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Eley C, Mellor K, Luton O, James OP, Bowman CR, Robinson DB, Powell AG, Hopkins L, Hemington-Gorse S, Egan RJ, Pollitt MJ, Lewis WG. The Leaning Tower of Pasta: Lessons in Team Performance and Creativity From a Core Surgical Training Boot Camp Design Challenge. J Surg Educ 2021; 78:1702-1708. [PMID: 33455895 DOI: 10.1016/j.jsurg.2020.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 06/12/2023]
Abstract
AIMS Unity of effort is an important component of strategic leadership and management theory associated with Core Surgical Training (CST) outcome. The aim was to determine the impact of team diversity on task completion: a creative design challenge, during CST Boot camp. METHODS Attendees (n = 44) at a single Statutory Education Body's CST Boot camp were stratified into teams related to specialty theme, and set a design challenge as described by Peter Skillman, to build the tallest free-standing tower out of spaghetti (20 pieces), tape (1 m), and string (1 m), with a marshmallow on top in 18 minutes. Primary outcome measure was tower height. RESULTS Five teams (50%) completed the task with the tallest tower measuring 70 cm (median 51, range 0-70). Median satisfaction with the simulation exercise was 4 (2-5) on a scale of 0 to 5, with 5 corresponding with highest satisfaction. Successful task completion was associated with team surgical specialty (p = 0.032), ethnicity ratio (p = 0.010,), and gender ratio (p = 0.003), respectively. On multivariable analysis, only team gender ratio was independently associated with tower height (Hazard ratio 0.515, 95% confidence interval 0.350-0.759, p = 0.001). CONCLUSION Modern leadership theory emphasizes the important dynamic relationship between individual team members, the team, and task completion. General surgery themed teams with a gender mix were most successful in completing the design challenge; whether relative simulation performance predicts strategic organizational skill and career progression will be the next question.
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Affiliation(s)
- Catherine Eley
- Health Education and Improvement Wales' School of Surgery, Nantgarw, United Kingdom.
| | - Katie Mellor
- Health Education and Improvement Wales' School of Surgery, Nantgarw, United Kingdom
| | - Oliver Luton
- Health Education and Improvement Wales' School of Surgery, Nantgarw, United Kingdom
| | - Osian P James
- Health Education and Improvement Wales' School of Surgery, Nantgarw, United Kingdom
| | - Chris R Bowman
- Health Education and Improvement Wales' School of Surgery, Nantgarw, United Kingdom
| | - David Bt Robinson
- Health Education and Improvement Wales' School of Surgery, Nantgarw, United Kingdom
| | - Arfon Gmt Powell
- Health Education and Improvement Wales' School of Surgery, Nantgarw, United Kingdom; Division of Cancer & Genetics, Cardiff University, United Kingdom
| | - Luke Hopkins
- Health Education and Improvement Wales' School of Surgery, Nantgarw, United Kingdom; Department of Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Sarah Hemington-Gorse
- Health Education and Improvement Wales' School of Surgery, Nantgarw, United Kingdom; Department of Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Richard J Egan
- Department of Surgery, Morriston Hospital, Swansea, United Kingdom; Swansea University, Swansea, United Kingdom
| | - M John Pollitt
- Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, United Kingdom
| | - Wyn G Lewis
- Health Education and Improvement Wales' School of Surgery, Nantgarw, United Kingdom
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Robinson DBT, Luton O, Mellor K, James OP, Hopkins L, Powell AG, Hemington-Gorse S, Harries RL, Egan RJ, Lewis WG. Trainee perspective of the causes of stress and burnout in surgical training: a qualitative study from Wales. BMJ Open 2021; 11:e045150. [PMID: 34341033 PMCID: PMC8330580 DOI: 10.1136/bmjopen-2020-045150] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Stress and burn-out among surgical trainees has been reported most prevalent in core surgical trainees (CST) and female trainees in particular. This study aimed to identify factors perceived by CSTs to be associated with stress and burnout in those at risk. DESIGN An open-ended questionnaire was distributed to 79 CSTs and two researchers categorised responses independently, according to Michie's model of workplace stress. SETTING A UK regional postgraduate medical region (Wales). PARTICIPANTS Sixty-three responses were received; 42 males, 21 females. The response rate was 79.7%. RESULTS Inter-rater reliability was good (k=0.792 (79.2%), p<0.001). The most common theme of Michie's model related to CST stress and burnout was career development, with most statements associated with curriculum, examination and academic demands required to attain a CST certificate of completion of training, and higher surgical national training number appointment. This was closely followed by those intrinsic to the job with recurrent discussion around the difficulties balancing work perceived to be service provision (ward work and on-calls), outpatient clinic and operative experience. Conversely, the most common themes relevant to stress and burnout among female trainees were associated with relationships at work (primarily the male-dominated nature of surgery), extraorganisational factors (family-work life balance) and individual characteristics (personality and physiological differences). CONCLUSION CSTs' perceptions regarding the causes of National Health Service related stress and burnout are numerous, and these findings provide a basis for the development of targeted stressor counter-measures to improve training and well-being.
