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Al-Ibraheem A, Ruzzeh S, Badarneh M, Al-Adhami D, Telfah A. Beyond CT: A Case Analysis of Serial [18F]FDG PET/CT for Assessment of Necrosis and Early Recurrence in Colorectal Liver Metastases. Cureus 2023; 15:e51393. [PMID: 38292976 PMCID: PMC10826454 DOI: 10.7759/cureus.51393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 02/01/2024] Open
Abstract
Colorectal cancer is a common malignancy, with the liver being the most frequent site of metastases. [18F] Fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) has emerged as a valuable tool in detecting and evaluating liver metastases and extrahepatic disease. Herein, we present a case of a 76-year-old male with colorectal cancer associated with lung and liver metastases. The patient received 12 chemoimmunotherapy cycles and was then put on maintenance cetuximab; serial [18F]FDG PET/CT scans were utilized to evaluate treatment response. The patient exhibited a positive response to chemoimmunotherapy, with regression of rectal disease and resolution of pulmonary metastatic nodules. Serial [18F]FDG PET/CT scans unveiled three distinct necrotic patterns. The case report advocates that [18F]FDG PET/CT plays an important role in evaluating colorectal liver metastases (CRLM) response to treatment, identifying transient necrosis, early recurrence, and emphasizing the limitations of post-treatment CT scans in identifying early CRLM recurrence. Integrating functional imaging, particularly [18F]FDG PET/CT, promises for management monitoring and surveillance of CRLM patients.
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Affiliation(s)
- Akram Al-Ibraheem
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman, JOR
- School of Medicine, University of Jordan, Amman, JOR
| | - Saad Ruzzeh
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman, JOR
| | - Mohannad Badarneh
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman, JOR
| | - Dhuha Al-Adhami
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman, JOR
| | - Ahmad Telfah
- Department of Medicine, King Hussein Cancer Center (KHCC), Amman, JOR
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Perrin ML, Bardet SM, Yardin C, Durand Fontanier S, Taibi A. Effect of 5-Fluoro-Uracile + Oxaliplatin chemotherapy on the histological response of PEritoneal and hePatIc corectal metasTases in a mOuse model: PEPITO experimental study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:619-625. [PMID: 36443179 DOI: 10.1016/j.ejso.2022.11.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/12/2022] [Accepted: 11/17/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The histological responses (HRs) after systemic chemotherapy should be used to determine the optimal management of patients with peritoneal and liver metastasis from colorectal cancer (cPM, cLM), in curative intent. We aimed to compare HRs of cPM and cLM in metastatic mice model after chemotherapy. METHODS Colon carcinoma CT26-luc cells were transplanted into syngeneic BALB/c mice by intraperitoneal (leading to cPM), intrasplenic (leading to cLM), or intraperitoneal + intrasplenic (leading to cPM cLM) injections and follow up using bioluminescence during 21 days. Bi-chemotherapeutic treatment (5-fluorouracil at D11, D17, and D20, and oxaliplatin at D13 and D19) was administered. The peritoneal cancer index (PCI) and HRs using Peritoneal Regression Grading Score (PRGS) and Tumor Regression Grade (TRG) classifications were analyzed at day 21. RESULTS Unlike bioluminescence rate, PCI was reduced after chemotherapy in all treated groups with cPM comparatively to controls (33 ± 9.5 vs. 19.8 ± 5, p = 0.002 for cPM groups; 37.7 ± 3.6 vs. 25.2 ± 10.8, p = 0.0003 for the cPM + cLM groups). The complete or major HR rates were higher in all treated groups compared to the non-treated mice (cPM, 2.29 ± 0.55 vs. 3.56 ± 1.01; cLM, 2.43 ± 1.89 vs. 4.86 ± 0.378; cPM + cLM, 2.73 ± 1.03 and 2.2 ± 0.65 vs. 3.79 ± 0.75 and 4.36 ± 0.43). The complete or major HR rates after chemotherapy were similar across the metastatic sites in 60% for cPM + cLM group. CONCLUSIONS The efficacy of chemotherapeutic treatment did not differ between the metastatic sites. Murine models are suitable in histological analyses to study tumor development and regression but clinical study will be performed to confirm these results.
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Affiliation(s)
| | - Sylvia M Bardet
- University Limoges, CNRS, XLIM, UMR 7252, F-87000, Limoges, France
| | - Catherine Yardin
- University Limoges, CNRS, XLIM, UMR 7252, F-87000, Limoges, France; Cytology Department, Dupuytren Limoges University Hospital, France
| | - Sylvaine Durand Fontanier
- Digestive Surgery Department, Dupuytren Limoges University Hospital, France; University Limoges, CNRS, XLIM, UMR 7252, F-87000, Limoges, France
| | - Abdelkader Taibi
- Digestive Surgery Department, Dupuytren Limoges University Hospital, France; University Limoges, CNRS, XLIM, UMR 7252, F-87000, Limoges, France.
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3
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Sanuki N, Takeda A, Tsurugai Y, Eriguchi T. Role of stereotactic body radiotherapy in multidisciplinary management of liver metastases in patients with colorectal cancer. Jpn J Radiol 2022; 40:1009-1016. [PMID: 35857212 PMCID: PMC9529716 DOI: 10.1007/s11604-022-01307-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022]
Abstract
In the treatment of colorectal cancer patients with distant metastases, the development of new anticancer agents has considerably prolonged progression-free survival. Such survival benefits attributed to chemotherapy have increased the relative significance of local therapy in patients with limited metastases. The liver is recognized as the most common site of metastasis of colorectal cancer because of the intestinal mesenteric drainage to the portal veins. Hepatic resection of isolated liver metastases of colorectal cancer is the only option for a potential cure. However, hepatic metastases are resectable in only approximately 20% of the patients. For remaining patients with high-risk resectable liver metastases or those who are unfit for surgery, less invasive, local therapies including radiation therapy (stereotactic body radiation therapy, SBRT) may have a potential role in treatment. Although the local control rate of SBRT for colorectal liver metastases has room for improvement, its less-invasive nature and broad indications deserve consideration. Future research should include SBRT dose escalation or the selection of patients who benefit from local ablative therapies. SBRT may offer an alternative, non-invasive approach for the treatment of colorectal liver metastases in a multidisciplinary treatment strategy.
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Affiliation(s)
- Naoko Sanuki
- Department of Radiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, 510-8567, Japan.
