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | | | - Lisa Kottschade
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN
| | - Jennifer Downs
- Division of Cancer Surgery, Peter MacCallum Cancer Center, Melbourne, Australia
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Center, Melbourne, Australia
| | - Emma Stahlie
- Division of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alexander van Akkooi
- Division of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - David W Ollila
- Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Jill Frank
- Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Yun Song
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | | | - Marc Moncrieff
- Department of Plastic Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Jenny Nobes
- Department of Plastic Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - John Vetto
- Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Dale Han
- Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Jeffrey Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Jeremiah L Deneve
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Martin D Fleming
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Matthew Perez
- Department of Surgery, Emory University, Atlanta, GA
| | | | - Michael Lowe
- Department of Surgery, Emory University, Atlanta, GA
| | - Roger Olofsson Bagge
- Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Mattsson
- Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann Y Lee
- Department of Surgery, NYU Langone Health, New York, NY
| | | | - Harvey Chai
- Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia; Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Hidde M Kroon
- Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia; Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Roland M Teras
- Surgery Clinic, North Estonia Medical Centre Foundation, Tallinn, Estonia
| | - Juri Teras
- Surgery Clinic, North Estonia Medical Centre Foundation, Tallinn, Estonia
| | | | | | - Jane Yc Hui
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Lukas Been
- Department of Surgical Oncology, University of Groningen, University Medical Center, Groningen, Netherlands
| | - Schelto Kruijff
- Department of Surgical Oncology, University of Groningen, University Medical Center, Groningen, Netherlands
| | - David Boulware
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL
| | - Amod A Sarnaik
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL; Department of Oncologic Sciences, University of South Florida, Tampa, FL
| | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL; Department of Oncologic Sciences, University of South Florida, Tampa, FL
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL; Department of Oncologic Sciences, University of South Florida, Tampa, FL
| |
Collapse
|
25
|
Chou M, Illa-Bochaca I, Minxi B, Darvishian F, Johannet P, Moran U, Shapiro RL, Berman RS, Osman I, Jour G, Zhong H. Optimization of an automated tumor-infiltrating lymphocyte algorithm for improved prognostication in primary melanoma. Mod Pathol 2021; 34:562-571. [PMID: 33005020 PMCID: PMC7983061 DOI: 10.1038/s41379-020-00686-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 12/11/2022]
Abstract
Tumor-infiltrating lymphocytes (TIL) have potential prognostic value in melanoma and have been considered for inclusion in the American Joint Committee on Cancer (AJCC) staging criteria. However, interobserver discordance continues to prevent the adoption of TIL into clinical practice. Computational image analysis offers a solution to this obstacle, representing a methodological approach for reproducibly counting TIL. We sought to evaluate the ability of a TIL-quantifying machine learning algorithm to predict survival in primary melanoma. Digitized hematoxylin and eosin (H&E) slides from prospectively enrolled patients in the NYU melanoma database were scored for % TIL using machine learning and manually graded by pathologists using Clark's model. We evaluated the association of % TIL with recurrence-free survival (RFS) and overall survival (OS) using Cox proportional hazards modeling and concordance indices. Discordance between algorithmic and manual TIL quantification was assessed with McNemar's test and visually by an attending dermatopathologist. In total, 453 primary melanoma patients were scored using machine learning. Automated % TIL scoring significantly differentiated survival using an estimated cutoff of 16.6% TIL (log-rank P < 0.001 for RFS; P = 0.002 for OS). % TIL was associated with significantly longer RFS (adjusted HR = 0.92 [0.84-1.00] per 10% increase in % TIL) and OS (adjusted HR = 0.90 [0.83-0.99] per 10% increase in % TIL). In comparison, a subset of the cohort (n = 240) was graded for TIL by melanoma pathologists. However, TIL did not associate with RFS between groups (P > 0.05) when categorized as brisk, nonbrisk, or absent. A standardized and automated % TIL scoring algorithm can improve the prognostic impact of TIL. Incorporation of quantitative TIL scoring into the AJCC staging criteria should be considered.
Collapse
Affiliation(s)
- Margaret Chou
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Irineu Illa-Bochaca
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Ben Minxi
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Farbod Darvishian
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | - Paul Johannet
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Una Moran
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Richard L Shapiro
- Division of Surgical Oncology, Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Russell S Berman
- Division of Surgical Oncology, Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Iman Osman
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
| | - George Jour
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA.
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA.
| | - Hua Zhong
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
| |
Collapse
|
26
|
Vitiello GA, Wang A, Lee RM, Russell MC, Yopp A, Ryon EL, Goel N, Luu S, Hsu C, Silberfein E, Correa-Gallego C, Berman RS, Lee AY. Surgical resection of early stage hepatocellular carcinoma improves patient survival at safety net hospitals. J Surg Oncol 2021; 123:963-969. [PMID: 33497478 DOI: 10.1002/jso.26381] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Surgical resection is indicated for hepatocellular carcinoma (HCC) patients with Child A cirrhosis. We hypothesize that surgical intervention and survival are limited by advanced HCC presentation at safety net hospitals (SNHs) versus academic medical centers (AMCs). METHODS Patients with HCC and Child A cirrhosis in the US Safety Net Collaborative (2012-2014) were evaluated. Demographics, clinicopathologic features, operative characteristics, and outcomes were compared between SNHs and AMCs. Liver transplantation was excluded. Kaplan-Meier and Cox proportional-hazards models were used to identify the effect of surgery on overall (OS). RESULTS A total of 689 Child A patients with HCC were identified. SNH patients frequently presented with T3/T4 stage (35% vs. 24%) and metastases (17% vs. 8%; p < .05). SNH patients were as likely to undergo surgery as AMC patients (17% vs. 18%); however, SNH patients were younger (56 vs. 64 years), underwent minor hepatectomy (65% vs. 38%), and frequently harbored well-differentiated tumors (23% vs. 2%; p < .05). On multivariate analysis, surgical resection and stage, but not hospital type, were associated with improved OS. CONCLUSIONS Although SNH patients present with advanced HCC, survival outcomes for early stage HCC are similar at SNHs and AMCs. Identifying barriers to early diagnosis at SNH may increase surgical candidacy and improve outcomes.
