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Wu C, Pai RK, Kosiorek H, Banerjee I, Pfeiffer A, Hagen CE, Hartley CP, Graham RP, Sonbol MB, Bekaii-Saab T, Xie H, Sinicrope FA, Patel B, Westerling-Bui T, Shivji S, Conner J, Swallow C, Savage P, Cyr DP, Kirsch R, Pai RK. Improved risk stratification scheme for mismatch repair proficient stage II colorectal cancers using the digital pathology biomarker QuantCRC. Clin Cancer Res 2024:734991. [PMID: 38421684 DOI: 10.1158/1078-0432.ccr-23-3211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/27/2023] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE There is a need to improve current risk stratification of stage II colorectal cancer (CRC) to better inform risk of recurrence and guide adjuvant chemotherapy. We sought to examine whether integration of QuantCRC, a digital pathology biomarker utilizing hematoxylin and eosin-stained slides, provides improved risk stratification over current American Society of Clinical Oncology (ASCO) guidelines. EXPERIMENTAL DESIGN ASCO and QuantCRC-integrated schemes were applied to a cohort of 398 mismatch repair proficient (MMRP) stage II CRCs from three large academic medical centers. The ASCO stage II scheme was taken from recent guidelines. The QuantCRC-integrated scheme utilized pT3 vs. pT4 and a QuantCRC-derived risk classification. Evaluation of recurrence free survival (RFS) according to these risk schemes was compared using the log-rank test and hazard ratios. RESULTS Integration of QuantCRC provides improved risk stratification compared to the ASCO scheme for stage II MMRP CRCs. The QuantCRC-integrated scheme placed more stage II tumors in the low-risk group compared to the ASCO scheme (62.5% vs. 42.2%) without compromising excellent 3-year RFS. The QuantCRC-integrated scheme provided larger hazard ratios (HR) for both intermediate-risk (2.27, 95%CI 1.32-3.91, P=0.003) and high-risk (3.27, 95%CI 1.42-7.55, P=0.006) groups compared to ASCO intermediate-risk (1.58, 95%CI 0.87-2.87, P=0.1) and high-risk (2.24, 95%CI 1.09-4.62, P=0.03) groups. The QuantCRC-integrated risk groups remained prognostic in the subgroup of patients that did not receive any adjuvant chemotherapy. CONCLUSIONS Incorporation of QuantCRC into risk stratification provides a powerful predictor of RFS that has potential to guide subsequent treatment and surveillance for stage II MMRP CRCs.
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Affiliation(s)
- Christina Wu
- Mayo Clinic Hospital, Phoenix, Arizona, United States
| | - Reetesh K Pai
- University of Pittsburgh, Pittsburgh, PA, United States
| | | | | | | | | | | | | | | | | | - Hao Xie
- Mayo Clinic, Rochester, MN, United States
| | | | | | | | | | | | - Carol Swallow
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Paul Savage
- University of Toronto, Toronto, ONTARIO, Canada
| | - David P Cyr
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | | | - Rish K Pai
- Mayo Clinic, Scottsdale, AZ, United States
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Graff D, Hernandez-Rocha C, Borowski K, Stempak J, Conner J, Silverberg MS. A181 HIGHER CUMULATIVE HISTOLOGIC INFLAMMATORY BURDEN SCORE IS ASSOCIATED WITH THE RISK OF DEVELOPMENT OF COLORECTAL NEOPLASIA IN ULCERATIVE COLITIS. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991270 DOI: 10.1093/jcag/gwac036.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Ulcerative colitis (UC) patients have an elevated risk of colorectal neoplasia (CRN). Younger age at diagnosis, extent of colitis, and longer duration of colitis, as well as increased severity, which is a component of the cumulative inflammatory burden score (CIB), have been associated with the development of CRN. CIB was developed based on a large cohort of UC patients from St. Mark’s Hospital (UK) but needs further validation in independent cohorts. Purpose We analyzed the association between higher histologic CIB and development of CRN in longstanding UC patients. Method A matched case-control cohort of UC patients with at least 8 years of disease duration was analyzed at Mount Sinai Hospital. Patients with primary sclerosing cholangitis were excluded. Cases consisted of UC patients with colitis-associated neoplasia defined as indefinite for dysplasia (IND), low-grade dysplasia (LGD), high-grade dysplasia (HGD), or colorectal cancer (CRC). Each case was matched to two controls by age at disease onset, disease duration, and histological extent of colitis. Histologic reports obtained by colonoscopy were reviewed and histological activity was assessed as quiescent/normal (0), mild (1), moderate (2), and severe (3). The colonic area with the higher score was utilized and the CIB was calculated by summing each score and multiplying it by the interval of surveillance. A mean CIB (mCIB) was also calculated for each patient dividing the CIB by the number of colonoscopies. Continuous variables including CIB scores and mCIB scores were summarized as median and interquartile range (IQR) and differences between groups were compared by Mann-Whitney test. Result(s) Fifty-four UC patients were analyzed with 18 having CRN (6 CRC, 2 HGD, 3 LGD and 7 IND) and 36 controls without CRN. The clinical characteristics of the total cohort, cases and controls are depicted in the Table. Median age at last colonoscopy assessed was 45 years (36-55) and 40.7% were female. The median age at onset of UC was 23 years (19-37) and median duration of UC was 16 years (11-23). All patients had extensive histologic colonic disease. There were no differences between cases and controls in interval of surveillance evaluated (7.5 vs 7.8 years, p = 0.7) and median number of colonoscopies with histologic assessment (4 vs 4, p =0.6). Cases with CRN had significantly higher CIB (11.4 vs 7.9, p = 0.02) and mCIB (2.9 vs 2.0, p = 0.02) compared to controls. Image ![]()
Conclusion(s) The histologic CIB score is associated with an increased risk of developing CRN in UC patients with similar age at onset of disease, disease duration and colitis extent. Given CIB reflects the severity of histologic inflammation over the years, treatment strategies to improve histologic inflammation could reduce the incidence of CRN in UC. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
- D Graff
- Zane Cohen Centre for Digestive Diseases, Lunenfeld-Tanenbaum Research Institute, Sinai Health System
| | - C Hernandez-Rocha
- Zane Cohen Centre for Digestive Diseases, Lunenfeld-Tanenbaum Research Institute, Sinai Health System,Division of Gastroenterology, Sinai Health System, University of Toronto
| | - K Borowski
- Zane Cohen Centre for Digestive Diseases, Lunenfeld-Tanenbaum Research Institute, Sinai Health System
| | - J Stempak
- Zane Cohen Centre for Digestive Diseases, Lunenfeld-Tanenbaum Research Institute, Sinai Health System
| | - J Conner
- Department of Pathology & Laboratory Medicine, Sinai Health Systems, Toronto, Canada
| | - M S Silverberg
- Zane Cohen Centre for Digestive Diseases, Lunenfeld-Tanenbaum Research Institute, Sinai Health System,Division of Gastroenterology, Sinai Health System, University of Toronto
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Pai RK, Banerjee I, Shivji S, Jain S, Hartman D, Buchanan DD, Jenkins MA, Schaeffer DF, Rosty C, Como J, Phipps AI, Newcomb PA, Burnett-Hartman AN, Marchand LL, Samadder NJ, Patel B, Swallow C, Lindor NM, Gallinger SJ, Grant RC, Westerling-Bui T, Conner J, Cyr DP, Kirsch R, Pai RK. Quantitative Pathologic Analysis of Digitized Images of Colorectal Carcinoma Improves Prediction of Recurrence-Free Survival. Gastroenterology 2022; 163:1531-1546.e8. [PMID: 35985511 PMCID: PMC9716432 DOI: 10.1053/j.gastro.2022.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS To examine whether quantitative pathologic analysis of digitized hematoxylin and eosin slides of colorectal carcinoma (CRC) correlates with clinicopathologic features, molecular alterations, and prognosis. METHODS A quantitative segmentation algorithm (QuantCRC) was applied to 6468 digitized hematoxylin and eosin slides of CRCs. Fifteen parameters were recorded from each image and tested for associations with clinicopathologic features and molecular alterations. A prognostic model was developed to predict recurrence-free survival using data from the internal cohort (n = 1928) and validated on an internal test (n = 483) and external cohort (n = 938). RESULTS There were significant differences in QuantCRC according to stage, histologic subtype, grade, venous/lymphatic/perineural invasion, tumor budding, CD8 immunohistochemistry, mismatch repair status, KRAS mutation, BRAF mutation, and CpG methylation. A prognostic model incorporating stage, mismatch repair, and QuantCRC resulted in a Harrell's concordance (c)-index of 0.714 (95% confidence interval [CI], 0.702-0.724) in the internal test and 0.744 (95% CI, 0.741-0.754) in the external cohort. Removing QuantCRC from the model reduced the c-index to 0.679 (95% CI, 0.673-0.694) in the external cohort. Prognostic risk groups were identified, which provided a hazard ratio of 2.24 (95% CI, 1.33-3.87, P = .004) for low vs high-risk stage III CRCs and 2.36 (95% CI, 1.07-5.20, P = .03) for low vs high-risk stage II CRCs, in the external cohort after adjusting for established risk factors. The predicted median 36-month recurrence rate for high-risk stage III CRCs was 32.7% vs 13.4% for low-risk stage III and 15.8% for high-risk stage II vs 5.4% for low-risk stage II CRCs. CONCLUSIONS QuantCRC provides a powerful adjunct to routine pathologic reporting of CRC. A prognostic model using QuantCRC improves prediction of recurrence-free survival.
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Affiliation(s)
- Reetesh K. Pai
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Imon Banerjee
- Department of Radiology and Machine Intelligence in Medicine and Imaging Center (MI-2), Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Sameer Shivji
- Department of Pathology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Suchit Jain
- Department of Radiology and Machine Intelligence in Medicine and Imaging Center (MI-2), Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Douglas Hartman
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Daniel D. Buchanan
- Colorectal Oncogenomics Group, Department of Clinical Pathology, The University of Melbourne, Parkville, VIC, Australia
- University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
- Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Mark A. Jenkins
- University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - David F. Schaeffer
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - Christophe Rosty
- Colorectal Oncogenomics Group, Department of Clinical Pathology, The University of Melbourne, Parkville, VIC, Australia
- Envoi Specialist Pathologists, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Julia Como
- Colorectal Oncogenomics Group, Department of Clinical Pathology, The University of Melbourne, Parkville, VIC, Australia
- University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
| | - Amanda I. Phipps
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Polly A. Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Andrea N. Burnett-Hartman
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Loic Le Marchand
- Department of Epidemiology, University of Hawaii, Seattle, Washington, USA
| | - Niloy J. Samadder
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Bhavik Patel
- Department of Radiology and Machine Intelligence in Medicine and Imaging Center (MI-2), Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Carol Swallow
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Noralane M. Lindor
- Department of Health Sciences Research Mayo Clinic, Scottsdale, Arizona, USA
| | - Steven J. Gallinger
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Hepatobiliary/Pancreatic Surgical Oncology Program, University Health Network, Toronto, Ontario, Canada
| | - Robert C. Grant
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Vector Institute, Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - James Conner
- Department of Pathology, Mount Sinai Hospital, Toronto, ON, Canada
| | - David P. Cyr
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Richard Kirsch
- Department of Pathology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Rish K. Pai
- Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
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Selim Y, Di Lena É, Abu-Omar N, Baig Z, Verhoeff K, La J, Purich K, Albacete S, Valji R, Purich K, Safar A, Schellenberg M, Schellenberg M, Schellenberg M, Schellenberg M, Schellenberg M, Schellenberg M, Daza J, Glass LT, Verhoeff K, Johnson G, Guidolin K, Glass LT, Balvardi S, Gawad N, McKechnie T, McKechnie T, Purich K, Henley J, Imbert E, Li C, Skinner S, Lenet T, Lenet T, Metz J, Ahn H(S, Do U, Rouhi A, Greenberg B, Muaddi H, Park L, Vogt K, Bradley N, Deng SX, Murphy P, Alhabboubi M, Lie J, Laplante S, Lie J, Drung J, Nixon T, Allard-Coutu A, Mansouri S, Lee A, Tweedy J, D’Elia MA, Hopkins B, Srivastava A, Alibhai K, Lee C, Moon J(J, How N, Spoyalo K, Lalande A, Baig Z, Schweitzer C, Keogh J, Huo B, Patel YS, Patel YS, Jogiat U, McGuire AL, Jogiat U, Lee Y, Barber E, Akhtar-Danesh GG, Bondzi-Simpson A, Bowker R, Ahmadi N, Abdul SA, Patel P, Harrison L, Shi G, Shi G, Alaichi JA, Kidane B, Qu LC, Alaichi J, Mackay E, Lee J, Purich K, Castelo M, Caycedo-Marulanda A, Caycedo-Marulanda A, Brennan K, Brennan K, Brennan K, Garfinkle R, Sharma S, Candy S, Patel S, LeGal G, Spadafora S, Maclellan S, Trottier D, Jonker D, Asmis T, Mallick R, Ramsay T, Carrier M, McKechnie T, Shojaei D, Motamedi A, Ghuman A, Karimuddin A, Raval M, Brown C, Shojaei D, Wang H, Buie D, Wang H, McKechnie T, Buie D, Al Busaidi N, Rajabiyazdi F, Demian M, Boutros M, Farooq A, Brown C, Phang T, Ghuman A, Karimuddin A, McKechnie T, Raval M, Udwadia F, Marinescu D, Alqahtani M, Pang A, Vasilevsky CA, Boutros M, Oviedo SC, McFadden N, Spence R, Lee L, Hirsch G, Neumann K, Neumann K, Spence R, Johnson G, Singh H, Helewa R, Yilbas A, Netto FS, Katz J, Robitaille S, Sharma B, Khan U, Selzner M, Mocanu V, Dang J, Wilson H, Switzer N, Birch D, Karmali S, Mocanu V, Robitaille S, Jogiat U, Forbes H, Switzer N, Birch D, Karmali S, Verhoeff K, Mocanu V, Kung J, Purich K, Switzer N, Sadri H, Birch D, Karmali S, Tassé N, Tchernof A, Nadeau M, Dawe P, Beckett A, Biertho L, Lin A, Verhoeff K, Selznick S, Mocanu V, Kung JY, Birch DW, Karmali S, Switzer NJ, Fowler-Woods M, Fowler-Woods A, Shingoose G, Hatala A, Daeninck F, Wiseman V, Vergis A, Hardy K, Clouston K, Debru E, Sun W, Dang J, Switzer N, Birch D, Karmali S, De Gara C, Wiseman V, Halasz J, Dang J, Switzer N, Kanji A, Birch D, Modi R, Karmali S, Gu J, Jarrar A, Kolozsvari N, Wiseman V, Samarasinghe Y, Chen L, Hapugall A, Javidan A, McKechnie T, Doumouras A, Hong D, Laplante S, Stogryn S, Maeda A, Brennan K, Jackson T, Okrainec A, Birch D, Karmali S, Kanji A, Switzer N, Balas M, Gee D, Hutter M, Meireles O, Baker L, Jung J, Vergis A, Hardy K, Boudreau V, Hong D, Anvari M, Iranmanesh P, Barlow K, Cookson T, Bolis R, Ichhpuniani S, Shanthanna H, Shiroky J, Deghan S, Zevin B, Cloutier Z, Cookson T, Barlow K, Boudreau V, Anvari M, Brodie J, Johnson G, O’Brien E, Tedman-Aucoin K, Lawlor D, Murphy R, Twells L, Pace D, Ellsmere J, Evans B, Zhang T, Deehan E, Zhang L, Kao D, Hotte N, Birch D, Karmali S, Samarasinghe K, Walter J, Madsen K, Williams E, Kong W, Fundytus A, Holden J, Booth C, Patel S, Caycedo-Marulanda A, Chung W, Nanji S, Merchant S, Hansen B, Paszat L, Baxter N, Scheer A, Moon J(J, Ghezeljeh TN, Lapointe-Gagner M, Nguyen-Powanda P, Elhaj H, Rajabiyazdi F, Lee L, Feldman LS, Fiore J, Sutradhar R, Haas B, Moon J(J, Guttman M, Eskander A, Coburn N, Chesney T, Tillman B, Zuk V, Mahar A, Hsu A, Chan W, Hallet J, Moon J(J, Guidolin K, Servidio-Italiano F, Quereshy F, Sapisochin G, Prisman E, Mitmaker E, Walker R, Wu J, Nguyen A, Wiseman S, Moon J(J, Hong D, Gupta M, Pasternak J, Vergara-Fernandez O, Brar A, Conner J, Kirsch R, Brar M, Kennedy E, Govindarajan A, Paradis T, Gryfe R, MacRae H, Cohen Z, McLeod R, Swallow C, Ghasemi F, Delisle M, Stacey D, Abou-Khalil J, Balaa F, Bayat Z, Bertens K, Dingley B, Martel G, McAlpine K, Nessim C, Tadros S, Carrier M, Auer R, Lim D, Eskander A, Patel S, Coburn N, Sutradhar R, Chan W, Hallet J, Pickard F, Mathieson A, Hogan M, Seal M, Acidi B, Johnston W, Maalouf MF, Callegaro D, Brar S, Gladdy R, Chung P, Catton C, Khalili K, Honore C, Swallow C, Fu N, Kazazian K, Wachtel A, Pacholczyk K, Ng D, Swett-Cosentino J, Savage P, Shibahara Y, Kalimuthu S, Espin-Garcia O, Conner J, Yeung J, Darling G, Baronas V, Swallow C, Mercier F, Barabash V, Law C, Coburn N, Singh S, Myrehaug S, Chan W, Hallet J, Auer RC, Wiseman V, Muhn N, Heller B, Lovrics P, Ng D, Koerber D, Al-Sukhni E, Cyr D, Kazazian K, Swallow C, Apte S, Lie J, Nessim C, Ban J, Chen L, McKevitt E, Warburton R, Pao JS, Dingee C, Kuusk U, Bazzarelli A, Hong NL, Hajjar R, Gagliardi A, Nyhof B, Marfil-Garza B, Sandha G, Cooper D, Dajani K, Bigam D, Anderson B, Kin T, Lam A, Ehlebracht A, O’Gorman D, Senior P, Ricordi C, Shapiro AJ, Moser M, Lam H, Flemming J, Jalink D, Nanji S, Bennett S, Caminsky N, Zhang B, Tywonek K, Meyers B, Serrano P, Lenet T, Shorr R, Abou-Khalil J, Bertens K, Balaa F, Martel G, Caminsky N, Jayaraman S, Wei A, Mahar A, Kaliwal Y, Martel G, Coburn N, Hallet J, Williams P, Claasen M, Ivanics T, Gilbert R, Englesakis M, Gallinger S, Hansen B, Sapisochin G, Ivanics T, Claasen M, Gallinger S, Hansen B, Sapisochin G, Lenet T, Morin G, Abou-Khalil J, Balaa F, Martel G, Brind’Amour A, Bertens K, Balaa F, Bertens K, Martel G, Abou-Khalil J, Collin Y, Auer RC, Ivanics T, Toso C, Adam R, Ijzermans J, Sapisochin G, Polak W, Léveillé M, Lawson C, Collin Y, Tai LH, Phang T, Greene B, Jayaraman S, Tsang M, Al-Arnawoot A, Rajendran L, Lamb T, Turner A, Reid M, Rekman J, Mimeault R, Hopkins J, Abou-Khalil J, Bertens K, Martel G, Balaa F, Zhang C, Lemke M, Glinka J, Leslie K, Skaro A, Tang E, Hopkins J, Greene B, Tsang M, Jayaraman S, Bubis L, Jayaraman S, Tsang ME, Ganescu O, Vanounou T, Pelletier JS, Greene B, Levin Y, Tsang M, Jayaraman S, Ganescu O, Pelletier JS, Vanounou T, Choi WJ, Muaddi H, Ivanics T, Classen MP, Sapisochin G, Alam A, Caminsky N, Mansouri S, Lagace P, Lagace P, El-Kefraoui C, Mainprize M, Melland-Smith M, Verhoeff K, Verhoeff K, Nasser K, Mailloux O, Purich K, Whyte M, Li T, Ahmad MS, Sun W, Ahn H(S, Lee Y, Roach E, Chow A, Trac J, He W, Ramji K, Kouzmina E, Koziak C, Hossain I, Mocanu V, Hanna N, Castelo M, Pook M, Zuckerman J, Choi WJ, Watanabe A, Saravana-Bawan B, Cyr D, Brackstone M, Ivankovic V, Nair AG, Hirpara D, Stockley C, Ng D, Luu S, Meloche-Dumas L, D’Elia MA, Eom A, Tang K, Khan S, Schmitz E, Chen KT, Newman-Bremang J, Verhoeff K, Jette N, Mir Z, Griffiths C, Rajendran L, Zuckerman J, Choi WJ, Choi WJ, Gilbert R, Lenet T, Amhis N, Claasen M, Mansouri S, Workewych A, Lee A, Waugh E, Zhu A, Nabavian H, Roldan J, Lagrotteria A, Roldan J, Rajendran L, Safa N, Rahman S, Kaneva P, Feldman L, Baig Z, Ginther N, Gill D, Sarwar Z, Verdiales C, Moser M, Mocanu V, Fang B, Dang J, Sun W, Switzer N, Birch D, Karmali S, Alqaydi A, Wei X, Digby G, Brogly S, Merchant S, Verhoeff K, Miles A, Kung JY, Shapiro AJ, Bigam DL, Matkin A, Dumestre D, Peiris L, Turner S, Verhoeff K, Mador B, McLennan S, Jastaniah A, Owattanapanich N, Grigorian A, Lam L, Nahmias J, Inaba K, Liasidis P, Inaba K, Demetriades D, Benjamin ER, Cowan S, Owattanapanich N, Wong MD, Inaba K, Demetriades D, Owattanapanich N, Emigh B, Karavites L, Clark DH, Lam L, Inaba K, Benjamin ER, Owattanapanich N, Inaba K, Demetriades D, Anderson GA, Owattanapanich N, Cheng V, Lam L, Inaba K, Myers L, Cuthbertson B, Myles P, Shulman M, Wijeysundera D, Murphy PB, Allen L, Minkhorst K, Bowker D, Tang ES, Leslie K, Hawel JE, Ma O, Purich K, Skinner S, Dhaliwal R, Strickland M, Park J, Vergis A, Gillman L, Rivard J, Lin J, Zorigtbaatar A, Nadeem M, Ibrahim T, Neilson Z, Kim KY(P, Rajendran L, Chadi S, Quereshy F, Davidson M, Friedrich E, Champion C, Semsar-Kazerooni K, Kaneva P, Mueller C, Vassiliou M, Al Mahroos M, Fiore J, Schwartzman K, Feldman L, Purich K, Verhoeff K, Anderson B, Daniel R, Kruse C, Levin M, Lee Y, Doumouras A, Hong D, Eskicioglu C, Povolo C, Lee J, Lee Y, Park L, Doumouras A, Hong D, Bhandari M, Eskicioglu C, Lee E, Verhoeff K, Sydora D, Turner S, Strickland M, Boone D, Roberts S, McGrouther D, Manuel P, Dykstra M, Wang H, Snelgrove R, Verhoeff K, Purich K, Perry T, Strickland M, Dhaliwal R, Skanes S, Tropiano J, McIsaac D, Tinmouth A, Hallet J, Nicholls S, Fergusson D, Martel G, Tropiano J, Skanes S, Ivankovic V, McIsaac D, Tinmouth A, Patey A, Fergusson D, Martel G, Naqvi R, Noppens R, Hawel J, Elnahas A, Schlachta C, Alkhamesi N, Lenet T, Gilbert R, Mallick R, Shaw J, McIsaac D, Martel G, Pook M, Najafi T, Rajabiyazdi F, El-Kefraoui C, Balvardi S, Barone N, Elhaj H, Nguyen-Powanda P, Lee L, Baldini G, Feldman L, Fiore J, Purich K, Jogiat U, Mapiour D, Kim M, Nadler A, Stukel T, De Mestral C, Nathens A, Pautler S, Shayegan B, Hanna W, Schlachta C, Breau R, Hopkins L, Jackson T, Karanicolas P, Griffiths C, Ali S, Archer V, Cloutier Z, Choi D, McKechnie T, Serrano P, McClure JA, Jones P, Mrkobrada M, Flier S, Welk B, Dubois L, Khwaja K, Allen L, Tung L, Hameed M, Spoyalo K, Lampron J, Garcia-Ochoa C, Jastaniah A, Engels P, Talwar G, Cloutier Z, Minor S, Moffat B, Parry N, Vogt K, Ebeye T, Sharma BT, Samman A, Zulfiqar A, Purzner RH, Greene B, Tsang M, Jayaraman S, Allen L, Ball CG, Hameed M, Engels P, Nenshi R, Widder S, Minor S, Parry N, Bradley N, Moffat B, Vogt K, Liberman S, Wong E, Chughtai T, Turner J, Wiseman S, Li J, Mak N, Namazi B, Kiani P, Hashimoto D, Alseidi A, Pasten M, Brunt LM, Gill S, Davis B, Bloom M, Pernar L, Okrainec A, Madani A, Hamilton T, Nabata K, Zhang JW, Zhao D, Dawe P, Hameed M, Allen L, Leslie K, Drung J, Purich K, Verhoeff K, Skinner S, Dhaliwal R, Strickland M, Heller B, Wright V, Cho W, Wong M, Singh K, Comeau É, Collin Y, Oviedo SC, Rajendran L, Lamb T, Reid M, Turner A, Bertens K, Rekman J, Balaa F, Neumann K, Porter G, Teo I, Forse CL, Musselman R, Grozman L, Alshawan N, Fraser S, Bergman S, Pelletier JS, Vanounou T, Wong EG, Nolan B, Qiao L, Jung J, Raîche I, McDonald H, Gawad N, Cheifetz R, Hawley P, Rehany Z, Bakhshi M, Razek T, Grushka J, Boulanger N, 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D, Wallace A, Safieddine N, Gazala S, Simone C, Wright F, Finley C, Villeneuve PJ, Gilbert S, Sundaresan S, Seely AJ, Maziak DE, Manos D, Wallace A, Plourde M, Turner D, Ringash J, Manuel D, Kidane B, Gupta V, Decker K, Davis L, Darling G, Compton C, Coburn N, Boyes R, Pugliese M, Mahar A, Hsu A, Kokavec A, Ho E, Waterman R, Wang E, Harnden K, Malthaner R, Nayak R, Qiabi M, Malthaner R, Nayak R, Qiabi M, Patel Y, Farrokhyar F, Simunovic M, Hanna WC, Gowing S, Liu R, Srinathan S, Tan L, Malthaner R, Malik P, Patel Y, Hanna W, Fahim U, Hafizi A, Ashrafi AS, McKechnie T, Amin N, Doumouras A, Hong D, Eskicioglu C, Streu C, Wong C, Schiller D, Sue-Chue-Lam C, Paszat L, Scheer A, Hansen B, Kishibe T, Baxter N, Neary E, Ibrahim T, Verschoor C, Patel S, Merchant S, Chadi S, Romagnolo L, Verschoor C, Brown C, Karimuddin A, Raval M, Phang T, Vikis E, Melich G, Patel S, Patel S, Caycedo-Marulanda A, Merchant S, Booth C, Kong W, McClintock C, Bankhead C, Heneghan C, Patel S, McClintock C, Merchant S, Caycedo-Marulanda A, Booth C, Bankhead C, Heneghan C, Zhang L, Flemming J, Djerboua M, Nanji S, Caycedo-Marulanda A, Merchant S, Patel S, Demian M, Sabboobeh S, Moon J, Hulme-Moir M, Liberman AS, Feinberg S, Hayden DM, Chadi SA, Demyttenaere S, Samuel L, Hotakorzian N, Quintin L, Morin N, Ghitulescu G, Faria J, Vasilevsky CA, Boutros M, Mckechnie T, Khamar J, Ichhpuniani S, Eskicioglu C, Patel S, Merchant S, Caycedo-Marulanda A, Bankhead C, Heneghan C, Govind S, Lee J, Lee Y, Hong D, Eskicioglu C, Lu J, Khamar J, Lee Y, Amin N, Hong D, Eskicioglu C, Cardenas L, Schep D, Doumouras A, Hong D, Wong R, Levine O, Eskicioglu C, Mueller C, Stein B, Charlebois P, Liberman S, Fried G, Feldman L, Wang A, Liberman S, Charlebois P, Stein B, Fiore JF, Feldman L, Lee L, Wang A, Liberman S, Charlebois P, Stein B, Fiore JF, Feldman L, Lee L, Barkun A, Levy J, Bogdan R, Hawel J, Elnahas A, Alkhamesi NA, Schlachta CM, Caycedo-Marulanda A, Iaboni N, Hurlbut D, Kaufmann M, Ren KYM, Jamzad A, Mousavi P, Fichtinger G, Nicol CJ, Rudan JF, Brennan K, Caycedo-Marulanda A, Merchant S, McClintock C, Patel SV, McClintock C, Bankhead C, Merchant S, Caycedo-Marulanda A, Booth C, Heneghan C, Zhang L, Huo B, Donaldson A, Flemming J, Nanji S, Caycedo-Marulanda A, Merchant S, Brogly S, Patel S, Lenet T, Park L, Murthy S, Musselman R, McKechnie T, Lee J, Biro J, Lee Y, Park L, Doumouras A, Hong D, Eskicioglu C, Singh H, Helewa R, Reynolds K, Sibley K, Doupe M, Brennan K, Flemming J, Nanji S, Merchant S, Djerboua M, Caycedo-Marulanda A, Patel S, Johnson G, Hochman D, Helewa R, Garfinkle R, Dell’Aniello S, Zelkowitz P, Vasilevsky CA, Brassard P, Boutros M, Zoughlami A, Abibula W, Amar A, Ghitulescu G, Vasilevsky CA, Brassard P, Boutros M, Araji T, Pang A, Vasilevsky CA, Boutros M, Ehlebracht A, Faria J, Ghitulescu G, Morin N, Pang A, Vasilevsky CA, Boutros M, Robitaille S, Oliver M, Charlebois P, Stein B, Liberman S, Feldman LS, Lee L, Kennedy E, Victor C, Govindarajan A, Zhang L, Brennan K, Djerboua M, Nanji S, Merchant SJ, Caycedo-Marulanda A, Flemming J, Robitaille S, Penta R, Pook M, Fiore JF, Feldman L, Lee L, Wong-Chong N, Marinescu D, Bhatnagar S, Morin N, Ghitulescu G, Vasilevsky CA, Faria J, Boutros M, Arif A, Ladua G, Bhang E, Brown C, Donellan F, Stuart H, Loree J, Patel S, Zhang L, MacDonald PH, Merchant S, Barnett KW, Caycedo-Marulanda A, Brown C, Karimuddin A, Stuart H, Ghuman A, Phang T, Raval M, Yoon HM, Fragoso G, Oliero M, Calvé A, Rendos HV, Gonzalez E, Brereton NJ, Cuisiniere T, Gerkins C, Djediai S, Annabi B, Diop K, Routy B, Laplante P, Cailhier JF, Taleb N, Alratrout H, Dagbert F, Loungnarath R, Sebajang H, Schwenter F, Wassef R, Ratelle R, Debroux E, Richard C, Santos MM, Hamad D, Alsulaim H, Monton O, Marinescu D, Pang A, Vasilevsky CA, Boutros M, Marinescu D, Alqahtani M, Pang A, Ghitulescu G, Vasilevsky CA, Boutros M, Marinescu D, Garfinkle R, Boutros M, Zwiep T, Greenberg J, Lenet T, Musselman R, Williams L, Raiche I, McIsaac D, Thavorn K, Fergusson D, Moloo H, Charbonneau J, Paré X, Frigault J, Letarte F, Ott M, Karanicolas P, Brackstone M, Ashmalla S, Weaver J, Tagalakis V, Boutros M, Stotland P, Caycedo-Marulanda A, Moloo H, Jayaraman S. 2022 Canadian Surgery Forum Sept. 15–17, 202201. Operative classification of ventral abdominal hernias: new and practical classification02. Watchful waiting for large primary splenic cysts03. Transversus abdominis plane (TAP) blocks with and without dexamethasone in colorectal surgery04. What factors determine publication of resident research day projects?05. Characterization of near-infrared imaging and indocyanine green use amongst general surgeons06. Variation in opioid prescribing after outpatient breast surgery: Time for a streamlined approach?07. Trends in graduate degree types and research output for Canadian academic general surgeons08. Would you prefer to undergo breast-conserving therapy or a mastectomy for early breast cancer? Comparison of perceptions of general and plastic surgeons09. Lack of representation of women and BIPOC individuals in Canadian academic surgery10. Medical student interest and perspectives on pursuing surgical careers: a multicentre survey evaluating 5-year trends11. Difficult cholecystectomy with cholecystogastric fistula12. Surviving nonsurvivable injuries: patients who elude the “lethal” Abbreviated Injury Scale (AIS) score of six13. Gunshot wounds sustained during legal intervention v. those inflicted by civilians: a comparative analysis14. The impact of delayed time to first head CT on functional outcomes after blunt head trauma with moderately depressed GCS15. Contemporary utility of diagnostic peritoneal aspiration in trauma16. Impact of delayed time to first head CT in traumatic brain injury17. Radiologic predictors of in-hospital mortality after traumatic craniocervical dissociation18. Measurement properties of a patient-reported instrument to evaluate functional status after major surgery19. The safety of venous thromboembolism chemoprophylaxis use in endoscopic retrograde cholangiopancreatography20. Characterizing Canadian rural surgeons: trends over time and 10-year replacement needs21. Contextual interference for skills development and transfer in laparoscopic surgery: a randomized controlled trial22. Evaluating the accuracy and design of visual backgrounds in academic surgical journals23. Defining rural surgery in Canada24. Validity of video-based general and procedure-specific self-assessment tools for surgical trainees in laparoscopic cholecystectomy25. Examining the equity and diversity characteristics of academic general surgeons in Canada26. Video-based coaching for surgical residents: a systematic review and meta-analysis27. Very-low-energy diets prior to nonbariatric surgery: a systematic review and meta-analysis28. Factors associated with resident research success: a descriptive analysis of Canadian general surgery trainees29. Global surgery pilot curriculum in Canadian undergraduate medical education: a novel approach30. How useful is ultrasound in predicting surgical findings of “mild cholecystitis”?31. Implementing a colorectal surgery “virtual hospital”: description of a novel outpatient care pathway to advance surgical care32. Trends in training and workforce planning for Canadian pediatric surgeons: a 10-year model33. Patient perspectives on intraoperative blood transfusion: results of semistructured interviews with perioperative patients34. Understanding intraoperative transfusion decision-making variability: a qualitative study using the Theoretical Domains Framework35. Effectiveness of preoperative oscillating positive expiratory pressure (OPEP) therapy in reduction of postoperative respiratory morbidity in patients undergoing surgery: a systematic review37. Accuracy of point-of-care testing devices for hemoglobin in the operating room: a systematic review and meta-analysis38. Opioid-free analgesia after outpatient general surgery: a qualitative study focused on the perspectives of patients and clinicians involved in a pilot trial39. The impact of the COVID-19 pandemic on general surgery residency: an analysis of operative volumes by residents at a Canadian general surgery residency program40. Postoperative care protocols for elderly emergency surgical patients: a quality improvement initiative42. Adverse events following robotic compared to laparoscopic and open surgery: a population-based analysis43. Is accrual higher for patients randomized to pragmatic v. exploratory randomized clinical trials? A systematic review and meta-analysis44. Effect of preoperative proton-pump inhibitor use on postoperative infectious and renal complications after elective general surgery45. The early burden of