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24, Ofuna, Kamakura, Kanagawa, 247-0056, Japan.
| | - Atsuya Takeda
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24, Ofuna, Kamakura, Kanagawa, 247-0056, Japan
| | - Yuichiro Tsurugai
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24, Ofuna, Kamakura, Kanagawa, 247-0056, Japan
| | - Takahisa Eriguchi
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24, Ofuna, Kamakura, Kanagawa, 247-0056, Japan
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4
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High-Throughput Profiling of Colorectal Cancer Liver Metastases Reveals Intra- and Inter-Patient Heterogeneity in the EGFR and WNT Pathways Associated with Clinical Outcome. Cancers (Basel) 2022; 14:cancers14092084. [PMID: 35565214 PMCID: PMC9104154 DOI: 10.3390/cancers14092084] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/11/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Tumor heterogeneity can greatly influence therapy outcome and patient survival. In this study, we aimed at unraveling inter- and intra-patient heterogeneity of colorectal cancer liver metastases (CRLM). To this end, we comprehensively characterized CRLM using state-of-the-art high-throughput technologies combined with bioinformatics analyses. We found a high degree of inter- and intra-patient heterogeneity among the metastases, in particular in genes of the WNT and EGFR pathways. Through analyzing the master regulators and effectors associated with the regulation of these genes, we identified a specific gene signature that was highly expressed in a large cohort of colorectal cancer patients and associated with clinical outcome. Abstract Seventy percent of patients with colorectal cancer develop liver metastases (CRLM), which are a decisive factor in cancer progression. Therapy outcome is largely influenced by tumor heterogeneity, but the intra- and inter-patient heterogeneity of CRLM has been poorly studied. In particular, the contribution of the WNT and EGFR pathways, which are both frequently deregulated in colorectal cancer, has not yet been addressed in this context. To this end, we comprehensively characterized normal liver tissue and eight CRLM from two patients by standardized histopathological, molecular, and proteomic subtyping. Suitable fresh-frozen tissue samples were profiled by transcriptome sequencing (RNA-Seq) and proteomic profiling with reverse phase protein arrays (RPPA) combined with bioinformatic analyses to assess tumor heterogeneity and identify WNT- and EGFR-related master regulators and metastatic effectors. A standardized data analysis pipeline for integrating RNA-Seq with clinical, proteomic, and genetic data was established. Dimensionality reduction of the transcriptome data revealed a distinct signature for CRLM differing from normal liver tissue and indicated a high degree of tumor heterogeneity. WNT and EGFR signaling were highly active in CRLM and the genes of both pathways were heterogeneously expressed between the two patients as well as between the synchronous metastases of a single patient. An analysis of the master regulators and metastatic effectors implicated in the regulation of these genes revealed a set of four genes (SFN, IGF2BP1, STAT1, PIK3CG) that were differentially expressed in CRLM and were associated with clinical outcome in a large cohort of colorectal cancer patients as well as CRLM samples. In conclusion, high-throughput profiling enabled us to define a CRLM-specific signature and revealed the genes of the WNT and EGFR pathways associated with inter- and intra-patient heterogeneity, which were validated as prognostic biomarkers in CRC primary tumors as well as liver metastases.
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Strömberg C, Martinez de la Maza L, Fernández Moro C, Gerling M, Jorns C, Sparrelid E, Löhr J, Villard C. Prognostic impact of inter-metastatic heterogeneity of viable tumour cells in colorectal liver metastases. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1656-1663. [DOI: 10.1016/j.ejso.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022]
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Au L, Hatipoglu E, Robert de Massy M, Litchfield K, Beattie G, Rowan A, Schnidrig D, Thompson R, Byrne F, Horswell S, Fotiadis N, Hazell S, Nicol D, Shepherd STC, Fendler A, Mason R, Del Rosario L, Edmonds K, Lingard K, Sarker S, Mangwende M, Carlyle E, Attig J, Joshi K, Uddin I, Becker PD, Sunderland MW, Akarca A, Puccio I, Yang WW, Lund T, Dhillon K, Vasquez MD, Ghorani E, Xu H, Spencer C, López JI, Green A, Mahadeva U, Borg E, Mitchison M, Moore DA, Proctor I, Falzon M, Pickering L, Furness AJS, Reading JL, Salgado R, Marafioti T, Jamal-Hanjani M, Kassiotis G, Chain B, Larkin J, Swanton C, Quezada SA, Turajlic S. Determinants of anti-PD-1 response and resistance in clear cell renal cell carcinoma. Cancer Cell 2021; 39:1497-1518.e11. [PMID: 34715028 PMCID: PMC8599450 DOI: 10.1016/j.ccell.2021.10.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/19/2021] [Accepted: 10/06/2021] [Indexed: 02/08/2023]
Abstract
ADAPTeR is a prospective, phase II study of nivolumab (anti-PD-1) in 15 treatment-naive patients (115 multiregion tumor samples) with metastatic clear cell renal cell carcinoma (ccRCC) aiming to understand the mechanism underpinning therapeutic response. Genomic analyses show no correlation between tumor molecular features and response, whereas ccRCC-specific human endogenous retrovirus expression indirectly correlates with clinical response. T cell receptor (TCR) analysis reveals a significantly higher number of expanded TCR clones pre-treatment in responders suggesting pre-existing immunity. Maintenance of highly similar clusters of TCRs post-treatment predict response, suggesting ongoing antigen engagement and survival of families of T cells likely recognizing the same antigens. In responders, nivolumab-bound CD8+ T cells are expanded and express GZMK/B. Our data suggest nivolumab drives both maintenance and replacement of previously expanded T cell clones, but only maintenance correlates with response. We hypothesize that maintenance and boosting of a pre-existing response is a key element of anti-PD-1 mode of action.
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Affiliation(s)
- Lewis Au
- Cancer Dynamics Laboratory, The Francis Crick Institute, London NW1 1AT, UK; Renal and Skin Unit, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Emine Hatipoglu
- Renal and Skin Unit, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; Cancer Immunology Unit, Research Department of Hematology, University College London Cancer Institute, London WC1E 6DD, UK; Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London WC1E 6DD, UK
| | - Marc Robert de Massy
- Cancer Immunology Unit, Research Department of Hematology, University College London Cancer Institute, London WC1E 6DD, UK; Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London WC1E 6DD, UK
| | - Kevin Litchfield
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - Gordon Beattie
- Cancer Immunology Unit, Research Department of Hematology, University College London Cancer Institute, London WC1E 6DD, UK; Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London WC1E 6DD, UK
| | - Andrew Rowan
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - Desiree Schnidrig
- Cancer Dynamics Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - Rachael Thompson
- Retroviral Immunology, The Francis Crick Institute, London NW1 1AT, UK
| | - Fiona Byrne
- Cancer Dynamics Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - Stuart Horswell
- Department of Bioinformatics and Biostatistics, The Francis Crick Institute, London NW1 1AT, UK
| | - Nicos Fotiadis
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, London SW3 6JJ, UK
| | - Steve Hazell
- Department of Pathology, the Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - David Nicol
- Department of Urology, the Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Scott T C Shepherd
- Cancer Dynamics Laboratory, The Francis Crick Institute, London NW1 1AT, UK; Renal and Skin Unit, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Annika Fendler
- Cancer Dynamics Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - Robert Mason