Collapse
Affiliation(s)
- Gerardo A Vitiello
- Department of Surgery, New York University Langone Health, New York, New York, USA
| | - Annie Wang
- Department of Surgery, New York University Langone Health, New York, New York, USA
| | - Rachel M Lee
- Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - Maria C Russell
- Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - Adam Yopp
- Department of Surgery, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Emily L Ryon
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Neha Goel
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sommer Luu
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Cary Hsu
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Eric Silberfein
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Russell S Berman
- Department of Surgery, New York University Langone Health, New York, New York, USA
| | - Ann Y Lee
- Department of Surgery, New York University Langone Health, New York, New York, USA
| |
Collapse
|
27
|
Lee AY, Friedman EB, Sun J, Potdar A, Daou H, Farrow NE, Farley CR, Vetto JT, Han D, Tariq M, Shapiro R, Beasley G, Contreras CM, Osman I, Lowe M, Zager JS, Berman RS. The Devil's in the Details: Discrepancy Between Biopsy Thickness and Final Pathology in Acral Melanoma. Ann Surg Oncol 2020; 27:5259-5266. [PMID: 32529271 DOI: 10.1245/s10434-020-08708-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE We hypothesized that initial biopsy may understage acral lentiginous melanoma (ALM) and lead to undertreatment or incomplete staging. Understanding this possibility can potentially aid surgical planning and improve primary tumor staging. METHODS A retrospective review of primary ALMs treated from 2000 to 2017 in the US Melanoma Consortium database was performed. We reviewed pathology characteristics of initial biopsy, final excision specimens, surgical margins, and sentinel lymph node biopsy (SLNB). RESULTS We identified 418 primary ALMs (321 plantar, 34 palmar, 63 subungual) with initial biopsy and final pathology results. Median final thickness was 1.8 mm (range 0.0-19.0). There was a discrepancy between initial biopsy and final pathology thickness in 180 (43%) patients with a median difference of 1.6 mm (range 0.1-16.4). Final T category was increased in 132 patients (32%), including 47% of initially in situ, 32% of T1, 39% of T2, and 28% of T3 lesions. T category was more likely to be increased in subungual (46%) and palmar (38%) melanomas than plantar (28%, p = 0.01). Among patients upstaged to T2 or higher, 71% had ≤ 1-cm margins taken. Among the 27 patients upstaged to T1b or higher, 8 (30%) did not have a SLNB performed, resulting in incomplete initial staging. CONCLUSIONS In this large series of ALMs, final T category was frequently increased on final pathology. A high index of suspicion is necessary for lesions initially in situ or T1 and consideration should be given to performing additional punch biopsies, wider margin excisions, and/or SLNB.
Collapse
Affiliation(s)
- Ann Y Lee
- Department of Surgery, NYU Langone Health, 462 First Ave, NBV 15S6, New York, NY, 10016, USA.
| | - Erica B Friedman
- Department of Surgery, NYU Langone Health, 462 First Ave, NBV 15S6, New York, NY, 10016, USA
| | - James Sun
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Aishwarya Potdar
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Hala Daou
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Clara R Farley
- Department of Surgery, Emory University, Atlanta, GA, USA
| | - John T Vetto
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Dale Han
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Marvi Tariq
- Department of Surgery, Emory University, Atlanta, GA, USA
| | - Richard Shapiro
- Department of Surgery, NYU Langone Health, 462 First Ave, NBV 15S6, New York, NY, 10016, USA
| | | | - Carlo M Contreras
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Iman Osman
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, NY, USA
| | - Michael Lowe
- Department of Surgery, Emory University, Atlanta, GA, USA
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Russell S Berman
- Department of Surgery, NYU Langone Health, 462 First Ave, NBV 15S6, New York, NY, 10016, USA
| |
Collapse
|
28
|
Medina BD, Choi BH, Rodogiannis KG, Moran U, Shapiro RL, Pavlick A, Osman I, Berman RS, Lee AY. Metastasectomy for melanoma is associated with improved overall survival in responders to targeted molecular or immunotherapy. J Surg Oncol 2020; 122:555-561. [DOI: 10.1002/jso.25987] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Benjamin D. Medina
- Division of Surgical Oncology, Department of Surgery New York University Langone Health New York New York
| | - Beatrix Hyemin Choi
- Division of Surgical Oncology, Department of Surgery New York University Langone Health New York New York
| | - Kathy G. Rodogiannis
- Interdisciplinary Melanoma Cooperative Group New York University Langone Health New York New York
| | - Una Moran
- Interdisciplinary Melanoma Cooperative Group New York University Langone Health New York New York
- Ronald O. Perelman Department of Dermatology New York University Langone Health New York New York
| | - Richard L. Shapiro
- Division of Surgical Oncology, Department of Surgery New York University Langone Health New York New York
- Interdisciplinary Melanoma Cooperative Group New York University Langone Health New York New York
| | - Anna Pavlick
- Interdisciplinary Melanoma Cooperative Group New York University Langone Health New York New York
- Division of Hematology and Oncology, Department of Medicine New York University Langone Health New York New York
| | - Iman Osman
- Interdisciplinary Melanoma Cooperative Group New York University Langone Health New York New York
- Ronald O. Perelman Department of Dermatology New York University Langone Health New York New York
| | - Russell S. Berman
- Division of Surgical Oncology, Department of Surgery New York University Langone Health New York New York
- Interdisciplinary Melanoma Cooperative Group New York University Langone Health New York New York
| | - Ann Y. Lee
- Division of Surgical Oncology, Department of Surgery New York University Langone Health New York New York