COVID-19 in emergency general surgery care across Canada46. Laparoscopic subtotal cholecystectomy for the difficult gallbladder: evolution of technique at a single teaching hospital and retrospective review47. The demand for emergency general surgery in Canada: a public health crisis48. Attitudes of Canadian general surgery staff and residents toward point-of-care ultrasound49. Psychological impact of COVID-19 on Canadian surgical residents50. Validation of an artificial intelligence platform for the guidance of safe laparoscopic cholecystectomy51. Predictors of recurrent appendicitis after nonoperative management: a prospective cohort study52. The effect of the first wave of the COVID-19 pandemic on colorectal and hepatobiliary oncologic outcomes at a tertiary care centre53. Trends in training and workforce representation for Canadian general surgeons working in critical care: a descriptive study54. White presentation: teaching safe opioid prescription and opioid use disorder management in Canadian universities56. How bad is really bad, eh? Impact of the first wave of the COVID-19 pandemic on residents’ operative volume: the experience of a Canadian general surgery program57. Surgeon-specific encounters within a multidisciplinary care pathway: Is there a role for shared care models in surgery?59. A pan-Canadian analysis of approach to treatment for acute appendicitis60. Appendix neoplasm stratified by age: understanding the best treatment for appendicitis61. Predicting acute cholecystitis on final pathology to prioritize surgical urgency: an evaluation of the Tokyo criteria and development of a novel predictive score62. Obesity is an independent predictor of acute renal failure after surgery64. Validation of a clinical decision-making assessment tool in general surgery65. Moral distress in the provision of palliative care delivery for surgical patients in British Columbia: lessons learned from the perspectives of general surgeons66. Delays in presentation and severity of illness predict adverse surgical outcomes among patients transferred from rural Indigenous communities for acute care surgery67. Remote video-based suturing education with smartphones (REVISE): a randomized controlled trial68. Modified Delphi consensus on appropriate use of laboratory investigations in acute care surgery patients72. Impacts of inpatient food at a tertiary care centre on patient satisfaction, nutrition and planetary health73. Racial disparities in health outcomes for oncological surgery in Canada75. Risk of recurrent laryngeal nerve injury from thyroidectomy is lower when intraoperative nerve monitoring (IONM) is used: an analysis of 17 688 patients from the NSQIP database01. The impact of the COVID-19 pandemic on non-smallcell lung cancer pathologic stage and presentation02. Screening criteria evaluation for expansion in pulmonary neoplasias (screen)03. Robotic-assisted lobectomy for early-stage lung cancer provides better patient-reported quality of life than video-assisted lobectomy: early results of the RAVAL trial04. Breathe Anew: designing and testing the feasibility of a novel intervention for lung cancer survivorship05. Learning objectives for thoracic surgery: developing a national standard for undergraduate medical education06. Plasma cell-free DNA as a point-of-care well-being biomarker for early-stage non-small-cell lung cancer patients07. Sarcopenia determined by skeletal muscle index predicts overall survival, disease-free survival and postoperative complications in resectable esophageal cancer: a systematic review and meta-analysis08. The short- and long-term effects of open v. minimally invasive thymectomy in myasthenia gravis patients: a systematic review and meta-analysis09. Optimizing opioid prescribing practices following minimally invasive lung resections through a structured quality improvement process10. Effects of virtual postoperative postdischarge care in patients undergoing lung resection during the COVID-19 pandemic11. Initiating Ethiopia’s first minimally invasive surgery program: a novel approach for collaborations in global surgical education12. Patient outcomes following salvage lung cancer surgery after definitive chemotherapy or radiation13. Replacing chest X-rays after chest tube removal with clinical assessment in postoperative thoracic surgery patients14. Updating the practice of thoracic surgery in Canada: a survey of the Canadian Association of Thoracic Surgeons15. The impact of COVID-19 on the diagnosis and treatment of lung cancer16. Development of a prediction model for survival time in esophageal cancer patients treated with resection17. The development and validation of a mixed reality thoracic surgical anatomy atlas18. Routine placement of feeding tubes should be avoided in esophageal cancer patients undergoing surgery19. Nodal count is no different during robotic segmentectomy compared with robotic lobectomy20. Point-of-care ultrasound-guided percutaneous biopsy of solid masses in the thoracic outpatient clinic: a safe, high-yield procedure to accelerate tissue diagnosis for patients with advanced thoracic malignancy21. Sarcopenia and modified frailty index are not associated with adverse outcomes after esophagectomy for esophageal cancer: a retrospective cohort study22. Near-infrared-guided segmental resection for lung cancer: an analysis of the learning curve23. Routine use of feeding jejunostomy tubes in patients undergoing esophagectomy for esophageal malignancy is safe and associated with low complication rates01. Ghost ileostomy versus loop ileostomy following total mesorectal excision for rectal cancer: a systematic review and meta-analysis02. Analysis of 100 consecutive colorectal cancers presenting at a Canadian tertiary care centre: delayed diagnosis and advanced disease03. Clinical delays and comparative outcomes in younger and older adults with colorectal cancer: a systematic review04. Recurrence rates of rectal cancer after transanal total mesorectal excision (taTME): a systematic review and meta-analysis05. Transanal total mesorectal excision for abdominoperineal resection (taTME-APR) is associated with poor oncological outcomes in rectal cancer patients: a word of caution from a multicentric Canadian cohort study06. Association between survival and receipt of recommended and timely treatment in locally advanced rectal cancer: a population-based study07. Trends and the impact of incomplete preoperative staging in rectal cancer08. Postoperative outcomes after elective colorectal surgery in patients with cirrhosis09. Bowel stimulation before loop ileostomy closure to reduce postoperative ileus: a multicentre, single-blinded, randomized controlled trial10. Recurrence following perineal rectosigmoidectomy ( Altemeier) with levatorplasty: a systematic review and meta-analysis11. Nonmodifiable risk factors and receipt of surveillance investigations following treatment of rectal cancer12. Safety and effectiveness of endoscopic full-thickness resection for the management of colorectal lesions: a systematic review and meta-analysis13. Impact of preoperative carbohydrate loading before colectomy: a systematic review and meta-analysis of randomized controlled trials14. Statin therapy in patients undergoing short-course neoadjuvant radiotherapy for rectal cancer15. Feasibility of targeted lymphadenectomy during complete mesocolic excision for colon cancer using indocyanine green immunofluorescence lymphatic mapping16. Feasibility of expanding an ambulatory colectomy protocol: a retrospective analysis of early discharge following minimally invasive colectomy in an enhanced recovery pathway17. Impact of rectal cancer on bowel dysfunction before treatment and its relationship with post-treatment function18. Canadian cost–utility analysis of artificial-intelligence-assisted colonoscopy for adenoma detection in fecal immunochemical-based colorectal cancer screening19. A comparison of outcomes following intracorporeal and extracorporeal anastomotic techniques in laparoscopic right colectomies20. Assessment of metabolic signatures using desorption electrospray ionization mass spectrometry (DESI) and rapid evaporative ionization mass spectrometry (REIMS) of rectal cancer samples to assist in determining treatment response21. The association between hospital characteristics and minimally invasive rectal cancer surgery: a population-based study22. Cancer centre level designation and the impact on treatment and outcomes in those with rectal cancer: a population-based study23. Oncological outcomes after colorectal cancer in patients with liver cirrhosis: a systematic review and meta-analysis24. Optimal preoperative nutrition for penetrating Crohn disease: a systematic review and meta-analysis25. Lymph node ratio as a predictor of survival for colon cancer: a systematic review and meta-analysis26. Barriers and facilitators for use of new recommendations for optimal endoscopic localization of colorectal neoplasms according to gastroenterologists and surgeons27. Emergency colorectal surgery in patients with cirrhosis: a population-based descriptive study28. Local recurrence rates and associated risk factors after transanal endoscopic microsurgery for benign polyps and adenocarcinomas29. Bowel dysfunction impacts mental health after restorative proctectomy for rectal cancer30. Evolution of psychological morbidity following restorative proctectomy for rectal cancer: a systematic review and meta-analysis31. Frailty predicts LARS and quality of life in rectal cancer survivors after restorative proctectomy32. Low anterior resection syndrome in a reference North American population: prevalence and predictive factors33. The evolution of enhanced recovery: same day discharge after laparoscopic colectomy34. Effect of ERAS protocols on length of stay after colorectal surgery: an interrupted time series analysis35. Practice patterns and outcomes in individuals with cirrhosis and colorectal cancer: a population-based study36. Understanding the impact of bowel function on quality of life after rectal cancer surgery37. Right-sided colectomies for diverticulitis have worse outcomes compared with left-sided colectomies38. Symptom burden and time from symptom onset to cancer diagnosis in patients with early-onset colorectal cancer39. The impact of access to robotic rectal surgery at a tertiary care centre: a Canadian perspective40. Management of rectal neuroendocrine tumours by transanal endoscopic microsurgery41. The gut microbiota modulates colorectal anastomotic healing in patients undergoing surgery for colorectal cancer42. Is there added risk of complications for concomitant procedures during an ileocolic resection for Crohn disease?43. Cost of stoma-related hospital readmissions for rectal cancer patients following restorative proctectomy with a diverting loop ileostomy: a nationwide readmissions database analysis44. Older age associated with quality of rectal cancer care: an ACS-NSQIP database study45. Outcomes of patients undergoing elective bowel resection before and after implementation of an anemia screening and treatment program47. Loop ileostomy closure as a 23-hour stay procedure: a randomized controlled trial48. Extended duration perioperative thromboprophylaxis with low-molecular-weight heparin to improve disease-free survival following surgical resection of colorectal cancer: a multicentre randomized controlled trial (PERIOP-01 Trial)49. Three-stage versus modified 2-stage ileal pouch anal anastomosis: perioperative outcomes, function and quality of life50. Compliance with extended venous thromboembolism prophylaxis in rectal cancer51. Extended-duration venous thromboembolism prophylaxis after diversion in rectal cancer52. Financial and occupational impact of low anterior resection syndrome: a qualitative study53. Nonoperative management for rectal cancer: patient perspectives54. Trends in ileostomy-related emergency department visits for rectal cancer patients55. Long-term implications of treatment of fecal incontinence: a single Canadian centre’s retrospective cohort study: a 17-year follow-up56. Externally benchmarking colorectal resection outcomes in our province against the ACS NSQIP risk calculator: identifying opportunities for improvement57. Externally benchmarking our provincial colectomy outcomes against the ACS NSQIP using the Codman Score: to identify possible opportunities for improvement of outcomes58. Rural v. urban documentation of recommended practices for optimal endoscopic colorectal lesion localization01. Incidence of in-hospital opioid use and pain after inguinal hernia repair02. Ventral hernia repair following liver transplantation: outcome of repair techniques and risk factors for recurrence01. Impact of the COVID-19 pandemic on bariatric surgery in North America: a retrospective analysis of 834 647 patients02. Patient selection and 30-day outcomes of SADI-S compared to RYGB: a retrospective cohort study of 47 375 patients03. New persistent opioid use following bariatric surgery: a systematic review and pooled proportion meta-analysis04. Bariatric surgery should be offered to active-duty military personnel: a retrospective study of the Canadian Armed Forces experience05. Opioid prescribing practices and use following bariatric surgery: a systematic review and pooled summary of data06. Sacred sharing circles: urban Indigenous Manitobans’ experiences with bariatric surgery07. Gastrogastric hernia after laparoscopic gastric great curve plication: a video presentation08. Characterization of comorbidities predictive of bariatric surgery09. Efficacy of preoperative high-dose liraglutide in patients with superobesity10. The effect of linear stapled gastrojejunostomy size in Roux-en-Y gastric bypass11. Fragility of statistically significant outcomes in randomized trials comparing bariatric surgeries12. Weight loss outcomes for patients undergoing conversion to Roux-en-Y gastric bypass after sleeve gastrectomy13. Are long waiting lists for bariatric surgery detrimental to patients? A single-centre experience14. Does upper gastrointestinal swallow study after bariatric surgery lead to earlier detection of leak?15. Pharmaceutical utilization before and after bariatric surgery16. Same-day discharge Roux-en-Y gastric bypass at a Canadian bariatric centre: pathway implementation and early experiences17. Safety and efficiency of performing primary bariatric surgery at an ambulatory site of a tertiary care hospital: a 5-year experience18. Impact of psychiatric diagnosis on weight loss outcomes 3 years after bariatric surgery19. Ursodeoxycholic acid (UDCA) for prevention of gallstone disease after laparoscopic sleeve gastrectomy (LSG): an Atlantic Canada perspective20. Fecal microbial transplantation and fibre supplementation in patients with severe obesity and metabolic syndrome: a randomized double-blind, placebo-controlled phase 2 trial01. Incidence, timing and outcomes of venous thromboembolism in patients undergoing surgery for esophagogastric cancer: a population-based cohort study04. Omission of axillary staging and survival in elderly women with early-stage breast cancer: a population-based cohort study05. Patients’ experiences receiving cancer surgery during the COVID-19 pandemic: a qualitative study06. Cancer surgery outcomes are better at high-volume centres07. Attitudes of Canadian colorectal cancer care providers toward liver transplantation for colorectal liver metastases: a national survey08. Quality of narrative central and lateral neck dissection reports for thyroid cancer treatment suggests need for a national standardized synoptic operative template09. Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications and technique10. Temporal trends in lymph node assessment as a quality indicator in colorectal cancer patients treated at a high-volume Canadian centre11. Molecular landscape of early-stage breast cancer with nodal metastasis12. Beta testing of a risk-stratified patient decision aid to facilitate shared decision making for postoperative extended thromboprophylaxis in patients undergoing major abdominal surgery for cancer13. Breast reconstruction use and impact on oncologic outcomes among inflammatory breast cancer patients: a systematic review14. Association between patient-reported symptoms and health care resource utilization: a first step to develop patient-centred value measures in cancer care15. Complications after colorectal liver metastases resection in Newfoundland and Labrador16. Why do patients with nonmetastatic primary retroperitoneal sarcoma not undergo resection?17. Loss of FAM46Cexpression predicts inferior postresection survival and induces ion channelopathy in gastric adenocarcinoma18. Liver-directed therapy of neuroendocrine liver metastases19. Neoadjuvant pembrolizumab use in microsatellite instability high (MSI-H) rectal cancer: benefits of its use in lynch syndrome20. MOLLI for excision of nonpalpable breast lesions: a case series22. Patients awaiting mastectomy report increased depression, anxiety, and decreased quality of life compared with patients awaiting lumpectomy for treatment of breast cancer23. Is microscopic margin status important in retroperitoneal sarcoma (RPS) resection? A systematic review and meta-analysis24. Absence of benefit of routine surveillance in very-low-risk and low-risk gastric gastrointestinal stromal tumors25. Effect of intraoperative in-room specimen radiography on margin status in breast-conserving surgery26. Active surveillance for DCIS of the breast: qualitative interviews with patients and physicians01 Outcomes following extrahepatic and intraportal pancreatic islet transplantation: a comparative cohort study02. Cholang-funga-gitis03. Evaluating the effect of a low-calorie prehepatectomy diet on perioperative outcomes: a systematic review and meta-analysis04. Toxicity profiles of systemic therapy for advanced hepatocellular carcinoma: a systematic review to guide neoadjuvant trials05. Should cell salvage be used in liver resection and transplantation? A systematic review and meta-analysis06. The association between surgeon and hospital variation in use of laparoscopic liver resection and short-term outcomes07. Systematic review and meta-analysis of prognostic factors for early recurrence in intrahepatic cholangiocarcinoma after curative-intent resection08. Impact of neoadjuvant chemotherapy on postoperative outcomes of patients undergoing hepatectomy for intrahepatic cholangiocarcinoma: ACS-NSQIP propensity-matched analysis09. The impact of prophylactic negative pressure wound therapy on surgical site infections in pancreatic resection: a systematic review and meta-analysis10. Does hepatic pedicle clamping increase the risk of colonic anastomotic leak after combined hepatectomy and colectomy? Analysis of the ACS NSQIP database11. Development of a culture process to grow a full-liver tissue substitute12. Liver transplantation for fibrolamellar hepatocellular carcinoma: an analysis of the European Liver Transplant Registry13. Arming beneficial viruses to treat pancreatic cancer14. Hepaticoduodenostomy versus hepaticojenunostomy for biliary reconstruction: a retrospective review of a single-centre experience15. Feasibility and safety of a “shared care” model in complex hepatopancreatobiliary surgery: a 5-year analysis of pancreaticoduodenectomy16. Laparoscopic v. open pancreaticoduodenectomy: initial institutional experience and NSQIP-matched analysis17. Laparoscopic spleen-preserving distal pancreatectomy: Why not do a Warshaw?18. The impact of COVID-19 on pancreaticoduodenectomy outcomes in a high-volume hepatopancreatobiliary centre19. Transitioning from open to minimally invasive pancreaticoduodenectomy: the learning curve factor in an academic centre20. Closed-incision negative-pressure wound therapy following pancreaticoduodenectomy for prevention of surgical site infections in high-risk patients21. Robotic Appleby procedure for recurrent pancreatic cancer22. The influence of viral hepatitis status on posthepatectomy complications in patients with hepatocellular carcinoma: a NSQIP analysis. Can J Surg 2022. [DOI: 10.1503/cjs.014322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Ng D, Ali A, Lee K, Eymael D, Abe K, Luu S, Kazazian K, Lu YQ, Brar S, Conner J, Magalhaes M, Swallow CJ. Investigating the mechanisms of peritoneal metastasis in gastric adenocarcinoma using a novel ex vivo peritoneal explant model. Sci Rep 2022; 12:11499. [PMID: 35798764 PMCID: PMC9262973 DOI: 10.1038/s41598-022-13948-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/31/2022] [Indexed: 11/09/2022] Open
Abstract
Gastric adenocarcinoma, commonly known as stomach cancer, has a predilection for metastasis to the peritoneum, which portends limited survival. The peritoneal metastatic cascade remains poorly understood, and existing models fail to recapitulate key elements of the interaction between cancer cells and the peritoneal layer. To explore the underlying cellular and molecular mechanisms of peritoneal metastasis, we developed an ex vivo human peritoneal explant model. Fresh peritoneal tissue samples were suspended, mesothelial layer down but without direct contact, above a monolayer of red-fluorescent dye stained AGS human gastric adenocarcinoma cells for 24 h, then washed thoroughly. Implantation of AGS cells within the explanted peritoneum and invasion beyond the mesothelial layer were examined serially using real-time confocal fluorescence microscopy. Histoarchitecture of the explanted peritoneum was preserved over 5 days ex vivo. Both implantation and invasion were suppressed by restoration of functional E-cadherin through stable transfection of AGS cells, demonstrating sensitivity of the model to molecular manipulation. Thus, our ex vivo human peritoneal explant model permits meaningful investigation of the pathways and mechanism that contribute to peritoneal metastasis. The model will facilitate screening of new therapies that target peritoneal dissemination of gastric, ovarian and colorectal cancer.
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Affiliation(s)
- Deanna Ng
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Aiman Ali
- Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Kiera Lee
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Denise Eymael
- Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Kento Abe
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Shelly Luu
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada.,Department of Surgical Oncology and Division of General Surgery, Princess Margaret Cancer Centre, University Health Network/Mount Sinai Hospital, 600 University Avenue #1225, Toronto, ON, M5G 1X5, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Karineh Kazazian
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada.,Department of Surgical Oncology and Division of General Surgery, Princess Margaret Cancer Centre, University Health Network/Mount Sinai Hospital, 600 University Avenue #1225, Toronto, ON, M5G 1X5, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Yi Qing Lu
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Savtaj Brar
- Department of Surgical Oncology and Division of General Surgery, Princess Margaret Cancer Centre, University Health Network/Mount Sinai Hospital, 600 University Avenue #1225, Toronto, ON, M5G 1X5, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - James Conner
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada
| | - Marco Magalhaes
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Carol J Swallow
- Institute of Medical Science, University of Toronto, Toronto, Canada. .,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada. .,Department of Surgical Oncology and Division of General Surgery, Princess Margaret Cancer Centre, University Health Network/Mount Sinai Hospital, 600 University Avenue #1225, Toronto, ON, M5G 1X5, Canada. .,Department of Surgery, University of Toronto, Toronto, Canada.
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Conner J, Mahon R, Camps J. Pulmonary lymphangiectasia a rare cause of chylothorax: A case report. J Neonatal Surg 2022. [DOI: 10.47338/jns.v11.1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Pulmonary lymphangiectasia (PL) is a rare disease characterized by dilation of the pulmonary lymphatic vessels. PL should be considered in the differential diagnosis in infants with pleural effusion, especially in the presence of chylothorax.
Case Presentation: A 3-week-old neonate presented with tachypnea, cough, and reluctance to feed. Work-up found bilateral chylous pleural effusion. The patient was initially managed conservatively with bilateral tube thoracostomies and octreotide, however output from chest tubes did not subside. A left thoracotomy was performed with wedge biopsy of the apical segment of the left inferior lung lobe and multiple titanium clips were used to control thoracic duct. Postoperatively the patient continued to have high chest tube output, despite placement of clips. Histology of the biopsy confirmed the diagnosis of congenital pulmonary lymphangiectasia.
Conclusion: Pulmonary lymphangiectasia is a rare cause of chylothorax. The treatment is often challenging as found in the index case.
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Sari A, Cyr DP, Brar A, Messenger DE, Driman DK, Shivji S, Assarzadegan N, Juda A, Swallow CJ, Kennedy ED, Brar MS, Conner J, Kirsch R. Routine Elastin Staining in Surgically Resected Colorectal Cancer: Impact on Venous Invasion Detection and its Association With Oncologic Outcomes. Am J Surg Pathol 2022; 46:200-212. [PMID: 34411028 DOI: 10.1097/pas.0000000000001790] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Venous invasion (VI) is a powerful yet underreported prognostic factor in colorectal cancer (CRC). Its detection can be improved with an elastin stain. We evaluated the impact of routine elastin staining on VI detection in resected CRC and its relationship with oncologic outcomes. Pathology reports from the year before (n=145) and the year following (n=128) the implementation of routine elastin staining at our institution were reviewed for established prognostic factors, including VI. A second review, using elastin stains, documented the presence/absence, location, number, and size of VI foci. The relationship between VI and oncologic outcomes was evaluated for original and review assessments. VI detection rates increased from 21% to 45% following implementation of routine elastin staining (odds ratio [OR]=3.1; 95% confidence interval [CI]: 1.8-5.3; P<0.0001). The second review revealed a lower VI miss rate postimplementation than preimplementation (22% vs. 48%, respectively; P=0.007); this difference was even greater for extramural VI-positive cases (9% vs. 38%, respectively; P=0.0003). Missed VI cases postimplementation had fewer VI foci per missed case (P=0.02) and a trend towards less extramural VI than those missed preimplementation. VI assessed with an elastin stain was significantly associated with recurrence-free survival (P=0.003), and cancer-specific survival (P=0.01) in contrast to VI assessed on hematoxylin and eosin alone (P=0.053 and 0.1, respectively). The association between VI and hematogenous metastasis was far stronger for elastin-detected VI (OR=11.5; 95% CI: 3.4-37.1; P<0.0001) than for hematoxylin and eosin-detected VI (OR=3.7; 95% CI: 1.4-9.9; P=0.01). Routine elastin staining enhances VI detection and its ability to stratify risk in CRC and should be considered for evaluation of CRC resection specimens.
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Affiliation(s)
- Aysegul Sari
- Department of Pathology and Laboratory Medicine
- Department of Pathology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - David P Cyr
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Mount Sinai Hospital
- Department of Surgery, Division of General Surgery
- Institute of Medical Science
| | | | - David E Messenger
- Division of General Surgery, Royal United Hospital NHS Trust, Bath, UK
| | - David K Driman
- Department of Pathology, London Health Sciences Centre and Western University, London, ON, Canada
| | | | - Naziheh Assarzadegan
- Department of Pathology and Laboratory Medicine, The Johns Hopkins Hospital, Baltimore, MD
| | - Ari Juda
- Department of Pathology and Laboratory Medicine
| | - Carol J Swallow
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Mount Sinai Hospital
- Department of Surgery, Division of General Surgery
- Institute of Medical Science
| | - Erin D Kennedy
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Mount Sinai Hospital
- Department of Surgery, Division of General Surgery
| | | | - James Conner
- Department of Pathology and Laboratory Medicine
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System
- Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto
| | - Richard Kirsch
- Department of Pathology and Laboratory Medicine
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System
- Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto
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Shibahara Y, Espin-Garcia O, Conner J, Weiss J, Derouet M, Allen J, Allison F, Kalimuthu S, Yeung JC, Darling GE. Intestinal Stem Cell Marker ASCL2 is a Novel Prognostic Predictor in Esophageal Adenocarcinoma. Cureus 2022; 14:e21021. [PMID: 35154991 PMCID: PMC8818334 DOI: 10.7759/cureus.21021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Intestinal stem cell markers play a significant role in esophageal adenocarcinoma carcinogenesis via Barrett’s esophagus; however, its utility as a prognostic biomarker has not been established. Methods We analyzed the immunohistochemical expression of intestinal stem cell markers, ASCL2 and LGR5, using whole slides (35 cases) and tissue microarray (TMA; 64 cases). On TMA slides, adjacent normal squamous epithelium, metaplastic glandular epithelium (Barrett's esophagus), and dysplastic glandular epithelium were inserted when applicable. Two pathologists semi-quantitatively scored stained slides independently, and the results were correlated with clinicopathologic factors and outcomes. Results In whole slides, 51% and 57% expressed high ASCL2 and high LGR5; in TMA, 69% and 88% expressed high ASCL2 and high LGR5, respectively. In TMA, high ASCL2 and low LGR5 expression significantly correlated to a higher number of involved lymph nodes (p=0.027 and p=0.0039), and LGR5 expression significantly correlated to the pathological stage (p=0.0032). Kaplan-Meier analysis showed a negative impact of high ASCL2 expression on overall survival (OS; WS p=0.0168, TMA p=0.0276) as well as progression-free survival (PFS; WS p=0.000638, TMA p=0.0466) but not LGR5. Multivariate Cox regression analysis revealed that ASCL2 expression is an independent prognostic factor for esophageal adenocarcinoma (OS; WS p=0.25, TMA p=0.011. PFS; WS p=0.012, TMA p=0.038). Analysis of the TCGA dataset showed that ASCL2 mRNA levels were correlated to nodal status but not overall survival. Conclusion High expression of the intestinal stem cell marker ASCL2 may predict unfavorable outcomes in surgically resected esophageal adenocarcinoma.