- Renal and Skin Unit, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Lyra Del Rosario
- Renal and Skin Unit, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Kim Edmonds
- Renal and Skin Unit, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Karla Lingard
- Renal and Skin Unit, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Sarah Sarker
- Renal and Skin Unit, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Mary Mangwende
- Renal and Skin Unit, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Eleanor Carlyle
- Renal and Skin Unit, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Jan Attig
- Retroviral Immunology, The Francis Crick Institute, London NW1 1AT, UK
| | - Kroopa Joshi
- Cancer Immunology Unit, Research Department of Hematology, University College London Cancer Institute, London WC1E 6DD, UK; Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London WC1E 6DD, UK
| | - Imran Uddin
- Cancer Immunology Unit, Research Department of Hematology, University College London Cancer Institute, London WC1E 6DD, UK; Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London WC1E 6DD, UK; Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Pablo D Becker
- Cancer Immunology Unit, Research Department of Hematology, University College London Cancer Institute, London WC1E 6DD, UK
| | - Mariana Werner Sunderland
- Cancer Immunology Unit, Research Department of Hematology, University College London Cancer Institute, London WC1E 6DD, UK
| | - Ayse Akarca
- Department of Cellular Pathology, University College London Hospital, London NW1 2BU, UK
| | - Ignazio Puccio
- Department of Cellular Pathology, University College London Hospital, London NW1 2BU, UK
| | - William W Yang
- Department of Cellular Pathology, University College London Hospital, London NW1 2BU, UK
| | - Tom Lund
- Translational Immune Oncology Lab, Centre for Molecular Pathology, The Royal Marsden Hospital, Sutton SM2 5PT, UK
| | - Kim Dhillon
- Department of Cellular Pathology, University College London Hospital, London NW1 2BU, UK
| | - Marcos Duran Vasquez
- Cancer Immunology Unit, Research Department of Hematology, University College London Cancer Institute, London WC1E 6DD, UK; Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London WC1E 6DD, UK
| | - Ehsan Ghorani
- Cancer Immunology Unit, Research Department of Hematology, University College London Cancer Institute, London WC1E 6DD, UK; Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London WC1E 6DD, UK
| | - Hang Xu
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - Charlotte Spencer
- Cancer Dynamics Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - José I López
- Department of Pathology, Cruces University Hospital, Biocruces-Bizkaia Institute, 48903 Barakaldo, Bizkaia, Spain
| | - Anna Green
- Department of Cellular Pathology, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London SE1 7EH, UK
| | - Ula Mahadeva
- Department of Cellular Pathology, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London SE1 7EH, UK
| | - Elaine Borg
- Department of Cellular Pathology, University College London Hospital, London NW1 2BU, UK
| | - Miriam Mitchison
- Department of Cellular Pathology, University College London Hospital, London NW1 2BU, UK
| | - David A Moore
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London WC1E 6DD, UK; Department of Cellular Pathology, University College London Hospital, London NW1 2BU, UK
| | - Ian Proctor
- Department of Cellular Pathology, University College London Hospital, London NW1 2BU, UK
| | - Mary Falzon
- Department of Cellular Pathology, University College London Hospital, London NW1 2BU, UK
| | - Lisa Pickering
- Renal and Skin Unit, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Andrew J S Furness
- Renal and Skin Unit, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - James L Reading
- Cancer Immunology Unit, Research Department of Hematology, University College London Cancer Institute, London WC1E 6DD, UK; Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London WC1E 6DD, UK
| | - Roberto Salgado
- Division of Research, Peter MacCallum Cancer Centre, Melbourne VIC 300, Australia; Department of Pathology, GZA-ZNA Hospitals, Wilrijk, Antwerp, Belgium
| | - Teresa Marafioti
- Department of Cellular Pathology, University College London Hospital, London NW1 2BU, UK
| | - Mariam Jamal-Hanjani
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London WC1E 6DD, UK; Cancer Metastasis Laboratory, University College London Cancer Institute, London WC1E 6DD, UK; Department of Medical Oncology, University College London Hospitals, London NW1 2BU, UK
| | - George Kassiotis
- Retroviral Immunology, The Francis Crick Institute, London NW1 1AT, UK
| | - Benny Chain
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK; University College London Cancer Institute, London WC1E 6DD, UK
| | - James Larkin
- Renal and Skin Unit, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Charles Swanton
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London WC1E 6DD, UK; Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London NW1 1AT, UK; Department of Medical Oncology, University College London Hospitals, London NW1 2BU, UK; University College London Cancer Institute, London WC1E 6DD, UK
| | - Sergio A Quezada
- Cancer Immunology Unit, Research Department of Hematology, University College London Cancer Institute, London WC1E 6DD, UK; Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London WC1E 6DD, UK.
| | - Samra Turajlic
- Cancer Dynamics Laboratory, The Francis Crick Institute, London NW1 1AT, UK; Renal and Skin Unit, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK.
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Uutela A, Ovissi A, Hakkarainen A, Ristimäki A, Lundbom N, Kallio R, Soveri LM, Salminen T, Ålgars A, Halonen P, Ristamäki R, Nordin A, Blanco Sequeiros R, Rinta-Kiikka I, Lantto E, Virtanen J, Pääkkö E, Liukkonen E, Saunavaara J, Ryymin P, Lammentausta E, Osterlund P, Isoniemi H. Treatment response of colorectal cancer liver metastases to neoadjuvant or conversion therapy: a prospective multicentre follow-up study using MRI, diffusion-weighted imaging and 1H-MR spectroscopy compared with histology (subgroup in the RAXO trial). ESMO Open 2021; 6:100208. [PMID: 34325107 PMCID: PMC8332656 DOI: 10.1016/j.esmoop.2021.100208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Colorectal cancer liver metastases respond to chemotherapy and targeted agents not only by shrinking, but also by morphologic and metabolic changes. The aim of this study was to evaluate the value of advanced magnetic resonance imaging (MRI) methods in predicting treatment response and survival. PATIENTS AND METHODS We investigated contrast-enhanced MRI, apparent diffusion coefficient (ADC) in diffusion-weighted imaging and 1H-magnetic resonance spectroscopy (1H-MRS) in detecting early morphologic and metabolic changes in borderline or resectable liver metastases, as a response to first-line neoadjuvant or conversion therapy in a prospective substudy of the RAXO trial (NCT01531621, EudraCT2011-003158-24). MRI findings were compared with histology of resected liver metastases and Kaplan-Meier estimates of overall survival (OS). RESULTS In 2012-2018, 52 patients at four Finnish university hospitals were recruited. Forty-seven patients received neoadjuvant or conversion chemotherapy and 40 liver resections were carried out. Low ADC values (below median) of the representative liver metastases, at baseline and after systemic therapy, were associated with partial response according to RECIST criteria, but not with morphologic MRI changes or histology. Decreasing ADC values following systemic therapy were associated with improved OS compared to unchanged or increasing ADC, both in the liver resected subgroup (5-year OS rate 100% and 34%, respectively, P = 0.022) and systemic therapy subgroup (5-year OS rate 62% and 23%, P = 0.049). 1H-MRS revealed steatohepatosis induced by systemic therapy. CONCLUSIONS Low ADC values at baseline or during systemic therapy were associated with treatment response by RECIST but not with histology, morphologic or detectable metabolic changes. A decreasing ADC during systemic therapy is associated with improved OS both in all patients receiving systemic therapy and in the resected subgroup.