- Interdisciplinary Melanoma Cooperative Group New York University Langone Health New York New York
| |
Collapse
|
29
|
Chou M, Illa-Bochaca I, Minxi B, Giles KM, Darvishian F, Jour G, Moran U, Shapiro RL, Berman RS, Osman I, Zhong H. Using digital-image analysis of tumor-infiltrating lymphocytes to predict survival outcomes in primary melanoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.10066] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10066 Background: Inclusion of tumor-infiltrating lymphocytes (TIL) into AJCC staging criteria has been proposed due to evidence suggesting its prognostic significance. However, subjective inter-observer discordance prevents adoption of semi-quantitative TIL grading (e.g. absent, non-brisk, brisk) into clinical practice. We hypothesize that digital-image analysis (DIA) of TIL can provide a standardized, quantitative scoring system that more accurately predicts survival compared to currently used semi-quantitative grading methods. Methods: Clinical data and tumor specimens were analyzed from prospectively enrolled primary melanoma patients in the New York University Interdisciplinary Melanoma Cooperative Group with median follow-up of 5 years. H&E-stained slides were digitized using an Aperio ScanScope at 20X magnification. QuPath software was used for automated TIL quantification. Cox regression analysis was used to assess the improved prognostic value of TIL on recurrence-free (RFS) and overall survival (OS). Patients were separated into high- and low-TIL groups using a score threshold determined by the Youden Index. Results: 453 patients (18% stage I, 42% stage II, 40% stage III) were scored using automated TIL assessment and scores were significantly correlated with better RFS and OS per 10% increase in TIL (stage adjusted hazard ratio [aHR] = 0.92 [0.84-1.00] for RFS and aHR = 0.90 [0.83-0.99] for OS). A model combining TIL score with stage increased prognostic ability for both RFS (0.68 to 0.70, P = 0.02) and OS (0.62 to 0.64, P = 0.01), as assessed by concordance indices (C-index). Kaplan-Meier curves of high- ( > 16.6%) versus low-TIL (≤16.6%) patients showed clear separation in RFS and OS (median RFS = 155 vs 48 months, P < 0.001; median OS = 155 vs 89 months, P = 0.002). For comparison, a subset of the cohort (n = 250) was semi-quantitatively graded (absent, non-brisk, brisk) by an attending melanoma pathologist; however, this did not significantly differentiate RFS between groups (P > 0.05). Conclusions: A standardized, quantitative TIL scoring system significantly improved prediction of RFS and OS in primary melanoma patients compared with semi-quantitative TIL grading. Incorporation of quantitative TIL scoring into prognostic algorithms, such as AJCC criteria, should be considered.
Collapse
Affiliation(s)
- Margaret Chou
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Irineu Illa-Bochaca
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Ben Minxi
- School of Life Sciences, Fudan University, Shanghai, NY, China
| | - Keith M. Giles
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Farbod Darvishian
- Department of Pathology, New York University School of Medicine, New York, NY
| | | | - Una Moran
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Richard L. Shapiro
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| | - Russell S. Berman
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| | - Iman Osman
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Hua Zhong
- Department of Population Health, New York University School of Medicine, New York, NY
| |
Collapse
|
30
|
Lee AY, Delman KA, Berman RS. Development of a surgical oncology training curriculum for accreditation. J Surg Oncol 2020; 122:15-20. [PMID: 32424822 DOI: 10.1002/jso.25933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 03/31/2020] [Accepted: 04/05/2020] [Indexed: 11/08/2022]
Abstract
In 2011, the American Board of Surgery announced a new specialty board certification for Complex General Surgical Oncology. The development of a 2-year fellowship training curriculum was based on the core values of multidisciplinary care, surgical management of oncologic disease, education in basic research and clinical trial design, community outreach, patient counseling, and leadership in oncology. This article highlights the elements necessary for developing a fellowship training program in the context of these core values.
Collapse
Affiliation(s)
- Ann Y Lee
- Division of Surgical Oncology, Department of Surgery, NYU Langone Health, New York City, New York
| | - Keith A Delman
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Russell S Berman
- Division of Surgical Oncology, Department of Surgery, NYU Langone Health, New York City, New York
| |
Collapse
|
31
|
Carrano FM, Wang B, Sherman SE, Makarov DV, Berman RS, Newman E, Pachter HL, Melis M. Artificial Intelligence Outperforms Clinical Judgment in Triage for Postoperative ICU Care: Prospective Preliminary Results. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
32
|
Fisher JC, Lee S, Savadamuthu V, Garcia J, Stellakis V, Ude-Welcome A, Berman RS, Pachter LH. Innovative Approach to Evaluating Trainee Operative Skills: Electronic Health Record-Mediated Real-Time Resident Assessment. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
33
|
Abstract
Surgery with or without radiation has always been the mainstay of treatment for patients with non-melanoma skin cancers, including basal cell carcinoma, squamous cell carcinoma, and Merkel cell carcinoma. Until recently, there were no effective systemic therapies for patients with advanced disease. This review will focus on the landmark clinical trials that led to Food and Drug Administration (FDA) approval of Vismodegib for advanced basal cell carcinoma (ERIVANCE BCC) and pembrolizumab for advanced Merkel cell carcinoma (KEYNOTE-017). These trials have not only changed the landscape for patients with metastatic disease but also notably for patients with locally advanced disease that is either unresectable or resectable with high morbidity. Additional mention is made for the clinical trial that led to FDA approval of cemiplimab for advanced cutaneous squamous cell carcinoma (EMPOWER-CSCC-1), which is already changing practice patterns, but for which longer-term data are still needed.