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Affiliation(s)
- David Bryan Thomas Robinson
- Postgraduate Research Department, Cardiff University School of Medicine, Cardiff, UK
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
- General Surgery, Royal Gwent Hospital, Newport, UK
| | - Oliver Luton
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
- General Surgery, Morriston Hospital, Swansea, UK
| | - Katie Mellor
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
- General Surgery, Ysbyty Gwynedd, Bangor, UK
| | - Osian Penri James
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
- General Surgery, Royal Gwent Hospital, Newport, UK
| | - Luke Hopkins
- Postgraduate Research Department, Cardiff University School of Medicine, Cardiff, UK
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
- General Surgery, Morriston Hospital, Swansea, UK
| | - Arfon Gmt Powell
- Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK
| | - Sarah Hemington-Gorse
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
- Department of Plastic Surgery, Morriston Hospital, Swansea, UK
| | | | - Richard J Egan
- General Surgery, Morriston Hospital, Swansea, UK
- Swansea University College of Medicine, Swansea, UK
| | - Wyn G Lewis
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
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3
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Mellor K, Powell AG, James OP, Robinson DB, Hopkins L, Egan RJ, Lewis WG. Gongs galore: phaleristic study of the relative risk of a healing art related New Year Honour. Postgrad Med J 2021; 98:252-257. [PMID: 33563714 DOI: 10.1136/postgradmedj-2020-139368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/03/2020] [Accepted: 12/12/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare proportional representation of healthcare specialty workers, in receipt of New Year Honours (NYHs) and examine system bias. DESIGN Observational study of UK honours system including comparative analysis of proportional representation of the UK medical workforce. PARTICIPANTS Recipients of NYHs from 2010 to 2019. MAIN OUTCOME MEASURES Absolute risk of receiving an NYH, related to medical specialty, gender and geographical region. Relative risk (RR) of receiving an NYH for services to healthcare related to specialty. RESULTS 11 207 NYHs were bestowed, with 368 (3.3%) awarded to healthcare professionals: 212 (57.6%) women, 156 (42.4%) men. The RR of a healthcare professional receiving an NYH was 0.76 (95% CI 0.68 to 0.84, p<0.001) when compared with the remaining UK workforce. Doctors received most NYHs (n=181), with public health, clinical oncology and general medicine specialties most likely to be rewarded (RR 20.35 (95% CI 9.61 to 43.08, p<0.001), 8.43 (95% CI 2.70 to 26.30, p<0.001) and 8.22 (95% CI 6.22 to 10.86, p<0.001)), respectively; anaesthetists received fewest NYHs (RR 0.52 (95% CI 0.13 to 2.10), p=0.305). Men were more likely to receive NYHs than women (OR 0.44, 95% CI 0.36 to 0.54; p<0.001). Two hundred and fifty-four NYHs (69.0%) were bestowed on residents of England (60, 16.3% London), 49 (13.3%) Scotland (p=0.003), 39 (10.6%) Wales (p<0.001) and 26 (7.1%) Northern-Ireland (p<0.001). CONCLUSIONS Relative risk of receiving an NYH varied over 150-fold by specialty, twofold by gender and threefold by geographical location. Public health physicians are perceived to be the pick of the parade.