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Affiliation(s)
- A Uutela
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A Ovissi
- Department of Radiology, HUS Medical Imaging Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A Hakkarainen
- Department of Radiology, HUS Medical Imaging Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Helsinki, Finland
| | - A Ristimäki
- Department of Pathology, HUS Diagnostic Centre and Applied Tumour Genomics, Research Programs Unit, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - N Lundbom
- Department of Radiology, HUS Medical Imaging Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - R Kallio
- Department of Oncology, Oulu University Hospital, Oulu, Finland
| | - L M Soveri
- Joint Municipal Authority for Health Care and Social Services in Keski-Uusimaa, Home Care Geriatric Clinic and Palliative Care, Hyvinkää, Finland
| | - T Salminen
- Department of Oncology, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - A Ålgars
- Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland
| | - P Halonen
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland
| | - R Ristamäki
- Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland
| | - A Nordin
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - R Blanco Sequeiros
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland; Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - I Rinta-Kiikka
- Department of Radiology, Medical Imaging Centre Tampere University Hospital and University of Tampere, Tampere, Finland; Department of Medical Physics, Medical Imaging Centre Tampere University Hospital and University of Tampere, Tampere, Finland
| | - E Lantto
- Department of Radiology, Päijät-Häme Central Hospital, Lahti, Finland
| | - J Virtanen
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland
| | - E Pääkkö
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - E Liukkonen
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - J Saunavaara
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland
| | - P Ryymin
- Department of Radiology, Medical Imaging Centre Tampere University Hospital and University of Tampere, Tampere, Finland; Department of Medical Physics, Medical Imaging Centre Tampere University Hospital and University of Tampere, Tampere, Finland
| | - E Lammentausta
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - P Osterlund
- Department of Oncology, Tampere University Hospital and University of Tampere, Tampere, Finland; Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland; Department of Pathology/Oncology, Karolinska Institutet and Karolinska sjukhuset - Tema Cancer, Stockholm, Sweden.
| | - H Isoniemi
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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8
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Tong Z, Wang L, Shi W, Zeng Y, Zhang H, Liu L, Zheng Y, Chen C, Xia W, Fang W, Zhao P. Clonal Evolution Dynamics in Primary and Metastatic Lesions of Pancreatic Neuroendocrine Neoplasms. Front Med (Lausanne) 2021; 8:620988. [PMID: 34026777 PMCID: PMC8131504 DOI: 10.3389/fmed.2021.620988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 04/06/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Data on inter-tumoral heterogeneity and clonal evolution of pancreatic neuroendocrine neoplasms (panNENs) with liver metastasis are limited. The aim of this study was to explore different patterns of clonal evolution of pancreatic neuroendocrine neoplasms with liver metastasis and the possible distinctive signaling pathways involved between G2 neuroendocrine tumors (NETs) and neuroendocrine carcinomas (NECs). Methods: Tumor tissues of five patients (10 samples) with pancreatic neuroendocrine neoplasms with synchronous liver metastasis were analyzed using next-generation sequencing. PyClone, Gene Ontology, and Reactome pathway enrichment analysis were also applied. Results: Mutated genes varied in individuals, reflecting the inter-tumoral heterogeneity of panNENs. The distribution of subclones varied during tumor metastasis, and different clonal evolution patterns were revealed between NETs and NECs. Gene Ontology and Reactome analyses revealed that in both NETs and NECs, signaling pathways and biological processes shared similarities and differences in the primary and metastatic lesions. In addition, the signaling pathway features were different between NETs and NECs. In the primary lesions, epigenetic changes and post-transcriptional modifications participated in NETs, while FGFR signaling, EGFR signaling, and NTRK2 signaling were largely involved in NECs. Although DNA repair and TP53 regulation were both involved in the metastatic lesions, most of the signaling pathways and biological processes disrupted by the mutated genes were different. Conclusions: Our study revealed spatial inter-tumoral heterogeneity and temporal clonal evolution in PanNENs, providing potential therapeutic targets for further prospective clinical trials.
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Affiliation(s)
- Zhou Tong
- Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Wang
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | | | - Hangyu Zhang
- Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lulu Liu
- Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Zheng
- Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunlei Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weiliang Xia
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weijia Fang
- Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang Provincial Key Laboratory of Pancreatic Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peng Zhao
- Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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9
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Hepatic and Extrahepatic Colorectal Metastases Have Discordant Responses to Systemic Therapy. Pathology Data from Patients Undergoing Simultaneous Resection of Multiple Tumor Sites. Cancers (Basel) 2021; 13:cancers13030464. [PMID: 33530435 PMCID: PMC7865224 DOI: 10.3390/cancers13030464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary The standard treatment of patients with hepatic and extrahepatic metastases from colorectal cancer is systemic chemotherapy. We assume that this therapy has the same effectiveness on all disease foci, independent of the involved organ. The effectiveness of chemotherapy is assessed by the pathological response rate: the higher the response rate, the higher the effectiveness of chemotherapy. In the present manuscript, we analyzed patients undergoing resection of hepatic and extrahepatic metastases from colorectal cancer after preoperative chemotherapy. We observed unexpected heterogeneity of the response to chemotherapy of distant metastases from colorectal cancer according to the involved organ. Peritoneal metastases had the highest pathological response rate, which was much higher than the hepatic metastases, while lung and lymph node metastases had extremely poor response rates. Such inhomogeneous effectiveness of systemic treatment in different organs open new perspectives in the treatment of colorectal cancer with distant metastases and oncological research. Abstract Background: Systemic therapy is the standard treatment for patients with hepatic and extrahepatic colorectal metastases. It is assumed to have the same effectiveness on all disease foci, independent of the involved organ. The present study aims to compare the response rates of hepatic and extrahepatic metastases to systemic therapy. Methods: All consecutive patients undergoing simultaneous resection of hepatic and extrahepatic metastases from colorectal cancer after oxaliplatin- and/or irinotecan-based preoperative chemotherapy were analyzed. All specimens were reviewed. Pathological response to chemotherapy was classified according to tumor regression grade (TRG). Results: We analyzed 45 patients undergoing resection of 134 hepatic and 72 extrahepatic metastases. Lung and lymph node metastases had lower response rates to chemotherapy than liver metastases (TRG 4–5 95% and 100% vs. 67%, p = 0.008, and p = 0.006). Peritoneal metastases had a higher pathological response rate than liver metastases (TRG 1–3 66% vs. 33%, p < 0.001) and non-hepatic non-peritoneal metastases (3%, p < 0.001). Metastases site was an independent predictor of pathological response to systemic therapy. Conclusions: Response to chemotherapy of distant metastases from colorectal cancer varies in different organs. Systemic treatment is highly effective for peritoneal metastases, more so than liver metastases, while it has a very poor impact on lung and lymph node metastases.
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10
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Baldin P, Van den Eynde M, Mlecnik B, Bindea G, Beniuga G, Carrasco J, Haicheur N, Marliot F, Lafontaine L, Fredriksen T, Lanthier N, Hubert C, Navez B, Huyghe N, Pagès F, Jouret‐Mourin A, Galon J, Komuta M. Prognostic assessment of resected colorectal liver metastases integrating pathological features, RAS mutation and Immunoscore. J Pathol Clin Res 2021; 7:27-41. [PMID: 32902189 PMCID: PMC7737782 DOI: 10.1002/cjp2.178] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 05/24/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022]
Abstract
Surgical resection of colorectal liver metastases combined with systemic treatment aims to maximize patient survival. However, recurrence rates are very high postsurgery. In order to assess patient prognosis after metastasis resection, we evaluated the main patho-molecular and immune parameters of all surgical specimens. Two hundred twenty-one patients who underwent, after different preoperative treatment, curative resection of 582 metastases were analyzed. Clinicopathological parameters, RAS tumor mutation, and the consensus Immunoscore (I) were assessed for all patients. Overall survival (OS) and time to relapse (TTR) were estimated using the Kaplan-Meier method and compared by log-rank tests. Cox proportional hazard models were used for uni- and multivariate analysis. Immunoscore and clinicopathological parameters (number of metastases, surgical margin, histopathological growth pattern, and steatohepatitis) were associated with relapse in multivariate analysis. Overall, pathological score (PS) that combines relevant clinicopathological factors for relapse, and I, were prognostic for TTR (2-year TTR rate PS 0-1: 49.8.% (95% CI: 42.2-58.8) versus PS 2-4: 20.9% (95% CI: 13.4-32.8), hazard ratio (HR) = 2.54 (95% CI: 1.82-3.53), p < 0.0000; and 2-year TTR rate I 0: 25.7% (95% CI: 16.3-40.5) versus I 3-4: 60% (95% CI: 47.2-76.3), HR = 2.87 (95% CI: 1.73-4.75), p = 0.0000). Immunoscore was also prognostic for OS (HR [I 3-4 versus I 0] = 4.25, 95% CI: 1.95-9.23; p = 0.0001). Immunoscore (HR [I 3-4 versus I 0] = 0.27, 95% CI: 0.12-0.58; p = 0.0009) and RAS mutation (HR [mutated versus WT] = 1.66, 95% CI: 1.06-2.58; p = 0.0265) were significant for OS. In conclusion, PS including relevant clinicopathological parameters and Immunoscore permit stratification of stage IV colorectal cancer patient prognosis in terms of TTR and identify patients with higher risk of recurrence. Immunoscore remains the major prognostic factor for OS.