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Hernández-Rocha C, Nayeri S, Turpin W, Steel M, Borowski K, Stempak JM, Conner J, Silverberg MS. Combined Histo-endoscopic Remission but not Endoscopic Healing Alone in Ulcerative Colitis is Associated with a Mucosal Transcriptional Profile Resembling Healthy Mucosa. J Crohns Colitis 2022; 16:1020-1029. [PMID: 34999763 PMCID: PMC9351979 DOI: 10.1093/ecco-jcc/jjac001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/14/2021] [Accepted: 01/05/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS A composite endpoint of histological and endoscopic remission is proposed to be the most complete measure of mucosal healing in ulcerative colitis [UC]. We aim to establish the prognosis, and transcriptional and microbial features of histo-endoscopic remission and activity. METHODS A cross-sectional endoscopic rectosigmoid colon sample collection from UC patients and healthy controls [HC] was performed for histopathology and host genome-wide RNA-sequencing. Histo-endoscopic remission and histo-endoscopic activity were defined as Mayo endoscopic subscore [MES] 0-1 with and without histological activity, respectively. UC relapse, defined as symptomatic and endoscopic worsening, was retrospectively recorded for survival analysis. Unsupervised and differential gene expression analyses were performed, and the interaction between transcriptomics and mucosal gut microbiota was analysed based on the 16S rRNA gene sequencing profile. RESULTS UC patients with histo-endoscopic remission showed a significantly lower risk of relapse compared to histo-endoscopic activity. Unsupervised analysis of the transcriptomic profile showed that histo-endoscopic remission and histo-endoscopic activity samples clustered with HC and MES 2-3 samples, respectively. A total of 452 host genes enriched for humoral immune response, antimicrobial defence, chemokine and TH17 signalling pathway were upregulated in histo-endoscopic activity compared to histo-endoscopic remission. A set of host genes with antimicrobial properties showed significant associations with mucosal microbiota. CONCLUSIONS The rectosigmoid mucosa transcriptional profile of UC patients in histo-endoscopic remission resembles that of HC mucosa and confers a lower risk of relapse. These data support that the combination of histo-endoscopic remission could be the most appropriate definition of mucosal healing in UC.
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Affiliation(s)
- Cristian Hernández-Rocha
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada,Zane Cohen Centre for Digestive Diseases, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Shadi Nayeri
- Zane Cohen Centre for Digestive Diseases, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Williams Turpin
- Zane Cohen Centre for Digestive Diseases, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mike Steel
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Krzysztof Borowski
- Zane Cohen Centre for Digestive Diseases, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Joanne M Stempak
- Zane Cohen Centre for Digestive Diseases, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - James Conner
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Mark S Silverberg
- Corresponding author: Mark S. Silverberg, MD, PhD, FRCPC, University of Toronto, Division of Gastroenterology, Mount Sinai Hospital Inflammatory Bowel Disease Centre, 441–600 University Avenue, Toronto, ON, M5G1X5, Canada. Tel: 1-416-586-4800 ext 8236; Fax: 1-416-619-5524;
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Johnson G, Vergis A, Unger B, Park J, Gillman L, Hickey K, Pace D, Azin A, Guidolin K, Lam-Tin-Cheung K, Chadi S, Quereshy F, Guidolin K, Catton J, Rubin B, Bell J, Marangos J, Heesters A, Stuart-McEwan T, Quereshy F, Shariff F, Wright F, Ahmed N, Nadler A, Hallet J, Gentles J, Chen L, Hwang H, Parapini M, Hirpara D, Sidhu R, Scott T, Karimuddin A, Guo R, Nguyen A, Osborn J, Wiseman S, Nabata K, Ertel E, Hwang H, Lenet T, Baker L, Park L, Vered M, Zahrai A, Shorr R, Davis A, McIsaac D, Tinmouth A, Fergusson D, Martel G, Nabata K, Rummel S, Stefic-Cubic M, Karimuddin A, Stewart M, Melck A, McKechnie T, Anpalagan T, Ichhpuniani S, Lee Y, Ramji K, Eskicioglu C, Zhu A, Deng S, Greene B, Tsang M, Palter V, Jayaraman S, McKechnie T, Mann A, Tittley J, Cadeddu M, Nguyen M, Madani A, Pasternak J, McKechnie T, Ramji K, Hong D, Qu L, Istl A, Tang E, Gray D, Zuckerman J, Coburn N, Callum J, McLeod R, Pearsall E, Lin Y, Turgeon A, Martel G, Hallet J, Mahar A, Kammili A, Kriviraltcheva-Kaneva P, Lee L, Cools-Lartigue J, Ferri L, Mueller C, Zuckerman J, Haas B, Tillman B, Guttman M, Chesney T, Zuk V, Mahar A, Hsu A, Chan W, Vasdev R, Coburn N, Hallet J, D'Souza K, Huynh C, Ling LCJ, Warburton R, Hwang H, Hameed M, Glass L, Williamson H, Murphy P, Tang E, Leslie K, Hawel J, Kerr L, Zablotny S, Roldan H, He W, Jiang X, Zheng B, Lee L, Fiore J, Feldman L, Fried G, Mueller C, Valanci S, Balvardi S, Cipolla J, Kaneva P, Demyttenaere S, Boutros M, Lee L, Feldman L, Fiore J, Balvardi S, Alhashemi M, Cipolla J, Lee L, Fiore J, Feldman L, Miles A, Purich K, Verhoeff K, Shapiro J, Bigam D, Kung J, Fecso A, Chesney T, Mosko J, Skubleny D, Hamilton P, Ghosh S, Widder S, Schiller D, Do U, El Kefraoui C, Pook M, Barone N, Balvardi S, Montgomery H, Nguyen-Powanda P, Rajabiyazdi F, Elhaj H, Lapointe-Gagner M, Olleik G, Kaneva P, Antoun A, Safa N, Di Lena E, Meterissian S, Meguerditchian A, Fried G, Alhashemi M, Lee F, Baldini G, Feldman L, Fiore J, Serrano Aybar PE, Parpia S, Ruo L, Tywonek K, Lee S, O'Neill C, Faisal N, Alfayyadh A, Gundayao M, Meyers BM, Habashi R, Kruse C, McKechnie T, Levin M, Aldrich K, Grantcharov T, Langerman A, Forbes H, Anantha R, Fawcett V, Hetherington A, Pravong V, Gervais M, Rakovich G, Selvam R, Hu R, Musselman R, Raiche I, Moloo H, Liu R, Elnahas A, Alkhamesi N, Hawel J, Tang E, Alnumay A, Schlachta C, Walser E, Zhang C, Cristancho S, Ott M, Lee A, Niu B, Balaa F, Gawad N, Ren K, Qiu Y, Hamann K, How N, Leveille C, Davidson A, Eqbal A, Sardiwalla Y, Korostensky M, McKechnie T, Lee E, Yang I, Ren K, Muaddi H, Stukel T, de Mestral C, Nathens A, Karanicolas P, Frigault J, Lemieux S, Breton D, Bouchard P, Bouchard A, Grégoire R, Letarte F, Bouchard G, Drolet S, Frigault J, Avoine S, Drolet S, Letarte F, Bouchard A, Gagné J, Thibault C, Grégoire R, Jutras Bouthillette N, Gosselin M, Bouchard P, Rosenzveig A, Stuleanu T, Jarrar A, Kolozsvari N, Skelhorne-Gross G, Nenshi R, Jerath A, Gomez D, Singh K, Amir T, Liu E, Farquharson S, Mao R, Lan L, Yan J, Allard-Coutu A, Mierzwa A, Tin R, Brisebois R, Bradley N, Wigen R, Walser E, Hartford L, Van Koughnett J, Vogt K, Hilsden R, Parry N, Allen L, Leslie K, Raskin R, Jones J, Neumann K, Dwyer C, Strickland M, Bradley N, O'Dochartaigh D, Lobay K, Kabaroff A, Chang E, Widder S, Anantha R, Sun W, Beck J, Anantha R, Liu R, Davidson J, Jones S, Van Hooren T, Van Koughnett J, Ott M, Schmitz E, Raiche I, Sun W, El Hafid M, Dang J, Mocanu V, Lutzak G, Sultanian R, Wong C, Karmali S, Schmitz E, Petrera M, Pickell M, Auer R, Patro N, Li B, Lee Y, Wilson H, Mocanu V, Sun W, Dang J, Jogiat U, Kung J, Switzer N, Karmali S, Wong C, Li C, Al Hinai A, Cieply A, Hawes H, Joos E, Saleh A, Li C, Saleh A, Engels P, Drung J, Allen L, Leslie K, Pang G, Kwong M, Schlachta C, Alkhamesi N, Hawel J, Elnahas A, Guidolin K, Ellsmere J, Chadi S, Quereshy F, Chang D, Hutter M, Spence R, Abou Khalil M, Boutros M, Vasilevsky C, Morin N, Longtin Y, Liberman S, Demyttenaere S, Montpetit P, Poirier M, Mukherjee K, Sebajang H, Younan R, Schwenter F, De Broux E, Larsen K, Skelhorne-Gross G, Beckett A, Nantais J, Gomez D, Lan L, Mao R, Kay J, Lohre R, Ayeni O, Goel D, de Sa D, He R, Hylton D, Bedard E, Johnson S, Laing B, Valji A, Hanna W, Turner S, Akhtar-Danesh G, Akhtar-Danesh N, Shargall Y, Akhtar-Danesh G, Akhtar-Danesh N, Shargall Y, Hirpara D, Gupta V, Kidane B, Limbachia J, Sullivan K, Farrokhyar F, Leontiadis G, Patel Y, Churchill I, Hylton D, Xie F, Seely A, Spicer J, Kidane B, Turner S, Yasufuku K, Hanna W, Jogiat U, Sun W, Dang J, Mocanu V, Kung J, Karmali S, Turner S, Switzer N, Patel Y, Churchill I, Sullivan K, Beauchamp M, Wald J, Mbuagbaw L, Agzarian J, Shargall Y, Finley C, Fahim C, Hanna W, Abbas M, Olaiya O, Begum H, Mbuagbaw L, Finley C, Hanna W, Agzarian J, Shargall Y, Ednie A, Palma D, Warner A, Malthaner R, Fortin D, Qiabi M, Nayak R, Nguyen T, Louie A, Rodrigues G, Yaremko B, Laba J, Inculet R, Alaichi J, Patel Y, Hanna W, Turner S, Mador B, Lai H, White J, Kim M, Hirpara D, Kidane B, Louie A, Zuk V, Darling G, Rousseau M, Chesney T, Coburn N, Hallet J, Lee Y, Samarasinghe Y, Lee M, Thiru L, Shargall Y, Finley C, Hanna W, Levine O, Juergens R, Agzarian J, Nayak R, Brogly S, Li W, Lougheed D, Petsikas D, Mistry N, Gatti A, Churchill I, Patel Y, Hanna W, Abdul S, Anestee C, Gilbert S, Sundaresan S, Seely A, Villeneuve P, Maziak D, Razzak R, Ashrafi A, Tregobov N, Hassanzadeh N, Stone S, Panjwani A, Bong T, Bond R, Hafizi A, De Meo M, Rayes R, Milette S, Vagai M, Usatii M, Chandrasekaran A, Giannias B, Bourdeau F, Sangwan V, Bertos N, Moraes C, Huang S, Quail D, Walsh L, Camilleri-Broet S, Fiset P, Cools-Lartigue J, Ferri L, Spicer J, Kammili A, Bilgic E, Quaiattini A, Maurice-Ventouris M, Najmeh S, Mueller C, Esther L, Begum H, Agzarian J, Hanna W, Finley C, Shargall Y, Lee Y, Lu J, Malhan R, Shargall Y, Finley C, Hanna W, Agzarian J, Brophy S, Brennan K, French D, Resende V, Momtazi M, Solaja O, Gilbert S, Maziak D, Seely A, Sundaresan S, Villeneuve P, Sisson D, Donahoe L, Bedard P, Hansen A, De Perrot M, Alghamedi A, Simone A, Begum H, Hanna W, Shargall Y, Turner S, Huang J, Lai H, Bedard E, Shargall Y, Murthy S, Lin J, Darling G, Malthaner R, Kidane B, Seely A, Li H, Crowther M, Linkins L, Lau E, Schneider L, Hanna W, Finley C, Agzarian J, Douketis J, Greenberg B, Gupta V, Allen-Avodabo C, Davis L, Zhao H, Kidane B, Darling G, Coburn N, Huynh C, Cools-Lartigue J, Ferri L, Najmeh S, Sirois C, Mulder D, Spicer J, Al Rawahi A, Aftab Abdul S, Nguyen D, Anstee C, Delic E, Gilbert S, Maziak D, Villeneuve P, Seely A, Sisson D, Sasewich H, Islam T, Low D, Darling G, Turner S, Humer M, Abdul S, Nguyen D, Al Rawahi A, Anstee C, Delic E, Gilbert S, Villeneuve P, Maziak D, Seely A, Le Nguyen D, Aftab Abdul S, Al Rawahi A, Anstee C, Delic E, Gilbert S, Villeneuve P, Maziak D, Seely A, Patel Y, Kay M, Churchill I, Sullivan K, Shargall Y, Shayegan B, Adili A, Hanna W, Kaafarani M, Huynh C, Chouiali F, Muthukrishnan N, Maleki F, Ovens K, Gold M, Sorin M, Falutz R, Rayes R, Forghani R, Spicer J, Hunka N, Kennedy R, Bigsby R, Bharadwaj S, Gowing S, Churchill I, Gatti A, Hylton D, Sullivan K, Patel Y, Farrokhyar F, Leontiadis G, Hanna W, Finley C, Begum H, Pearce K, Agzarian J, Hanna W, Shargall Y, Akhtar-Danesh N, Jones D, Anstee C, Kumar S, Gingrich M, Simone A, Ahmadzai Z, Thavorn K, Seely A, Gupta V, Namavarian A, Mohammed A, Uddin S, Jones D, Behzadi A, Brar A, Qu L, Qiabi M, Nayak R, Malthaner R, Peters E, Buduhan G, Tan L, Liu R, Srinathan S, Kidane B, Gupta V, Levy J, Kidane B, Mahar A, Ringash J, Sutradhar R, Darling G, Coburn N, Robinson M, Bednarek L, Buduhan G, Liu R, Tan L, Srinathan S, Kidane B, Wang H, French D, MacDonald D, Graham K, Enns S, Buduhan G, Srinathan S, Liu R, Tan A, Kidane B, Bruinooge A, Poole E, Pascoe C, Karakach T, Buduhan G, Tan L, Srinathan S, Halayko A, Kidane B, Verhoeff K, Mocanu V, Fang B, Dang J, Kung J, Switzer N, Birch D, Karmali S, Johnson G, Singh H, Vergis A, Park J, Hershorn O, Hochman D, Helewa R, Johnson G, Robertson R, Vergis A, Johnson G, Vergis A, Singh H, Park J, Helewa R, Azin A, Cahill C, Lipson M, Afzal A, Maclean A, Wong C, Roen S, Buie W, McKechnie T, Anpalagan T, Chu M, Lee Y, Amin N, Hong D, Eskicioglu C, McKechnie T, Ramji K, Kruse C, Jaffer H, Rebello R, Amin N, Doumouras A, Hong D, Eskicioglu C, Hajjar R, Oliero M, Cuisiniere T, Fragoso G, Calvé A, Djediai S, Annabi B, Richard C, Santos M, Purich K, Zhou Y, Dodd S, Ring B, Yuan Y, White J, Garfinkle R, Dell'Aniello S, Bhatnagar S, Morin N, Ghitulescu G, Faria J, Vasilevsky C, Brassard P, Boutros M, Garfinkle R, Salama E, Amar-Zifkin A, Morin N, Ghitulescu G, Faria J, Vasilevsky C, Boutros M, Talwar G, Daniel R, McKechnie T, Levine O, Eskicioglu C, AlSulaim H, Alqahtani M, Garfinkle R, Al-Masrouri S, Vasilevsky C, Morin N, Boutros M, McKechnie T, Chen A, Patel A, Lee Y, Doumouras A, Hong D, Eskicioglu C, Brissette V, Al Busaidi N, Rajabiyazdi F, Moon J, Demian M, Vasilevsky C, Morin N, Boutros 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S, Mierzwa A, Jarrar A, Hardy-Henry A, Kolozsvari N, Lin W, Hagen J, Connell M, Sun W, Dang J, Mocanu V, Kung J, Switzer N, Birch D, Karmali S. 2021 Canadian Surgery Forum01. Design and validation of a unique endoscopy simulator using a commercial video game03. Is ethnicity an appropriate measure of health care marginalization?: A systematic review and meta-analysis of the outcomes of diabetic foot ulceration in the Aboriginal population04. Racial disparities in surgery — a cross-specialty matched comparison between black and white patients05. Starting late does not increase the risk of postoperative complications in patients undergoing common general surgical procedures06. Ethical decision-making during a health care crisis: a resource allocation framework and tool07. Ensuring stability in surgical training program leadership: a survey of program directors08. Introducing oncoplastic breast surgery in a community hospital09. Leadership development programs for surgical residents: a review of the literature10. Superiority of non-opioid postoperative pain management after thyroid and parathyroid operations: a systematic review and meta-analysis11. Timing of ERCP relative to cholecystectomy in patients with ductal gallstone disease12. A systematic review and meta-analysis of randomized controlled trials comparing intraoperative red blood cell transfusion strategies13. Postoperative outcomes after frail elderly preoperative assessment clinic: a single-institution Canadian perspective14. Selective opioid antagonists following bowel resection for prevention of postoperative ileus: a systematic review and meta-analysis15. Peer-to-peer coaching after bile duct injury16. Laparoscopic median arcuate ligament release: a video abstract17. Retroperitoneoscopic approach to adrenalectomy19. Endoscopic Zenker diverticulotomy: a video abstract20. Variability in surgeons’ perioperative management of pheochromocytomas in Canada21. The contribution of surgeon and hospital variation in transfusion practice to outcomes for patients undergoing elective gastrointestinal cancer surgery: a population-based analysis22. Perioperative transfusions for gastroesophageal cancers: risk factors and short- and long-term outcomes23. The association between frailty and time alive and at home after cancer surgery among older adults: a population-based analysis24. Psychological and workplace-related effects of providing surgical care during the COVID-19 pandemic in British Columbia, Canada25. Safety of venous thromboembolism prophylaxis in endoscopic retrograde cholangiopancreatography: a systematic review26. Complications and reintervention following laparoscopic subtotal cholecystectomy: a systematic review and meta-analysis27. Synchronization of pupil dilations correlates with team performance in a simulated laparoscopic team coordination task28. Receptivity to and desired design features of a surgical peer coaching program: an international survey9. Impact of the COVID-19 pandemic on rates of emergency department utilization due to general surgery conditions30. The impact of the current COVID-19 pandemic on the exposure of general surgery trainees to operative procedures31. Association between academic degrees and research productivity: an assessment of academic general surgeons in Canada32. Laparoscopic endoscopic cooperative surgery (LECS) for subepithelial gastric lesion: a video presentation33. Effect of the COVID-19 pandemic on acute care general surgery at an academic Canadian centre34. Opioid-free analgesia after outpatient general surgery: a pilot randomized controlled trial35. Impact of neoadjuvant immunotherapy or targeted therapies on surgical resection in patients with solid tumours: a systematic review and meta-analysis37. Surgical data recording in the operating room: a systematic review of modalities and metrics38. Association between nonaccidental trauma and neighbourhood socioeconomic status during the COVID-19 pandemic: a retrospective analysis39. Laparoscopic repair of a transdiaphragmatic gastropleural fistula40. Video-based interviewing in medicine: a scoping review41. Indocyanine green fluorescence angiography for prevention of anastomotic leakage in colorectal surgery: a cost analysis from the hospital payer’s perspective43. Perception or reality: surgical resident and faculty assessments of resident workload compared with objective data45. When illness and loss hit close to home: Do health care providers learn how to cope?46. Remote video-based suturing education with smartphones (REVISE): a randomized controlled trial47. The evolving use of robotic surgery: a population-based analysis48. Prophylactic retromuscular mesh placement for parastomal hernia prevention: a retrospective cohort study of permanent colostomies and ileostomies49. Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: a retrospective cohort study on anastomotic complications50. A lay of the land — a description of Canadian academic acute care surgery models51. Emergency general surgery in Ontario: interhospital variability in structures, processes and models of care52. Trauma 101: a virtual case-based trauma conference as an adjunct to medical education53. Assessment of the National Surgical Quality Improvement Program Surgical Risk Calculator for predicting patient-centred outcomes of emergency general surgery patients in a Canadian health care system54. Sustainability of a narcotic reduction initiative: 1 year following the Standardization of Outpatient Procedure (STOP) Narcotics Study55. Barriers to transanal endoscopic microsurgery referral56. Geospatial analysis of severely injured rural patients in a geographically complex landscape57. Implementation of an incentive spirometry protocol in a trauma ward: a single-centre pilot study58. Impostor phenomenon is a significant risk factor for burnout and anxiety in Canadian resident physicians: a cross-sectional survey59. Understanding the influence of perioperative education on performance among surgical trainees: a single-centre experience60. The effect of COVID-19 pandemic on current and future endoscopic personal protective equipment practices: a national survey of 77 endoscopists61. Case report: delayed presentation of perforated sigmoid diverticulitis as necrotizing infection of the lower limb62. Investigating disparities in surgical outcomes in Canadian Indigenous populations63. Fundoplication is superior to medical therapy for Barrett esophagus disease regression and progression: a systematic review and meta-analysis64. Development of a novel online general surgery learning platform and a qualitative preimplementation analysis65. Hagfish slime exudate as a potential novel hemostatic agent: developing a standardized assessment protocol66. The effect of the first wave of the COVID-19 pandemic on surgical oncology case volumes and wait times67. Safety of same-day discharge in high-risk patients undergoing ambulatory general surgery68. External validation of the Codman score in colorectal surgery: a pragmatic tool to drive quality improvement69. Improved morbidity and gastrointestinal restoration rates without compromising survival rates for diverting loop ileostomy with colonic lavage versus total abdominal colectomy for fulminant Clostridioides difficile colitis: a multicentre retrospective cohort study70. Potential access to emergency general surgical care in Ontario71. Immersive virtual reality (iVR) improves procedural duration, task completion and accuracy in surgical trainees: a systematic review01. Clinical validation of the Canada Lymph Node Score for endobronchial ultrasound02. Venous thromboembolism in surgically treated esophageal cancer patients: a provincial population-based study03. Venous thromboembolism in surgically treated lung cancer patients: a population-based study04. Is frailty associated with failure to rescue after esophagectomy? A multi-institutional comparative analysis of outcomes05. Routine systematic sampling versus targeted sampling of lymph nodes during endobronchial ultrasound: a feasibility randomized controlled trial06. Gastric ischemic conditioning reduces anastomotic complications in patients undergoing esophagectomy: a systematic review and meta-analysis07. Move For Surgery, a novel preconditioning program to optimize health before thoracic surgery: a randomized controlled trial08. In case of emergency, go to your nearest emergency department — Or maybe not?09. Does preoperative SABR increase the risk of complications from lung cancer resection? A secondary analysis of the MISSILE trial10. Segmental resection for lung cancer: the added value of near-infrared fluorescence mapping diminishes with surgeon experience11. Toward competency-based continuing professional development for practising surgeons12. Stereotactic body radiotherapy versus surgery in older adults with NSCLC — a population-based, matched analysis of long-term dependency outcomes13. Role of adjuvant therapy in esophageal cancer patients after neoadjuvant therapy and curative esophagectomy: a systematic review and meta-analysis14. Evaluation of population characteristics on the incidence of thoracic empyema: an ecological study15. Determining the optimal stiffness colour threshold and stiffness area ratio cut-off for mediastinal lymph node staging using EBUS elastography and AI: a pilot study16. Quality assurance on the use of sequential compression stockings in thoracic surgery (QUESTs)17. The relationship between fissureless technique and prolonged air leak for patients undergoing video-assisted thoracoscopic lobectomy18. CXCR2 inhibition as a candidate for immunomodulation in the treatment of K-RAS-driven lung adenocarcinoma19. Assessment tools for evaluating competency in video-assisted thoracoscopic lobectomy: a systematic review20. Understanding the current practice on chest tube management following lung resection among thoracic surgeons across Canada21. Effect of routine jejunostomy tube insertion in esophagectomy: a systematic review and meta-analysis22. Recurrence of primary spontaneous pneumothorax following bullectomy with pleurodesis or pleurectomy: a retrospective analysis23. Surgical outcomes following chest wall resection and reconstruction24. Outcomes following surgical management of primary mediastinal nonseminomatous germ cell tumours25. Does robotic approach offer better nodal staging than thoracoscopic approach in anatomical resection for non–small cell lung cancer? A single-centre propensity matching analysis26. Competency assessment for mediastinal mass resection and thymectomy: design and Delphi process27. The contemporary significance of venous thromboembolism (deep venous thrombosis [DVT] and pulmonary embolus [PE]) in patients undergoing esophagectomy: a prospective, multicentre cohort study to evaluate the incidence and clinical outcomes of VTE after major esophageal resections28. Esophageal cancer: symptom severity at the end of life29. The impact of pulmonary artery reconstruction on postoperative and oncologic outcomes: a systematic review30. Association with surgical technique and recurrence after laparoscopic repair of paraesophageal hernia: a single-centre experience31. Enhanced recovery after surgery (ERAS) in esophagectomy32. Surgical treatment of esophageal cancer: trends in surgical approach and early mortality at a single institution over the past 18 years34. Adverse events and length of stay following minimally invasive surgery in paraesophageal hernia repair35. Long-term symptom control comparison of Dor and Nissen fundoplication following laparoscopic para-esophageal hernia repair: a retrospective analysis36. Willingness to pay: a survey of Canadian patients’ willingness to contribute to the cost of robotic thoracic surgery37. Radiomics in early-stage lung adenocarcinoma: a prediction tool for tumour immune microenvironments38. Effectiveness of intraoperative pyloric botox injection during esophagectomy: how often is endoscopic intervention required?39. An artificial intelligence algorithm for predicting lymph node malignancy during endobronchial ultrasound40. The effect of major and minor complications after lung surgery on length of stay and readmission41. Measuring cost of adverse events following thoracic surgery: a scoping review42. Laparoscopic paraesophageal hernia repair: characterization by hospital and surgeon volume and impact on outcomes43. NSQIP 5-Factor Modified Frailty Index predicts morbidity but not mortality after esophagectomy44. Trajectory of perioperative HRQOL and association with postoperative complications in thoracic surgery patients45. Variation in treatment patterns and outcomes for resected esophageal cancer at designated thoracic surgery centres46. Patient-reported pretreatment health-related quality of life (HRQOL) predicts short-term survival in esophageal cancer patients47. Analgesic efficacy of surgeon-placed paravertebral catheters compared with thoracic epidural analgesia after Ivor Lewis esophagectomy: a retrospective noninferiority study48. Rapid return to normal oxygenation after lung surgery49. Examination of local and systemic inflammatory changes during lung surgery01. Implications of near-infrared imaging and indocyanine green on anastomotic leaks following colorectal surgery: a systematic review and meta-analysis02. Repeat preoperative endoscopy after regional implementation of electronic synoptic endoscopy reporting: a retrospective comparative study03. Consensus-derived quality indicators for operative reporting in transanal endoscopic surgery (TES)04. Colorectal lesion localization practices at endoscopy to facilitate surgical and endoscopic planning: recommendations from a national consensus Delphi process05. Black race is associated with increased mortality in colon cancer — a population-based and propensity-score matched analysis06. Improved survival in a cohort of patients 75 years and over with FIT-detected colorectal neoplasms07. Laparoscopic versus open loop ileostomy reversal: a systematic review and meta-analysis08. Posterior mesorectal thickness as a predictor of increased operative time in rectal cancer surgery: a retrospective cohort study09. Improvement of colonic anastomotic healing in mice with oral supplementation of oligosaccharides10. How can we better identify patients with rectal bleeding who are at high risk of colorectal cancer?11. Assessment of long-term bowel dysfunction in rectal cancer survivors: a population-based cohort study12. Observational versus antibiotic therapy for acute uncomplicated diverticulitis: a noninferiority meta-analysis based on a Delphi consensus13. Radiotherapy alone versus chemoradiotherapy for stage I anal squamous cell carcinoma: a systematic review and meta-analysis14. Is the Hartmann procedure for diverticulitis obsolete? National trends in colectomy for diverticulitis in the emergency setting from 1993 to 201515. Sugammadex in colorectal surgery: a systematic review and meta-analysis16. Sexuality and rectal cancer treatment: a qualitative study exploring patients’ information needs and expectations on sexual dysfunction after rectal cancer treatment17. Video-based interviews in selection process18. Impact of delaying colonoscopies during the COVID-19 pandemic on colorectal cancer detection and prevention19. Opioid use disorder associated with increased anastomotic leak and major complications after colorectal surgery20. Effectiveness of a rectal cancer education video on patient expectations21. Robotic-assisted rectosigmoid and rectal cancer resection: implementation and early experience at a Canadian tertiary centre22. An online educational app for rectal cancer survivors with low anterior resection syndrome: a pilot study23. The effects of surgeon specialization on the outcome of emergency colorectal surgery24. Outcomes after colorectal cancer resections in octogenarians and older in a regional New Zealand setting — What are the predictors of mortality?25. Long-term outcomes after seton placement for perianal fistulae with and without Crohn disease26. A survey of patient and surgeon preference for early ileostomy closure following restorative proctectomy for rectal cancer — Why aren’t we doing it?27. Crohn disease independently associated with longer hospital admission after surgery28. Short-stay (≤ 1 d) diverting loop ileostomy closure can be selectively implemented without an increase in readmission and complication rates: an ACS-NSQIP analysis29. A comparison of perineal stapled rectal prolapse resection and the Altemeier procedure at 2 Canadian academic hospitals30. Mental health and substance use disorders predict 90-day readmission and postoperative complications following rectal cancer surgery31. Early discharge after colorectal cancer resection: trends and impact on patient outcomes32. Oral antibiotics without mechanical bowel preparation prior to emergency colectomy reduces the risk of organ space surgical site infections: a NSQIP propensity score matched study33. The impact of robotic surgery on a tertiary care colorectal surgery program, an assessment of costs and short-term outcomes — a Canadian perspective34. Should we scope beyond the age limit of guidelines? Adenoma detection rates and outcomes of screening and surveillance colonoscopies in patients aged 75–79 years35. Emergency department admissions for uncomplicated diverticulitis: a nationwide study36. Obesity is associated with a complicated episode of acute diverticulitis: a nationwide study37. Green indocyanine angiography for low anterior resection in patients with rectal cancer: a prospective before-and-after study38. The impact of age on surgical recurrence of fibrostenotic ileocolic Crohn disease39. A qualitative study to explore the optimal timing and approach for the LARS discussion01. Racial, ethnic and socioeconomic disparities in diagnosis, treatment and survival of patients with breast cancer: a SEER-based population analysis02. First-line palliative chemotherapy for esophageal and gastric cancer: practice patterns and outcomes in the general population03. Frailty as a predictor for postoperative outcomes following pancreaticoduodenectomy04. Synoptic electronic operative reports identify practice variation in cancer surgery allowing for directed interventions to decrease variation05. The role of Hedgehog signalling in basal-like breast cancer07. Clinical and patient-reported outcomes in oncoplastic breast conservation surgery from a single surgeon’s practice in a busy community hospital in Canada08. Upgrade rate of atypical ductal hyperplasia: 10 years of experience and predictive factors09. Time to first adjuvant treatment after oncoplastic breast reduction10. Preparing to survive: improving outcomes for young women with breast cancer11. Opioid prescription and consumption in patients undergoing outpatient breast surgery — baseline data for a quality improvement initiative12. Rectal anastomosis and hyperthermic intraperitoneal chemotherapy: Should we avoid diverting loop ileostomy?13. Delays in operative management of early-stage, estrogen-receptor positive breast cancer during the COVID-19 pandemic — a multi-institutional matched historical cohort study14. Opioid prescribing practices in breast oncologic surgery15. Oncoplastic breast reduction (OBR) complications and patient-reported outcomes16. De-escalating breast cancer surgery: Should we apply quality indicators from other jurisdictions in Canada?17. The breast cancer patient experience of telemedicine during COVID-1918. A novel ex vivo human