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Simon BD, Merriman KM, Harmon SA, Tetreault J, Yilmaz EC, Blake Z, Merino MJ, An JY, Marko J, Law YM, Gurram S, Wood BJ, Choyke PL, Pinto PA, Turkbey B. Automated Detection and Grading of Extraprostatic Extension of Prostate Cancer at MRI via Cascaded Deep Learning and Random Forest Classification. Acad Radiol 2024:S1076-6332(24)00220-4. [PMID: 38670874 DOI: 10.1016/j.acra.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
RATIONALE AND OBJECTIVES Extraprostatic extension (EPE) is well established as a significant predictor of prostate cancer aggression and recurrence. Accurate EPE assessment prior to radical prostatectomy can impact surgical approach. We aimed to utilize a deep learning-based AI workflow for automated EPE grading from prostate T2W MRI, ADC map, and High B DWI. MATERIAL AND METHODS An expert genitourinary radiologist conducted prospective clinical assessments of MRI scans for 634 patients and assigned risk for EPE using a grading technique. The training set and held-out independent test set consisted of 507 patients and 127 patients, respectively. Existing deep-learning AI models for prostate organ and lesion segmentation were leveraged to extract area and distance features for random forest classification models. Model performance was evaluated using balanced accuracy, ROC AUCs for each EPE grade, as well as sensitivity, specificity, and accuracy compared to EPE on histopathology. RESULTS A balanced accuracy score of .390 ± 0.078 was achieved using a lesion detection probability threshold of 0.45 and distance features. Using the test set, ROC AUCs for AI-assigned EPE grades 0-3 were 0.70, 0.65, 0.68, and 0.55 respectively. When using EPE≥ 1 as the threshold for positive EPE, the model achieved a sensitivity of 0.67, specificity of 0.73, and accuracy of 0.72 compared to radiologist sensitivity of 0.81, specificity of 0.62, and accuracy of 0.66 using histopathology as the ground truth. CONCLUSION Our AI workflow for assigning imaging-based EPE grades achieves an accuracy for predicting histologic EPE approaching that of physicians. This automated workflow has the potential to enhance physician decision-making for assessing the risk of EPE in patients undergoing treatment for prostate cancer due to its consistency and automation.
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Affiliation(s)
- Benjamin D Simon
- Molecular Imaging Branch, NCI, NIH, Bethesda, Maryland, USA (B.D.S., K.M.M., S.A.H., E.C.Y., P.L.C., B.T.); Institute of Biomedical Engineering, Department Engineering Science, University of Oxford, UK (B.D.S.)
| | - Katie M Merriman
- Molecular Imaging Branch, NCI, NIH, Bethesda, Maryland, USA (B.D.S., K.M.M., S.A.H., E.C.Y., P.L.C., B.T.)
| | - Stephanie A Harmon
- Molecular Imaging Branch, NCI, NIH, Bethesda, Maryland, USA (B.D.S., K.M.M., S.A.H., E.C.Y., P.L.C., B.T.)
| | | | - Enis C Yilmaz
- Molecular Imaging Branch, NCI, NIH, Bethesda, Maryland, USA (B.D.S., K.M.M., S.A.H., E.C.Y., P.L.C., B.T.)
| | - Zoë Blake
- Urology Oncology Branch, NCI, NIH, Bethesda, Maryland, USA (Z.B., S.G., P.A.P.)
| | - Maria J Merino
- Laboratory of Pathology, NCI, NIH, Bethesda, Maryland, USA (M.J.M.)
| | - Julie Y An
- Department of Radiology, University of California, San Diego, California, USA (J.Y.A.)
| | - Jamie Marko
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA (J.M.)
| | - Yan Mee Law
- Department of Radiology, Singapore General Hospital, Singapore (Y.M.L.)
| | - Sandeep Gurram
- Urology Oncology Branch, NCI, NIH, Bethesda, Maryland, USA (Z.B., S.G., P.A.P.)
| | - Bradford J Wood
- Center for Interventional Oncology, NCI, NIH, Bethesda, Maryland, USA (B.J.W.); Department of Radiology, Clinical Center, NIH, Bethesda, Maryland, USA (B.J.W.)
| | - Peter L Choyke
- Molecular Imaging Branch, NCI, NIH, Bethesda, Maryland, USA (B.D.S., K.M.M., S.A.H., E.C.Y., P.L.C., B.T.)
| | - Peter A Pinto
- Urology Oncology Branch, NCI, NIH, Bethesda, Maryland, USA (Z.B., S.G., P.A.P.)
| | - Baris Turkbey
- Molecular Imaging Branch, NCI, NIH, Bethesda, Maryland, USA (B.D.S., K.M.M., S.A.H., E.C.Y., P.L.C., B.T.).