Collapse
Affiliation(s)
- Ann Y Lee
- Department of Surgery, NYU Langone Health, New York, NY, USA.
| | | |
Collapse
|
34
|
Bajaj S, Collado A, Moran U, Donnelly DM, Johannet P, Shapiro RL, Berman RS, Weber JS, Zhong J, Osman I. The solved and unresolved issues of melanoma staging: A comparison of American Joint Committee on Cancer (AJCC) 7th versus 8th edition. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9578] [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: 11/20/2022] Open
Abstract
9578 Background: The recently revised (AJCC) Staging Manual, 8th edition, introduced changes including removal of mitotic index and addition of the IIID substage. There is active debate on the utility of this revision, especially, without the inclusion of a novel prognostic biomarker, during an era of major therapeutic shifts and amidst accrual of adjuvant clinical trials for high-risk resected primary melanoma. We examined whether re-staging primary melanoma patients using the new AJCC 8 system yielded improved prognostication as compared to AJCC 7. Methods: We compared the impact of changes in staging criteria in stage I-III melanoma patients who were prospectively enrolled in a NYU clinicopathological database between January 2010 and December 2016 with active protocol-driven follow up (FU). We assessed primary tumor category (T) and nodal status (N) according to both AJCC 7 and 8. Progression free survival (PFS) and overall survival (OS) curves were generated for both editions and then stratified by substage. We analyzed discordance using Cox Regression Models. Results: 1,379 patients (56% male, mean thickness 1.6, median FU 34.8 months) were included in the analyses. All but one patient remained in the same ‘major’ stage using AJCC 7 and 8 (stage I- 998; II- 224, 225; III- 157, 156) whereas 44% of stage III substage classifications were discordant comparing AJCC 7 to 8. Despite removing mitoses as a criterion for Stage I, there was no significant change between editions in PFS/OS when evaluating major and substages of stage I. Stage IIC patients had worse PFS/OS than stage IIIA patients in AJCC 8 (PFS p = 0.04, OS p = 0.02). AJCC 8, which implemented four rather than three substages, had improved PFS prognostication (c-index = 0.59 vs 0.66, p = 0.05 for AJCC 7 vs 8). Conclusions: Our results reinforce the added value of AJCC 8 compared to 7, as removing an operator dependent variable is more practical for stage I, and increased influence of thickness/ulceration and the addition of a new substage is more prognostically informative for stage III. Nevertheless, the poor prognosis of stage IIC patients, despite nodal negative disease, continues to be an unaddressed gap within our current staging framework.
Collapse
Affiliation(s)
- Shirin Bajaj
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Anthony Collado
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Una Moran
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | | | | | - Richard L. Shapiro
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| | - Russell S. Berman
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| | - Jeffrey S. Weber
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY
| | - Judy Zhong
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Iman Osman
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| |
Collapse
|
35
|
Berman RS, Gershenwald JE. Completion Node Dissection for Sentinel Node-Positive Melanoma: Can a Systematic Review Bring One Discussion to a Close While Leaving the Broader Conversation Still Open? Ann Surg Oncol 2019; 26:921-923. [PMID: 30737667 DOI: 10.1245/s10434-019-07211-3] [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] [Received: 12/04/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Russell S Berman
- Department of Surgery, Division of Oncology, New York University School of Medicine, New York, NY, USA.
| | - Jeffrey E Gershenwald
- Division of Surgery, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
36
|
Robinson EM, Rosenbaum BE, Zhang Y, Rogers R, Tchack J, Berman RS, Darvishian F, Osman I, Shapiro RL, Shao Y, Polsky D. Association between Ki-67 expression and clinical outcomes among patients with clinically node-negative, thick primary melanoma who underwent nodal staging. J Surg Oncol 2018; 118:150-156. [PMID: 29878361 DOI: 10.1002/jso.25111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 02/12/2018] [Accepted: 04/25/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with thick primary melanomas (≥4 mm) have highly variable survival outcomes. Cell proliferation marker Ki-67 has been identified as promising biomarker in thick melanoma but has not been evaluated since the wide spread adoption of sentinel lymph node biopsy. We revisit its prognostic relevance in the sentinel node era. METHODS We studied patients with thick (≥4 mm) primary melanoma prospectively enrolled in a clinicopathological biospecimen database from 2002 to 2015, and evaluated the prognostic value of Ki-67 expression while controlling for features included in the existing staging criteria. RESULTS We analyzed 68 patients who underwent lymph node sampling and who had an available tumor for Ki-67 immunohistochemical (IHC) staining. The median tumor thickness was 6.0 mm; the median follow-up was 2.6 years. In multivariable analysis including nodal status and primary tumor ulceration, Ki-67 expression was an independent predictor of worse recurrence-free survival (HR 2.19, P = 0.024) and overall survival (HR 2.49, P = 0.028). Natural log-transformed tumor thickness (ln [thickness]) was also significantly associated with worse OS (HR 2.39, P = 0.010). CONCLUSION We identify Ki-67 and ln (thickness) as potential biomarkers for patients with thick melanoma who have undergone nodal staging. If validated in additional studies, these biomarkers could be integrated into the staging criteria to improve risk-stratification.