peritoneal model to investigate mechanisms of peritoneal metastasis in gastric adenocarcinoma (GCa)19. Preliminary uptake and outcomes utilizing the BREAST-Q patient-reported outcomes questionnaire in patients following breast cancer surgery20. Routine elastin staining improves detection of venous invasion and enhances prognostication in resected colorectal cancer21. Analysis of exhaled volatile organic compounds: a new frontier in colon cancer screening and surveillance22. A clinical pathway for radical cystectomy leads to a shorter hospital stay and decreases 30-day postoperative complications: a NSQIP analysis23. Fertility preservation in young breast cancer patients: a population-based study24. Investigating factors associated with postmastectomy unplanned emergency department visits: a population-based analysis25. Impact of patient, tumour and treatment factors on psychosocial outcomes after treatment in women with invasive breast cancer26. The relationship between breast and axillary pathologic complete response in women receiving neoadjuvant chemotherapy for breast cancer01. The association between bacterobilia and the risk of postoperative complications following pancreaticoduodenectomy02. Surgical outcome and quality of life following exercise-based prehabilitation for hepatobiliary surgery: a systematic review and meta-analysis03. Does intraoperative frozen section and revision of margins lead to improved survival in patients undergoing resection of perihilar cholangiocarcinoma? A systematic review and meta-analysis04. Prolonged kidney procurement time is associated with worse graft survival after transplantation05. Venous thromboembolism following hepatectomy for colorectal metastases: a population-based retrospective cohort study06. Association between resection approach and transfusion exposure in liver resection for gastrointestinal cancer07. The association between surgeon volume and use of laparoscopic liver resection for gastrointestinal cancer08. Immune suppression through TIGIT in colorectal cancer liver metastases09. “The whole is greater than the sum of its parts” — a combined strategy to reduce postoperative pancreatic fistula after pancreaticoduodenectomy10. Laparoscopic versus open synchronous colorectal and hepatic resection for metastatic colorectal cancer11. Identifying prognostic factors for overall survival in patients with recurrent disease following liver resection for colorectal cancer metastasis12. Modified Blumgart pancreatojejunostomy with external stenting in laparoscopic Whipple reconstruction13. Laparoscopic versus open pancreaticoduodenectomy: a single centre’s initial experience with introduction of a novel surgical approach14. Neoadjuvant chemotherapy versus upfront surgery for borderline resectable pancreatic cancer: a single-centre cohort analysis15. Thermal ablation and telemedicine to reduce resource utilization during the COVID-19 pandemic16. Cost-utility analysis of normothermic machine perfusion compared with static cold storage in liver transplantation in the Canadian setting17. Impact of adjuvant therapy on overall survival in early-stage ampullary cancers: a single-centre retrospective review18. Presence of biliary anaerobes enhances response to neoadjuvant chemotherapy in pancreatic ductal adenocarcinoma19. How does tumour viability influence the predictive capability of the Metroticket model? Comparing predicted-to-observed 5-year survival after liver transplant for hepatocellular carcinoma20. Does caudate resection improve outcomes in patients undergoing curative resection for perihilar cholangiocarcinoma? A systematic review and meta-analysis21. Appraisal of multivariable prognostic models for postoperative liver decompensation following partial hepatectomy: a systematic review22. Predictors of postoperative liver decompensation events following resection in patients with cirrhosis and hepatocellular carcinoma: a population-based study23. Characteristics of bacteriobilia and impact on outcomes after Whipple procedure01. Inverting the y-axis: the future of MIS abdominal wall reconstruction is upside down02. Progressive preoperative pneumoperitoneum: a single-centre retrospective study03. The role of radiologic classification of parastomal hernia as a predictor of the need for surgical hernia repair: a retrospective cohort study04. Comparison of 2 fascial defect closure methods for laparoscopic incisional hernia repair01. Hypoalbuminemia predicts serious complications following elective bariatric surgery02. Laparoscopic adjustable gastric band migration inducing jejunal obstruction associated with acute pancreatitis: aurgical approach of band removal03. Can visceral adipose tissue gene expression determine metabolic outcomes after bariatric surgery?04. Improvement of kidney function in patients with chronic kidney disease and severe obesity after bariatric surgery: a systematic review and meta-analysis05. A prediction model for delayed discharge following gastric bypass surgery06. Experiences and outcomes of Indigenous patients undergoing bariatric surgery: a mixed-methods scoping review07. What is the optimal common channel length in revisional bariatric surgery?08. Laparoscopic management of internal hernia in a 34-week pregnant woman09. Characterizing timing of postoperative complications following elective Roux-en-Y gastric bypass and sleeve gastrectomy10. Canadian trends in bariatric surgery11. Common surgical stapler problems and how to correct them12. Management of choledocholithiasis following Roux-en-Y gastric bypass: a systematic review and meta-analysis. Can J Surg 2021; 64:S80-S159. [PMID: 35483046 PMCID: PMC8677574 DOI: 10.1503/cjs.021321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- G Johnson
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - B Unger
- From the University of Manitoba, Winnipeg, Man
| | - J Park
- From the University of Manitoba, Winnipeg, Man
| | - L Gillman
- From the University of Manitoba, Winnipeg, Man
| | - K Hickey
- From Memorial University, St. John's, Nfld
| | - D Pace
- From Memorial University, St. John's, Nfld
| | - A Azin
- From the University of Toronto, Toronto, Ont
| | | | | | - S Chadi
- University Health Network, Toronto, Ont
| | | | | | - J Catton
- University Health Network, Toronto, Ont
| | - B Rubin
- University Health Network, Toronto, Ont
| | - J Bell
- University Health Network, Toronto, Ont
| | | | | | | | | | - F Shariff
- From the University of Toronto, Toronto, Ont
| | - F Wright
- From the University of Toronto, Toronto, Ont
| | - N Ahmed
- From the University of Toronto, Toronto, Ont
| | - A Nadler
- From the University of Toronto, Toronto, Ont
| | - J Hallet
- From the University of Toronto, Toronto, Ont
| | - J Gentles
- From the University of British Columbia, Vancouver, B.C
| | - L Chen
- From the University of British Columbia, Vancouver, B.C
| | - H Hwang
- From the University of British Columbia, Vancouver, B.C
| | - M Parapini
- University of British Columbia, Vancouver, B.C
| | | | - R Sidhu
- University of British Columbia, Vancouver, B.C
| | - T Scott
- University of British Columbia, Vancouver, B.C
| | | | - R Guo
- From the University of British Columbia, Vancouver, B.C
| | - A Nguyen
- From the University of British Columbia, Vancouver, B.C
| | - J Osborn
- From the University of British Columbia, Vancouver, B.C
| | - S Wiseman
- From the University of British Columbia, Vancouver, B.C
| | - K Nabata
- From the University of British Columbia, Vancouver, B.C
| | - E Ertel
- From the University of British Columbia, Vancouver, B.C
| | - H Hwang
- From the University of British Columbia, Vancouver, B.C
| | - T Lenet
- University of Ottawa, Ottawa, Ont
| | - L Baker
- University of Ottawa, Ottawa, Ont
| | - L Park
- University of Ottawa, Ottawa, Ont
| | - M Vered
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Zahrai
- University of Ottawa, Ottawa, Ont
| | - R Shorr
- The Ottawa Hospital, Ottawa, Ont
| | - A Davis
- The Ottawa Hospital, Ottawa, Ont
| | | | | | - D Fergusson
- Ottawa Hospital Research Institute, Ottawa, Ont
| | - G Martel
- The Ottawa Hospital, Ottawa, Ont
| | - K Nabata
- From the University of British Columbia, Vancouver, B.C
| | - S Rummel
- From the University of British Columbia, Vancouver, B.C
| | | | - A Karimuddin
- From the University of British Columbia, Vancouver, B.C
| | - M Stewart
- From the University of British Columbia, Vancouver, B.C
| | - A Melck
- From the University of British Columbia, Vancouver, B.C
| | | | | | | | - Y Lee
- From McMaster University, Hamilton, Ont
| | - K Ramji
- From McMaster University, Hamilton, Ont
| | | | - A Zhu
- From the University of Toronto, Toronto, Ont
| | - S Deng
- From the University of Toronto, Toronto, Ont
| | - B Greene
- From the University of Toronto, Toronto, Ont
| | - M Tsang
- From the University of Toronto, Toronto, Ont
| | - V Palter
- From the University of Toronto, Toronto, Ont
| | - S Jayaraman
- From the University of Toronto, Toronto, Ont
| | | | - A Mann
- From McMaster University, Hamilton, Ont
| | - J Tittley
- From McMaster University, Hamilton, Ont
| | - M Cadeddu
- From McMaster University, Hamilton, Ont
| | - M Nguyen
- University of Toronto, Toronto, Ont
| | - A Madani
- University Health Network, Toronto, Ont
| | | | | | - K Ramji
- From McMaster University, Hamilton, Ont
| | - D Hong
- From McMaster University, Hamilton, Ont
| | - L Qu
- Western University, London, Ont
| | - A Istl
- Johns Hopkins Hospital, Baltimore, Md
| | - E Tang
- Western University, London, Ont
| | - D Gray
- Western University, London, Ont
| | | | - N Coburn
- University of Toronto, Toronto, Ont
| | - J Callum
- Queen's University, Kingston, Ont
| | - R McLeod
- University of Toronto, Toronto, Ont
| | | | - Y Lin
- University of Toronto, Toronto, Ont
| | | | - G Martel
- University of Ottawa, Ottawa, Ont
| | - J Hallet
- University of Toronto, Toronto, Ont
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | - A Kammili
- From the McGill University Health Centre, Montreal, Que
| | | | - L Lee
- From the McGill University Health Centre, Montreal, Que
| | | | - L Ferri
- From the McGill University Health Centre, Montreal, Que
| | - C Mueller
- From the McGill University Health Centre, Montreal, Que
| | | | - B Haas
- University of Toronto, Toronto, Ont
| | | | | | | | - V Zuk
- Sunnybrook Research Institute, Toronto, Ont
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | - A Hsu
- University of Ottawa, Ottawa, Ont
| | | | - R Vasdev
- Sunnybrook Research Institute, Toronto, Ont
| | - N Coburn
- University of Toronto, Toronto, Ont
| | - J Hallet
- University of Toronto, Toronto, Ont
| | - K D'Souza
- From the University of British Columbia, Vancouver, B.C
| | - C Huynh
- From the University of British Columbia, Vancouver, B.C
| | | | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - H Hwang
- From the University of British Columbia, Vancouver, B.C
| | - M Hameed
- From the University of British Columbia, Vancouver, B.C
| | - L Glass
- Western University, London, Ont
| | | | - P Murphy
- Medical College of Wisconsin, Milwaukee, Wis
| | - E Tang
- Western University, London, Ont
| | | | - J Hawel
- Western University, London, Ont
| | - L Kerr
- From the Northern Ontario School of Medicine, Thunder Bay, Ont
| | - S Zablotny
- From the Northern Ontario School of Medicine, Thunder Bay, Ont
| | - H Roldan
- From the Northern Ontario School of Medicine, Thunder Bay, Ont
| | - W He
- University of Manitoba, Winnipeg, Man
| | - X Jiang
- Memorial University of Newfoundland, St. John's, Nfld
| | - B Zheng
- University of Alberta, Edmonton, Alta
| | - L Lee
- From McGill University, Montreal, Que
| | - J Fiore
- From McGill University, Montreal, Que
| | - L Feldman
- From McGill University, Montreal, Que
| | - G Fried
- From McGill University, Montreal, Que
| | - C Mueller
- From McGill University, Montreal, Que
| | - S Valanci
- From McGill University, Montreal, Que
| | | | - J Cipolla
- From McGill University, Montreal, Que
| | - P Kaneva
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | - L Lee
- From McGill University, Montreal, Que
| | - L Feldman
- From McGill University, Montreal, Que
| | - J Fiore
- From McGill University, Montreal, Que
| | | | | | - J Cipolla
- From McGill University, Montreal, Que
| | - L Lee
- From McGill University, Montreal, Que
| | - J Fiore
- From McGill University, Montreal, Que
| | - L Feldman
- From McGill University, Montreal, Que
| | - A Miles
- From the University of Alberta, Edmonton, Alta
| | - K Purich
- From the University of Alberta, Edmonton, Alta
| | - K Verhoeff
- From the University of Alberta, Edmonton, Alta
| | - J Shapiro
- From the University of Alberta, Edmonton, Alta
| | - D Bigam
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - A Fecso
- From the University of Toronto, Toronto, Ont
| | - T Chesney
- From the University of Toronto, Toronto, Ont
| | - J Mosko
- From the University of Toronto, Toronto, Ont
| | - D Skubleny
- From the University of Alberta, Edmonton, Alta
| | - P Hamilton
- From the University of Alberta, Edmonton, Alta
| | - S Ghosh
- From the University of Alberta, Edmonton, Alta
| | - S Widder
- From the University of Alberta, Edmonton, Alta
| | - D Schiller
- From the University of Alberta, Edmonton, Alta
| | - U Do
- McGill University, Montreal, Que
| | | | - M Pook
- McGill University, Montreal, Que
| | - N Barone
- McGill University, Montreal, Que
| | | | | | | | | | - H Elhaj
- McGill University Health Centre, Montreal, Que
| | | | - G Olleik
- McGill University, Montreal, Que
| | - P Kaneva
- McGill University Health Centre, Montreal, Que
| | - A Antoun
- McGill University, Montreal, Que
| | - N Safa
- McGill University, Montreal, Que
| | | | | | | | - G Fried
- McGill University Health Centre, Montreal, Que
| | - M Alhashemi
- McGill University Health Centre, Montreal, Que
| | - F Lee
- McGill University Health Centre, Montreal, Que
| | - G Baldini
- McGill University Health Centre, Montreal, Que
| | - L Feldman
- McGill University Health Centre, Montreal, Que
| | - J Fiore
- McGill University Health Centre, Montreal, Que
| | | | - S Parpia
- McMaster University, Hamilton, Ont
| | - L Ruo
- McMaster University, Hamilton, Ont
| | | | - S Lee
- McMaster University, Hamilton, Ont
| | | | - N Faisal
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Alfayyadh
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | - C Kruse
- McMaster University, Hamilton, Ont
| | | | - M Levin
- University of Toronto, Toronto, Ont
| | - K Aldrich
- Center for Medical Interoperability, Nashville, Tenn
| | - T Grantcharov
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - A Langerman
- Vanderbilt University Medical Center, Nashville, Tenn
| | - H Forbes
- From the University of Alberta, Edmonton, Alta
| | - R Anantha
- From the University of Alberta, Edmonton, Alta
| | - V Fawcett
- From the University of Alberta, Edmonton, Alta
| | | | - V Pravong
- University of Montreal, Montreal, Que
| | - M Gervais
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - G Rakovich
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - R Selvam
- From the University of Ottawa, Ottawa, Ont
| | - R Hu
- From the University of Ottawa, Ottawa, Ont
| | | | - I Raiche
- From the University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the University of Ottawa, Ottawa, Ont
| | - R Liu
- Western University, London, Ont
| | - A Elnahas
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - N Alkhamesi
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - J Hawel
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - E Tang
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - A Alnumay
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - C Schlachta
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - E Walser
- From Western University, London, Ont
| | - C Zhang
- From Western University, London, Ont
| | | | - M Ott
- From Western University, London, Ont
| | - A Lee
- From the University of Ottawa, Ottawa, Ont
| | - B Niu
- From the University of Ottawa, Ottawa, Ont
| | - F Balaa
- From the University of Ottawa, Ottawa, Ont
| | - N Gawad
- From the University of Ottawa, Ottawa, Ont
| | - K Ren
- From McMaster University, Hamilton, Ont
| | - Y Qiu
- From McMaster University, Hamilton, Ont
| | - K Hamann
- From McMaster University, Hamilton, Ont
| | - N How
- From McMaster University, Hamilton, Ont
| | | | | | - A Eqbal
- From McMaster University, Hamilton, Ont
| | | | | | | | - E Lee
- From McMaster University, Hamilton, Ont
| | - I Yang
- From McMaster University, Hamilton, Ont
| | - K Ren
- From McMaster University, Hamilton, Ont
| | - H Muaddi
- University of Toronto, Toronto, Ont
| | - T Stukel
- ICES, University of Toronto, Toronto, Ont
| | - C de Mestral
- St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - A Nathens
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - P Karanicolas
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - J Frigault
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Lemieux
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - D Breton
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - P Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - A Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - R Grégoire
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - F Letarte
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - G Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Drolet
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - J Frigault
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Avoine
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Drolet
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - F Letarte
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - A Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - J Gagné
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - C Thibault
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - R Grégoire
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | | | - M Gosselin
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - P Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | | | - T Stuleanu
- From the University of Ottawa, Ottawa, Ont
| | - A Jarrar
- From the University of Ottawa, Ottawa, Ont
| | | | | | - R Nenshi
- McMaster University, Hamilton, Ont
| | - A Jerath
- University of Toronto, Toronto, Ont
| | - D Gomez
- University of Toronto, Toronto, Ont
| | - K Singh
- University of Toronto, Toronto, Ont
| | - T Amir
- McMaster University, Hamilton, Ont
| | - E Liu
- McMaster University, Hamilton, Ont
| | | | - R Mao
- McMaster University, Hamilton, Ont
| | - L Lan
- McMaster University, Hamilton, Ont
| | - J Yan
- University of British Columbia, Vancouver, B.C
| | | | - A Mierzwa
- From the University of Alberta, Edmonton, Alta
| | - R Tin
- From the University of Alberta, Edmonton, Alta
| | - R Brisebois
- From the University of Alberta, Edmonton, Alta
| | - N Bradley
- From the University of Alberta, Edmonton, Alta
| | - R Wigen
- From Western University, London, Ont
| | - E Walser
- From Western University, London, Ont
| | | | | | - K Vogt
- From Western University, London, Ont
| | - R Hilsden
- From Western University, London, Ont
| | - N Parry
- From Western University, London, Ont
| | - L Allen
- From Western University, London, Ont
| | - K Leslie
- From Western University, London, Ont
| | - R Raskin
- From Dalhousie University, Halifax, N.S
| | - J Jones
- From Dalhousie University, Halifax, N.S
| | - K Neumann
- From Dalhousie University, Halifax, N.S
| | - C Dwyer
- University of Alberta, Edmonton, Alta
| | | | - N Bradley
- University of Alberta, Edmonton, Alta
| | | | - K Lobay
- University of Alberta, Edmonton, Alta
| | | | - E Chang
- University of Alberta, Edmonton, Alta
| | - S Widder
- University of Alberta, Edmonton, Alta
| | - R Anantha
- University of Alberta, Edmonton, Alta
| | - W Sun
- University of Alberta, Edmonton, Alta
| | - J Beck
- Royal Alexandra Hospital, Edmonton, Alta
| | - R Anantha
- University of Alberta, Edmonton, Alta
| | - R Liu
- From Western University, London, Ont
| | | | - S Jones
- From Western University, London, Ont
| | | | | | - M Ott
- From Western University, London, Ont
| | - E Schmitz
- From the University of Ottawa, Ottawa, Ont
| | - I Raiche
- From the University of Ottawa, Ottawa, Ont
| | - W Sun
- University of Alberta, Edmonton, Alta
| | | | - J Dang
- University of Alberta, Edmonton, Alta
| | - V Mocanu
- University of Alberta, Edmonton, Alta
| | - G Lutzak
- University of Alberta, Edmonton, Alta
| | | | - C Wong
- University of Alberta, Edmonton, Alta
| | - S Karmali
- University of Alberta, Edmonton, Alta
| | - E Schmitz
- From the University of Ottawa, Ottawa, Ont
| | - M Petrera
- From the University of Ottawa, Ottawa, Ont
| | - M Pickell
- From the University of Ottawa, Ottawa, Ont
| | - R Auer
- From the University of Ottawa, Ottawa, Ont
| | - N Patro
- From McMaster University, Hamilton, Ont
| | - B Li
- From McMaster University, Hamilton, Ont
| | - Y Lee
- From McMaster University, Hamilton, Ont
| | - H Wilson
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - W Sun
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - U Jogiat
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - C Wong
- From the University of Alberta, Edmonton, Alta
| | - C Li
- University of Alberta, Edmonton, Alta
| | | | - A Cieply
- University of Alberta, Edmonton, Alta
| | - H Hawes
- University of British Columbia, Vancouver, B.C
| | - E Joos
- University of British Columbia, Vancouver, B.C
| | - A Saleh
- University of Alberta, Edmonton, Alta
| | - C Li
- University of Alberta, Edmonton, Alta
| | - A Saleh
- University of Alberta, Edmonton, Alta
| | - P Engels
- McMaster University, Hamilton, Ont
| | - J Drung
- From the University of Western Ontario, London, Ont
| | - L Allen
- From the University of Western Ontario, London, Ont
| | - K Leslie
- From the University of Western Ontario, London, Ont
| | - G Pang
- From Western University, London, Ont
| | - M Kwong
- From Western University, London, Ont
| | | | | | - J Hawel
- From Western University, London, Ont
| | - A Elnahas
- From Western University, London, Ont
| | | | | | - S Chadi
- University of Toronto, Toronto, Ont
| | | | - D Chang
- Harvard University, Cambridge, Mass
| | - M Hutter
- Harvard University, Cambridge, Mass
| | - R Spence
- Dalhousie University, Halifax, N.S
| | | | - M Boutros
- Jewish General Hospital, Montreal, Que
| | | | - N Morin
- Jewish General Hospital, Montreal, Que
| | - Y Longtin
- Jewish General Hospital, Montreal, Que
| | - S Liberman
- McGill University Health Centre, Montreal, Que
| | | | | | - M Poirier
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Que
| | | | - H Sebajang
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - R Younan
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - F Schwenter
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - E De Broux
- Centre hospitalier de l'Université de Montreal, Montreal, Que
| | - K Larsen
- University of Toronto, Toronto, Ont
| | | | | | - J Nantais
- University of Manitoba, Winnipeg, Man
| | - D Gomez
- University of Toronto, Toronto, Ont
| | - L Lan
- McMaster University, Hamilton, Ont
| | - R Mao
- McMaster University, Hamilton, Ont
| | - J Kay
- McMaster University, Hamilton, Ont
| | - R Lohre
- University of British Columbia, Vancouver, B.C
| | - O Ayeni
- McMaster University, Hamilton, Ont
| | - D Goel
- University of British Columbia, Vancouver, B.C
| | - D de Sa
- McMaster University, Hamilton, Ont
| | - R He
- University of Alberta, Edmonton, Alta
| | - D Hylton
- McMaster University, Hamilton, Ont
| | - E Bedard
- University of Alberta, Edmonton, Alta
| | - S Johnson
- University of Alberta, Edmonton, Alta
| | - B Laing
- University of Alberta, Edmonton, Alta
| | - A Valji
- University of Alberta, Edmonton, Alta
| | | | - S Turner
- University of Alberta, Edmonton, Alta
| | | | | | | | | | | | | | | | - V Gupta
- University of Toronto, Toronto, Ont
| | - B Kidane
- University of Manitoba, Winnipeg, Man
| | | | | | | | | | - Y Patel
- McMaster University, Hamilton, Ont
| | | | - D Hylton
- McMaster University, Hamilton, Ont
| | - F Xie
- McMaster University, Hamilton, Ont
| | - A Seely
- University of Ottawa, Ottawa, Ont
| | - J Spicer
- McGill University, Montreal, Que
| | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - S Turner
- University of Alberta, Edmonton, Alta
| | | | - W Hanna
- McMaster University, Hamilton, Ont
| | - U Jogiat
- From the University of Alberta, Edmonton, Alta
| | - W Sun
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - S Turner
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - Y Patel
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - I Churchill
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - K Sullivan
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - M Beauchamp
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - J Wald
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - L Mbuagbaw
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - J Agzarian
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Y Shargall
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - C Finley
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - C Fahim
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - W Hanna
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - M Abbas
- From McMaster University, Hamilton, Ont
| | - O Olaiya
- From McMaster University, Hamilton, Ont
| | - H Begum
- From McMaster University, Hamilton, Ont
| | | | - C Finley
- From McMaster University, Hamilton, Ont
| | - W Hanna
- From McMaster University, Hamilton, Ont
| | | | | | - A Ednie
- Western University, London, Ont
| | - D Palma
- Western University, London, Ont
| | | | | | | | - M Qiabi
- Western University, London, Ont
| | - R Nayak
- Western University, London, Ont
| | | | - A Louie
- Sunnybrook Health Sciences Centre
| | | | | | - J Laba
- Western University, London, Ont
| | | | - J Alaichi
- From McMaster University, Hamilton, Ont
| | - Y Patel
- From McMaster University, Hamilton, Ont
| | - W Hanna
- From McMaster University, Hamilton, Ont
| | - S Turner
- From the University of Alberta, Edmonton, Alta
| | - B Mador
- From the University of Alberta, Edmonton, Alta
| | - H Lai
- From the University of Alberta, Edmonton, Alta
| | - J White
- From the University of Alberta, Edmonton, Alta
| | - M Kim
- From the University of Alberta, Edmonton, Alta
| | | | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - A Louie
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - V Zuk
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - G Darling
- Toronto General Hospital, Toronto, Ont
| | | | - T Chesney
- St. Michael's Hospital, Toronto, Ont
| | - N Coburn
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - J Hallet
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Y Lee
- McMaster University, Hamilton, Ont
| | | | - M Lee
- University of Toronto, Toronto, Ont
| | - L Thiru
- McMaster University, Hamilton, Ont
| | | | - C Finley
- McMaster University, Hamilton, Ont
| | - W Hanna
- McMaster University, Hamilton, Ont
| | - O Levine
- McMaster University, Hamilton, Ont
| | | | | | - R Nayak
- Western University, London, Ont
| | - S Brogly
- Queen's University, Kingston, Ont
| | - W Li
- ICES Queen's, Kingston, Ont
| | | | | | - N Mistry
- From McMaster University, Hamilton, Ont
| | - A Gatti
- From McMaster University, Hamilton, Ont
| | | | - Y Patel
- From McMaster University, Hamilton, Ont
| | - W Hanna
- From McMaster University, Hamilton, Ont
| | - S Abdul
- University of Ottawa, Ottawa, Ont
| | - C Anestee
- Ottawa Hospital Research Institute, Ottawa, Ont
| | | | | | - A Seely
- University of Ottawa, Ottawa, Ont
| | | | - D Maziak
- University of Ottawa, Ottawa, Ont
| | - R Razzak
- University of Manitoba, Winnipeg, Man
| | - A Ashrafi
- University of British Columbia, Vancouver, B.C
| | | | | | - S Stone
- University of British Columbia, Vancouver, B.C
| | | | - T Bong
- Fraser Health Authority, B.C
| | - R Bond
- University of British Columbia, Vancouver, B.C
| | - A Hafizi
- Surrey Thoracic Surgery Group, Surrey, B.C
| | - M De Meo
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - R Rayes
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - S Milette
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - M Vagai
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - M Usatii
- Research Institute of the McGill University Health Centre, Montreal, Que
| | | | - B Giannias
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - F Bourdeau
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - V Sangwan
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - N Bertos
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - C Moraes
- McGill University, Montreal, Que
| | - S Huang
- McGill University, Montreal, Que
| | - D Quail
- McGill University, Montreal, Que
| | - L Walsh
- McGill University, Montreal, Que
| | - S Camilleri-Broet
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - P Fiset
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - J Cools-Lartigue
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - L Ferri
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - J Spicer
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - A Kammili
- McGill University Health Centre, Montreal, Que
| | - E Bilgic
- McGill University Health Centre, Montreal, Que
| | | | | | - S Najmeh
- McGill University Health Centre, Montreal, Que
| | - C Mueller
- McGill University Health Centre, Montreal, Que
| | - L Esther
- From McMaster University, Hamilton, Ont
| | - H Begum
- From McMaster University, Hamilton, Ont
| | | | - W Hanna
- From McMaster University, Hamilton, Ont
| | - C Finley
- From McMaster University, Hamilton, Ont
| | | | - Y Lee
- McMaster University, Hamilton, Ont
| | - J Lu
- University of Toronto, Toronto, Ont
| | - R Malhan
- McMaster University, Hamilton, Ont
| | | | - C Finley
- McMaster University, Hamilton, Ont
| | - W Hanna
- McMaster University, Hamilton, Ont
| | | | - S Brophy
- From Dalhousie University, Halifax, N.S
| | - K Brennan
- From Dalhousie University, Halifax, N.S
| | - D French
- From Dalhousie University, Halifax, N.S
| | - V Resende
- Ottawa Hospital Research Institute, Ottawa, Ont
| | | | - O Solaja
- The Ottawa Hospital, Ottawa, Ont
| | | | - D Maziak
- The Ottawa Hospital, Ottawa, Ont
| | - A Seely
- The Ottawa Hospital, Ottawa, Ont
| | | | | | - D Sisson
- From the University of Toronto, Toronto, Ont
| | - L Donahoe
- From the University of Toronto, Toronto, Ont
| | - P Bedard
- From the University of Toronto, Toronto, Ont
| | - A Hansen
- From the University of Toronto, Toronto, Ont
| | - M De Perrot
- From the University of Toronto, Toronto, Ont
| | | | - A Simone
- University of Ottawa, Ottawa, Ont
| | - H Begum
- McMaster University, Hamilton, Ont
| | - W Hanna
- McMaster University, Hamilton, Ont
| | | | - S Turner
- University of Alberta, Edmonton, Alta
| | - J Huang
- Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - H Lai
- University of Alberta, Edmonton, Alta
| | - E Bedard
- University of Alberta, Edmonton, Alta
| | | | - S Murthy
- Cleveland Clinic, Cleveland, Ohio
| | - J Lin
- University of Michigan, Ann Arbor, Mich
| | | | | | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - A Seely
- University of Ottawa, Ottawa, Ont
| | - H Li
- Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | | | | | - E Lau
- McMaster University, Hamilton, Ont
| | | | - W Hanna
- McMaster University, Hamilton, Ont
| | - C Finley
- McMaster University, Hamilton, Ont
| | | | | | | | - V Gupta
- University of Toronto, Toronto, Ont
| | | | - L Davis
- McGill University, Montreal, Que
| | | | - B Kidane
- University of Toronto, Toronto, Ont
| | - G Darling
- University Health Network, Toronto, Ont
| | - N Coburn
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - C Huynh
- From McGill University, Montreal, Que
| | | | - L Ferri
- From McGill University, Montreal, Que
| | - S Najmeh
- From McGill University, Montreal, Que
| | - C Sirois