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Ricketts CJ, De Cubas AA, Fan H, Smith CC, Lang M, Reznik E, Bowlby R, Gibb EA, Akbani R, Beroukhim R, Bottaro DP, Choueiri TK, Gibbs RA, Godwin AK, Haake S, Hakimi AA, Henske EP, Hsieh JJ, Ho TH, Kanchi RS, Krishnan B, Kwiatkowski DJ, Liu W, Merino MJ, Mills GB, Myers J, Nickerson ML, Reuter VE, Schmidt LS, Shelley CS, Shen H, Shuch B, Signoretti S, Srinivasan R, Tamboli P, Thomas G, Vincent BG, Vocke CD, Wheeler DA, Yang L, Kim WY, Robertson AG, Spellman PT, Rathmell WK, Linehan WM. The Cancer Genome Atlas Comprehensive Molecular Characterization of Renal Cell Carcinoma. Cell Rep 2024; 43:113063. [PMID: 38578829 DOI: 10.1016/j.celrep.2023.113063] [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: 04/07/2024] Open
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Gelikman DG, Kenigsberg AP, Mee Law Y, Yilmaz EC, Harmon SA, Parikh SH, Hyman JA, Huth H, Koller CR, Nethala D, Hesswani C, Merino MJ, Gurram S, Choyke PL, Wood BJ, Pinto PA, Turkbey B. Evaluating Diagnostic Accuracy and Inter-reader Agreement of the Prostate Imaging After Focal Ablation Scoring System. EUR UROL SUPPL 2024; 62:74-80. [PMID: 38468864 PMCID: PMC10925932 DOI: 10.1016/j.euros.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/13/2024] Open
Abstract
Background and objective Focal therapy (FT) is increasingly recognized as a promising approach for managing localized prostate cancer (PCa), notably reducing treatment-related morbidities. However, post-treatment anatomical changes present significant challenges for surveillance using current imaging techniques. This study aimed to evaluate the inter-reader agreement and efficacy of the Prostate Imaging after Focal Ablation (PI-FAB) scoring system in detecting clinically significant prostate cancer (csPCa) on post-FT multiparametric magnetic resonance imaging (mpMRI). Methods A retrospective cohort study was conducted involving patients who underwent primary FT for localized csPCa between 2013 and 2023, followed by post-FT mpMRI and a prostate biopsy. Two expert genitourinary radiologists retrospectively evaluated post-FT mpMRI using PI-FAB. The key measures included inter-reader agreement of PI-FAB scores, assessed by quadratic weighted Cohen's kappa (κ), and the system's efficacy in predicting in-field recurrence of csPCa, with a PI-FAB score cutoff of 3. Additional diagnostic metrics including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were also evaluated. Key findings and limitations Scans from 38 patients were analyzed, revealing a moderate level of agreement in PI-FAB scoring (κ = 0.56). Both radiologists achieved sensitivity of 93% in detecting csPCa, although specificity, PPVs, NPVs, and accuracy varied. Conclusions and clinical implications The PI-FAB scoring system exhibited high sensitivity with moderate inter-reader agreement in detecting in-field recurrence of csPCa. Despite promising results, its low specificity and PPV necessitate further refinement. These findings underscore the need for larger studies to validate the clinical utility of PI-FAB, potentially aiding in standardizing post-treatment surveillance. Patient summary Focal therapy has emerged as a promising approach for managing localized prostate cancer, but limitations in current imaging techniques present significant challenges for post-treatment surveillance. The Prostate Imaging after Focal Ablation (PI-FAB) scoring system showed high sensitivity for detecting in-field recurrence of clinically significant prostate cancer. However, its low specificity and positive predictive value necessitate further refinement. Larger, more comprehensive studies are needed to fully validate its clinical utility.
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Affiliation(s)
- David G. Gelikman
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexander P. Kenigsberg
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yan Mee Law
- Department of Radiology, Singapore General Hospital, Singapore
| | - Enis C. Yilmaz
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stephanie A. Harmon
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sahil H. Parikh
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason A. Hyman
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Hannah Huth
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Christopher R. Koller
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Daniel Nethala
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Charles Hesswani
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Maria J. Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter L. Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bradford J. Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Yilmaz EC, Lin Y, Belue MJ, Harmon SA, Phelps TE, Merriman KM, Hazen LA, Garcia C, Johnson L, Lay NS, Toubaji A, Merino MJ, Patel KR, Parnes HL, Law YM, Wood BJ, Gurram S, Choyke PL, Pinto PA, Turkbey B. PI-RADS Version 2.0 Versus Version 2.1: Comparison of Prostate Cancer Gleason Grade Upgrade and Downgrade Rates From MRI-Targeted Biopsy to Radical Prostatectomy. AJR Am J Roentgenol 2024; 222:e2329964. [PMID: 37729551 DOI: 10.2214/ajr.23.29964] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
