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Goodfellow PJ, Billingsley CC, Lankes HA, Ali S, Cohn DE, Broaddus RJ, Ramirez N, Pritchard CC, Hampel H, Chassen AS, Simmons LV, Schmidt AP, Gao F, Brinton LA, Backes F, Landrum LM, Geller MA, DiSilvestro PA, Pearl ML, Lele SB, Powell MA, Zaino RJ, Mutch D. Combined Microsatellite Instability, MLH1 Methylation Analysis, and Immunohistochemistry for Lynch Syndrome Screening in Endometrial Cancers From GOG210: An NRG Oncology and Gynecologic Oncology Group Study. J Clin Oncol 2015; 33:4301-8. [PMID: 26552419 PMCID: PMC4678181 DOI: 10.1200/jco.2015.63.9518] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The best screening practice for Lynch syndrome (LS) in endometrial cancer (EC) remains unknown. We sought to determine whether tumor microsatellite instability (MSI) typing along with immunohistochemistry (IHC) and MLH1 methylation analysis can help identify women with LS. PATIENTS AND METHODS ECs from GOG210 patients were assessed for MSI, MLH1 methylation, and mismatch repair (MMR) protein expression. Each tumor was classified as having normal MMR, defective MMR associated with MLH1 methylation, or probable MMR mutation (ie, defective MMR but no methylation). Cancer family history and demographic and clinical features were compared for the three groups. Lynch mutation testing was performed for a subset of women. RESULTS Analysis of 1,002 ECs suggested possible MMR mutation in 11.8% of tumors. The number of patients with a family history suggestive of LS was highest among women whose tumors were classified as probable MMR mutation (P = .001). Lynch mutations were identified in 41% of patient cases classified as probable mutation (21 of 51 tested). One of the MSH6 Lynch mutations was identified in a patient whose tumor had intact MSH6 expression. Age at diagnosis was younger for mutation carriers than noncarriers (54.3 v 62.3 years; P < .01), with five carriers diagnosed at age > 60 years. CONCLUSION Combined MSI, methylation, and IHC analysis may prove useful in Lynch screening in EC. Twenty-four percent of mutation carriers presented with ECs at age > 60 years, and one carrier had an MSI-positive tumor with no IHC defect. Restricting Lynch testing to women diagnosed at age < 60 years or to women with IHC defects could result in missing a substantial fraction of genetic disease.
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Affiliation(s)
- Paul J Goodfellow
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA.
| | - Caroline C Billingsley
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Heather A Lankes
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Shamshad Ali
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - David E Cohn
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Russell J Broaddus
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Nilsa Ramirez
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Colin C Pritchard
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Heather Hampel
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Alexis S Chassen
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Luke V Simmons
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Amy P Schmidt
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Feng Gao
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Louise A Brinton
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Floor Backes
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Lisa M Landrum
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Melissa A Geller
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Paul A DiSilvestro
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Michael L Pearl
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Shashikant B Lele
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Matthew A Powell
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Richard J Zaino
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - David Mutch
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
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