- From McGill University, Montreal, Que
| | - D Mulder
- From McGill University, Montreal, Que
| | - J Spicer
- From McGill University, Montreal, Que
| | | | | | - D Nguyen
- From the University of Ottawa, Ottawa, Ont
| | - C Anstee
- From the University of Ottawa, Ottawa, Ont
| | - E Delic
- From the University of Ottawa, Ottawa, Ont
| | - S Gilbert
- From the University of Ottawa, Ottawa, Ont
| | - D Maziak
- From the University of Ottawa, Ottawa, Ont
| | | | - A Seely
- From the University of Ottawa, Ottawa, Ont
| | - D Sisson
- University of Toronto, Toronto, Ont
| | | | | | - D Low
- Virginia Mason Medical Center, Seattle, Wash
| | | | - S Turner
- University of Alberta, Edmonton, Alta
| | - M Humer
- From the University of British Columbia, Kelowna, B.C
| | - S Abdul
- University of Ottawa, Ottawa, Ont
| | - D Nguyen
- University of Ottawa, Ottawa, Ont
| | - A Al Rawahi
- Department of Surgery, University of Ottawa, Ottawa, Ont
| | - C Anstee
- Ottawa Hospital Research Institute, Ottawa, Ont
| | - E Delic
- Ottawa Hospital Research Institute, Ottawa, Ont
| | | | | | - D Maziak
- University of Ottawa, Ottawa, Ont
| | - A Seely
- University of Ottawa, Ottawa, Ont
| | | | | | | | - C Anstee
- Ottawa Hospital Research Institute, Ottawa, Ont
| | - E Delic
- Ottawa Hospital Research Institute, Ottawa, Ont
| | | | | | - D Maziak
- University of Ottawa, Ottawa, Ont
| | - A Seely
- University of Ottawa, Ottawa, Ont
| | - Y Patel
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - M Kay
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - I Churchill
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - K Sullivan
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Y Shargall
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - B Shayegan
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - A Adili
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - W Hanna
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | | | - C Huynh
- From McGill University, Montreal, Que
| | | | | | - F Maleki
- From McGill University, Montreal, Que
| | - K Ovens
- From McGill University, Montreal, Que
| | - M Gold
- From McGill University, Montreal, Que
| | - M Sorin
- From McGill University, Montreal, Que
| | - R Falutz
- From McGill University, Montreal, Que
| | - R Rayes
- From McGill University, Montreal, Que
| | | | - J Spicer
- From McGill University, Montreal, Que
| | - N Hunka
- From the University of Saskatchewan, Saskatoon, Sask
| | - R Kennedy
- From the University of Saskatchewan, Saskatoon, Sask
| | - R Bigsby
- From the University of Saskatchewan, Saskatoon, Sask
| | - S Bharadwaj
- From the University of Saskatchewan, Saskatoon, Sask
| | - S Gowing
- From the University of Saskatchewan, Saskatoon, Sask
| | | | - A Gatti
- From McMaster University, Hamilton, Ont
| | - D Hylton
- From McMaster University, Hamilton, Ont
| | | | - Y Patel
- From McMaster University, Hamilton, Ont
| | | | | | - W Hanna
- From McMaster University, Hamilton, Ont
| | - C Finley
- From McMaster University, Hamilton, Ont
| | - H Begum
- From McMaster University, Hamilton, Ont
| | - K Pearce
- From McMaster University, Hamilton, Ont
| | | | - W Hanna
- From McMaster University, Hamilton, Ont
| | | | | | - D Jones
- From The Ottawa Hospital, Ottawa, Ont
| | - C Anstee
- From The Ottawa Hospital, Ottawa, Ont
| | - S Kumar
- From The Ottawa Hospital, Ottawa, Ont
| | | | - A Simone
- From The Ottawa Hospital, Ottawa, Ont
| | | | - K Thavorn
- From The Ottawa Hospital, Ottawa, Ont
| | - A Seely
- From The Ottawa Hospital, Ottawa, Ont
| | - V Gupta
- From the University of Toronto, Toronto, Ont
| | | | - A Mohammed
- From the University of Toronto, Toronto, Ont
| | - S Uddin
- From the University of Toronto, Toronto, Ont
| | - D Jones
- From the University of Toronto, Toronto, Ont
| | - A Behzadi
- From the University of Toronto, Toronto, Ont
| | - A Brar
- From the University of Toronto, Toronto, Ont
| | - L Qu
- From Western University, London, Ont
| | - M Qiabi
- From Western University, London, Ont
| | - R Nayak
- From Western University, London, Ont
| | | | - E Peters
- From the University of Manitoba, Winnipeg, Man
| | - G Buduhan
- From the University of Manitoba, Winnipeg, Man
| | - L Tan
- From the University of Manitoba, Winnipeg, Man
| | - R Liu
- From the University of Manitoba, Winnipeg, Man
| | - S Srinathan
- From the University of Manitoba, Winnipeg, Man
| | - B Kidane
- From the University of Manitoba, Winnipeg, Man
| | - V Gupta
- University of Toronto, Toronto, Ont
| | - J Levy
- University of Toronto, Toronto, Ont
| | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | | | | | | | - N Coburn
- University of Toronto, Toronto, Ont
| | - M Robinson
- From the University of Manitoba, Winnipeg, Man
| | - L Bednarek
- From the University of Manitoba, Winnipeg, Man
| | - G Buduhan
- From the University of Manitoba, Winnipeg, Man
| | - R Liu
- From the University of Manitoba, Winnipeg, Man
| | - L Tan
- From the University of Manitoba, Winnipeg, Man
| | - S Srinathan
- From the University of Manitoba, Winnipeg, Man
| | - B Kidane
- From the University of Manitoba, Winnipeg, Man
| | - H Wang
- From Dalhousie University, Halifax, N.S
| | - D French
- From Dalhousie University, Halifax, N.S
| | | | - K Graham
- From the University of Manitoba, Winnipeg, Man
| | - S Enns
- From the University of Manitoba, Winnipeg, Man
| | - G Buduhan
- From the University of Manitoba, Winnipeg, Man
| | - S Srinathan
- From the University of Manitoba, Winnipeg, Man
| | - R Liu
- From the University of Manitoba, Winnipeg, Man
| | - A Tan
- From the University of Manitoba, Winnipeg, Man
| | - B Kidane
- From the University of Manitoba, Winnipeg, Man
| | | | - E Poole
- University of Manitoba, Winnipeg, Man
| | - C Pascoe
- Children's Hospital Research Institute of Manitoba, Winnipeg, Man
| | - T Karakach
- Children's Hospital Research Institute of Manitoba, Winnipeg, Man
| | - G Buduhan
- University of Manitoba, Winnipeg, Man
| | - L Tan
- University of Manitoba, Winnipeg, Man
| | | | - A Halayko
- Children's Hospital Research Institute of Manitoba, Winnipeg, Man
| | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - K Verhoeff
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - B Fang
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - D Birch
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - G Johnson
- From the University of Manitoba, Winnipeg, Man
| | - H Singh
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - J Park
- From the University of Manitoba, Winnipeg, Man
| | - O Hershorn
- From the University of Manitoba, Winnipeg, Man
| | - D Hochman
- From the University of Manitoba, Winnipeg, Man
| | - R Helewa
- From the University of Manitoba, Winnipeg, Man
| | - G Johnson
- From the University of Manitoba, Winnipeg, Man
| | - R Robertson
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - G Johnson
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - H Singh
- From the University of Manitoba, Winnipeg, Man
| | - J Park
- From the University of Manitoba, Winnipeg, Man
| | - R Helewa
- From the University of Manitoba, Winnipeg, Man
| | - A Azin
- From the University of Toronto, Toronto, Ont
| | - C Cahill
- University of Calgary, Calgary, Alta
| | - M Lipson
- University of Calgary, Calgary, Alta
| | - A Afzal
- University of Calgary, Calgary, Alta
| | - A Maclean
- University of Calgary, Calgary, Alta
| | - C Wong
- University of Alberta, Edmonton, Alta
| | - S Roen
- University of Calgary, Calgary, Alta
| | - W Buie
- University of Calgary, Calgary, Alta
| | | | | | - M Chu
- From McMaster University, Hamilton, Ont
| | - Y Lee
- From McMaster University, Hamilton, Ont
| | - N Amin
- From McMaster University, Hamilton, Ont
| | - D Hong
- From McMaster University, Hamilton, Ont
| | | | | | - K Ramji
- McMaster University, Hamilton, Ont
| | - C Kruse
- McMaster University, Hamilton, Ont
| | - H Jaffer
- University of Toronto, Toronto, Ont
| | | | - N Amin
- McMaster University, Hamilton, Ont
| | | | - D Hong
- McMaster University, Hamilton, Ont
| | | | - R Hajjar
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - M Oliero
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - T Cuisiniere
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - G Fragoso
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - A Calvé
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - S Djediai
- Université du Québec à Montréal, Montreal, Que
| | - B Annabi
- Université du Québec à Montréal, Montreal, Que
| | - C Richard
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - M Santos
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - K Purich
- From the University of Alberta, Edmonton, Alta
| | - Y Zhou
- From the University of Alberta, Edmonton, Alta
| | - S Dodd
- From the University of Alberta, Edmonton, Alta
| | - B Ring
- From the University of Alberta, Edmonton, Alta
| | - Y Yuan
- From the University of Alberta, Edmonton, Alta
| | - J White
- From the University of Alberta, Edmonton, Alta
| | | | | | | | - N Morin
- Jewish General Hospital, Montreal, Que
| | | | - J Faria
- Jewish General Hospital, Montreal, Que
| | | | | | - M Boutros
- Jewish General Hospital, Montreal, Que
| | | | - E Salama
- Jewish General Hospital, Montreal, Que
| | | | - N Morin
- Jewish General Hospital, Montreal, Que
| | | | - J Faria
- Jewish General Hospital, Montreal, Que
| | | | - M Boutros
- Jewish General Hospital, Montreal, Que
| | - G Talwar
- McMaster University, Hamilton, Ont
| | - R Daniel
- University of Toronto, Toronto, Ont
| | | | - O Levine
- McMaster University, Hamilton, Ont
| | | | | | | | | | | | | | - N Morin
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | | | - A Chen
- McMaster University, Hamilton, Ont
| | - A Patel
- Western University, London, Ont
| | - Y Lee
- McMaster University, Hamilton, Ont
| | | | - D Hong
- McMaster University, Hamilton, Ont
| | | | | | | | | | - J Moon
- Jewish General Hospital, Montreal, Que
| | - M Demian
- Jewish General Hospital, Montreal, Que
| | | | - N Morin
- Jewish General Hospital, Montreal, Que
| | - M Boutros
- Jewish General Hospital, Montreal, Que
| | - R Selvam
- University of Ottawa, Ottawa, Ont
| | - H Moloo
- University of Ottawa, Ottawa, Ont
| | - H MacRae
- University of Toronto, Toronto, Ont
| | - F Alam
- University of Toronto, Toronto, Ont
| | - I Raiche
- University of Ottawa, Ottawa, Ont
| | - J Holland
- From McGill University, Montreal, Que
| | - M Cwintal
- From McGill University, Montreal, Que
| | - G Rigas
- From McGill University, Montreal, Que
| | | | - N Morin
- From McGill University, Montreal, Que
| | | | - J Faria
- From McGill University, Montreal, Que
| | - A Pang
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | - J Holland
- From McGill University, Montreal, Que
| | - J Moon
- From McGill University, Montreal, Que
| | | | - N Morin
- From McGill University, Montreal, Que
| | | | - A Pang
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | - C Brown
- From St. Paul's Hospital, Vancouver, B.C
| | | | - M Raval
- From St. Paul's Hospital, Vancouver, B.C
| | - P Phang
- From St. Paul's Hospital, Vancouver, B.C
| | - A Ghuman
- From St. Paul's Hospital, Vancouver, B.C
| | - M Li
- University of Calgary, Calgary, Alta
| | - S Muncner
- University of Alberta, Edmonton, Alta
| | | | - M Dykstra
- University of Alberta, Edmonton, Alta
| | | | - H Wang
- University of Alberta, Edmonton, Alta
| | - O Monton
- McMaster University, Hamilton, Ont
| | - A Smith
- Western University, London, Ont
| | - J Moon
- McGill University, Montreal, Que
| | - M Demian
- McGill University, Montreal, Que
| | | | | | | | | | - O AlAamer
- From King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - N AlSelaim
- From King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - M AlMalki
- From King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - A Al-Osail
- From King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - R Ruxton
- From Southland Hospital, Invercargill, New Zealand
| | - P Manuel
- From Southland Hospital, Invercargill, New Zealand
| | - F Mohamed
- From Southland Hospital, Invercargill, New Zealand
| | | | - S Serahati
- University of Saskatchewan, Saskatoon, Saskatchewan
| | | | - C Brown
- Providence Health Care, Vancouver, B.C
| | - M Raval
- Providence Health Care, Vancouver, B.C
| | | | - A Ghuman
- Providence Health Care, Vancouver, B.C
| | - T Phang
- Providence Health Care, Vancouver, B.C
| | | | - J Moon
- McGill University, Montreal, Que
| | | | - S Chadi
- University Health Network, Toronto, Ont
| | - K Alavi
- University of Massachusetts, Amherst, Mass
| | - I Paquette
- University of Cincinnati, Cincinnati, Ohio
| | - T MacLean
- University of Calgary, Calgary, Alta
| | - S Wexner
- Cleveland Clinic Florida, Weston, Fla
| | | | - S Steele
- Cleveland Clinic, Cleveland, Ohio
| | - J Park
- University of Manitoba, Winnipeg, Man
| | - S Patel
- Queen's University, Kingston, Ont
| | | | - R Auer
- The Ottawa Hospital, Ottawa, Ont
| | - P Sylla
- Icahn School of Medicine at Mount Sinai, New York, N.Y
| | - N Morin
- McGill University, Montreal, Que
| | - A Ghuman
- McGill University, Montreal, Que
| | | | - Z Bayat
- From the University of Toronto, Toronto, Ont
| | - E Kennedy
- From the University of Toronto, Toronto, Ont
| | - C Victor
- From the University of Toronto, Toronto, Ont
| | | | - J Liang
- From McGill University, Montreal, Que
| | | | - A Pang
- From McGill University, Montreal, Que
| | | | - J Faria
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | | | - H Roy
- University of Saskatchewan, Saskatoon, Sask
| | - Z Baig
- University of Saskatchewan, Saskatoon, Sask
| | | | - M Raval
- University of British Columbia, Vancouver, B.C
| | - C Brown
- University of British Columbia, Vancouver, B.C
| | - T Phang
- University of British Columbia, Vancouver, B.C
| | - D Gill
- University of Saskatchewan, Saskatoon, Sask
| | - N Ginther
- University of Saskatchewan, Saskatoon, Sask
| | - J Moon
- From McGill University, Montreal, Que
| | | | - A Pang
- From McGill University, Montreal, Que
| | | | - J Faria
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | - J Moon
- From McGill University, Montreal, Que
| | - A Pang
- From McGill University, Montreal, Que
| | | | - J Faria
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | - E Salama
- From McGill University, Montreal, Que
| | | | | | | | - J Faria
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | - V Wiseman
- From Queen's University, Kingston, Ont
| | - L Zhang
- From Queen's University, Kingston, Ont
| | | | | | | | | | - S V Patel
- From Queen's University, Kingston, Ont
| | - Z Harra
- From McGill University, Montreal, Que
| | | | | | - N Morin
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | - A Pang
- From McGill University, Montreal, Que
| | - M Hegagi
- From McGill University, Montreal, Que
| | | | - N Morin
- From McGill University, Montreal, Que
| | | | | | - M Boutros
- From McGill University, Montreal, Que
| | | | | | | | - A Pang
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | | | - N Kasteel
- University of Calgary, Calgary, Alta
| | - G Kaur
- University of Calgary, Calgary, Alta
| | - S Bindra
- University of Calgary, Calgary, Alta
| | - A Malhotra
- Vardhman Mahavir Medical College, New Delhi, India
| | - C Graham
- University of Calgary, Calgary, Alta
| | - A MacLean
- University of Calgary, Calgary, Alta
| | - P Beck
- University of Calgary, Calgary, Alta
| | - H Jijon
- University of Calgary, Calgary, Alta
| | - J Ferraz
- University of Calgary, Calgary, Alta
| | - W Buie
- University of Calgary, Calgary, Alta
| | - R Szwimer
- From McGill University, Montreal, Que
| | - J Moon
- From McGill University, Montreal, Que
| | - M Demian
- From McGill University, Montreal, Que
| | - A Pang
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | | | | | - M Boutros
- From McGill University, Montreal, Que
| | - A Azin
- From the University of Toronto, Toronto, Ont
| | | | - W Kong
- Queen's Cancer Research Institute, Kingston, Ont
| | | | - T Hanna
- Queen's University, Kingston, Ont
| | - W Chung
- Queen's University, Kingston, Ont
| | - S Nanji
- Queen's University, Kingston, Ont
| | - S Patel
- Queen's University, Kingston, Ont
| | - C Booth
- Queen's University, Kingston, Ont
| | - V Li
- From McMaster University, Hamilton, Ont
| | - A Awan
- From McMaster University, Hamilton, Ont
| | - P Serrano
- From McMaster University, Hamilton, Ont
| | - M Jacobson
- From the University of Calgary, Calgary, Alta
| | - M Chanco
- From the University of Calgary, Calgary, Alta
| | - V Wen
- From the University of Calgary, Calgary, Alta
| | - N Singh
- From the University of Calgary, Calgary, Alta
| | - L Peiris
- From the University of Calgary, Calgary, Alta
| | - J Pasieka
- From the University of Calgary, Calgary, Alta
| | - P Ghatage
- From the University of Calgary, Calgary, Alta
| | - D Buie
- From the University of Calgary, Calgary, Alta
| | - T MacLean
- From the University of Calgary, Calgary, Alta
| | | | - L Mack
- From the University of Calgary, Calgary, Alta
| | - W Marini
- From the University of Toronto, Toronto, Ont
| | - W Zheng
- From the University of Toronto, Toronto, Ont
| | - C Swallow
- From the University of Toronto, Toronto, Ont
| | - M Reedijk
- From the University of Toronto, Toronto, Ont
| | | | - L Peiris
- From the University of Alberta, Edmonton, Alta
| | | | - L Delmar
- From the University of Alberta, Edmonton, Alta
| | - N Gagnon
- Université de Sherbrooke, Sherbrooke, Que
| | | | | | | | | | | | - S Mysuria
- From the University of British Columbia, Vancouver, B.C
| | - A Bazzarelli
- From the University of British Columbia, Vancouver, B.C
| | - J Pao
- From the University of British Columbia, Vancouver, B.C
| | - L Chen
- From the University of British Columbia, Vancouver, B.C
| | - M Zhang
- From the University of British Columbia, Vancouver, B.C
| | - E McKevitt
- From the University of British Columbia, Vancouver, B.C
| | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - U Kuusk
- From the University of British Columbia, Vancouver, B.C
| | - N Van Laeken
- From the University of British Columbia, Vancouver, B.C
| | - E Bovill
- From the University of British Columbia, Vancouver, B.C
| | - K Isaac
- From the University of British Columbia, Vancouver, B.C
| | - C Dingee
- From the University of British Columbia, Vancouver, B.C
| | | | | | | | - L Barbera
- University of Calgary, Calgary, Alta
| | - Y Efegoma
- University of Calgary, Calgary, Alta
| | - D Howell
- Princess Margaret Research Institute, Toronto, Ont
| | | | | | - A Scheer
- St. Michael's Hospital, Toronto, Ont
| | - C Simmons
- University of British Columbia, Vancouver, B.C
| | | | | | - Y Xu
- University of Calgary, Calgary, Alta
| | | | - M Quan
- University of Calgary, Calgary, Alta
| | - A Alqaydi
- From Queen's University, Kingston, Ont
| | - J la
- From Queen's University, Kingston, Ont
| | | | - G Digby
- From Queen's University, Kingston, Ont
| | - V Pravong
- University of Montreal, Montreal, Que
| | | | - L Sidéris
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - P Dubé
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | | | - S Fortin
- University of Montreal, Montreal, Que
| | - M Auclair
- University of Montreal, Montreal, Que
| | - B Trilling
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - J Tremblay
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - É Di Lena
- From McGill University, Montreal, Que
| | - B Hopkins
- From McGill University, Montreal, Que
| | - S Wong
- From McGill University, Montreal, Que
| | | | - É Di Lena
- From McGill University, Montreal, Que
| | - N Barone
- From McGill University, Montreal, Que
| | - B Hopkins
- From McGill University, Montreal, Que
| | - S Dumitra
- From McGill University, Montreal, Que
| | - P Kaneva
- From McGill University, Montreal, Que
| | - J Fiore
- From McGill University, Montreal, Que
| | | | - S Mysuria
- From the University of British Columbia, Vancouver, B.C
| | - E McKevitt
- From the University of British Columbia, Vancouver, B.C
| | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - L Chen
- From the University of British Columbia, Vancouver, B.C
| | - A Bazzarelli
- From the University of British Columbia, Vancouver, B.C
| | - J Pao
- From the University of British Columbia, Vancouver, B.C
| | - E Bovill
- From the University of British Columbia, Vancouver, B.C
| | - M Zhang
- From the University of British Columbia, Vancouver, B.C
| | - U Kuusk
- From the University of British Columbia, Vancouver, B.C
| | - K Isaac
- From the University of British Columbia, Vancouver, B.C
| | - N Van Laeken
- From the University of British Columbia, Vancouver, B.C
| | - C Dingee
- From the University of British Columbia, Vancouver, B.C
| | - H Kapur
- From the University of British Columbia, Vancouver, B.C
| | - E McKevitt
- From the University of British Columbia, Vancouver, B.C
| | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - J Pao
- From the University of British Columbia, Vancouver, B.C
| | - C Dingee
- From the University of British Columbia, Vancouver, B.C
| | - A Bazarelli
- From the University of British Columbia, Vancouver, B.C
| | - U Kuusk
- From the University of British Columbia, Vancouver, B.C
| | - L Chen
- From the University of British Columbia, Vancouver, B.C
| | - L Cadili
- From the University of British Columbia, Vancouver, B.C
| | - K DeGirolamo
- From the University of British Columbia, Vancouver, B.C
| | - E McKevitt
- From the University of British Columbia, Vancouver, B.C
| | - J Pao
- From the University of British Columbia, Vancouver, B.C
| | - C Dingee
- From the University of British Columbia, Vancouver, B.C
| | - A Bazzarelli
- From the University of British Columbia, Vancouver, B.C
| | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - D Ng
- From the University of Toronto, Toronto, Ont
| | - A Ali
- From the University of Toronto, Toronto, Ont
| | - D Eymae
- From the University of Toronto, Toronto, Ont
| | - K Lee
- From the University of Toronto, Toronto, Ont
| | - S Brar
- From the University of Toronto, Toronto, Ont
| | - J Conner
- From the University of Toronto, Toronto, Ont
| | - M Magalhaes
- From the University of Toronto, Toronto, Ont
| | - C Swallow
- From the University of Toronto, Toronto, Ont
| | - K Allen
- From the University of British Columbia, Vancouver, B.C
| | - C Baliski
- From the University of British Columbia, Vancouver, B.C
| | - D Cyr
- University of Toronto, Toronto, Ont
| | - A Sari
- Sinai Health System, Toronto, Ont
| | | | - D Driman
- London Health Sciences Centre, London, Ont
| | | | - A Juda
- Sinai Health System, Toronto, Ont
| | | | | | - M Brar
- University of Toronto, Toronto, Ont
| | - J Conner
- Sinai Health System, Toronto, Ont
| | - R Kirsch
- Sinai Health System, Toronto, Ont
| | | | - K Singh
- University of Toronto, Toronto, Ont
| | | | - Y Gamache
- ASDevices, Spira Innovations, Thetford, Que
| | | | - C Mardinger
- From the University of Calgary, Calgary, Alta
| | - C Lee
- From the University of Calgary, Calgary, Alta
| | - R Duckworth
- From the University of Calgary, Calgary, Alta
| | - M Brindle
- From the University of Calgary, Calgary, Alta
| | - F Fraulin
- From the University of Calgary, Calgary, Alta
| | - L Austen
- From the University of Calgary, Calgary, Alta
| | - J Kortbeek
- From the University of Calgary, Calgary, Alta
| | - M Hyndman
- From the University of Calgary, Calgary, Alta
| | - D Nguyen
- From McGill University, Montreal, Que
| | - G Jamjoum
- From McGill University, Montreal, Que
| | | | - S Langer
- University of Calgary, Calgary, Alta
| | - Y Yuan Xu
- University of Calgary, Calgary, Alta
| | - S Kong
- Alberta Health Services, Calgary, Alta
| | - M Quan
- University of Calgary, Calgary, Alta
| | - D Lim
- Women's College Hospital, Toronto, Ont
| | | | | | - K Butler
- University Health Network, Toronto, Ont
| | | | - T Cil
- University of Toronto, Toronto, Ont
| | - T Zhong
- University of Toronto, Toronto, Ont
| | - S Hofer
- University of Toronto, Toronto, Ont
| | | | | | - D Lim
- Women's College Hospital, Toronto, Ont
| | - B Greene
- University of Toronto, Toronto, Ont
| | | | - M Parapini
- University of British Columbia, Vancouver, B.C
| | - J Skipworth
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, U.K
| | - A Mah
- University of British Columbia, Vancouver, B.C
| | - S Desai
- University of British Columbia, Vancouver, B.C
| | - S Chung
- University of British Columbia, Vancouver, B.C
| | - C Scudamore
- University of British Columbia, Vancouver, B.C
| | - M Segedi
- University of British Columbia, Vancouver, B.C
| | - E Vasilyeva
- University of British Columbia, Vancouver, B.C
| | - J Li
- University of British Columbia, Vancouver, B.C
| | - P Kim
- University of British Columbia, Vancouver, B.C
| | - K Verhoeff
- From the University of Alberta, Edmonton, Alta
| | - A Deprato
- From the University of Alberta, Edmonton, Alta
| | - K Purich
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - D Bigam
- From the University of Alberta, Edmonton, Alta
| | - K Dajani
- From the University of Alberta, Edmonton, Alta
| | - T Lenet
- University of Ottawa, Ottawa, Ont
| | | | - R Smoot
- Mayo Clinic, Rochester, Minn
| | - G Martel
- The Ottawa Hospital, Ottawa, Ont
| | - C Tzeng
- MD Anderson Cancer Center, Houston, Tex
| | - F Rocha
- Oregon Health & Science University, Portland, Ore
| | | | | | | | | | | | | | - N Hanna
- Queen's University, Kingston, Ont
| | - S Brogly
- Queen's University, Kingston, Ont
| | | | - C Booth
- Queen's University, Kingston, Ont
| | - S Nanji
- Queen's University, Kingston, Ont
| | | | - N Coburn
- University of Toronto, Toronto, Ont
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | - J Callum
- Queen's University, Kingston, Ont
| | | | | | - A Wei
- Memorial Sloan Kettering Cancer Center, New York, N.Y
| | | | - J Hallet
- University of Toronto, Toronto, Ont
| | | | | | - A Wei
- Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | | | - G Martel
- University of Ottawa, Ottawa, Ont
| | - N Coburn
- University of Toronto, Toronto, Ont
| | - J Hallet
- University of Toronto, Toronto, Ont
| | - D Henault
- From the University of Montreal, Montreal, Que
| | - B Barrette
- From the University of Montreal, Montreal, Que
| | - S Pelletier
- From the University of Montreal, Montreal, Que
| | - P Thebault
- From the University of Montreal, Montreal, Que
| | | | - Z Rong
- From the University of Montreal, Montreal, Que
| | - M Plasse
- From the University of Montreal, Montreal, Que
| | | | | | - R Lapointe
- From the University of Montreal, Montreal, Que
| | | | - B Nguyen
- From the University of Montreal, Montreal, Que
| | - G Soucy
- From the University of Montreal, Montreal, Que
| | - S Turcotte
- From the University of Montreal, Montreal, Que
| | - M Lemke
- From Western University, London, Ont
| | - E Waugh
- From Western University, London, Ont
| | - K Leslie
- From Western University, London, Ont
| | - D Quan
- From Western University, London, Ont
| | - A Skaro
- From Western University, London, Ont
| | - E Tang
- From Western University, London, Ont
| | - M Lund
- From the University of Western Ontario, London, Ont
| | - L Allen
- From the University of Western Ontario, London, Ont
| | - J Glinka
- From the University of Western Ontario, London, Ont
| | - G Jada
- From the University of Western Ontario, London, Ont
| | - D Quan
- From the University of Western Ontario, London, Ont
| | - A Skaro
- From the University of Western Ontario, London, Ont
| | - E Tang
- From the University of Western Ontario, London, Ont
| | - L Park
- McMaster University, Hamilton, Ont
| | - J Daza
- University of Toronto, Toronto, Ont
| | - V Li
- McMaster University, Hamilton, Ont
| | | | - B Zhang
- McMaster University, Hamilton, Ont
| | | | - S Faisal
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - R Faisal
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M Fabbro
- University of Toronto, Toronto, Ont
| | - C Gu
- McMaster University, Hamilton, Ont
| | | | - V Zuk
- University of Toronto, Toronto, Ont
| | - J Hallet
- University of Toronto, Toronto, Ont
| | - G Martel
- University of Ottawa, Ottawa, Ont
| | | | | | - J Glinka
- From the Western University, London, Ont
| | - A Skaro
- From the Western University, London, Ont
| | - K Leslie
- From the Western University, London, Ont
| | - G Jada
- From the Western University, London, Ont
| | - D Quan
- From the Western University, London, Ont
| | - E Tang
- From the Western University, London, Ont
| | - E Waugh
- From Western University, London, Ont
| | - M Lemke
- From Western University, London, Ont
| | - J Glinka
- From Western University, London, Ont
| | - A Skaro
- From Western University, London, Ont
| | - K Leslie
- From Western University, London, Ont
| | - E Tang
- From Western University, London, Ont
| | - E Waugh
- From Western University, London, Ont
| | | | - R Liu
- From Western University, London, Ont
| | - E Tang
- From Western University, London, Ont
| | - L Allen
- From Western University, London, Ont
| | - S Welch
- From Western University, London, Ont
| | - A Skaro
- From Western University, London, Ont
| | - K Leslie
- From Western University, London, Ont
| | - J Glinka
- From Western University, London, Ont
| | - E Waugh
- From Western University, London, Ont
| | - E Tang
- From Western University, London, Ont
| | - G Jada
- From Western University, London, Ont
| | - D Quan
- From Western University, London, Ont
| | - A Skaro
- From Western University, London, Ont
| | - A Webb
- From the University of Alberta, Edmonton, Alta
| | - E Lester
- From the University of Alberta, Edmonton, Alta
| | - A Shapiro
- From the University of Alberta, Edmonton, Alta
| | - D Eurich
- From the University of Alberta, Edmonton, Alta
| | - D Bigam
- From the University of Alberta, Edmonton, Alta
| | - Y Essaji
- From Virginia Mason Medical Center, Seattle, Wash
| | - H Shrader
- From the University of Iowa, Iowa City, Iowa
| | - A Nayyar
- From the University of Iowa, Iowa City, Iowa
| | - M Suraju
- From the University of Iowa, Iowa City, Iowa
| | | | - P Ear
- From the University of Iowa, Iowa City, Iowa
| | - C Chan
- From the University of Iowa, Iowa City, Iowa
| | - V Smith
- From Dalhousie University, Halifax, N.S
| | | | - A Costa
- From Dalhousie University, Halifax, N.S
| | - A Stueck
- From Dalhousie University, Halifax, N.S
| | | | - S Allen
- From Dalhousie University, Halifax, N.S
| | | | | | - T Lenet
- University of Ottawa, Ottawa, Ont
| | | | - R Smoot
- Mayo Clinic, Rochester, Minn
| | - C Tzeng
- MD Anderson Cancer Center, Houston, Tex
| | - F Rocha
- Oregon Health and Science University, Portland, Ore
| | - G Martel
- University of Ottawa, Ottawa, Ont
| | | | - Z Mir
- From Queen's University, Kingston, Ont
| | - H Golding
- From Queen's University, Kingston, Ont
| | - S McKeown
- From Queen's University, Kingston, Ont
| | - S Nanji
- From Queen's University, Kingston, Ont
| | | | - P Groome
- From Queen's University, Kingston, Ont
| | - Z Mir
- From Queen's University, Kingston, Ont
| | | | - S Nanji
- From Queen's University, Kingston, Ont
| | | | - P Groome
- From Queen's University, Kingston, Ont
| | - S Elbekri
- University of Sherbrooke, Sherbrooke, Que
| | - S Turcotte
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - E Girard
- Centre hospitalier universitaire de Grenoble Alpes, Grenoble, France
| | | | - R Lapointe
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | | | - M Dagenais
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - A Roy
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - R Letourneau
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - M Plasse
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - E Simoneau
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - Z Rong
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - N Zuker
- From SUNY Upstate Medical University, Syracuse, N.Y
| | - M Oakley
- From SUNY Upstate Medical University, Syracuse, N.Y
| | - G Chartrand
- From the University of Montreal, Montreal, Que
| | - B Misheva