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Affiliation(s)
- Pamela Baldin
- Department of PathologyCliniques Universitaires Saint‐Luc/Université Catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Marc Van den Eynde
- Department of Medical Oncology and Hepato‐GastroenterologyCliniques Universitaires Saint‐Luc/Université Catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Bernhard Mlecnik
- INSERM, Laboratory of Integrative Cancer ImmunologySorbonne Université, Université de Paris, Equipe labellisée Ligue Contre le Cancer, Centre de Recherche des CordeliersParisFrance
- InovarionParisFrance
| | - Gabriela Bindea
- INSERM, Laboratory of Integrative Cancer ImmunologySorbonne Université, Université de Paris, Equipe labellisée Ligue Contre le Cancer, Centre de Recherche des CordeliersParisFrance
| | - Gabriela Beniuga
- Department of PathologyInstitute of Pathology and Genetics (IPG)CharleroiBelgium
| | - Javier Carrasco
- Department of Medical OncologyGrand Hzal de Charleroi (GHdC)CharleroiBelgium
| | - Nacilla Haicheur
- INSERM, Laboratory of Integrative Cancer ImmunologySorbonne Université, Université de Paris, Equipe labellisée Ligue Contre le Cancer, Centre de Recherche des CordeliersParisFrance
| | - Florence Marliot
- INSERM, Laboratory of Integrative Cancer ImmunologySorbonne Université, Université de Paris, Equipe labellisée Ligue Contre le Cancer, Centre de Recherche des CordeliersParisFrance
| | - Lucie Lafontaine
- INSERM, Laboratory of Integrative Cancer ImmunologySorbonne Université, Université de Paris, Equipe labellisée Ligue Contre le Cancer, Centre de Recherche des CordeliersParisFrance
| | - Tessa Fredriksen
- INSERM, Laboratory of Integrative Cancer ImmunologySorbonne Université, Université de Paris, Equipe labellisée Ligue Contre le Cancer, Centre de Recherche des CordeliersParisFrance
| | - Nicolas Lanthier
- Department of Hepato‐GastroenterologyInstitut Roi Albert II, Cliniques Universitaires Saint‐Luc/Université Catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Catherine Hubert
- Hepatobiliary Surgery Unit, Department of Abdominal Surgery and TransplantationInstitut Roi Albert II, Cliniques Universitaires Saint‐Luc/Université Catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Benoît Navez
- Hepatobiliary Surgery Unit, Department of Abdominal Surgery and TransplantationInstitut Roi Albert II, Cliniques Universitaires Saint‐Luc/Université Catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Nicolas Huyghe
- Institut de Recherche Clinique et Expérimentale (Pole MIRO)Institut Roi Albert II, Cliniques Universitaires Saint‐Luc/Université Catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Franck Pagès
- INSERM, Laboratory of Integrative Cancer ImmunologySorbonne Université, Université de Paris, Equipe labellisée Ligue Contre le Cancer, Centre de Recherche des CordeliersParisFrance
- InovarionParisFrance
| | - Anne Jouret‐Mourin
- Department of PathologyCliniques Universitaires Saint‐Luc/Université Catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Jérôme Galon
- INSERM, Laboratory of Integrative Cancer ImmunologySorbonne Université, Université de Paris, Equipe labellisée Ligue Contre le Cancer, Centre de Recherche des CordeliersParisFrance
| | - Mina Komuta
- Department of PathologyCliniques Universitaires Saint‐Luc/Université Catholique de Louvain (UCLouvain)BrusselsBelgium
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11
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Paulatto L, Dioguardi Burgio M, Sartoris R, Beaufrère A, Cauchy F, Paradis V, Vilgrain V, Ronot M. Colorectal liver metastases: radiopathological correlation. Insights Imaging 2020; 11:99. [PMID: 32844319 PMCID: PMC7447704 DOI: 10.1186/s13244-020-00904-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023] Open
Abstract
With the development of chemotherapy regimens, targeted therapies, and hepatic surgery, the survival of patients with colorectal liver metastases (CRLM) has dramatically improved. Imaging plays a central role for the diagnosis, staging, and treatment allocation in these patients. To interpret CRLM on imaging, radiologists must be familiar with the main imaging features of untreated tumors as well as the modifications induced by systemic therapies, and their meaning in relation to pathological tumor response and tumor biology. CRLM have the same histological features as the primary tumor. Most are “non-otherwise specified” (NOS) adenocarcinomas. The mucinous tumor is the most common of the rare subtypes. In NOS tumors, imaging usually differentiates central areas of necrosis from peripheral proliferating tumors and desmoplastic reaction. Areas of mucin mixed with fibrosis are seen in mucinous subtypes to help differentiate the metastases from other tumors cysts or hemangiomas. After treatment, the viable tumor is gradually replaced by ischemic-like necrosis and fibrosis, and remnants cells are mainly located on the periphery of tumors. Imaging can help predict the degree of tumor response, but changes can be difficult to differentiate from the pretherapeutic appearance. When chemotherapy is interrupted or in case of resistance to treatment, a peripheral infiltrating halo of tumor growth may appear. The purpose of the article is to illustrate the significance of the imaging features of colorectal liver metastases during systemic therapy, using radiopathological correlations.
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Affiliation(s)
- Luisa Paulatto
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Hauts-de-Seine, Clichy, France
| | - Marco Dioguardi Burgio
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Hauts-de-Seine, Clichy, France.,Université de Paris, Paris, France.,INSERM U1149, CRI, Paris, France
| | - Riccardo Sartoris
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Hauts-de-Seine, Clichy, France.,Université de Paris, Paris, France.,INSERM U1149, CRI, Paris, France
| | - Aurélie Beaufrère
- INSERM U1149, CRI, Paris, France.,Department of Pathology, University Hospitals Paris Nord Val de Seine, Beaujon, Hauts-de-Seine, Clichy, France
| | - François Cauchy
- Department of HPB Surgery, University Hospitals Paris Nord Val de Seine, Beaujon, Hauts-de-Seine, Clichy, France
| | - Valérie Paradis
- INSERM U1149, CRI, Paris, France.,Department of Pathology, University Hospitals Paris Nord Val de Seine, Beaujon, Hauts-de-Seine, Clichy, France
| | - Valérie Vilgrain
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Hauts-de-Seine, Clichy, France.,Université de Paris, Paris, France.,INSERM U1149, CRI, Paris, France
| | - Maxime Ronot
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Hauts-de-Seine, Clichy, France. .,Université de Paris, Paris, France. .,INSERM U1149, CRI, Paris, France.