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Affiliation(s)
- Katie Mellor
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
| | - Arfon Gmt Powell
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK.,Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK
| | - Osian P James
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
| | - David B Robinson
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
| | - Luke Hopkins
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK.,Department of Surgery, Morriston Hospital, Swansea, UK
| | - Richard John Egan
- Department of Surgery, Morriston Hospital, Swansea, UK.,Medical School, Swansea University, Swansea, UK
| | - Wyn G Lewis
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
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Hopkins L, Robinson DB, Brown C, Abdelrahman T, Powell AG, Pollitt MJ, Hemington-Gorse S, Lewis WG, Egan RJ. Summative Supervisor Reporting: A Quality Performance Perspective. J Surg Educ 2020; 77:88-95. [PMID: 31481311 DOI: 10.1016/j.jsurg.2019.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/26/2019] [Accepted: 08/19/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study aimed to quality assure Assigned Educational Supervisor (AES) reports, using UK Joint Committee on Surgical Training objective criteria, to evaluate contribution to Annual Review of Competence Progression. DESIGN Consecutive 145 AES reports from 75 trainers regarding 68 Core Surgical Trainees were assessed from 9 hospitals (2 Tertiary centers [77 reports], 7 District General Hospitals [68 reports]). Reports were assessed by independent assessors based on free text related to performance mapped to curricular objectives, operative logbooks, and Clinical Supervisor reports, and overall summary grades assigned ranging from development required, adequate, good to excellent. SETTING A core surgical training program serving a single UK (Wales) deanery. PARTICIPANTS Sixty-eight consecutively appointed core surgical trainees and 75 consultant surgeon trainers. RESULTS Summary grades of adequate or above were achieved in 101 of 145 (69.7%) reports. Trainees' objective setting meetings were completed within 6 weeks of starting placements in 124 of 145 (85.5%). The proportions of AES reports containing free text commentary on curricular objectives, portfolio objectives, and operative logbook development were 128 of 145, 123 of 145, and 55 of 145, respectively. AES report quality was not associated with hospital status, subspecialty, or trainee grade. Female trainers were significantly more likely to provide reports graded as Good or Excellent compared with their male colleagues (7 of 12 vs. 27 of 133, χ2 (2) = 9.389, p = 0.009). AES reports for male trainees were significantly more likely to be rated as further development required (40 of 85, 47.1%) when compared with female trainees (4 of 32, 12.5%, p = 0.007). CONCLUSIONS Three in ten AES reports were insufficient to contribute to objective Annual Review of Competence Progression outcomes and a gender gap was apparent related to engagement. AES trainers should provide more focus if this summative tool is to be an effective career progression metric.
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Affiliation(s)
- Luke Hopkins
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, Wales; Swansea University Medical School, Sketty, Wales.