- From the University of Montreal, Montreal, Que
| | - Y Bendavid
- From the University of Montreal, Montreal, Que
| | - J Frigault
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Lemieux
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - D Breton
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - G Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Drolet
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | | | - L Smith
- North York General Hospital, North York, Ont
| | - J Tan
- Humber River Hospital, North York, Ont
| | - U Kahn
- University of Toronto, Toronto, Ont
| | - C McLean
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - D Birch
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - M Fortin
- Centre hospitalier affilié universitaire régional de Trois-Rivières, Trois-Rivières, Que
| | - X Paré
- Centre hospitalier affilié universitaire régional de Trois-Rivières, Trois-Rivières, Que
| | - A Doyon
- Centre hospitalier affilié universitaire régional de Trois-Rivières, Trois-Rivières, Que
| | | | | | - J Yadav
- University of Toronto, Toronto, Ont
| | - S Fischer
- University Health Network, Toronto, Ont
| | - T Jackson
- University Health Network, Toronto, Ont
| | - J Allard
- University Health Network, Toronto, Ont
| | | | - Y Lee
- McMaster University, Hamilton, Ont
| | - S Anvari
- McMaster University, Hamilton, Ont
| | - M Chu
- McMaster University, Hamilton, Ont
| | | | - I Aditya
- University of Toronto, Toronto, Ont
| | - R Malhan
- McMaster University, Hamilton, Ont
| | | | - M Walsh
- McMaster University, Hamilton, Ont
| | | | - D Hong
- McMaster University, Hamilton, Ont
| | - W He
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - K Hardy
- From the University of Manitoba, Winnipeg, Man
| | - R Romanescu
- From the University of Manitoba, Winnipeg, Man
| | - F Deaninck
- From the University of Manitoba, Winnipeg, Man
| | - J Linton
- From the University of Manitoba, Winnipeg, Man
| | | | | | - G Shingoose
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - K Hardy
- From the University of Manitoba, Winnipeg, Man
| | | | | | | | - Y Lee
- From McMaster University, Hamilton, Ont
| | - V Archer
- From McMaster University, Hamilton, Ont
| | | | - J Shiroky
- From McMaster University, Hamilton, Ont
| | | | - K Ramji
- From McMaster University, Hamilton, Ont
| | | | - A Mierzwa
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - G Marcil
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - D Birch
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - A Mierzwa
- From the University of Alberta, Edmonton, Alta
| | - A Jarrar
- The Ottawa Hospital, Ottawa, Ont
| | | | | | - W Lin
- University of Toronto, Toronto, Ont
| | - J Hagen
- Humber River Hospital, North York, Ont
| | - M Connell
- From the University of Alberta, Edmonton, Alta
| | - W Sun
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - D Birch
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
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11
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Shivji S, Kak I, Reid SL, Muir J, Hafezi-Bakhtiari S, Li-Chang H, Deliallisi A, Newell KJ, Grin A, Conner J, Kirsch R. Feasibility and Performance of Elastin Trichrome as a Primary Stain in Colorectal Cancer Resection Specimens: Results of an Interobserver Variability Study. Am J Surg Pathol 2021; 45:1419-1427. [PMID: 33756495 DOI: 10.1097/pas.0000000000001707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Venous invasion (VI) is a powerful prognostic factor in colorectal cancer (CRC) that is widely underreported. The ability of elastin stains to improve VI detection is now recognized in several international CRC pathology protocols. However, concerns related to the cost and time required to perform and evaluate these stains in addition to routine hematoxylin and eosin (H&E) stains remains a barrier to their wider use. We therefore sought to determine whether an elastin trichrome (ET) stain could be used as a "stand-alone" stain in CRC resections, by comparing the sensitivity, accuracy, and reproducibility of detection of CAP-mandated prognostic factors using ET and H&E stains. Representative H&E- and ET-stained slides from 50 CRC resections, including a representative mix of stages and prognostic factors, were used to generate 2 study sets. Each case was represented by H&E slides in 1 study set and by corresponding ET slides from the same blocks in the other study set. Ten observers (3 academic gastrointestinal [GI] pathologists, 4 community pathologists, 3 fellows) evaluated each study set for CAP-mandated prognostic factors. ET outperformed H&E in the assessment of VI with respect to detection rates (50% vs. 28.6%; P<0.0001), accuracy (82% vs. 59%, P<0.0001), and reproducibility (k=0.554 vs. 0.394). No significant differences between ET and H&E were observed for other features evaluated. In a poststudy survey, most observers considered the ease and speed of assessment at least equivalent for ET and H&E for most prognostic factors, and felt that ET would be feasible as a stand-alone stain in practice. If validated by others, our findings support the use of ET, rather than H&E, as the primary stain for the evaluation of CRC resections.
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Affiliation(s)
- Sameer Shivji
- Mount Sinai Hospital
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
| | - Ipshita Kak
- Mount Sinai Hospital
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
| | - Stephanie L Reid
- Mount Sinai Hospital
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
| | - Jennifer Muir
- Mount Sinai Hospital
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
| | - Sara Hafezi-Bakhtiari
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
- Lakeridge Health, Oshawa
| | | | | | | | - Andrea Grin
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - James Conner
- Mount Sinai Hospital
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
| | - Richard Kirsch
- Mount Sinai Hospital
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
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12
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Lambert M, Zhang Y, Spinazzola J, Widrick J, Conner J, Kunkel L. DMD – ANIMAL MODELS. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Zhang Y, Lambert M, Widrick J, Conner J, Spinazzola J, Kunkel L. PRE-CLINICAL DEVELOPMENTS IN NEUROMUSCULAR DISORDERS. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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DeWilde JF, Ho CR, Conner J, Smith A, Kirilin AV, Malek A, Witt PM. Kinetics of Direct Olefin Synthesis from Syngas over Mixed Beds of Zn–Zr Oxides and SAPO-34. Ind Eng Chem Res 2021. [DOI: 10.1021/acs.iecr.1c03246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Joseph F. DeWilde
- The Dow Chemical Company, 1776 Building, Midland, Michigan 48674, United States
| | - Christopher R. Ho
- The Dow Chemical Company, 1776 Building, Midland, Michigan 48674, United States
| | - James Conner
- The Dow Chemical Company, 1776 Building, Midland, Michigan 48674, United States
| | - Austin Smith
- The Dow Chemical Company, 1776 Building, Midland, Michigan 48674, United States
| | - Alexey V. Kirilin
- Dow Benelux B.V., Herbert H. Dowweg 5, Building 443 (BBB), 4252 NM, Hoek, Netherlands
| | - Andrzej Malek
- The Dow Chemical Company, 1776 Building, Midland, Michigan 48674, United States
| | - Paul M. Witt
- The Dow Chemical Company, 1776 Building, Midland, Michigan 48674, United States
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15
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Lek A, Zhang Y, Woodman KG, Huang S, DeSimone AM, Cohen J, Ho V, Conner J, Mead L, Kodani A, Pakula A, Sanjana N, King OD, Jones PL, Wagner KR, Lek M, Kunkel LM. Applying genome-wide CRISPR-Cas9 screens for therapeutic discovery in facioscapulohumeral muscular dystrophy. Sci Transl Med 2021; 12:12/536/eaay0271. [PMID: 32213627 DOI: 10.1126/scitranslmed.aay0271] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 12/23/2019] [Accepted: 03/03/2020] [Indexed: 12/13/2022]
Abstract
The emergence of CRISPR-Cas9 gene-editing technologies and genome-wide CRISPR-Cas9 libraries enables efficient unbiased genetic screening that can accelerate the process of therapeutic discovery for genetic disorders. Here, we demonstrate the utility of a genome-wide CRISPR-Cas9 loss-of-function library to identify therapeutic targets for facioscapulohumeral muscular dystrophy (FSHD), a genetically complex type of muscular dystrophy for which there is currently no treatment. In FSHD, both genetic and epigenetic changes lead to misexpression of DUX4, the FSHD causal gene that encodes the highly cytotoxic DUX4 protein. We performed a genome-wide CRISPR-Cas9 screen to identify genes whose loss-of-function conferred survival when DUX4 was expressed in muscle cells. Genes emerging from our screen illuminated a pathogenic link to the cellular hypoxia response, which was revealed to be the main driver of DUX4-induced cell death. Application of hypoxia signaling inhibitors resulted in increased DUX4 protein turnover and subsequent reduction of the cellular hypoxia response and cell death. In addition, these compounds proved successful in reducing FSHD disease biomarkers in patient myogenic lines, as well as improving structural and functional properties in two zebrafish models of FSHD. Our genome-wide perturbation of pathways affecting DUX4 expression has provided insight into key drivers of DUX4-induced pathogenesis and has identified existing compounds with potential therapeutic benefit for FSHD. Our experimental approach presents an accelerated paradigm toward mechanistic understanding and therapeutic discovery of a complex genetic disease, which may be translatable to other diseases with well-established phenotypic selection assays.
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Affiliation(s)
- Angela Lek
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA. .,Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Pediatrics and Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Yuanfan Zhang
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Pediatrics and Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Keryn G Woodman
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
| | - Shushu Huang
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA.,First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.,Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Alec M DeSimone
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA.,Wellstone Muscular Dystrophy Program, Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Justin Cohen
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
| | - Vincent Ho
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
| | - James Conner
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA 02115, USA
| | - Lillian Mead
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA 02115, USA
| | - Andrew Kodani
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Pediatrics and Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Anna Pakula
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Pediatrics and Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Neville Sanjana
- New York Genome Center, New York, NY 10013, USA.,Department of Biology, New York University, New York, NY 10003, USA
| | - Oliver D King
- Wellstone Muscular Dystrophy Program, Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Peter L Jones
- Department of Pharmacology, University of Nevada, Reno School of Medicine, Reno, NV 89557, USA
| | - Kathryn R Wagner
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, MD 21205, USA.,Departments of Neurology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Monkol Lek
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
| | - Louis M Kunkel
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA 02115, USA. .,Department of Pediatrics and Genetics, Harvard Medical School, Boston, MA 02115, USA.,Harvard Stem Cell Institute, Cambridge, MA 02138, USA.,Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
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16
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Iwaya M, Ota H, Nakajima T, Uehara T, Riddell R, Conner J. Most colitis associated carcinomas lack expression of LGR5: a preliminary study with implications for unique pathways of carcinogenesis compared to sporadic colorectal carcinoma. BMC Cancer 2021; 21:119. [PMID: 33541282 PMCID: PMC7863293 DOI: 10.1186/s12885-021-07835-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022] Open
Abstract
Background Leucine-rich repeat-containing G-protein-coupled receptor 5 (LGR5), a component of the Wnt receptor complex, is thought to lineage label gastric and intestinal stem cells. LGR5 expression is increased in colorectal carcinoma (CRC) compared to normal tissue. Colitis associated colorectal adenocarcinoma (CAC) often shows distinct morphologic and molecular phenotypes compared to sporadic cases. However, the expression profile of LGR5, and by extension the potential role of an intestinal stem cell phenotype, has not been well described in a series of human CAC. Method RNA in situ hybridization (ISH) for LGR5 expression on 30 CACs (12 cases with conventional morphology and 18 cases with non-conventional type morphology) from 29 inflammatory bowel disease (IBD) patients was performed and compared the expression profile to a control group of 10 sporadic CRCs. Immunohistochemistry for beta-catenin and SATB2 was performed on the 30 CACs. Result LGR5 was positive in 30% (9/30) of CAC cases and 90% (9/10) of sporadic CRCs (p = 0.002). A large majority (89%) of LGR5 positive CACs were of the conventional histologic type, and conventional type CAC showed a significantly higher LGR5 score (median 3.0; interquartile range 1.75–3.25) than non-conventional type CAC (median 1.5; interquartile range 1.00–2.00) (p = 0.034). CAC with conventional morphology did have a lower level of LGR5 expression than sporadic CRC. Sporadic CRCs showed a significantly higher LGR5 level score than non-conventional type CACs (p < 0.001). Nuclear translocation of beta-catenin was strongly associated with LGR5 expression (p = 0.003), however no significant association was identified between SATB2 expression and LGR5 expression status in CACs. Conclusion These findings suggest that the wider spectrum of tumor morphology in CAC may be associated with absence of a LGR5-expressing intestinal stem cell phenotype.
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Affiliation(s)
- Mai Iwaya
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada. .,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada. .,Department of Laboratory Medicine, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano, Japan.
| | - Hiroyoshi Ota
- Department of Clinical Laboratory Sciences, School of Health Sciences, Shinshu University, Matsumoto, Japan
| | - Tomoyuki Nakajima
- Department of Laboratory Medicine, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Takeshi Uehara
- Department of Laboratory Medicine, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Robert Riddell
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - James Conner
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
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17
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Saliba G, Detlefsen S, Carneiro F, Conner J, Dorer R, Fléjou JF, Hahn H, Kamaradova K, Mastracci L, Meijer SL, Sabo E, Sheahan K, Riddell R, Wang N, Yantiss RK, Lundell L, Low D, Vieth M, Klevebro F. Tumor regression grading after neoadjuvant treatment of esophageal and gastroesophageal junction adenocarcinoma: results of an international Delphi consensus survey. Hum Pathol 2020; 108:60-67. [PMID: 33221343 DOI: 10.1016/j.humpath.2020.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/08/2020] [Indexed: 12/21/2022]
Abstract
Complete histopathologic tumor regression after neoadjuvant treatment is a well-known prognostic factor for survival among patients with adenocarcinomas of the esophagus and gastroesophageal junction. The aim of this international Delphi survey was to reach a consensus regarding the most useful tumor regression grading (TRG) system that could represent an international standard for histopathologic TRG grading of gastroesophageal carcinomas. Fifteen pathologists with special interest in esophageal and gastric pathology participated in the online survey. The initial questionnaire contained of 43 statements that addressed the following topics: (1) specimen processing, (2) gross examination, (3) cross sectioning, (4) staining, (5) Barrett's esophagus, (6) TRG systems, and (7) TRG in lymph node (LN). Participants rated the items using a 5-point Likert style scale and were encouraged to write comments for each statement. The expert panel recommended a 4-tiered TRG system for assessing the primary tumor: grade 1: No residual tumor (complete histopathologic tumor regression), grade 2: less than 10% residual tumor (near-complete regression), grade 3: 10%-50% residual tumor (partial regression), grade 4: greater than 50% residual tumor (minimal/no regression), combined with a 3-tiered system for grading therapeutic response in metastatic LNs: grade a: no residual tumor (complete histopathologic TRG), grade b: partial regression (tumor cells and regression), grade c: no regression (no sign of tumor response). This TRG grading system can be recommended as an international standard for histopathologic TRG grading in esophageal and gastroesophageal junction adenocarcinoma.
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Affiliation(s)
- G Saliba
- Department of Upper Abdominal Surgery, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska University Hospital, Karolinska Institutet, 141 57, Huddinge, Stockholm, Sweden.
| | - S Detlefsen
- Department of Pathology, Odense University Hospital, Denmark& Dept. of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5000, Odense, Denmark
| | - F Carneiro
- Centro Hospitalar Universitário de São João (CHUSJ)/Faculty of Medicine of the University of Porto (FMUP) and Instituto de Investigação e Inovação Em Saúde (i3S)/Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), 4200-319, Porto, Portugal
| | - J Conner
- Department of Laboratory Medicine and Pathobiology, Mount Sinai Hospital, University of Toronto, M5G 1X5, Toronto, Canada
| | - R Dorer
- Department of Pathology, Virginia Mason Medical Center, 98101, Seattle, WA, USA
| | - J F Fléjou
- Department of Pathology, Saint-Antoine Hospital, Pierre et Marie Curie University, 75571, Paris, France
| | - H Hahn
- Department of Pathology, Virginia Mason Medical Center, 98101, Seattle, WA, USA
| | - K Kamaradova
- The Fingerland Department of Pathology, Charles University Faculty of Medicine and University Hospital Hradec Králové, Hradec Králové, 500 03, Czech Republic
| | - L Mastracci
- Division of Anatomic Pathology, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genoa and Ospedale Policlinico IRCCS San Martino, 16126, Genoa, Italy
| | - S L Meijer
- Department of Pathology, Amsterdam University Medical Centers, Location AMC, 1081 HV, Amsterdam, the Netherlands
| | - E Sabo
- Department of Pathology, Carmel Medical Center, 3436212, Haifa, Israel
| | - K Sheahan
- Department of Pathology, St Vincent's University Hospital & UCD School of Medicine, Dublin, D04 T6F4, Ireland
| | - R Riddell
- Department of Laboratory Medicine and Pathobiology, Mount Sinai Hospital, University of Toronto, M5G 1X5, Toronto, Canada
| | - N Wang
- Department of Clinical Pathology, Karolinska University Hospital, Huddinge, 141 86, Stockolm, Sweden
| | - R K Yantiss
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, 10065, New York, NY, USA
| | - L Lundell
- Department of Upper Abdominal Surgery, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska University Hospital, Karolinska Institutet, 141 57, Huddinge, Stockholm, Sweden; Department of Surgery, Odense University Hospital, 5000, Odense, Denmark
| | - D Low
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - M Vieth
- Institute of Pathology, Klinikum Bayreuth, 95445, Bayreuth, Germany
| | - F Klevebro
- Department of Upper Abdominal Surgery, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska University Hospital, Karolinska Institutet, 141 57, Huddinge, Stockholm, Sweden
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18
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Auer R, Sivajohanathan D, Biagi J, Conner J, Kennedy E, May T. Response to letter commenting on 'indications for hyperthermic intraperitoneal chemotherapy (Hipec) with cytoreductive surgery: a systematic review'. Eur J Cancer 2020; 139:188-189. [PMID: 32900560 DOI: 10.1016/j.ejca.2020.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Rebecca Auer
- Department of Surgery, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
| | - Duvaraga Sivajohanathan
- Department of Oncology, McMaster University & Program in Evidence-Based Care, Cancer Care Ontario, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Jim Biagi
- Department of Medical Oncology, Cancer Centre of Southeastern Ontario, 25 King Street West, Kingston, ON, K7L 5P9, Canada
| | - James Conner
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Erin Kennedy
- Department of Surgery, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Taymaa May
- Department of Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2C1, Canada
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19
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Cyr D, Akder A, Shivji S, Brar A, Zerhouni S, Brar M, Gryfe R, MacRae H, Kennedy E, Conner J, Kirsch R, Swallow C. P-133 Extramural venous invasion detected with an elastin stain is a powerful predictor of cancer-specific mortality in STAGE I-IIIB resected colorectal cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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20
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Auer RC, Sivajohanathan D, Biagi J, Conner J, Kennedy E, May T. Indications for hyperthermic intraperitoneal chemotherapy with cytoreductive surgery: a clinical practice guideline. ACTA ACUST UNITED AC 2020; 27:146-154. [PMID: 32669924 DOI: 10.3747/co.27.6033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective The purpose of the present review was to provide evidence-based guidance about the provision of cytoreductive surgery (crs) with hyperthermic intraperitoneal chemotherapy (hipec) in the treatment of peritoneal cancers. Methods The guideline was developed by the Program in Evidence-Based Care together with the Surgical Oncology Program at Ontario Health (Cancer Care Ontario) through a systematic review of relevant literature, patient- and caregiver-specific consultation, and internal and external reviews. Results Recommendation 1a: For patients with newly diagnosed stage iii primary epithelial ovarian or fallopian tube carcinoma, or primary peritoneal carcinoma, hipec should be considered for those with at least stable disease after neoadjuvant chemotherapy at the time that interval crs (if complete) or optimal cytoreduction is achieved. Recommendation 1b: There is insufficient evidence to recommend the addition of hipec when primary crs is performed for patients with newly diagnosed advanced primary epithelial ovarian or fallopian tube carcinoma, or primary peritoneal carcinoma, outside of a clinical trial. Recommendation 2: There is insufficient evidence to recommend hipec with crs in patients with recurrent ovarian cancer outside the context of a clinical trial. Recommendation 3: There is insufficient evidence to recommend hipec with crs in patients with peritoneal colorectal carcinomatosis outside the context of a clinical trial. Recommendation 4: There is insufficient evidence to recommend hipec with crs for the prevention of peritoneal carcinomatosis in colorectal cancer outside the context of a clinical trial; however, hipec using oxaliplatin is not recommended. Recommendation 5: There is insufficient evidence to recommend hipec with crs for the treatment of gastric peritoneal carcinomatosis outside the context of a clinical trial. Recommendation 6: There is insufficient evidence to recommend hipec with crs for the prevention of gastric peritoneal carcinomatosis outside the context of a clinical trial. Recommendation 7: There is insufficient evidence to recommend hipec with crs as a standard of care in patients with malignant peritoneal mesothelioma; however, patients should be referred to hipec specialty centres for assessment for treatment as part of an ongoing research protocol. Recommendation 8: There is insufficient evidence to recommend hipec with crs as a standard of care in patients with disseminated mucinous neoplasm in the appendix; however, patients should be referred to hipec specialty centres for assessment for treatment as part of an ongoing research protocol.
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Affiliation(s)
- R C Auer
- Departments of Surgery and of Biochemistry, Microbiology and Immunology, The Ottawa Hospital Research Institute, Ottawa, ON
| | - D Sivajohanathan
- Department of Oncology, McMaster University, and Program in Evidence-Based Care, Ontario Health (Cancer Care Ontario), Hamilton, ON
| | - J Biagi
- Department of Medical Oncology, Cancer Centre of Southeastern Ontario, Kingston, ON
| | - J Conner
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON
| | - E Kennedy
- Department of Surgery, Mount Sinai Hospital, Toronto, ON
| | - T May
- Department of Oncology, University Health Network, Princess Margaret Hospital, Toronto, ON
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21
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Beck LA, Ma LX, Espin-Garcia O, Suzuki C, Jiang DM, Liu G, Chen EX, Knox JJ, Wong R, Brar SS, Swallow CJ, Yeung J, Darling GE, Conner J, Elimova E, Jang RWJ. Clinicopathological features and treatment outcomes of young patients with gastric and esophageal cancers. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16577 Background: Gastric and esophageal (GE) cancers most commonly occur in older adults in their 60’s.However, there are inconsistent reports about prognosis in adolescent and young adult (AYA) pts, and treatment patterns and outcomes in this population have not been well characterized. Methods: A retrospective analysis was performed for AYA (age 18-40 years) pts with histologic diagnosis of GE cancers who presented to Princess Margaret Cancer Centre from 2008 to 2016. The Kaplan-Meier method was used to analyze progression free (PFS) and overall survival (OS). Results: We identified 57 AYA GE cancer pts (30 gastric, 27 esophageal). Baseline features included: median age 35 years, 51% female (70% in gastric, 30% in esophageal), 82% with Eastern Cooperative Oncology Group performance status 0-1, 82% Charlson Comorbidity Index 0, 54% stage IV. For gastric pts, 53% had diffuse subtype and 47% had signet ring adenocarcinoma. Most had negative family history (77%). Curative intent and palliative treatment was used in 23 (40%) and 34 pts (60%) respectively. In curative pts, 48% had neoadjuvant therapy, 52% had upfront surgery. Of pts who underwent curative resection, 62% had pT3/T4 and 38% had pN2/N3 disease; 5-year OS rate was 37% (95% CI 20-67). Of the palliative pts, 91% received systemic therapy. First-line regimen included triplet (81%) and doublet chemotherapy (13%), administered for a median of 6 cycles. Median PFS was 7.4 months. Second- and third-line treatments were administered in 14 and 3 pts respectively, 1 pt was treated beyond third-line. Median OS in palliative pts was 12.1 months (95% CI 8-21.3). Conclusions: Our gastric AYA pts had increased female predominance and diffuse histology. Many AYA pts had advanced GE cancer at diagnosis, with over half of pts presenting with metastatic disease. In both the curative and palliative setting, AYA pts did not appear to have better survival outcomes despite having few comorbidities, suggesting they may have more aggressive biology.
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Affiliation(s)
| | - Lucy Xiaolu Ma
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Chihiro Suzuki
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Di Maria Jiang
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Eric Xueyu Chen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jennifer J. Knox
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rebecca Wong
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Savtaj Singh Brar
- Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto, ON, Canada
| | - Carol Jane Swallow
- Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto, ON, Canada
| | - Jonathan Yeung
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | - Elena Elimova
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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22
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Murphy JF, Jones J, Conner J. The COVID‐19 pandemic: Is it a “Black Swan”? Some risk management challenges in common with chemical process safety. Proc Safety Prog 2020. [PMCID: PMC7235516 DOI: 10.1002/prs.12160] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Jerry Jones
- AIChE Center for Chemical Process Safety (CCPS) New York New York USA
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23
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Ma LX, Espin-Garcia O, Lim CH, Jiang DM, Sim HW, Natori A, Chan BA, Suzuki C, Chen EX, Liu G, Brar SS, Swallow CJ, Yeung JC, Darling GE, Wong RK, Kalimuthu SN, Conner J, Elimova E, Jang RW. Impact of adjuvant therapy in patients with a microscopically positive margin after resection for gastric and esophageal cancers. J Gastrointest Oncol 2020; 11:356-365. [PMID: 32399276 DOI: 10.21037/jgo.2020.03.03] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background A microscopically positive (R1) resection margin following resection for gastric and esophageal cancers has been documented to be a poor prognostic factor. The optimal strategy and impact of different modalities of adjuvant treatment for an R1 resection margin remain unclear. Methods A retrospective analysis was performed for patients with gastric and esophageal adenocarcinoma treated at the Princess Margaret Cancer Centre (PMCC) from 2006-2016. Electronic medical records of all patients with an R1 resection margin were reviewed. Kaplan-Meier and Cox proportional hazards methods were used to analyze recurrence free survival (RFS) and overall survival (OS) with stage and neoadjuvant treatment as covariates in the multivariate analysis. Results We identified 69 gastric and esophageal adenocarcinoma patients with a R1 resection. Neoadjuvant chemoradiation was used in 13% of patients, neoadjuvant chemotherapy in 12%, surgery alone in 75%. Margins involved included proximal in 30%, distal in 14%, radial in 52% and multiple margins in 3% of patients. Pathological staging showed 3% with stage I disease, 20% stage II and 74% stage III. Adjuvant therapy was given in 52% of R1 pts (28% CRT, 20% chemotherapy alone, 3% radiation alone, 1% reoperation). Median RFS was 14.1 months [95% confidence interval (CI), 11.1-17.2]. The site of first recurrence was 72% distant, 12% mixed, 16% locoregional alone. Median OS was 34.5 months (95% CI, 23.3-57.9) for all patients. There was no significant difference in RFS (adjusted P=0.26) or OS (adjusted P=0.83) comparing modality of adjuvant therapy. Conclusions Most patients with positive margins after resection for gastric and esophageal cancer had advanced pathologic stage and prognosis was poor. Our study did not find improved RFS or OS with adjuvant treatment and only one patient had reresection. The main failure pattern was distant recurrence, suggesting that patients being considered for adjuvant radiotherapy (RT) should be carefully selected. Further studies are required to determine factors to select patients with good prognosis despite a positive margin, or those who may benefit from adjuvant treatment.