Collapse
Affiliation(s)
- Eric M Robinson
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Brooke E Rosenbaum
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Yilong Zhang
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Robert Rogers
- Department of Pathology, New York University School of Medicine, New York, New York
| | - Jeremy Tchack
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Russell S Berman
- Division of Surgical Oncology, Department of Surgery, Perlmutter Cancer Center, New York University School of Medicine, New York, New York
| | - Farbod Darvishian
- Department of Pathology, New York University School of Medicine, New York, New York
| | - Iman Osman
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Richard L Shapiro
- Division of Surgical Oncology, Department of Surgery, Perlmutter Cancer Center, New York University School of Medicine, New York, New York
| | - Yongzhao Shao
- Department of Population Health, New York University School of Medicine, New York, New York
| | - David Polsky
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| |
Collapse
|
37
|
Lee Y, Masub N, Wechter T, Zhong J, Moran U, Darvishian F, Polsky D, Berman RS, Shapiro RL, Weber JS, Osman I, Pavlick AC, Wilson M. Bone metastasis to predict treatment response rate and overall survival of patients with metastatic melanoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e21585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yesung Lee
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | | | - Todd Wechter
- Stony Brook University School of Medicine, Stony Brook, NY
| | - Judy Zhong
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Una Moran
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Farbod Darvishian
- Department of Pathology, New York University School of Medicine, New York, NY
| | - David Polsky
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Russell S. Berman
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| | - Richard L. Shapiro
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| | | | - Iman Osman
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Anna C. Pavlick
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY
| | - Melissa Wilson
- Perlmutter Cancer Center, New York University School of Medicine, Division of Hematology and Oncology, Department of Medicine, New York, NY
| |
Collapse
|
38
|
Kim RH, Nomikou S, Dawood Z, Coudray N, Weber JS, Shapiro RL, Berman RS, Osman I, Tsirigos A. Using deep learning algorithms on histopathology images for the prediction of BRAF and NRAS mutations in invasive melanoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e21561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Randie H Kim
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Sofia Nomikou
- New York University School of Medicine, New York, NY
| | - Zarmeena Dawood
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | | | | | - Richard L. Shapiro
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| | - Russell S. Berman
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| | - Iman Osman
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | | |
Collapse
|
39
|
Are C, Wyld L, Berman RS, Audisio RA. In Reply: Alternative Ways to Study Global Variation in Cancer-Related Research Activity. Ann Surg Oncol 2018. [PMID: 29541906 DOI: 10.1245/s10434-018-6424-7] [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: 11/18/2022]
Affiliation(s)
- Chandrakanth Are
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA.
| | - L Wyld
- Chair of the Education and Training Committee of European Society of Surgical Oncology, British Association of Surgical Oncology, London, UK.,Jasmine Centre, Doncaster Royal Infirmary, University of Sheffield, Doncaster, UK
| | - Russell S Berman
- Surgical Education and Faculty Development, Surgical Residency Training Program, Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY, USA
| | | |
Collapse
|
40
|
Adelsheimer A, Berman RS, Pachter HL, Hochberg MS. Surgical clerkship or medical clerkship first: Does it make a difference? Am J Surg 2017; 215:304-308. [PMID: 29157890 DOI: 10.1016/j.amjsurg.2017.08.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/28/2017] [Accepted: 08/22/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This study compares NBME surgical clerkship scores of students who completed their medicine clerkship before their surgical clerkship with the performance of those who had not previously completed their medical clerkship. METHODS The study included 815 New York University School of Medicine students from the years 2014-2018 (571 students took medicine first, while 244 took surgery first). Performance on the surgical clerkship was assessed using the NBME SHELF examination. Statistical comparisons were performed via 2-tailed, independent-samples, unequal-variance t-tests. RESULTS Mean NBME surgical SHELF scores of the students who had previously taken medicine were significantly higher than students who had not (mean 78.6 vs. 73.5, p < 0.001). Students who had solely medicine (as their first clerkship) before surgery also performed significantly better (mean 78.8 vs. 73.5, p < 0.001). Students who completed surgery later in the year did not perform better on the surgical SHELF, so long as both surgical clerkship cohorts had completed medicine. CONCLUSION Students who completed their core medical clerkship prior to their surgical clerkship scored significantly better on the NBME surgical SHELF examination.
Collapse
Affiliation(s)
| | - Russell S Berman
- New York University School of Medicine, New York, NY, USA; Department of Surgery, NYU Langone Medical Center, New York, NY, USA
| | - H Leon Pachter
- New York University School of Medicine, New York, NY, USA; Department of Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Mark S Hochberg
- New York University School of Medicine, New York, NY, USA; Department of Surgery, NYU Langone Medical Center, New York, NY, USA.
| |
Collapse
|
41
|
Utter K, Goldman C, Weiss SA, Shapiro RL, Berman RS, Wilson MA, Pavlick AC, Osman I. Treatment Outcomes for Metastatic Melanoma of Unknown Primary in the New Era: A Single-Institution Study and Review of the Literature. Oncology 2017; 93:249-258. [PMID: 28746931 DOI: 10.1159/000478050] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/28/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Metastatic melanoma of unknown primary (MUP) is uncommon, biologically ill defined, and clinically understudied. MUP outcomes are seldom reported in clinical trials. In this study, we analyze responses of MUP patients treated with systemic therapy in an attempt to inform treatment guidelines for this unique population. METHODS New York University (NYU)'s prospective melanoma database was searched for MUP patients treated with systemic therapy. PubMed and Google Scholar were searched for MUP patients treated with immunotherapy or targeted therapy reported in the literature, and their response and survival data were compared to the MUP patient data from NYU. Both groups' response data were compared to those reported for melanoma of known primary (MKP). RESULTS The MUP patients treated at NYU had better outcomes on immunotherapy but worse on targeted therapy than the MUP patients in the literature. The NYU MUP patients and those in the literature had worse outcomes than the majority-MKP populations in 10 clinical trial reports. CONCLUSIONS Our study suggests that MUP patients might have poorer outcomes on systemic therapy as compared to MKP patients. Our cohort was small and limited data were available, highlighting the need for increased reporting of MUP outcomes and multi-institutional efforts to understand the mechanism behind the observed differences.