| | - David Bt Robinson
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, Wales
| | - Christopher Brown
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, Wales
| | - Tarig Abdelrahman
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, Wales
| | - Arfon Gmt Powell
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, Wales; Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, Wales
| | - M John Pollitt
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, Wales
| | - Sarah Hemington-Gorse
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, Wales
| | - Wyn G Lewis
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, Wales
| | - Richard J Egan
- Swansea University Medical School, Sketty, Wales; Department of Surgery, Morriston Hospital, Swansea, Wales
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Powell AG, Williams EA, Edwards P. Letter of response on: "Mode of presentation rather than the 'weekend effect' is a major determinant of in-hospital mortality". Surgeon 2019; 17:383. [PMID: 31445936 DOI: 10.1016/j.surge.2019.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/21/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Arfon Gmt Powell
- Division of Cancer and Genetics, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XW2, United Kingdom
| | - E Anwen Williams
- Nevill Hall Hospital, Brecon Road, Abergavenny, NP7 7EG, United Kingdom
| | - Paul Edwards
- Division of Cancer and Genetics, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XW2, United Kingdom
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Karsan RB, Powell AG, Nanjaiah P, Mehta D, Valtzoglou V. The top 100 manuscripts in emergency cardiac surgery. Potential role in cardiothoracic training. A bibliometric analysis. Ann Med Surg (Lond) 2019; 43:5-12. [PMID: 31193454 PMCID: PMC6531840 DOI: 10.1016/j.amsu.2019.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/29/2019] [Accepted: 05/09/2019] [Indexed: 12/15/2022] Open
Abstract
Background Emergency Cardiac Surgery (ECS) is a component of cardiothoracic training. Citations are considered to represent a papers influence. Bibliometric analyses allow us to identify the most influential work, and future research. We aim to highlight the key research themes within ECS and determine their potential impact on cardiothoracic training. Methods Thomas Reuters Web of Science was searched using terms [Emergency AND Card* AND Surg*]. Results were ranked by citation and reviewed by a panel of cardiac surgeons to identify the top 100 cited papers relevant to ECS. Papers were analysed by topic, journal and impact. Regression analysis was used to determine a link between impact factor and scientific impact. Results 3823 papers were identified. Median citations for the top 100 was 88. The paper with the highest impact was by Nashef et al. focusing on the use of EuroSCORE (2043 citations). The Annals of Thoracic Surgery published most papers (n = 18:1778 citations). The European Journal of Cardiothoracic Surgery coveted the most citations (n = 2649). The USA published most papers (n = 55).The most ubiquitous topics were; risk stratification, circulatory support and aortic surgery. A positive relationship between journal impact fact and the scientific impact of manuscripts in ECS (P = 0.043) was deduced. Conclusion This study is the first of its kind and identified the papers which are likely to the contribute most to training and understanding of ECS. A papers influence is partially determined by journal impact factor. Bibliometric analysis is a potent tool to identify surgical training needs.
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Affiliation(s)
- Rickesh B Karsan
- Department of Cardiothoracic Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Arfon Gmt Powell
- Division of Cancer and Genetics, Cardiff University, Heath Park, Cardiff, CF14 4XW, UK.,Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Prakash Nanjaiah
- Department of Cardiothoracic Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Dheeraj Mehta
- Department of Cardiothoracic Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Vasileious Valtzoglou
- Department of Cardiothoracic Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
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Patel N, Foley KG, Powell AG, Wheat JR, Chan D, Fielding P, Roberts SA, Lewis WG. Propensity score analysis of 18-FDG PET/CT-enhanced staging in patients undergoing surgery for esophageal cancer. Eur J Nucl Med Mol Imaging 2018; 46:801-809. [PMID: 30116837 PMCID: PMC6450839 DOI: 10.1007/s00259-018-4118-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/30/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE PET/CT is now integral to the staging pathway for potentially curable esophageal cancer (EC), primarily to identify distant metastases undetected by computed tomography. The aim of this study was to analyze the effect of PET/CT introduction on survival and assess patterns of recurrence after esophagectomy. METHODS A longitudinal cohort of EC patients staged between 1998 and 2016 were considered for inclusion. After co-variate adjustment using propensity scoring, a cohort of 496 patients (273 pre-PET/CT and 223 post-PET/CT) who underwent esophagectomy [median age 63 years (31-80), 395 males, 425 adenocarcinomas, 71 squamous cell carcinomas, 325 neoadjuvant therapy] were included. The primary outcome measure was overall survival (OS) based on intention to treat. RESULTS Three-year OS pre-PET/CT was 42.5% compared with 57.8% post-PET/CT (Chi2 6.571, df 1, p = 0.004). On multivariable analysis, pT stage (HR 1.496 [95% CI 1.28-1.75], p < 0.0001), pN stage (HR 1.114 [95% CI 1.04-1.19], p = 0.001) and PET/CT staging (HR 0.688 [95% CI 0.53-0.89] p = 0.004) were independently associated with OS. Recurrent cancer was observed in 125 patients (51.4%) pre-PET/CT, compared with 74 patients post-PET/CT (37.8%, p = 0.004), and was less likely to be distant recurrence after PET/CT introduction (39.5 vs. 27.0%, p = 0.006). CONCLUSIONS Enhanced PET/CT staging is an important modality and independent factor associated with improved survival in patients undergoing esophagectomy for cancer.