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Affiliation(s)
- Lucy X Ma
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Osvaldo Espin-Garcia
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Charles H Lim
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Di M Jiang
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Hao-Wen Sim
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Akina Natori
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada.,Department of Medical Oncology, University of Miami, Miami, FL, USA
| | - Bryan A Chan
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Chihiro Suzuki
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Eric X Chen
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Geoffrey Liu
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Savtaj S Brar
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and Sinai Health System, University of Toronto, Toronto, Canada
| | - Carol J Swallow
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and Sinai Health System, University of Toronto, Toronto, Canada
| | - Jonathan C Yeung
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Gail E Darling
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Rebecca K Wong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Sangeetha N Kalimuthu
- Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada
| | - James Conner
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Elena Elimova
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Raymond W Jang
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
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24
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Beck LA, Ma LX, Espin-Garcia O, Suzuki C, Jiang DM, Liu G, Chen EX, Knox JJ, Wong R, Brar SS, Swallow CJ, Yeung J, Darling GE, Conner J, Elimova E, Jang RWJ. Clinicopathological features and treatment outcomes of young patients with gastric and esophageal cancers. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
325 Background: Gastric and esophageal (GE) cancers most commonly occur in older adults in their 60’s. There are inconsistent reports about prognosis in adolescent and young adult (AYA) pts, and treatment patterns and outcomes in this population have not been well characterized. Methods: A retrospective analysis was performed for AYA (age < 40) pts with GE cancers who presented to Princess Margaret Cancer Centre from 2008 to 2016. The Kaplan-Meier method was used to analyze progression free (PFS) and overall survival (OS). Results: We identified 57 AYA GE cancer pts (30 gastric, 27 esophageal). Features at diagnosis included: median age 35, 51% female (70% in gastric, 30% in esophageal), 82% with performance status 0-1, 83% Charlson Comorbidity Index 0, 54% stage IV. For gastric pts, 53% had diffuse histology and 47% had signet ring adenocarcinoma. There was a negative family history of gastric or esophageal cancer in 77% of pts. Curative intent treatment was used in 23 pts, palliative in 34. In curative pts, 48% had neoadjuvant therapy, 52% had upfront surgery. Of pts who underwent surgery, 57% had T3 or T4a disease and 38% had N2 or N3 disease. Median OS in curative pts was 39.9 months (95% CI 19.7-69.9), with a 5-year OS rate of 37% (95% CI 20-67). Of the palliative pts, 91% had chemotherapy. First line chemotherapy was a triplet regimen in 80%, doublet in 13%. The median number of treatment cycles on first line chemotherapy was 6, with a median PFS of 7.4 months (95% CI 5.4-10.5). At progression, 14 pts had second line treatment, 3 pts had third line and only 1 pt was treated beyond third line. Median OS in palliative pts was 12.1 months (95% CI 8-21.3). Conclusions: Consistent with the literature, our gastric AYA pts had increased female predominance and diffuse histology. Many AYA pts had advanced disease at diagnosis, with over half of pts presenting with metastatic disease. In both the curative and palliative setting, AYA pts did not have better survival outcomes despite being young with few comorbidities, suggesting they may have more aggressive biology.
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Affiliation(s)
| | | | | | | | - Di Maria Jiang
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Eric Xueyu Chen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jennifer J. Knox
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rebecca Wong
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Savtaj Singh Brar
- Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto, ON, Canada
| | - Carol Jane Swallow
- Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto, ON, Canada
| | | | | | | | - Elena Elimova
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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25
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Auer RC, Sivajohanathan D, Biagi J, Conner J, Kennedy E, May T. Indications for hyperthermic intraperitoneal chemotherapy with cytoreductive surgery: a systematic review. Eur J Cancer 2020; 127:76-95. [PMID: 31986452 DOI: 10.1016/j.ejca.2019.10.034] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/25/2019] [Accepted: 10/30/2019] [Indexed: 12/27/2022]
Abstract
The purpose of the present review was to describe evidence-based indications for hyperthermic intraperitoneal chemotherapy (HIPEC), with cytoreductive surgery (CRS), in patients with a diagnosis of mesothelioma, appendiceal (including appendiceal mucinous neoplasm), colorectal, gastric, ovarian or primary peritoneal carcinoma. Relevant studies were identified from a systematic MEDLINE and EMBASE search of studies published from 1985 to 2019. Studies were included if they were RCTs. If no RCTs were identified, prospective and retrospecctive comparative studies (where confounders are controlled for studies with greater than 30 patients) were included. Overall survival, progression-free survival, recurrence-free survival, adverse events and quality of life data were extracted. For patients with newly diagnosed, primary stage III epithelial ovarian, fallopian tube or primary peritoneal carcinoma, HIPEC with CRS should be considered for those with at least stable disease following neoadjuvant chemotherapy at the time of interval CRS if complete or optimal cytoreduction is achieved. There is insufficient evidence to recommend the addition of HIPEC when primary CRS is performed for patients with newly diagnosed, primary advanced epithelial ovarian, fallopian tube or primary peritoneal carcinoma or in those with recurrent ovarian cancer outside of a clinical trial. There is insufficient evidence to recommend HIPEC with CRS for the prevention of or for the treatment of peritoneal colorectal carcinomatosis outside of a clinical trial. There is insufficient evidence to recommend HIPEC with CRS for the prevention of or for the treatment of gastric peritoneal carcinomatosis outside of a clinical trial. There is insufficient evidence to recommend HIPEC with CRS in patients with malignant peritoneal mesothelioma or in those with disseminated mucinous neoplasm in the appendix as a standard of care; however, these patients should be referred to HIPEC specialty centres for assessment for treatment as part of an ongoing research protocol.
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Affiliation(s)
- Rebecca C Auer
- Department of Surgery, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
| | - Duvaraga Sivajohanathan
- Department of Oncology, McMaster University & Program in Evidence-Based Care, Cancer Care Ontario, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Jim Biagi
- Department of Medical Oncology, Cancer Centre of Southeastern Ontario, 25 King Street West, Kingston, ON, K7L 5P9, Canada
| | - James Conner
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Erin Kennedy
- Department of Surgery, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Taymaa May
- Department of Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2C1, Canada
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26
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Jedrzkiewicz J, Tateishi Y, Kirsch R, Conner J, Bischof D, McCart A, Riddell R, Pollett A, Taylor EL, Govindarajan A. Impact of Referral Center Pathology Review on Diagnosis and Management of Patients With Appendiceal Neoplasms. Arch Pathol Lab Med 2019; 144:764-768. [DOI: 10.5858/arpa.2019-0214-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Data regarding the clinical impact of subspecialist pathology review of appendiceal neoplasms are limited.Objective.—To determine whether pathology review by gastrointestinal pathologists at a tertiary-care referral center resulted in significant changes in the diagnosis and clinical management of appendiceal neoplastic lesions.Design.—We conducted a retrospective review of all patients with an initial diagnosis of appendiceal neoplasm referred to a tertiary-care referral center in Ontario, Canada, from 2010–2016. The discordance rate between original and review pathology reports, the nature of discordances, and the impact of any discordance on patient management were recorded.Results.—A total of 145 patients with appendiceal lesions were identified (low-grade mucinous appendiceal neoplasm [n = 79], invasive mucinous adenocarcinoma [n = 12], “colorectal type” adenocarcinoma [n = 12], goblet cell carcinoid and adenocarcinomas ex goblet cell carcinoid [n = 24], and other lesions/neoplasms [n = 20]). One or more changes in diagnoses were found in 36 of 145 cases (24.8%), with changes within the same category of interpretation (n = 10), stage (n = 7), grade (n = 6), and categoric interpretation (n = 5) being the most common. In 10 of 36 patients (28%), the diagnostic change led to a significant change in management, including recommendation for additional surveillance, systemic chemotherapy, additional surgery, or discontinuation of surveillance.Conclusions.—Subspecialist pathology review of appendiceal neoplastic lesions led to a change in diagnosis in 36 of 145 cases (24.8%), of which nearly 30% (10 of 36 cases) led to a change in clinical management. The overall rate of clinically significant discordances was 7% (10 of 145). Our findings suggest that subspecialist pathology review of appendiceal neoplasms referred to specialized centers is justified.
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Affiliation(s)
- Jolanta Jedrzkiewicz
- From the Department of Pathology, University of Utah, Salt Lake City (Dr Jedrzkiewicz); the Department of Pathology, Yokohama City University, Yokohama, Japan (Dr Tateishi); and the Departments of Pathology (Drs Kirsch, Conner, Riddell, and Pollett) and Surgery (Drs Bischof, McCart, and Govindarajan, and Ms Taylor), Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Yoko Tateishi
- From the Department of Pathology, University of Utah, Salt Lake City (Dr Jedrzkiewicz); the Department of Pathology, Yokohama City University, Yokohama, Japan (Dr Tateishi); and the Departments of Pathology (Drs Kirsch, Conner, Riddell, and Pollett) and Surgery (Drs Bischof, McCart, and Govindarajan, and Ms Taylor), Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Richard Kirsch
- From the Department of Pathology, University of Utah, Salt Lake City (Dr Jedrzkiewicz); the Department of Pathology, Yokohama City University, Yokohama, Japan (Dr Tateishi); and the Departments of Pathology (Drs Kirsch, Conner, Riddell, and Pollett) and Surgery (Drs Bischof, McCart, and Govindarajan, and Ms Taylor), Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - James Conner
- From the Department of Pathology, University of Utah, Salt Lake City (Dr Jedrzkiewicz); the Department of Pathology, Yokohama City University, Yokohama, Japan (Dr Tateishi); and the Departments of Pathology (Drs Kirsch, Conner, Riddell, and Pollett) and Surgery (Drs Bischof, McCart, and Govindarajan, and Ms Taylor), Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Danielle Bischof
- From the Department of Pathology, University of Utah, Salt Lake City (Dr Jedrzkiewicz); the Department of Pathology, Yokohama City University, Yokohama, Japan (Dr Tateishi); and the Departments of Pathology (Drs Kirsch, Conner, Riddell, and Pollett) and Surgery (Drs Bischof, McCart, and Govindarajan, and Ms Taylor), Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | | | - Robert Riddell
- From the Department of Pathology, University of Utah, Salt Lake City (Dr Jedrzkiewicz); the Department of Pathology, Yokohama City University, Yokohama, Japan (Dr Tateishi); and the Departments of Pathology (Drs Kirsch, Conner, Riddell, and Pollett) and Surgery (Drs Bischof, McCart, and Govindarajan, and Ms Taylor), Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Pollett
- From the Department of Pathology, University of Utah, Salt Lake City (Dr Jedrzkiewicz); the Department of Pathology, Yokohama City University, Yokohama, Japan (Dr Tateishi); and the Departments of Pathology (Drs Kirsch, Conner, Riddell, and Pollett) and Surgery (Drs Bischof, McCart, and Govindarajan, and Ms Taylor), Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Emily L. Taylor
- From the Department of Pathology, University of Utah, Salt Lake City (Dr Jedrzkiewicz); the Department of Pathology, Yokohama City University, Yokohama, Japan (Dr Tateishi); and the Departments of Pathology (Drs Kirsch, Conner, Riddell, and Pollett) and Surgery (Drs Bischof, McCart, and Govindarajan, and Ms Taylor), Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Anand Govindarajan
- From the Department of Pathology, University of Utah, Salt Lake City (Dr Jedrzkiewicz); the Department of Pathology, Yokohama City University, Yokohama, Japan (Dr Tateishi); and the Departments of Pathology (Drs Kirsch, Conner, Riddell, and Pollett) and Surgery (Drs Bischof, McCart, and Govindarajan, and Ms Taylor), Sinai Health System, University of Toronto, Toronto, Ontario, Canada
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Luu S, Savage P, Swett-Cosentino J, Conner J, Brar S, Swallow C. Impact of Public Cancer Agency Policies on Perioperative Processes and Outcomes in Patients with Resectable Gastric Adenocarcinoma. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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28
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Ma LX, Espin-Garcia O, Lim CH, Sun P, Jiang DM, Sim HW, Natori A, Chan BA, Yokom D, Moignard S, Suzuki C, Chen EX, Liu G, Swallow CJ, Darling GE, Wong R, Hafezi-Bakhtiari S, Conner J, Elimova E, Jang RWJ. Impact of adjuvant therapy in patients with a microscopically positive margin after resection for gastroesophageal cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.4069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4069 Background: A microscopically positive (R1) resection margin following resection for gastroesophageal (GE) cancer has been documented to be a poor prognostic factor. The optimal strategy and impact of different modalities of adjuvant treatment for an R1 resection margin remain unclear. Methods: A retrospective analysis was performed for patients (pts) with GE cancer treated at the Princess Margaret Cancer Centre from 2006-2016. Electronic medical records of all pts with an R1 resection margin were reviewed. Kaplan-Meier and Cox proportional hazards methods were used to analyze recurrence free survival (RFS) and overall survival (OS) with stage and neoadjuvant treatment as covariates in the multivariate analysis. Results: We identified 78 GE cancer pts with an R1 resection. 11% had neoadjuvant chemotherapy, 14% chemoradiation (CRT), 75% surgery alone. 28% had involvement of the proximal margin, 13% distal, 56% radial, 3% had multiple positive margins. By the American Joint Committee on Cancer 7th edition classification, 88% had a pT3-4 tumour, 66% pN2-3 nodal involvement, 64% grade 3, 68% with lymphovascular invasion. 3% were pathological stage I, 21% stage II and 74% stage III. Adjuvant therapy was given in 46% of R1 pts (24% CRT, 18% chemotherapy alone, 3% radiation alone, 1% reoperation). Median RFS for all pts was 12.6 months (95% CI 10.3-17.2). Site of first recurrence was 71% distant, 16% locoregional, 13% mixed. Median OS was 29.3 months (95% CI 22.9-50) for all pts. The 5 year survival rate was 23% (95% CI 12%-43%). There was no significant difference in RFS (log-rank test p = 0.63, adjusted p = 0.14) or OS (log-rank test p = 0.68, adjusted p = 0.65) regardless of adjuvant therapy. Conclusions: Most pts with positive margins after resection for GE cancer had advanced pathologic stage and prognosis was poor. Our study did not find improved RFS or OS with adjuvant treatment and only one pt had reresection. The main failure pattern was distant recurrence, suggesting that pts being considered for adjuvant RT should be carefully selected. Further studies are required to determine factors to select pts with good prognosis despite a positive margin, or those who may benefit from adjuvant treatment.
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Affiliation(s)
| | | | | | - Peiran Sun
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Di Maria Jiang
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Hao-Wen Sim
- The Kinghorn Cancer Centre, St Vincent's Hospital Sydney, Sydney, Australia
| | | | | | | | | | | | - Eric Xueyu Chen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Carol Jane Swallow
- Princess Margaret Cancer Centre/ Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Rebecca Wong
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Elena Elimova
- University of Texas MD Anderson Cancer Center, Houston, TX
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29
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Ma LX, Espin-Garcia O, Lim CH, Sun P, Jiang DM, Sim HW, Natori A, Chan BA, Yokom D, Moignard S, Suzuki C, Chen EX, Liu G, Swallow CJ, Darling GE, Wong R, Hafezi-Bakhtiari S, Conner J, Elimova E, Jang RWJ. Impact of adjuvant therapy in patients with a microscopically positive margin after resection for gastroesophageal cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
164 Background: A microscopically positive (R1) resection margin following resection for gastroesophageal (GE) cancer has been documented to be a poor prognostic factor. The optimal strategy and impact of different modalities of adjuvant treatment for an R1 resection margin remain unclear. Methods: A retrospective analysis was performed for patients (pts) with GE cancer treated at the Princess Margaret Cancer Centre from 2006-2016. Electronic medical records of all pts with an R1 resection margin were reviewed. Kaplan-Meier and Cox proportional hazards methods were used to analyze recurrence free survival (RFS) and overall survival (OS) with stage and neoadjuvant treatment as covariates in the multivariate analysis. Results: We identified 78 GE cancer pts with an R1 resection. 11% had neoadjuvant chemotherapy, 14% chemoradiation (CRT), 75% surgery alone. 28% had involvement of the proximal margin, 13% distal, 56% radial, 3% had multiple positive margins. By the American Joint Committee on Cancer 7th edition classification, 88% had a pT3-4 tumour, 66% pN2-3 nodal involvement, 64% grade 3, 68% with lymphovascular invasion. 3% were pathological stage I, 21% stage II and 74% stage III. Adjuvant therapy was given in 46% of R1 pts (24% CRT, 18% chemotherapy alone, 3% radiation alone, 1% reoperation). Median RFS for all pts was 12.6 months (95% CI 10.3-17.2). Site of first recurrence was 71% distant, 16% locoregional, 13% mixed. Median OS was 29.3 months (95% CI 22.9-50) for all pts. The 5 year survival rate was 23% (95% CI 12%-43%). There was no significant difference in RFS (log-rank test p= 0.63, adjusted p= 0.14) or OS (log-rank test p= 0.68, adjusted p= 0.65) regardless of adjuvant therapy. Conclusions: Most pts with positive margins after resection for GE cancer had advanced pathologic stage and prognosis was poor. Our study did not find improved RFS or OS with adjuvant treatment and only one pt had reresection. The main failure pattern was distant recurrence, suggesting that pts being considered for adjuvant RT should be carefully selected. Further studies are required to determine factors to select pts with good prognosis despite a positive margin, or those who may benefit from adjuvant treatment.
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Affiliation(s)
- Lucy Xiaolu Ma
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | - Peiran Sun
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Di Maria Jiang
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Hao-Wen Sim
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Daniel Yokom
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | - Eric Xueyu Chen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Carol Jane Swallow
- Princess Margaret Cancer Centre/ Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Rebecca Wong
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | - Elena Elimova
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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30
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Natori A, Chan BA, Sim HW, Ma L, Yokom DW, Chen E, Liu G, Darling G, Swallow C, Brar S, Brierley J, Ringash J, Wong R, Kim J, Rogalla P, Hafezi-Bakhtiari S, Conner J, Knox J, Elimova E, Jang RW. Outcomes by treatment modality in elderly patients with localized gastric and esophageal cancer. ACTA ACUST UNITED AC 2018; 25:366-370. [PMID: 30607110 DOI: 10.3747/co.25.4208] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background We aimed to assess current treatment patterns and outcomes in elderly patients with localized gastric and esophageal (ge) cancers. Methods This retrospective analysis considered patients 75 years of age or older with ge cancers treated during 2012-2014. Patient demographics and tumour characteristics were collected. Overall survival (os) and disease-free survival were assessed by univariable and multivariable Cox proportional hazards regression, adjusting for demographics. Logistic regression analyses were used to examine factors affecting treatment choices. Results The 110 patients in the study cohort had a median age of 81 years (range: 75-99 years). Primary disease sites were esophageal (55%) and gastric (45%). Treatment received included radiation therapy alone (29%), surgery alone (26%), surgery plus perioperative therapy (14%), chemoradiation alone (10%), and supportive care alone (14%). In multivariable analyses, surgery (hazard ratio: 0.48; 95% confidence interval: 0.26 to 0.90; p = 0.02) was the only independent predictor for improved os. Patients with a good Eastern Cooperative Oncology Group performance status (p = 0.008), gastric disease site (p = 0.02), and adenocarcinoma histology (p = 0.01) were more likely to undergo surgery. Conclusions At our institution, few patients 75 years of age and older received multimodality therapy for localized ge cancers. Outcomes were better for patients who underwent surgery than for those who did not. To ensure optimal treatment selection, comprehensive geriatric assessment should be considered for patients 75 years of age and older with localized ge cancers.
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Affiliation(s)
- A Natori
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Medicine, University of Toronto, Toronto, ON
| | - B A Chan
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Medicine, University of Toronto, Toronto, ON
| | - H W Sim
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Medicine, University of Toronto, Toronto, ON
| | - L Ma
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Medicine, University of Toronto, Toronto, ON
| | - D W Yokom
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Medicine, University of Toronto, Toronto, ON
| | - E Chen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Medicine, University of Toronto, Toronto, ON.,Faculty of Medicine, University of Toronto, Toronto, ON
| | - G Liu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Medicine, University of Toronto, Toronto, ON.,Faculty of Medicine, University of Toronto, Toronto, ON
| | - G Darling
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Faculty of Medicine, University of Toronto, Toronto, ON.,Toronto General Hospital, University Health Network, Toronto, ON
| | - C Swallow
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Faculty of Medicine, University of Toronto, Toronto, ON.,Mount Sinai Hospital, Toronto, ON
| | - S Brar
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Faculty of Medicine, University of Toronto, Toronto, ON.,Mount Sinai Hospital, Toronto, ON
| | - J Brierley
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Faculty of Medicine, University of Toronto, Toronto, ON
| | - J Ringash
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Faculty of Medicine, University of Toronto, Toronto, ON
| | - R Wong
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Faculty of Medicine, University of Toronto, Toronto, ON
| | - J Kim
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Faculty of Medicine, University of Toronto, Toronto, ON
| | - P Rogalla
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Faculty of Medicine, University of Toronto, Toronto, ON
| | - S Hafezi-Bakhtiari
- Department of Medicine, University of Toronto, Toronto, ON.,Faculty of Medicine, University of Toronto, Toronto, ON
| | - J Conner
- Mount Sinai Hospital, Toronto, ON
| | - J Knox
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Medicine, University of Toronto, Toronto, ON.,Faculty of Medicine, University of Toronto, Toronto, ON
| | - E Elimova
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Medicine, University of Toronto, Toronto, ON.,Faculty of Medicine, University of Toronto, Toronto, ON
| | - R W Jang
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Medicine, University of Toronto, Toronto, ON.,Faculty of Medicine, University of Toronto, Toronto, ON
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31
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Lim CH, Yokom D, Jiang DM, Ma LX, Sun P, Sim HW, Natori A, Chan BA, Moignard S, Knox JJ, Chen EX, Liu G, Swallow CJ, Darling GE, Brar SS, Hafezi-Bakhtiari S, Conner J, Elimova E, Jang RWJ. Outcomes for advanced HER2 positive gastroesophageal cancer by anatomical location: Experience from the Princess Margaret Cancer Centre. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Daniel Yokom
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Peiran Sun
- University of Toronto, Toronto, ON, Canada
| | - Hao-Wen Sim
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Akina Natori
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | | | - Geoffrey Liu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Carol Jane Swallow
- Princess Margaret Cancer Centre/ Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Savtaj Singh Brar
- Princess Margaret Cancer Centre/ Mount Sinai Hospital, Toronto, ON, Canada
| | | | | | - Elena Elimova
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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32
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Natori A, Sim HW, Chan BA, Sun P, Moignard S, Yokom D, Lim CH, Jiang DM, Ma LX, Chen EX, Liu G, Knox JJ, Darling GE, Yeung JCW, Wong R, Hafezi-Bakhtiari S, Conner J, Rogalla P, Jang RWJ, Elimova E. Comparison of bimodality versus trimodality therapy for esophageal or gastroesophageal junction (GEJ) cancer: Experience from the Princess Margaret Cancer Centre. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.4066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Akina Natori
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Hao-Wen Sim
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Peiran Sun
- University of Toronto, Toronto, ON, Canada
| | | | - Daniel Yokom
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Di Maria Jiang
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Eric Xueyu Chen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Geoffrey Liu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | - Rebecca Wong
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | | | - Elena Elimova
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Derouet MF, Dakpo E, Wu L, Zehong G, Conner J, Keshavjee S, de Perrot M, Waddell T, Elimova E, Yeung J, Darling GE. miR-145 expression enhances integrin expression in SK-GT-4 cell line by down-regulating c-Myc expression. Oncotarget 2018; 9:15198-15207. [PMID: 29632636 PMCID: PMC5880596 DOI: 10.18632/oncotarget.24613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 02/21/2018] [Indexed: 12/13/2022] Open
Abstract
Adenocarcinoma of the esophagus is increasing in frequency and is the 6th most common cause of cancer death in North America. In adenocarcinoma cell lines, we have previously demonstrated that expression of miR-145, leads to enhanced invasion, resistance to anoikis and better attachment to fibronectin in esophageal adenocarcinoma. In contrast, expression of miR-145 acts as a tumor suppressor in squamous cell carcinoma. The molecular mechanisms responsible for the oncogenic effects of miR-145 were investigated. In this report, we demonstrate that we can partially recreate the miR-145 effects in EAC by knock down of the expression of c-Myc, which is one of the targets of miR-145. Knocking down of c-Myc expression resulted in upregulation of integrin subunits α5 and β3. Finally, we demonstrated that integrin α5 expression correlates to fibronectin attachment potential whereas integrin β3 expression correlates with resistance to anoikis and invasion potential. Finally, we demonstrate that expression of miR-145 in esophageal adenocarcinoma cell line (SK-GT-4) enhances tumor growth and metastasis in a NOD/SCID xenograft model. Overall, the oncogenic potential of miR-145 in EAC appears to be mediated by downregulation of c-Myc leading to the expression of integrins subunits α5 and β3.
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Affiliation(s)
- Mathieu Francois Derouet
- Latner Thoracic Surgery Research Laboratories, Princess Margaret Cancer Research Tower, University Health Network, Toronto, Ontario, Canada
| | - Eugenia Dakpo
- Latner Thoracic Surgery Research Laboratories, Princess Margaret Cancer Research Tower, University Health Network, Toronto, Ontario, Canada
| | - Licun Wu
- Latner Thoracic Surgery Research Laboratories, Princess Margaret Cancer Research Tower, University Health Network, Toronto, Ontario, Canada
| | - Guan Zehong
- Latner Thoracic Surgery Research Laboratories, Princess Margaret Cancer Research Tower, University Health Network, Toronto, Ontario, Canada
| | - James Conner
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Latner Thoracic Surgery Research Laboratories, Princess Margaret Cancer Research Tower, University Health Network, Toronto, Ontario, Canada.,Department of Surgery, Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Marc de Perrot
- Latner Thoracic Surgery Research Laboratories, Princess Margaret Cancer Research Tower, University Health Network, Toronto, Ontario, Canada.,Department of Surgery, Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Thomas Waddell
- Latner Thoracic Surgery Research Laboratories, Princess Margaret Cancer Research Tower, University Health Network, Toronto, Ontario, Canada.,Department of Surgery, Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Elena Elimova
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jonathan Yeung
- Latner Thoracic Surgery Research Laboratories, Princess Margaret Cancer Research Tower, University Health Network, Toronto, Ontario, Canada.,Department of Surgery, Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Gail Elizabeth Darling
- Latner Thoracic Surgery Research Laboratories, Princess Margaret Cancer Research Tower, University Health Network, Toronto, Ontario, Canada.,Department of Surgery, Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Lim CH, Yokom D, Jiang DM, Ma LX, Sun P, Sim HW, Natori A, Chan BA, Moignard S, Knox JJ, Chen EX, Liu G, Swallow CJ, Darling GE, Brar SS, Hafezi-Bakhtiari S, Conner J, Elimova E, Jang RWJ. Outcomes for advanced HER2-positive gastroesophageal cancer by anatomical location: Experience from the Princess Margaret Cancer Centre. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
131 Background: The landmark ToGA trial established trastuzumab (T) based therapy as the standard of care for advanced HER2+ gastric and gastroesophageal junction cancer. However, outcomes for T based therapy for HER2+ esophageal cancer have not been well characterized. Methods: We conducted a retrospective analysis of patients (pts) with HER2+ gastroesophageal cancer receiving T based therapy at our institution from 2011-2016. Distal esophagus ( < 35 cm) and Siewert type I/II tumours were defined as esophageal (E). Siewert type III and stomach tumours were defined as gastric (G). Trained abstractors collected pt demographics and treatment details. Overall survival (OS) and progression-free survival (PFS) were calculated from the date of first T treatment. Chi-square tests, t-tests and Cox proportional hazards models were applied where appropriate. Results: We identified 87 pts with advanced HER2+ disease. 62% (n = 54) had de novo metastatic (M1) disease. 57 patients were treated with T based therapy, with median age 57 years (IQR 48-67), 91% baseline performance status 0-1, 19% female, and 7% Asian. 63% (n = 36) had E and 37% (n = 21) had G primary tumours. 67% (n = 38) presented with M1 disease. 33% (n = 19) underwent surgery with curative intent and received T based therapy at recurrence. Baseline characteristics were balanced between the E and G groups. Survival data were available for 51 patients. The E and G groups did not have significant differences in PFS (median 9.5 vs. 9.1 months, HR 0.89 (95% CI 0.44-1.80), p = 0.74) or in OS (median 15.8 vs. 14.2 months, HR 0.88 (95% CI 0.42-1.82), p = 0.73). 63% (n = 36) were treated with subsequent systemic therapy after progression on T, with 23 receiving one line, 9 receiving two lines and 4 receiving three additional lines of treatment. The number subsequent therapies received was similar between E and G groups. Conclusions: Although patients with distal esophagus tumours were not included in the ToGA trial, our analysis suggests that patients with E and G tumours had similar outcomes. Our contemporary cohort had comparable survival outcomes relative to patients receiving T in the ToGA trial (median PFS = 6.7 months, median OS = 13.8 months).