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12
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Zhang MY, Zhang RJ, Jiang HJ, Jiang H, Xu HL, Pan WB, Wang YQ, Li X. 18F-fluoromisonidazole positron emission tomography may be applicable in the evaluation of colorectal cancer liver metastasis. Hepatobiliary Pancreat Dis Int 2019; 18:164-172. [PMID: 30850340 DOI: 10.1016/j.hbpd.2019.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/12/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Positron emission tomography (PET) imaging is a non-invasive functional imaging method used to reflect tumor spatial information, and to provide biological characteristics of tumor progression. The aim of this study was to focus on the application of 18F-fluoromisonidazole (FMISO) PET quantitative parameter of maximum standardized uptake value (SUVmax) ratio to detect the liver metastatic potential of human colorectal cancer (CRC) in mice. METHODS Colorectal liver metastases (CRLM) xenograft models were established by injecting tumor cells (LoVo, HT29 and HCT116) into spleen of mice, tumor-bearing xenograft models were established by subcutaneously injecting tumor cells in the right left flank of mice. Wound healing assays were performed to examine the ability of cell migration in vitro. 18F-FMISO uptake in CRC cell lines was measured by cellular uptake assay. 18F-FMISO-based micro-PET imaging of CRLM and tumor-bearing mice was performed and quantified by tumor-to-liver SUVmax ratio. The correlation between the 18F-FMISO SUVmax ratio, liver metastases number, hypoxia-induced factor 1α (HIF-1α) and serum starvation-induced glucose transporter 1 (GLUT-1) was evaluated using Pearson correlation analysis. RESULTS Compared with HT29 and HCT116, LoVo-CRLM mice had significantly higher liver metastases ratio and shorter median survival time. LoVo cells exhibited stronger migration capacity and higher radiotracer uptake compared with HT29 and HCT116 in in vitro. Moreover, 18F-FMISO SUVmax ratio was significantly higher in both LoVo-CRLM model and LoVo-bearing tumor model compared to models established using HT29 and HCT116. In addition, Pearson correlation analysis revealed a significant correlation between 18F-FMISO SUVmax ratio of CRLM mice and number of liver metastases larger than 0.5 cm, as well as between 18F-FMISO SUVmax ratio and HIF-1α or GLUT-1 expression in tumor-bearing tissues. CONCLUSIONS 18F-FMISO parameter of SUVmax ratio may provide useful tumor biological information in mice with CRLM, thus allowing for better prediction of CRLM and yielding useful radioactive markers for predicting liver metastasis potential in CRC.
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Affiliation(s)
- Ming-Yu Zhang
- Department of Radiology, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Rong-Jun Zhang
- Key Laboratory of Nuclear Medicine of the Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi 214063, China
| | - Hui-Jie Jiang
- Department of Radiology, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China.
| | - Hao Jiang
- Department of Radiology, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Hai-Long Xu
- Department of Radiology, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Wen-Bin Pan
- Department of Radiology, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Yi-Qiao Wang
- Department of Radiology, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Xin Li
- Department of Radiology, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
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13
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Late gadolinium MRI enhancement of colorectal liver metastases is associated with overall survival among nonsurgical patients. Eur Radiol 2019; 29:3901-3907. [PMID: 30937587 DOI: 10.1007/s00330-019-06177-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/26/2019] [Accepted: 03/18/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE To determine if late gadolinium MRI enhancement of colorectal liver metastases (CRCLM) is associated with overall survival among nonsurgical patients. MATERIALS AND METHODS This retrospective study was approved by the institutional research ethics board. Late gadolinium enhancement was measured using target tumour enhancement (TTE) in all nonsurgical patients with CRCLM who received a 10-min delayed phase gadobutrol-enhanced liver MRI between March 1, 2006, and August 31, 2014. A total of 122 patients met inclusion/exclusion criteria. Patients were dichotomized into strong and weak TTE. Kaplan-Meier and Cox regression statistics were used to determine whether TTE was associated with overall survival. Noncontributory potential confounding variables (age, sex, number and size of metastases, carcinoembryonic (CEA) level, and presence of extrahepatic disease) were excluded from the final Cox regression model using the backward Wald elimination. Subgroup Kaplan-Meier survival analyses were performed on patients who were chemotherapy-naïve and chemotherapy-treated at the time of MRI. RESULTS Strong TTE had increased survival compared with those with weak TTE on Kaplan-Meier analysis (2-year survival: 69.8% vs. 43.5%, p = 0.002). Among 96 patients where data was available for multivariable analysis, weak TTE was associated with death (adjusted hazard ratio 0.25, 95% CI 0.11-0.59, p = 0.002), after adjusting for CEA level. Other potential confounders were noncontributory. Subgroup analyses demonstrated that strong TTE had increased survival compared with those with weak TTE in both the chemotherapy-naïve (p = 0.047) and chemotherapy-treated (p = 0.008) groups. CONCLUSION Strong late gadolinium MRI enhancement of CRCLM is associated with overall survival among nonsurgical patients. KEY POINTS • MRI enhancement of colorectal liver metastases is associated with overall survival in nonsurgical patients. • MRI enhancement of colorectal liver metastases is associated with overall survival in both chemotherapy-naïve and chemotherapy-treated subgroups.
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14
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Sebagh M, Bosselut N, Santos AD, Allard MA, Ruiz A, Saffroy R, Cherqui D, Vibert E, Castaing D, Adam R, Cunha AS, Lemoine A. Rare genetic heterogeneity within single tumor discovered for the first time in colorectal liver metastases after liver resection. Oncotarget 2018; 9:21921-21929. [PMID: 29774112 PMCID: PMC5955166 DOI: 10.18632/oncotarget.25119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 03/21/2018] [Indexed: 02/07/2023] Open
Abstract
Effective individualized treatment of patients with colorectal liver metastases (CLM) requires tumor genotyping, usually based on the analysis of one single sample per patient. Therapy failure may partially be explained by sampling errors and/or intratumoral genetic heterogeneity. We aimed to demonstrate intratumoral genetic heterogeneity in CLM and enable pathologists to select tumor tissue for genotyping. All the tumors of 86 patients who underwent liver resection for a single CLM were reviewed. Of the 86 patients, 66 patients received chemotherapy and 20 patients did not receive chemotherapy before liver resection. All the tumor areas sampled were analyzed for KRAS, BRAF, PIK3CA, and NRAS mutations. The mutational status was tested in 74 cases, 7 cases had no tumoral cells due to complete responses and 5 blocks were unavailable. Of the 59/74 CLM with > 1 sample, 56 showed the same mutational status between the samples. The remaining 3 cases (5% of all cases) showed genetic heterogeneity for KRAS in 2 and BRAF in 1 patient. Genetic heterogeneity correlated with lower rate of viable tumor cells (p=0.009) and higher rate of mucin pools (p=0.013). We demonstrate for the first time the existence of genetic intratumoral heterogeneity in 5% of CLM. In routine practice, this low incidence does not require the genotyping of additional tumor samples. The correlation between the genetic heterogeneity and some histological components of the CLM should be verified by further in situ mutation assay.