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Affiliation(s)
- N Patel
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Kieran G Foley
- Division of Cancer & Genetics, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, UK.
| | - A G Powell
- Division of Cancer & Genetics, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, UK
| | - J R Wheat
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - D Chan
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - P Fielding
- Wales Research & Diagnostic Positron Emission Tomography Imaging Centre (PETIC), UHW, Cardiff, CF14 4XN, UK
| | - S A Roberts
- Department of Radiology, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - W G Lewis
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
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Roseweir AK, Halcrow ES, Chichilo S, Powell AG, McMillan DC, Horgan PG, Edwards J. ERK and p38MAPK combine to improve survival in patients with BRAF mutant colorectal cancer. Br J Cancer 2018; 119:323-329. [PMID: 29988110 PMCID: PMC6070918 DOI: 10.1038/s41416-018-0174-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND In colorectal cancer (CRC), BRAF mutations influence tumour progression. In mismatch repair-deficient (dMMR) tumours, BRAF mutations are associated with a good prognosis, whereas in MMR-competent tumours, they are detrimental. The differential expression of the downstream MAPK pathway members, which are constitutively activated in BRAF mutant patients, may account for these differences. METHODS Phosphorylation of ERK, p38MAPK and JNK was assessed by immunohistochemistry, utilising CRC tissue microarrays. A discovery cohort (n = 187) and a validation cohort (n = 801) were analysed for associations with BRAF mutations, clinicopathological characteristics and cancer-specific survival (CSS). RESULTS In 801 CRC patients, nuclear ERK phosphorylation (HR 0.65 95% CI 0.48-0.88, p = 0.004) and the combined nuclear pERK/p-p38 score (HR 0.61 95% CI 0.45-0.82, p = 0.001) were independently associated with CSS, and were further associated with increased BRAF mutations (p = 0.003 and p = 0.002). When stratified for BRAF status, only MMR-competent patients harbouring the mutation and a strong combined nuclear pERK/p-p38 score (HR 0.49 95% CI 0.27-0.89, p = 0.016) demonstrated improved CSS. This improvement in CSS was specific to stage III CRC (HR 0.25 95% CI 0.10-0.64, p = 0.002). CONCLUSIONS MMR-competent stage III tumours harbouring BRAF mutations have an improved prognosis when strong nuclear phosphorylation of both ERK and p38MAPK is present.
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Affiliation(s)
- Antonia K Roseweir
- Academic Unit of Surgery, School of Medicine-University of Glasgow, Royal Infirmary, Glasgow, G4 OSF, UK. .,Institute of Cancer Sciences, University of Glasgow, Wolfson Wohl Cancer Research Centre, Glasgow, G61 1QH, UK.
| | - Elaine S Halcrow
- Institute of Cancer Sciences, University of Glasgow, Wolfson Wohl Cancer Research Centre, Glasgow, G61 1QH, UK
| | - Sergey Chichilo
- Institute of Cancer Sciences, University of Glasgow, Wolfson Wohl Cancer Research Centre, Glasgow, G61 1QH, UK
| | - Arfon Gmt Powell
- Division of Cancer and Genetics, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine-University of Glasgow, Royal Infirmary, Glasgow, G4 OSF, UK
| | - Paul G Horgan
- Academic Unit of Surgery, School of Medicine-University of Glasgow, Royal Infirmary, Glasgow, G4 OSF, UK
| | - Joanne Edwards
- Institute of Cancer Sciences, University of Glasgow, Wolfson Wohl Cancer Research Centre, Glasgow, G61 1QH, UK
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