Collapse
Affiliation(s)
- Kierstin Utter
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Goldman C, Tchack J, Robinson EM, Han SW, Moran U, Polsky D, Berman RS, Shapiro RL, Ott PA, Osman I, Zhong H, Pavlick AC, Wilson MA. Outcomes in Melanoma Patients Treated with BRAF/MEK-Directed Therapy or Immune Checkpoint Inhibition Stratified by Clinical Trial versus Standard of Care. Oncology 2017; 93:164-176. [PMID: 28601879 DOI: 10.1159/000475715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 02/22/2017] [Accepted: 04/11/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Since 2011, metastatic melanoma treatment has evolved with commercial approval of BRAF- and MEK-targeted therapy and CTLA-4- and PD-1-blocking antibodies (immune checkpoint inhibitors, ICI). While novel therapies have demonstrated improved prognosis in clinical trials, few studies have examined the evolution of prognosis and toxicity of these drugs among an unselected population. We assess whether survival and toxicity reported in trials, which typically exclude most patients with brain metastases and poor performance status, are recapitulated within a commercial access population. METHODS 182 patients diagnosed with stage IV melanoma from July 2006 to December 2013 and treated with BRAF- and/or MEK-targeted therapy or ICI were prospectively studied. Outcomes and clinicopathologic differences between trial and commercial cohorts were assessed. RESULTS Patients receiving commercial therapy (vs. on trial) had poorer prognostic features (i.e., brain metastases) and lower median overall survival (mOS) when assessed across all treatments (9.2 vs. 17.5 months, p = 0.0027). While toxicity within trial and commercial cohorts did not differ, patients who experienced toxicity had increased mOS (p < 0.001), irrespective of stratification by trial status or therapy. CONCLUSION Metastatic melanoma patients receiving commercial treatment may represent a different clinical population with poor prognostic features compared to trial patients. Toxicity may prognosticate treatment benefit.
Collapse
Affiliation(s)
- Chloe Goldman
- The Ronald O. Perelman Department of Dermatology, Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Lattanzi M, Lee Y, Robinson EM, Weiss SA, Moran U, Simpson D, Shapiro RL, Berman RS, Pavlick AC, Wilson M, Kirchhoff T, Zhong J, Osman I. Primary melanoma histologic subtype (HS) impacts melanoma specific survival (MSS) and response to systemic therapy. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.9577] [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: 11/20/2022] Open
Abstract
9577 Background: Unlike other solid tumors, the impact of primary HS on melanoma survival and response to systemic therapy is not well studied. Nodular melanoma (NM) has a worse prognosis than superficial spreading melanoma (SSM), which is usually attributed to thicker primary tumors. Herein, we examine the hypothesis that HS might have an impact on MSS independent of thickness and that NM and SSM exhibit different mutational landscapes that associate with response to checkpoint inhibitor immunotherapy (IT) and BRAF targeted therapy (TT) in the metastatic setting. Methods: Primary NM and SSM patients prospectively enrolled at NYU (2002 - 2016) were compared to the most recent SEER cohort (1973 - 2012) and analyzed with respect to MSS. Next-Generation Sequencing (NGS) was performed on a subset of matched tumor-germline pairs, allowing a comparison of the mutational landscape between NM and SSM. In the metastatic setting, survival analyses were used to compare outcomes and responses to treatment across HS. Results: The NYU cohort of 1,621 patients with either NM (n = 510) or SSM (n = 1,111) was representative of the analogous SEER cohort (21,339 NM, 97,169 SSM), with NM presenting as thicker, more ulcerated, and later stage (all p < 0.001). Among the NYU cohort, NM was found to have lower rates of TIL (p = 0.047), higher mitotic index (p < 0.001), and higher rates of NRAS mutation (p < 0.001). In multivariate Cox models, NM was a significant predictor of worse MSS, independent of thickness and stage (p = 0.01). NM had a significantly lower mutational burden across the exome (p < 0.001). Some of the most under-mutated genes noted in NM were NOTCH4, BCL2L12 and RPS6KA6 (all p < 0.01). Among patients treated with TT (n = 56), NM remained a significant predictor of worse MSS (p = 0.004). However, there was no difference in response to IT. Conclusions: NM and SSM show divergent mutational patterns which may contribute to their different clinical behaviors and responses to BRAF targeted therapy. More studies are needed to better understand the key molecular and cellular processes driving such differences. Integration of HS data into prospective clinical trial reporting is needed to better assess its impact on response to treatment.