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Affiliation(s)
- Mylène Sebagh
- AP-HP Hôpital Paul Brousse, Laboratoire d'Anatomie Pathologique, Villejuif, France.,Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France.,Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France.,DHU Hepatinov, Villejuif, France
| | - Nelly Bosselut
- Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France.,Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France.,DHU Hepatinov, Villejuif, France.,AP-HP Hôpital Paul Brousse, Département d'Oncogénétique, Villejuif, France
| | - Alexandre Dos Santos
- Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France.,Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France.,DHU Hepatinov, Villejuif, France
| | - Marc-Antoine Allard
- Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France.,Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France.,DHU Hepatinov, Villejuif, France.,AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France.,Inserm, Unité 935, Université Paris-Saclay, Villejuif, France
| | - Aldrick Ruiz
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France.,University Medical Center Utrecht, Department of Surgery, Utrecht, The Netherlands
| | - Raphaël Saffroy
- Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France.,Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France.,DHU Hepatinov, Villejuif, France.,AP-HP Hôpital Paul Brousse, Département d'Oncogénétique, Villejuif, France
| | - Daniel Cherqui
- Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France.,Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France.,DHU Hepatinov, Villejuif, France.,AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - Eric Vibert
- Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France.,Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France.,DHU Hepatinov, Villejuif, France.,AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - Denis Castaing
- Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France.,Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France.,DHU Hepatinov, Villejuif, France.,AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - René Adam
- Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France.,DHU Hepatinov, Villejuif, France.,AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France.,Inserm, Unité 935, Université Paris-Saclay, Villejuif, France
| | - Antonio Sa Cunha
- Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France.,Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France.,DHU Hepatinov, Villejuif, France.,AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - Antoinette Lemoine
- Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France.,Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France.,DHU Hepatinov, Villejuif, France.,AP-HP Hôpital Paul Brousse, Département d'Oncogénétique, Villejuif, France
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15
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Testa U, Pelosi E, Castelli G. Colorectal cancer: genetic abnormalities, tumor progression, tumor heterogeneity, clonal evolution and tumor-initiating cells. Med Sci (Basel) 2018; 6:E31. [PMID: 29652830 PMCID: PMC6024750 DOI: 10.3390/medsci6020031] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/24/2018] [Accepted: 04/03/2018] [Indexed: 02/08/2023] Open
Abstract
Colon cancer is the third most common cancer worldwide. Most colorectal cancer occurrences are sporadic, not related to genetic predisposition or family history; however, 20-30% of patients with colorectal cancer have a family history of colorectal cancer and 5% of these tumors arise in the setting of a Mendelian inheritance syndrome. In many patients, the development of a colorectal cancer is preceded by a benign neoplastic lesion: either an adenomatous polyp or a serrated polyp. Studies carried out in the last years have characterized the main molecular alterations occurring in colorectal cancers, showing that the tumor of each patient displays from two to eight driver mutations. The ensemble of molecular studies, including gene expression studies, has led to two proposed classifications of colorectal cancers, with the identification of four/five non-overlapping groups. The homeostasis of the rapidly renewing intestinal epithelium is ensured by few stem cells present at the level of the base of intestinal crypts. Various experimental evidence suggests that colorectal cancers may derive from the malignant transformation of intestinal stem cells or of intestinal cells that acquire stem cell properties following malignant transformation. Colon cancer stem cells seem to be involved in tumor chemoresistance, radioresistance and relapse.
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Affiliation(s)
- Ugo Testa
- Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy.
| | - Elvira Pelosi
- Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy.
| | - Germana Castelli
- Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy.
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Romero I, Garrido C, Algarra I, Chamorro V, Collado A, Garrido F, Garcia-Lora AM. MHC Intratumoral Heterogeneity May Predict Cancer Progression and Response to Immunotherapy. Front Immunol 2018; 9:102. [PMID: 29434605 PMCID: PMC5796886 DOI: 10.3389/fimmu.2018.00102] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 01/12/2018] [Indexed: 12/12/2022] Open
Abstract
An individual tumor can present intratumoral phenotypic heterogeneity, containing tumor cells with different phenotypes that do not present irreversible genetic alterations. We have developed a mouse cancer model, named GR9, derived from a methylcholanthrene-induced fibrosarcoma that was adapted to tissue culture and cloned into different tumor cell lines. The clones showed diverse MHC-I phenotypes, ranging from highly positive to weakly positive MHC-I expression. These MHC-I alterations are due to reversible molecular mechanisms, because surface MHC-I could be recovered by IFN-γ treatment. Cell clones with high MHC-I expression demonstrated low local oncogenicity and high spontaneous metastatic capacity, whereas MHC-I-low clones showed high local oncogenicity and no spontaneous metastatic capacity. Although MHC-I-low clones did not metastasize, they produced MHC-I-positive dormant micrometastases controlled by the host immune system, i.e., in a state of immunodormancy. The metastatic capacity of each clone was directly correlated with the host T-cell subpopulations; thus, a strong decrease in cytotoxic and helper T lymphocytes was observed in mice with numerous metastases derived from MHC-I positive tumor clones but a strong increase was observed in those with dormant micrometastases. Immunotherapy was administered to the hosts after excision of the primary tumor, producing a recovery in their immune status and leading to the complete eradication of overt spontaneous metastases or their decrease. According to these findings, the combination of MHC-I surface expression in primary tumor and metastases with host T-cell subsets may be a decisive indicator of the clinical outcome and response to immunotherapy in metastatic disease, allowing the identification of responders to this approach.
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Affiliation(s)
- Irene Romero
- UGC Laboratorios, Complejo Hospitalario de Jaén, Jaén, Spain
| | - Cristina Garrido
- Departamento de Bioquímica, Biología Molecular e Inmunología III, Universidad de Granada, Granada, Spain
| | - Ignacio Algarra
- Departamento de Ciencias de la Salud, Universidad de Jaén, Jaén, Spain
| | - Virginia Chamorro
- Servicio de Análisis Clínicos e Inmunología, UGC Laboratorio Clínico, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
| | - Antonia Collado
- Unidad de Biobanco, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
| | - Federico Garrido
- Departamento de Bioquímica, Biología Molecular e Inmunología III, Universidad de Granada, Granada, Spain.,Servicio de Análisis Clínicos e Inmunología, UGC Laboratorio Clínico, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
| | - Angel M Garcia-Lora
- Servicio de Análisis Clínicos e Inmunología, UGC Laboratorio Clínico, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
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17
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Sabbagh C, Chatelain D, Attencourt C, Joly JP, Chauffert B, Cosse C, Regimbeau JM. Impact of homogeneous pathologic response to preoperative chemotherapy in patients with multiple colorectal liver metastases. World J Gastroenterol 2017; 23:8027-8034. [PMID: 29259378 PMCID: PMC5725297 DOI: 10.3748/wjg.v23.i45.8027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/28/2017] [Accepted: 09/05/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To analyze the homogeneity of pathologic response to preoperative chemotherapy (PRPC) after chemotherapy in patients with multiple liver metastases (LM).
METHODS From September 2011 to August 2014, patients with at least two LM undergoing preoperative chemotherapy prior to resection were included in this retrospective, single-center study. The endpoints were PRPC homogeneity (according to both the Rubbia-Brandt and MD Anderson classifications), the impact of PRPC on the MDT decision, factors associated with homogeneous PRPC and overall survival of patients with vs. without homogeneous PRPC.