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Affiliation(s)
| | | | | | | | - Peiran Sun
- University of Toronto, Toronto, ON, Canada
| | - Hao-Wen Sim
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Akina Natori
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | | | - Geoffrey Liu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Carol Jane Swallow
- Princess Margaret Cancer Centre/ Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Savtaj Singh Brar
- Princess Margaret Cancer Centre/ Mount Sinai Hospital, Toronto, ON, Canada
| | | | | | - Elena Elimova
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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Ma LX, Lim CH, Sun P, Jiang M, Sim HW, Natori A, Chan BA, Yokom D, Moignard S, Le LW, Chen EX, Liu G, Swallow CJ, Darling GE, Kongkham PN, Shultz D, Hafezi-Bakhtiari S, Conner J, Elimova E, Jang RWJ. Relationship between human epidermal growth factor receptor 2 (HER2) status and central nervous system metastases in gastroesophageal cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
145 Background: Central nervous system (CNS) metastases (mets) in gastroesophageal (GE) cancers are rare. There have only been limited studies examining the role of HER2 status in CNS mets in GE cancers. Methods: A retrospective analysis was performed for patients (pts) treated for GE cancers at the Princess Margaret Cancer Centre from 2011-2016. Quantitative and qualitative data were collected for all pts with CNS mets. Kaplan-Meier method was used to calculate overall survival (OS) and CNS progression free survival (PFS) for CNS mets pts. Results: Of 34 GE cancer pts diagnosed with CNS mets, 11 were HER2+, 11 HER2- and 12 had unknown HER2 status. Median time from initial cancer diagnosis to CNS mets was 10.3 months (13.4 in HER2+, 5.8 in HER2-, 11.7 in HER2 unknown). Characteristics at CNS mets diagnosis included: median age 63; 85% male; 74% had extracranial systemic mets; performance status ECOG 0-1 (64%), 2 (12%), 3-4 (24%). Treatment for CNS mets is shown in Table 1. Median OS from diagnosis of CNS mets was 6.1 months (95%CI 3.2-16.4) for all pts, 17.1 (95%CI 9.9-NA) in HER2+, 1.8 (95%CI 0.6-NA) in HER2-, 6.0 (95%CI 1.9-NA) in HER2 unknown, p=0.01. Median OS from initial cancer diagnosis was 18.5 months (95%CI 13.6-33.7) for all pts, 28.9 (95%CI 21.32-NA) in HER2+, 10.8 (95%CI 6.37-NA) in HER2-, 18.6 (95%CI 10-NA) in HER2 unknown, p=0.015. The 1 year CNS PFS rate was 35% (95%CI 22.1 – 55.5%) for all pts, 53% (95%CI 29.9 – 94%) in HER2+, 18.2% (95%CI 5.3 – 63.7%) in HER2-, 33% (95%CI 15 – 74.2%) in HER2 unknown, p=0.053. Conclusions: HER2+ pts tended to develop CNS mets later than HER2-. HER2+ pts were more likely to receive CNS-directed interventions, with more HER2+ pts having surgery for CNS mets while more HER2- had supportive care. This analysis is the first to suggest that in pts with CNS mets, HER2+ pts had longer survival than HER2-, both from initial diagnosis and after developing CNS metastases.[Table: see text]
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Affiliation(s)
| | | | - Peiran Sun
- University of Toronto, Toronto, ON, Canada
| | - Maria Jiang
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Hao-Wen Sim
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Akina Natori
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Daniel Yokom
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Lisa W Le
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Geoffrey Liu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Carol Jane Swallow
- Princess Margaret Cancer Centre/ Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Paul N. Kongkham
- Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - David Shultz
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Elena Elimova
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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Natori A, Sim HW, Chan BA, Sun P, Moignard S, Yokom D, Lim CH, Jiang M, Ma LX, Chen EX, Liu G, Knox JJ, Darling GE, Yeung JCW, Wong R, Hafezi-Bakhtiari S, Conner J, Rogalla P, Jang RWJ, Elimova E. Comparison of bimodality versus trimodality therapy for esophageal or gastroesophageal junction (GEJ) cancer: Experience from the Princess Margaret Cancer Centre. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
122 Background: There are no phase 3 trials comparing definitive chemoradiation (bimodality) versus. perioperative chemoradiation (trimodality) for locoregional esophageal/GEJ cancer. Methods: A retrospective analysis (2011-2015) compared bimodality and trimodality therapy in patients (pts) with locoregional esophageal/GEJ cancer treated with curative intent. Overall survival (OS) and disease-free survival (DFS) were calculated from the date of diagnosis. Uni- and multivariable Cox proportional hazards regression adjusted for patient and disease factors. Results: Of 108 patients, 82 (76%) were male. Mean ages were 69.5 ± 11.0 years (bimodality; N = 41) and 60.5 ± 11.1 years (trimodality; N = 67). For bimodality pts, 37% had adenocarcinoma and 63% had squamous cell carcinoma (SCC). For trimodality pts, 79% had adenocarcinoma and 21% had SCC (p < 0.0001). Bimodality pts received a higher radiation dose compared to trimodality pts (50.1 ± 6.7 vs. 45.2 ± 6.4 Gy). Median follow-up was 49.3 months. We found no significant OS difference between bimodality (27.0 months) and trimodality therapy (29.8 months) in the overall cohort (p = 0.57) (4 year OS rate: 42% vs. 38%). In the subgroup with adenocarcinoma histology, trimodality therapy significantly improved OS and DFS compared to bimodality (OS: 31.8 vs. 10.4 months, hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.18-0.66, p = 0.001; DFS: 15.0 vs. 6.7 months; HR 0.39, 95%CI 0.21-0.73, p = 0.003). In the SCC subgroup, median OS and DFS were similar (OS: not reached vs. 29.2 months, p = 0.48; DFS: 27.0 vs. 24.0, p = 0.96). Using multivariable regression with AIC backward selection, the only retained prognostic factors were treatment modality (p = 0.06) and histology (p = 0.01). Conclusions: Our findings support preferential use of trimodality therapy for pts with adenocarcinoma histology given superior OS and DFS, whereas bimodality and trimodality therapy appeared comparable in pts with SCC histology. Pending confirmation in a larger series with longer follow-up, these findings suggest differential treatment algorithms for locoregional esophageal and GEJ cancer based on tumor histology.
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Affiliation(s)
- Akina Natori
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Hao-Wen Sim
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Peiran Sun
- University of Toronto, Toronto, ON, Canada
| | | | - Daniel Yokom
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Maria Jiang
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Geoffrey Liu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | - Rebecca Wong
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | | | - Elena Elimova
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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Jiang DM, Lim CH, Ma LX, Sun P, Sim HW, Natori A, Chan BA, Yokom D, Moignard S, Chen EX, Liu G, Knox JJ, Swallow CJ, Darling GE, Brar SS, Hafezi-Bakhtiari S, Conner J, Jang RWJ, Elimova E. Patterns of recurrence and outcomes after curative resection of locally advanced HER2-positive gastroesophageal cancer (HPGEC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
147 Background: Literature on recurrence and outcomes of HPGEC is scarce. The aim of this study was to determine pattern of recurrence and outcomes after curative intent surgery for locally advanced HPGEC. Methods: A retrospective database was used to identify consecutive patients with gastroesophageal adenocarcinomas undergoing curative intent resection between 2011 and 2016 at the Princess Margaret Cancer Centre. Clinico-demographic data were extracted from the electronic health record. Patterns of relapse are classified as nonvisceral (defined as recurrences in the bone, peritoneal or both), visceral (not nonvisceral, including the brain), or both. Time to relapse (TTR) and overall survival (OS) were calculated from date of histologic diagnosis. Results: Of 45 patients with HPGEC, 78% were male, and 91% were non-Asian. Median age was 64.4 years (interquartile range [IQR] 53, 70); 60% were gastroesophageal junction, 24% were gastric, and 16% were esophageal adenocarcinomas; 31% were poorly differentiated tumors while 68% had clinical or pathological node positive disease. Complete R0 resection occurred in 93%, and 84% had received perioperative therapy (31% with perioperative chemotherapy; 40% with pre-operative chemoradiation; 9% with post-operative chemoradiation). With a median follow-up time of 26.0 months. relapse rate of HPGEC at last follow-up was 78%. Among first relapses, 94% were distant, while 6% were local recurrences. Among distant relapses, visceral recurrences occurred in 85%, nonvisceral in 3%, and 12% patients had both visceral and nonvisceral recurrences. None had peritoneal only recurrence. Median TTR was 12.2 months (IQR 8.8, 23.5), while median post-recurrence survival was 9.7 months (IQR 4.7, 16.3). Of the entire cohort, 2-year OS was 53% and 3-year OS was 26%. Conclusions: More than three-quarters of patients with HPGEC experienced recurrence after curative intent multimodality therapy. Our results suggest that HPGEC rarely relapse with peritoneal only disease or local recurrence, thereby calling into question the utility for aggressive surveillance, pending verification from larger cohorts.
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Affiliation(s)
| | | | | | - Peiran Sun
- University of Toronto, Toronto, ON, Canada
| | - Hao-Wen Sim
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Akina Natori
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | | | - Geoffrey Liu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Carol Jane Swallow
- Princess Margaret Cancer Centre/ Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Savtaj Singh Brar
- Princess Margaret Cancer Centre/ Mount Sinai Hospital, Toronto, ON, Canada
| | | | | | | | - Elena Elimova
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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Danson S, Woll P, Edwards J, Blyth K, Fisher P, Roman J, Simpson K, Spavin R, Learmonth K, Conner J. Oncolytic herpesvirus therapy for mesothelioma: A phase I/IIa trial of intrapleural administration of HSV1716 (NCT01721018). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx367.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tuszynski MH, Weidner N, McCormack M, Miller I, Powell H, Conner J. Grafts of Genetically Modified Schwann Cells to the Spinal Cord: Survival, Axon Growth, and Myelination. Cell Transplant 2017; 7:187-96. [PMID: 9588600 DOI: 10.1177/096368979800700213] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Schwann cells naturally support axonal regeneration after injury in the peripheral nervous system, and have also shown a significant, albeit limited, ability to support axonal growth and remyelination after grafting to the central nervous system (CNS). It is possible that Schwann cell-induced axonal growth in the CNS could be substantially increased by genetic manipulation to secrete augmented amounts of neurotrophic factors. To test this hypothesis, cultured primary adult rat Schwann cells were genetically modified using retroviral vectors to produce and secrete high levels of human nerve growth factor (NGF). These cells were then grafted to the midthoracic spinal cords of adult rats. Findings were compared to animals that received grafts of nontransduced Schwann cells. Spinal cord lesions were not placed prior to grafting because the primary aim of this study was to examine features of grafted Schwann cell survival, growth, and effects on host axons. In vitro prior to grafting, Schwann cells secreted 1.5 + 0.1 ng human NGF/ml/106 cells/day. Schwann cell transplants readily survived for 2 wk to 1 yr after in vivo placement. Some NGF-transduced grafts slowly increased in size over time compared to nontransduced grafts; the latter remained stable in size. NGF-transduced transplants were densely penetrated by primary sensory nociceptive axons originating from the dorsolateral fasciculus of the spinal cord, whereas control grafts showed significantly fewer penetrating sensory axons. Over time, Schwann cell grafts also became penetrated by TH- and DBH-labeled axons of putative coerulospinal origin, unlike control cell grafts. Ultrastructurally, axons in both graft types were extensively myelinated by Schwann cells. Grafted animals showed no changes in gross locomotor function. In vivo expression of the human NGF transgene was demonstrated for periods of at least 6 m. These findings demonstrate that primary adult Schwann cells 1) can be transduced to secrete augmented levels of neurotrophic factors, 2) survive grafting to the CNS for prolonged time periods, 3) elicit robust growth of host neurotrophin-responsive axons, 4) myelinate CNS axons, and 5) express the transgene for prolonged time periods in vivo. Some grafts slowly enlarge over time, a feature that may be attributable to the propensity of Schwann cells to immortalize after multiple passages. Transduced Schwann cells merit further study as tools for promoting CNS regeneration.
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Affiliation(s)
- M H Tuszynski
- Department of Neurosciences, University of California-San Diego, La Jolla 92093-0608, USA
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Natori A, Chan BA, Sim HW, Ma LX, Yokom D, Chen EX, Liu G, Darling GE, Swallow CJ, Brar SS, Brierley JD, Ringash J, Wong R, Kim J, Rogalla P, Hafezi-Bakhtiari S, Conner J, Knox JJ, Elimova E, Jang RWJ. Outcomes for patients ≥75 years with localized gastroesophageal cancer: Experience from the Princess Margaret Cancer Centre. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.10037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10037 Background: The optimal treatment and outcome for elderly patients (pts) with localized gastroesophageal (GE) cancer remains unclear as they are underrepresented in clinical trials. We aimed to assess survival in pts ≥75 years according to treatment received. Methods: A retrospective analysis was performed for all pts aged ≥75 years with GE cancer treated in 2012-2014. Frailty was measured using the Charlson comorbidity index (CCI) and ECOG performance status (PS). Overall survival (OS) and disease-free survival (DFS) were assessed via uni- and multivariable Cox proportional hazards regression, adjusting for demographics. Logistic regression analyses were used to examine factors impacting treatment choices. Results: Of 105 pts, median age was 81 years (range: 75-99), primary sites were esophageal (55%, with 43% squamous histology) and gastric (45%). Baseline characteristics included: PS: 0 (31%), 1 (42%), 2 (16%), 3 (10%), 4 (1%); and CCI: 0 (34%), 1 (25%), 2 (19%), ≥3 (22%). Treatment received included radiotherapy alone (RT) (31%); surgery alone (29%); surgery plus adjuvant chemotherapy (chemo) and/or RT (14%); chemoradiation alone (7%) and supportive care (18%). In univariable analyses; age < 85 (p = 0.003), PS < 2 (p = 0.03) and surgery (p < 0.001) were associated with improved OS. Chemo and RT, either alone or in combination, did not significantly improve OS. In multivariable analyses; surgery (HR 0.38, 95% CI 0.21-0.70, p = 0.002) was the only independent predictor for improved OS. Patients with good PS (p = 0.01), gastric disease site (p = 0.01) and adenocarcinoma histology (p = 0.02) were more likely to undergo surgery. Conclusions: At our institution, relatively few pts ≥75 years received multimodality therapy for localized GE cancers. Those pts ≥75 years who underwent surgery had excellent outcomes, but they were well-selected. Comprehensive assessment should be considered for pts ≥75 years with localized GE cancer to ensure optimal treatment selection, particularly given the potential benefit of surgery.
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Affiliation(s)
- Akina Natori
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Bryan Anthony Chan
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Hao-Wen Sim
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | - Eric Xueyu Chen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Geoffrey Liu
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Carol Jane Swallow
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Savtaj Singh Brar
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - James D. Brierley
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Rebecca Wong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - John Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Patrik Rogalla
- Department of Medical Imaging, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | - Jennifer J. Knox
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Elena Elimova
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Raymond Woo-Jun Jang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Natori A, Chan B, Sim HW, Chen EX, Liu G, Darling GE, Swallow CJ, Brar SS, Brierley JD, Ringash J, Wong R, Kim JHJ, Rogalla P, Hafezi-Bakhtiari S, Conner J, Knox JJ, Elimova E, Jang RWJ. Outcomes for patients ≥75 years with localized gastroesophageal cancer: Experience from the Princess Margaret Cancer Centre. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
189 Background: The optimal treatment and outcome for elderly patients (pts) with localized gastroesophageal (GE) cancer remains unclear as they are underrepresented in clinical trials. We aimed to assess survival in pts ≥ 75 years according to treatment received. Methods: A retrospective analysis was performed for all pts aged ≥ 75 years with GE cancer treated in 2012 and 2013. Frailty was measured using the Charlson comorbidity index (CCI) and ECOG performance status (PS). Overall survival (OS) and disease-free survival (DFS) were assessed via uni- and multivariable Cox proportional hazards regression, adjusting for demographics. Logistic regression analyses were used to examine factors impacting treatment choices. Results: Of 70 pts, median age was 82 years (range: 75-98), primary sites were esophageal (40%, with 61% squamous histology), GE junction (24%) and gastric (36%). Baseline characteristics included: PS: 0 (40%), 1 (39%), 2 (14%), 3 (7%); and CCI: 0 (36%), 1 (20%), 2 (21%), ≥ 3 (23%). Treatment received included surgery (33%), radiotherapy (RT) (31%); surgery plus adjuvant chemotherapy (chemo) and/or RT (9%); chemoradiation alone (7%) and 20% had no active treatment. In univariable analysis; age < 85 (p = 0.007) and surgery (p = 0.022) were associated with improved OS. Chemo and RT, either alone or in combination, did not significantly improve OS. In multivariable analysis; age < 85 (HR 0.46, 95% CI: 0.23-0.94, p = 0.034), surgery (HR 0.32, 95% CI: 0.14-0.74, p = 0.008) and CCI < 2 (HR 0.52, 95% CI: 0.27-0.99, p = 0.048) were identified as independent predictors for improved OS. Age ≥ 85 was significantly associated with omission of surgery (OR 3.61, 95% CI: 1.13-14.01, p = 0.041) but in contrast, PS ≥ 2 (p = 0.475) and CCI ≥ 2 (p = 0.939) were not predictive. Conclusions: At our institution, very few pts ≥ 75 years received multimodality therapy for localized GE cancers. Surgery was the only treatment modality associated with a significant survival advantage, and additional chemo and/or RT did not further improve OS. The only predictor for having surgery was age. Consequently, future studies should consider comprehensive assessment for surgery so that eligible elderly pts can benefit.
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Affiliation(s)
- Akina Natori
- Princess Margaret Cancer Centre, University Health Network, Department of Medical Oncology and Hematology, Toronto, ON, Canada
| | - Bryan Chan
- Princess Margaret Cancer Centre, University Health Network, Department of Medical Oncology and Hematology, Toronto, ON, Canada
| | - Hao-Wen Sim
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Eric Xueyu Chen
- Princess Margaret Cancer Centre, University Health Network, Department of Medical Oncology and Hematology, Toronto, ON, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, Department of Medical Oncology, University of Toronto, Toronto, ON, Canada
| | | | - Carol Jane Swallow
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Savtaj Singh Brar
- University of Toronto Princess Margaret Hospital, Toronto, ON, Canada
| | - James D. Brierley
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Rebecca Wong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Joon-Hyung J. Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - James Conner
- Mount Sinai Hospital, University Health Network, Toronto, ON, Canada
| | - Jennifer J. Knox
- Princess Margaret Cancer Centre, University Health Network, Department of Medical Oncology and Hematology, Toronto, ON, Canada
| | - Elena Elimova
- Princess Margaret Cancer Centre, University Health Network, Department of Medical Oncology and Hematology, Toronto, ON, Canada
| | - Raymond Woo-Jun Jang
- Princess Margaret Cancer Centre, University Health Network, Department of Medical Oncology and Hematology, Toronto, ON, Canada
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Sim HW, Chan B, Natori A, Lim CH, Jiang DM, Chen EX, Liu G, Darling GE, Swallow CJ, Brar SS, Brierley JD, Ringash J, Wong R, Kim J, Rogalla P, Hafezi-Bakhtiari S, Conner J, Knox JJ, Jang RWJ, Elimova E. Comparison of chemoradiotherapy (CRT) with carboplatin/paclitaxel (CP) versus cisplatin/5-FU (CF) for esophageal or junctional cancer: Experience from the Princess Margaret Cancer Centre. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
126 Background: The optimal CRT regimen for neoadjuvant or definitive treatment of locoregional esophageal or gastroesophageal junctional (GEJ) cancer is uncertain. There has been no direct comparison between concurrent Cisplatin/5-FU (CF) as per the CALGB 9781 trial (50.4 Gy) or Carboplatin/Paclitaxel (CP) as per the CROSS trial (41.4 Gy). Methods: A retrospective analysis comparing CF and CP was performed in all patients (pts) with locoregional esophageal or GEJ cancer treated in 2012-2014. Overall survival (OS) and disease-free survival (DFS) were assessed via uni- and multivariable Cox proportional hazards regression, adjusting for age, performance status and Charlson comorbidity index. Pathological complete response (pCR) rates were compared using Fisher’s exact test. Results: 64/86 (74%) pts were male. Median age was 64 years (range: 34-84). Primary sites were esophageal (56%, with 60% squamous histology) and GEJ (44%, with 11% squamous). 22 pts received CRT in 2012 (100% CF), 33 pts in 2013 (58% CF, 42% CP) and 31 pts in 2014 (16% CF, 84% CP). Surgery was undertaken in 19 (41%) CF and 27 (68%) CP pts. Median follow-up was 38 months. We found no significant OS difference between CF and CP overall (HR 0.82, 95% CI: 0.43-1.56, p = 0.55) or in the subgroup having surgery (n = 46; HR 2.01, 95% CI: 0.62-6.55, p = 0.25). However, in the subgroup without surgery (n = 40), CF (n = 27) was superior to CP (n = 13)(HR 0.11, 95% CI: 0.03-0.38, p < 0.001). OS was similar by histology (adenocarcinoma/squamous) in all-comers (p = 0.96), and in CF (p = 0.66) and CP subgroups (p = 0.66). DFS results were similar to OS. There was a non-significant numerical difference in pCR rates between CF (31%) and CP (18%) (p = 0.45). Conclusions: Survival is similar for CF and CP CRT regimens in patients undergoing trimodality therapy. pCR rates were comparable but lower than previously reported. In contrast, in the absence of surgical resection, CP given for CRT results in significantly inferior outcomes. Clinicians may prefer CP for surgical candidates given its toxicity profile. However, when treating with definitive CRT, CF may be preferable to CP as a standard regimen.
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Affiliation(s)
- Hao-Wen Sim
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Bryan Chan
- Princess Margaret Cancer Centre, University Health Network, Department of Medical Oncology and Hematology, Toronto, ON, Canada
| | - Akina Natori
- Princess Margaret Cancer Centre, University Health Network, Department of Medical Oncology and Hematology, Toronto, ON, Canada
| | - Charles Henry Lim
- Princess Margaret Cancer Centre, University Health Network, Department of Medical Oncology and Hematology, Toronto, ON, Canada
| | - Di Maria Jiang
- Princess Margaret Cancer Centre, University Health Network, Department of Medical Oncology and Hematology, Toronto, ON, Canada
| | - Eric Xueyu Chen
- Princess Margaret Cancer Centre, University Health Network, Department of Medical Oncology and Hematology, Toronto, ON, Canada
| | - Geoffrey Liu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | - Carol Jane Swallow
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Savtaj Singh Brar
- University of Toronto Princess Margaret Hospital, Toronto, ON, Canada
| | - James D. Brierley
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Rebecca Wong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - John Kim
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - James Conner
- Mount Sinai Hospital, University Health Network, Toronto, ON, Canada
| | - Jennifer J. Knox
- Princess Margaret Cancer Centre, University Health Network, Department of Medical Oncology and Hematology, Toronto, ON, Canada
| | - Raymond Woo-Jun Jang
- Princess Margaret Cancer Centre, University Health Network, Department of Medical Oncology and Hematology, Toronto, ON, Canada
| | - Elena Elimova
- Princess Margaret Cancer Centre, University Health Network, Department of Medical Oncology and Hematology, Toronto, ON, Canada
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Kadoya K, Lu P, Nguyen K, Lee-Kubli C, Kumamaru H, Yao L, Knackert J, Poplawski G, Dulin JN, Strobl H, Takashima Y, Biane J, Conner J, Zhang SC, Tuszynski MH. Spinal cord reconstitution with homologous neural grafts enables robust corticospinal regeneration. Nat Med 2016; 22:479-87. [PMID: 27019328 PMCID: PMC4860037 DOI: 10.1038/nm.4066] [Citation(s) in RCA: 249] [Impact Index Per Article: 31.1] [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: 03/19/2015] [Accepted: 02/12/2016] [Indexed: 02/07/2023]
Abstract
The corticospinal tract (CST) is the most important motor system in humans, yet robust regeneration of this projection after spinal cord injury (SCI) has not been accomplished. In murine models of SCI, we report robust corticospinal axon regeneration, functional synapse formation and improved skilled forelimb function after grafting multipotent neural progenitor cells into sites of SCI. Corticospinal regeneration requires grafts to be driven toward caudalized (spinal cord), rather than rostralized, fates. Fully mature caudalized neural grafts also support corticospinal regeneration. Moreover, corticospinal axons can emerge from neural grafts and regenerate beyond the lesion, a process that is potentially related to the attenuation of the glial scar. Rat corticospinal axons also regenerate into human donor grafts of caudal spinal cord identity. Collectively, these findings indicate that spinal cord 'replacement' with homologous neural stem cells enables robust regeneration of the corticospinal projection within and beyond spinal cord lesion sites, achieving a major unmet goal of SCI research and offering new possibilities for clinical translation.
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Affiliation(s)
- Ken Kadoya
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA.,Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Paul Lu
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA.,Veterans Administration San Diego Healthcare System, San Diego, California, USA
| | - Kenny Nguyen
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Corinne Lee-Kubli
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Hiromi Kumamaru
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Lin Yao
- Waisman Center, University of Wisconsin-Madison, Wisconsin, USA.,Department of Neuroscience, University of Wisconsin-Madison, Wisconsin, USA.,Department of Neurology, University of Wisconsin-Madison, Wisconsin, USA
| | - Joshua Knackert
- Waisman Center, University of Wisconsin-Madison, Wisconsin, USA.,Department of Neuroscience, University of Wisconsin-Madison, Wisconsin, USA.,Department of Neurology, University of Wisconsin-Madison, Wisconsin, USA
| | - Gunnar Poplawski
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Jennifer N Dulin
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Hans Strobl
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Yoshio Takashima
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Jeremy Biane
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - James Conner
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Su-Chun Zhang
- Waisman Center, University of Wisconsin-Madison, Wisconsin, USA
| | - Mark H Tuszynski
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA.,Veterans Administration San Diego Healthcare System, San Diego, California, USA
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Murphy JF, Conner J. Black swans, white swans, and 50 shades of grey: Remembering the lessons learned from catastrophic process safety incidents. Proc Safety Prog 2013. [DOI: 10.1002/prs.11651] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- John F. Murphy
- Process Safety Services; 2304 Kenya Lane Punta Gorda FL 33983
| | - James Conner
- Eiger Consulting, LLC; 15906 El Dorado Oaks Dr. Houston, TX
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Woll P, Danson S, Edwards J, Fisher P, Conner J. 98 Oncolytic virus therapy for mesothelioma – a phase I trial of intrapleural seprehvir. Lung Cancer 2013. [DOI: 10.1016/s0169-5002(13)70098-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cangemi JP, Lazarus H, McQuade T, Fitzgerald J, Conner J, Miller R, Murphree W. Successful leadership practices during turbulent times. Journal of Management Development 2011. [DOI: 10.1108/02621711111098343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeDuring difficult economic times the media often highlight examples of failing or failed business organizations. In some cases the demise of corporations is examined in considerable detail often resulting in the following take‐home messages: these are the sins that have brought about your failure; and if things had been done differently you might still be a viable company. This paper aims to point out success stories from creative leaders who successfully navigated through challenging environments.Design/methodology/approachThe paper draws on existing cases from the literature highlighting leaders who led their organizations to positive ends during turbulent times.FindingsThere are opportunities for company success despite difficult business environments.Originality/valueIt is rare to read about successful leadership practices during turbulent times. Yet, they do exist. The overwhelming number of examples and cases written about, however, are indeed in the negative direction, not the positive.
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Anderson G, Meyer D, Herrman CE, Sheppard C, Murray R, Fox EJ, Mathena J, Conner J, Buck PO. Tolerability and safety of novel half milliliter formulation of glatiramer acetate for subcutaneous injection: an open-label, multicenter, randomized comparative study. J Neurol 2010; 257:1917-23. [PMID: 20953791 PMCID: PMC2977058 DOI: 10.1007/s00415-010-5779-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 08/17/2010] [Accepted: 09/29/2010] [Indexed: 11/29/2022]
Abstract
Daily glatiramer acetate (GA) 20 mg/1.0 mL is a first-line treatment for relapsing-remitting multiple sclerosis (RRMS). To reduce the occurrence of injection pain and local injection site reactions (LISRs), a reduced volume formulation of GA was developed. This study compared pain and LISRs after injecting the marketed and the novel formulations. RRMS patients currently injecting GA participated in this multicenter, randomized, crossover comparative study. All patients administered once-daily subcutaneous injections of GA 20 mg/1.0 mL (marketed formulation) or GA 20 mg/0.5 mL (reduced volume formulation) for 14 days. Patients were crossed-over to the alternate treatment for an additional 14 days. Using a Visual Analog Scale (VAS), patients recorded in daily diaries the severity of injection pain immediately and 5 min post-injection, and the presence and severity of LISRs (swelling, redness, itching, lump) within 5 min and 24 h post-injection. VAS pain scores were ranked significantly lower immediately and 5 min after GA 20 mg/0.5 mL injections (p < 0.0001). Although LISRs were rare for both preparations, the severity of reactions ranked significantly lower and fewer symptoms occurred within 5 min and 24 h of using the reduced volume formulation (p < 0.0001). GA injected subcutaneously in a reduced volume formulation is a more tolerable option.
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Affiliation(s)
- G Anderson
- Associates in Neurology PSC, Suite #200, Lexington, KY 40513, USA.
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48
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Woll P, Edwards J, Danson S, Fisher P, Matthews S, Conner J. Oncolytic virus therapy for mesothelioma – a phase I trial proposal. Lung Cancer 2009. [DOI: 10.1016/s0169-5002(09)70080-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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49
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Conner J, Braidwood L, Brown SM. A strategy for systemic delivery of the oncolytic herpes virus HSV1716: redirected tropism by antibody-binding sites incorporated on the virion surface as a glycoprotein D fusion protein. Gene Ther 2008; 15:1579-92. [PMID: 18701918 DOI: 10.1038/gt.2008.121] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We report on the ability of single-chain variable fragment (scFv) incorporated into the viral envelope to alter the tropism of herpes simplex virus (HSV) 1716. Using recombinant viruses expressing fusion proteins comprising cell-surface antigen-specific scFvs N terminus linked to amino acids 274-393 of gD, we demonstrated that the tropism of these HSV1716 variants was modified such that infection was mediated by the cognate antigen. Thus, an HSV1716 variant that expressed an anti-CD55 scFv targeting moiety linked to these gD residues was able to infect non-permissive Chinese hamster ovary cells expressing CD55 and this infection was specifically blocked by an anti-CD55 monoclonal antibody. Similarly, the infection efficiency of an HSV1716 variant for semi-permissive human leukaemic, CD38-positive cell lines was greatly improved by an anti-CD38 scFv targeting moiety linked to gD residues 274-393, and this enhanced infectivity was abrogated specifically by an anti-CD38 monoclonal antibody. Finally, intravenous/intraperitoneal injection of an HSV1716 variant displaying an anti-epidermal growth factor receptor (EGFR) scFv linked to residues 274-393 of gD enhanced destruction of subcutaneous EGFR-positive tumours in nude mice compared to unmodified HSV1716. Therefore, targeting of HSV1716 oncolysis to specific cell types through the display of entry mediating scFv/gD fusion proteins represents an efficient route for systemic delivery.
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Affiliation(s)
- J Conner
- Crusade Laboratories Ltd, Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland, UK.
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