Collapse
Affiliation(s)
- Michael Lattanzi
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Yesung Lee
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Eric Michael Robinson
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | | | - Una Moran
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | | | - Richard L. Shapiro
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| | - Russell S. Berman
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| | - Anna C. Pavlick
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY
| | - Melissa Wilson
- Division of Hematology and Oncology, Department of Medicine, Perlmutter Cancer Center, New York University School of Medicine, New York, NY
| | | | - Judy Zhong
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Iman Osman
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| |
Collapse
|
44
|
Izsak A, Giles KM, Lui KP, Weiss SA, Moran U, Vega-Saenz de Miera E, Stein J, Lee AY, Darvishian F, Shapiro RL, Berman RS, Pavlick AC, Wilson M, Osman I. Targeting EZH2 in acral lentiginous melanoma (ALM). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.9534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9534 Background: Efforts to identify targeted therapies that can improve treatment outcome in metastatic ALM have been unsuccessful. In a previous genomic screening, we identified copy number amplification of the histone methyltransferase EZH2 in 47% of ALM cases, a higher frequency than previously reported in cutaneous melanomas (CM) (5%). Here, we tested the hypothesis that increased EZH2 expression contributes to ALM progression and may confer selective sensitivity to EZH2 inhibition. Methods: EZH2 expression was examined by immunohistochemistry (IHC) in 51 primary (21 stage I, 13 Stage II and 17 Stage III) and 23 metastatic (11 in transit, 8 nodal and 4 visceral) ALM cases with extensive clinicopathological data and protocol-driven follow up. Colony formation and cell proliferation was assessed following treatment of ALM and CM cell lines with three EZH2 inhibitors, including GSK126, currently in clinical trials. The effect of GSK126 on H3K27me3 and downstream EZH2 targets was analyzed by western blotting. Results: EZH2 is commonly overexpressed in both primary (30/51; 65%) and metastatic (20/23; 87%) ALM cases, with a significant increase in mean IHC score between primary and metastatic tumors (1.9 vs. 2.7, respectively, p = 0.047). EZH2 expression increased in 6/10 metastatic ALM tumors compared to their matched primary tumors. ALM tumors with EZH2 gene amplification showed increased EZH2 protein expression; however more cases showed overexpression with no amplification suggesting a potential epigenetic component of EZH2 regulation. GSK126 significantly suppressed ALM colony formation at lower doses compared to CM (1 µM vs. 5 µM, respectively). EZH2 inhibition also increased expression of the downstream tumor suppressor E-cadherin in ALM but not in CM cell lines. Finally, ALM cell lines had significantly lower basal H3K27me3 levels than CM cell lines, suggesting an additional, histone methyltransferase-independent function of EZH2 in ALM. Conclusions: Our data demonstrate thatEZH2 upregulation is common in ALM, and suggest that it may play a role in ALM’s metastatic progression that requires further investigation. Selective sensitivity of ALM cell lines to EZH2 inhibitors supports the therapeutic potential of EZH2-targeted therapy in ALM.
Collapse
Affiliation(s)
- Allison Izsak
- New York University School of Medicine, New York, NY
| | | | - Kevin Paul Lui
- Ronald O. Perelman Department of Dermatology, NYU Langone Medical Center, New York, NY
| | | | - Una Moran
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | | | - Jennifer Stein
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Ann Yeelin Lee
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| | - Farbod Darvishian
- Department of Pathology, New York University School of Medicine, New York, NY
| | - Richard L. Shapiro
- Department of Surgery, New York University School of Medicine, New York, NY
| | - Russell S. Berman
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| | - Anna C. Pavlick
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY
| | - Melissa Wilson
- Division of Hematology and Oncology, Department of Medicine, Perlmutter Cancer Center, New York University School of Medicine, New York, NY
| | - Iman Osman
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| |
Collapse
|
45
|
Balch CM, Coit DG, Berman RS. 2015 James Ewing Lecture: The 75-Year History of the Society of Surgical Oncology—Part II: The Transitional Years (1966–1990). Ann Surg Oncol 2016; 23:358-64. [PMID: 26464191 DOI: 10.1245/s10434-015-4863-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Indexed: 11/18/2022]
|
46
|
Vogelsang M, Martinez CN, Rendleman J, Bapodra A, Malecek K, Romanchuk A, Kazlow E, Shapiro RL, Berman RS, Krogsgaard M, Osman I, Kirchhoff T. The Expression Quantitative Trait Loci in Immune Pathways and their Effect on Cutaneous Melanoma Prognosis. Clin Cancer Res 2016; 22:3268-80. [PMID: 26733611 PMCID: PMC5024570 DOI: 10.1158/1078-0432.ccr-15-2066] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/11/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE The identification of personalized germline markers with biologic relevance for the prediction of cutaneous melanoma prognosis is highly demanded but to date, it has been largely unsuccessful. As melanoma progression is controlled by host immunity, here we present a novel approach interrogating immunoregulatory pathways using the genome-wide maps of expression quantitative trait loci (eQTL) to reveal biologically relevant germline variants modulating cutaneous melanoma outcomes. EXPERIMENTAL DESIGN Using whole genome eQTL data from a healthy population, we identified 385 variants significantly impacting the expression of 268 immune-relevant genes. The 40 most significant eQTLs were tested in a prospective cohort of 1,221 patients with cutaneous melanoma for their association with overall (OS) and recurrence-free survival using Cox regression models. RESULTS We identified highly significant associations with better melanoma OS for rs6673928, impacting IL19 expression (HR, 0.56; 95% CI, 0.41-0.77; P = 0.0002) and rs6695772, controlling the expression of BATF3 (HR, 1.64; 95% CI, 1.19-2.24; P = 0.0019). Both associations map in the previously suspected melanoma prognostic locus at 1q32. Furthermore, we show that their combined effect on melanoma OS is substantially enhanced reaching the level of clinical applicability (HR, 1.92; 95% CI, 1.43-2.60; P = 2.38e-5). CONCLUSIONS Our unique approach of interrogating lymphocyte-specific eQTLs reveals novel and biologically relevant immunomodulatory eQTL predictors of cutaneous melanoma prognosis that are independent of current histopathologic markers. The significantly enhanced combined effect of identified eQTLs suggests the personalized utilization of both SNPs in a clinical setting, strongly indicating the promise of the proposed design for the discovery of prognostic or risk germline markers in other cancers. Clin Cancer Res; 22(13); 3268-80. ©2016 AACR.