RESULTS seventy-three patients with a total of 88 liver resections (including 15 two-stage procedures) were included in the study. The homogeneous PRPC rate was 55% according to the Rubbia-Brandt classification and 53% according to the MD Anderson classification. The MDT decision was modified by the PRPC in only 2.7% of patients (n = 2).
CONCLUSION The PRPC was homogeneous in only one half of patients and had very little influence on the MDT decision.
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Affiliation(s)
- Charles Sabbagh
- Department of Digestive and Oncologic Surgery, Amiens University Medical Center, 80054 Amiens, France
- INSERM U1088, Jules Verne University of Picardie, 80054 Amiens, France
- University of Picardie, 80054 Amiens, France
| | - Denis Chatelain
- University of Picardie, 80054 Amiens, France
- Department of Anatomic Pathology, Amiens University Medical Center, 80054 Amiens, France
| | - Christophe Attencourt
- Department of Anatomic Pathology, Amiens University Medical Center, 80054 Amiens, France
| | - Jean-Paul Joly
- Department of Hepatogastroenterology, Amiens University Medical Center, 80054 Amiens, France
| | - Bruno Chauffert
- University of Picardie, 80054 Amiens, France
- Department of Medical Oncology, Amiens University Medical Center, 80054 Amiens, France
| | - Cyril Cosse
- Department of Digestive and Oncologic Surgery, Amiens University Medical Center, 80054 Amiens, France
- INSERM U1088, Jules Verne University of Picardie, 80054 Amiens, France
| | - Jean-Marc Regimbeau
- Department of Digestive and Oncologic Surgery, Amiens University Medical Center, 80054 Amiens, France
- University of Picardie, 80054 Amiens, France
- EA4294, Jules Verne University of Picardie, 80054 Amiens, France
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18
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Ulintz PJ, Greenson JK, Wu R, Fearon ER, Hardiman KM. Lymph Node Metastases in Colon Cancer Are Polyclonal. Clin Cancer Res 2017; 24:2214-2224. [PMID: 29203589 DOI: 10.1158/1078-0432.ccr-17-1425] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/22/2017] [Accepted: 11/28/2017] [Indexed: 11/16/2022]
Abstract
Purpose: Recent studies have highlighted the existence of subclones in tumors. Lymph nodes are generally the first location of metastasis for most solid epithelial tumors, including colorectal cancer. We sought to understand the genetic origin of lymph node metastasis in colorectal cancer by evaluating the relationship between colorectal cancer subclones present in primary tumors and lymph nodes.Experimental Design: A total of 33 samples from seven colorectal cancers, including two or three spatially disparate regions from each primary tumor and one to four matched lymph nodes for each tumor, underwent next-generation whole-exome DNA sequencing, Affymetrix OncoScan SNP arrays, and targeted deep confirmatory sequencing. We performed mapping between SNPs and copy number events from the primary tumor and matched lymph node samples, allowing us to profile heterogeneity and the mutational origin of lymph node metastases. The computational method PyClone was used to define subclones within each tumor. The method Clonality Inference in Tumors Using Phylogeny (CITUP) was subsequently used to infer phylogenetic relationships among subclones.Results: We found that there was substantial heterogeneity in mutations and copy number changes among all samples from any given patient. For each patient, the primary tumor regions and matched lymph node metastases were each polyclonal, and the clonal populations differed from one lymph node to another. In some patients, the cancer cell populations in a given lymph node originated from multiple distinct regions of a tumor.Conclusions: Our data support a model of lymph node metastatic spread in colorectal cancer whereby metastases originate from multiple waves of seeding from the primary tumor over time. Clin Cancer Res; 24(9); 2214-24. ©2017 AACRSee related commentary by Gerlinger, p. 2032.
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Affiliation(s)
- Peter J Ulintz
- Bioinformatics Core, University of Michigan, Ann Arbor, Michigan
| | - Joel K Greenson
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Rong Wu
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Eric R Fearon
- Department of Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Human Genetics, University of Michigan, Ann Arbor, Michigan.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Karin M Hardiman
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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19
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Golse N, Adam R. Liver Metastases From Breast Cancer: What Role for Surgery? Indications and Results. Clin Breast Cancer 2017; 17:256-265. [DOI: 10.1016/j.clbc.2016.12.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/26/2016] [Indexed: 12/30/2022]
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20
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Donati F, Boraschi P, Pacciardi F, Cervelli R, Castagna M, Urbani L, Falaschi F, Caramella D. 3T diffusion-weighted MRI in the response assessment of colorectal liver metastases after chemotherapy: Correlation between ADC value and histological tumour regression grading. Eur J Radiol 2017. [PMID: 28629572 DOI: 10.1016/j.ejrad.2017.03.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of the study was to correlate the apparent diffusion coefficient (ADC) values of diffusion-weighted MR imaging (DW-MRI) by 3T device with the histological tumour regression grading (TRG) analysis of colorectal liver metastases after preoperative chemotherapy. MATERIALS AND METHODS Our study included thirty-five patients with colorectal liver metastases who had undergone MRI by 3T device (GE DISCOVERY MR750; GE Healthcare) after preoperative chemotherapy. DW-MRI was performed using a single-shot spin-echo echo-planar sequence with multiple b-values (0, 150, 500, 1000, 1500s/mm2), thus obtaining an ADC map. For each liver lesion (more than 1cm in diameter) the fitted ADC values were calculated by two radiologists in conference and three ROIs were drawn: around the entire tumour (ADCe), at the tumour periphery (ADCp) and at the tumour center (ADCc). All ADC values were correlated with histopathological findings after surgery. Hepatic metastases were pathologically classified into five groups on the basis of TRG. Statistical analysis was performed on a per-lesion basis utilizing the one-way analysis of variance (ANOVA). This retrospective study was approved by our institutional review board; written informed consent was obtained from all patients. RESULTS A total of 106 colorectal liver metastases were included for image analysis. TRG1, TRG2, TRG3, TRG4 and TRG5 were observed in 4, 14, 36, 35 and 17 lesions, respectively. ADCe and ADCp values were significantly higher in lesions classified as TRG1 (2.40±0.12×10-9m2/s and 2.28±0.26×10-9m2/s, respectively) and as TRG2 (1.40±0.31×10-9m2/s and 1.44±0.35×10-9m2/s), compared to TRG3 (1.16±0.13×10-9m2/s and 1.01±0.18×10-9m2/s), TRG4 (1.10±0.26×10-9m2/s and 0.97±0.24×10-9m2/s), and TRG5 (0.93±0.17×10-9m2/s and 0.82±0.28×10-9m2/s). ADCe, ADCp and ADCc values were significantly different in TRG classes (p<0.0001). Statistical correlations were found between the ADCe, ADCp, ADCc values and the TRG classes (Spearman correlation coefficient were -0.568, -0.542 and -0.554, respectively). CONCLUSION Our study showed a significant correlation between ADC values of 3T DW-MRI and histological TRG of colorectal liver metastases after preoperative chemotherapy.
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Affiliation(s)
- Francescamaria Donati
- Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy.
| | - Piero Boraschi
- Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Federica Pacciardi
- Unit of Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Rosa Cervelli
- Unit of Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Maura Castagna
- Unit of Pathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Lucio Urbani
- Department of General Surgery, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Fabio Falaschi
- Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Davide Caramella
- Unit of Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
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