Collapse
Affiliation(s)
- Matjaz Vogelsang
- Perlmutter Cancer Center, New York University School of Medicine, New York, New York. Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, New York. The Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York
| | - Carlos N Martinez
- Perlmutter Cancer Center, New York University School of Medicine, New York, New York. Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, New York. The Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York
| | - Justin Rendleman
- Perlmutter Cancer Center, New York University School of Medicine, New York, New York. Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, New York. The Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York
| | - Anuj Bapodra
- Perlmutter Cancer Center, New York University School of Medicine, New York, New York. The Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York. Department of Pathology, New York University School of Medicine, New York, New York
| | - Karolina Malecek
- Perlmutter Cancer Center, New York University School of Medicine, New York, New York. The Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York. Department of Pathology, New York University School of Medicine, New York, New York
| | - Artur Romanchuk
- Perlmutter Cancer Center, New York University School of Medicine, New York, New York. Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, New York. The Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York
| | - Esther Kazlow
- Perlmutter Cancer Center, New York University School of Medicine, New York, New York. Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, New York. The Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York
| | - Richard L Shapiro
- The Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York. Department of Surgery, New York University School of Medicine, New York, New York
| | - Russell S Berman
- The Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York. Department of Surgery, New York University School of Medicine, New York, New York
| | - Michelle Krogsgaard
- Perlmutter Cancer Center, New York University School of Medicine, New York, New York. The Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York. Department of Pathology, New York University School of Medicine, New York, New York
| | - Iman Osman
- Perlmutter Cancer Center, New York University School of Medicine, New York, New York. The Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York. Department of Medicine, New York University School of Medicine, New York, New York. Ronald O. Perelman, Department of Dermatology, New York University, New York, New York
| | - Tomas Kirchhoff
- Perlmutter Cancer Center, New York University School of Medicine, New York, New York. Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, New York. The Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York.
| |
Collapse
|
47
|
Utter K, Rosenbaum BE, Han SW, Zhong J, Moran U, Vega-Saenz de Miera E, Darvishian F, Polsky D, Berman RS, Shapiro RL, Osman I, Pavlick AC, Wilson M. The impact of clinical stage at primary melanoma diagnosis on post-recurrence survival. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.9550] [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: 11/20/2022] Open
Affiliation(s)
| | - Brooke E Rosenbaum
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Sung Won Han
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY
| | - Judy Zhong
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Una Moran
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | | | - Farbod Darvishian
- Department of Pathology, New York University School of Medicine, New York, NY
| | - David Polsky
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Russell S. Berman
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| | - Richard L. Shapiro
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| | - Iman Osman
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | | | - Melissa Wilson
- Division of Hematology and Oncology, Department of Medicine, Perlmutter Cancer Center, New York University School of Medicine, New York, NY
| |
Collapse
|
48
|
Robinson EM, Rosenbaum BE, Rogers R, Han SW, Tchack J, Moran U, Zhong J, Berman RS, Darvishian F, Osman I, Polsky D, Shapiro RL. Prognostic value of mitoses in thick primary melanoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e21046] [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: 11/20/2022] Open
Affiliation(s)
- Eric Michael Robinson
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Brooke E Rosenbaum
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Robert Rogers
- Department of Pathology, New York University School of Medicine, New York, NY
| | - Sung Won Han
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Jeremy Tchack
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Una Moran
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Judy Zhong
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Russell S. Berman
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| | - Farbod Darvishian
- Department of Pathology, New York University School of Medicine, New York, NY
| | - Iman Osman
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - David Polsky
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Richard L. Shapiro
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| |
Collapse
|
49
|
Chang G, Robinson EM, Tadepalli JS, Salvaggio C, Zhang Y, Shao Y, Darvishian F, Berman RS, Shapiro RL, Osman I, Polsky D. Analysis of TERT promoter mutations, polymorphisms, clinicopathologic features and recurrence-free survival in primary melanoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e21065] [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: 11/20/2022] Open
Affiliation(s)
- Gregory Chang
- The Ronald O. Perelman Department of Dermatology, NYU Langone Medical Center, New York, NY
| | - Eric Michael Robinson
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | | | - Christine Salvaggio
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Yilong Zhang
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Yongzhao Shao
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Farbod Darvishian
- Department of Pathology, New York University School of Medicine, New York, NY
| | - Russell S. Berman
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| | - Richard L. Shapiro
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| | - Iman Osman
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - David Polsky
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| |
Collapse
|
50
|
Goldman C, Tchack J, Robinson EM, Han SW, Zhong J, Moran U, Vega-Saenz de Miera E, Darvishian F, Polsky D, Berman RS, Shapiro RL, Osman I, Pavlick AC, Wilson M. Metastatic melanoma outcomes in the era of commercially available targeted therapy and immunotherapy. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e21017] [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: 11/20/2022] Open
Affiliation(s)
- Chloe Goldman
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Jeremy Tchack
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Eric Michael Robinson
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Sung Won Han
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Judy Zhong
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Una Moran
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | | | - Farbod Darvishian
- Department of Pathology, New York University School of Medicine, New York, NY
| | - David Polsky
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Russell S. Berman
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| | - Richard L. Shapiro
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY
| | - Iman Osman
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | | | - Melissa Wilson
- Division of Hematology and Oncology, Department of Medicine, Perlmutter Cancer Center, New York University School of Medicine, New York, NY
| |
Collapse
|