BACKGROUND. Precise risk stratification through MRI/ultrasound (US) fusion-guided targeted biopsy (TBx) can guide optimal prostate cancer (PCa) management. OBJECTIVE. The purpose of this study was to compare PI-RADS version 2.0 (v2.0) and PI-RADS version 2.1 (v2.1) in terms of the rates of International Society of Urological Pathology (ISUP) grade group (GG) upgrade and downgrade from TBx to radical prostatectomy (RP). METHODS. This study entailed a retrospective post hoc analysis of patients who underwent 3-T prostate MRI at a single institution from May 2015 to March 2023 as part of three prospective clinical trials. Trial participants who underwent MRI followed by MRI/US fusion-guided TBx and RP within a 1-year interval were identified. A single genitourinary radiologist performed clinical interpretations of the MRI examinations using PI-RADS v2.0 from May 2015 to March 2019 and PI-RADS v2.1 from April 2019 to March 2023. Upgrade and downgrade rates from TBx to RP were compared using chi-square tests. Clinically significant cancer was defined as ISUP GG2 or greater. RESULTS. The final analysis included 308 patients (median age, 65 years; median PSA density, 0.16 ng/mL2). The v2.0 group (n = 177) and v2.1 group (n = 131) showed no significant difference in terms of upgrade rate (29% vs 22%, respectively; p = .15), downgrade rate (19% vs 21%, p = .76), clinically significant upgrade rate (14% vs 10%, p = .27), or clinically significant downgrade rate (1% vs 1%, p > .99). The upgrade rate and downgrade rate were also not significantly different between the v2.0 and v2.1 groups when stratifying by index lesion PI-RADS category or index lesion zone, as well as when assessed only in patients without a prior PCa diagnosis (all p > .01). Among patients with GG2 or GG3 at RP (n = 121 for v2.0; n = 103 for v2.1), the concordance rate between TBx and RP was not significantly different between the v2.0 and v2.1 groups (53% vs 57%, p = .51). CONCLUSION. Upgrade and downgrade rates from TBx to RP were not significantly different between patients whose MRI examinations were clinically interpreted using v2.0 or v2.1. CLINICAL IMPACT. Implementation of the most recent PI-RADS update did not improve the incongruence in PCa grade assessment between TBx and surgery.
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Affiliation(s)
- Enis C Yilmaz
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Yue Lin
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Mason J Belue
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Stephanie A Harmon
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Tim E Phelps
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Katie M Merriman
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Lindsey A Hazen
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD
- Department of Radiology, Clinical Center, NIH, Bethesda, MD
| | - Charisse Garcia
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD
- Department of Radiology, Clinical Center, NIH, Bethesda, MD
| | - Latrice Johnson
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Nathan S Lay
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Antoun Toubaji
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD
| | - Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - Howard L Parnes
- Division of Cancer Prevention, National Cancer Institute, NIH, Bethesda, MD
| | - Yan Mee Law
- Department of Radiology, Singapore General Hospital, Singapore
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD
- Department of Radiology, Clinical Center, NIH, Bethesda, MD
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
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Merriman KM, Harmon SA, Belue MJ, Yilmaz EC, Blake Z, Lay NS, Phelps TE, Merino MJ, Parnes HL, Law YM, Gurram S, Wood BJ, Choyke PL, Pinto PA, Turkbey B. Comparison of MRI-Based Staging and Pathologic Staging for Predicting Biochemical Recurrence of Prostate Cancer After Radical Prostatectomy. AJR Am J Roentgenol 2023; 221:773-787. [PMID: 37404084 DOI: 10.2214/ajr.23.29609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND. Currently most clinical models for predicting biochemical recurrence (BCR) of prostate cancer (PCa) after radical prostatectomy (RP) incorporate staging information from RP specimens, creating a gap in preoperative risk assessment. OBJECTIVE. The purpose of our study was to compare the utility of presurgical staging information from MRI and postsurgical staging information from RP pathology in predicting BCR in patients with PCa. METHODS. This retrospective study included 604 patients (median age, 60 years) with PCa who underwent prostate MRI before RP from June 2007 to December 2018. A single genitourinary radiologist assessed MRI examinations for extraprostatic extension (EPE) and seminal vesicle invasion (SVI) during clinical interpretations. The utility of EPE and SVI on MRI and RP pathology for BCR prediction was assessed through Kaplan-Meier and Cox proportional hazards analyses. Established clinical BCR prediction models, including the University of California San Francisco Cancer of the Prostate Risk Assessment (UCSF-CAPRA) model and the Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) model, were evaluated in a subset of 374 patients with available Gleason grade groups from biopsy and RP pathology; two CAPRA-MRI models (CAPRA-S model with modifications to replace RP pathologic staging features with MRI staging features) were also assessed. RESULTS. Univariable predictors of BCR included EPE on MRI (HR = 3.6), SVI on MRI (HR = 4.4), EPE on RP pathology (HR = 5.0), and SVI on RP pathology (HR = 4.6) (all p < .001). Three-year BCR-free survival (RFS) rates for patients without versus with EPE were 84% versus 59% for MRI and 89% versus 58% for RP pathology, and 3-year RFS rates for patients without versus with SVI were 82% versus 50% for MRI and 83% versus 54% for RP histology (all p < .001). For patients with T3 disease on RP pathology, 3-year RFS rates were 67% and 41% for patients without and with T3 disease on MRI. AUCs of CAPRA models, including CAPRA-MRI models, ranged from 0.743 to 0.778. AUCs were not significantly different between CAPRA-S and CAPRA-MRI models (p > .05). RFS rates were significantly different between low- and intermediate-risk groups for only CAPRA-MRI models (80% vs 51% and 74% vs 44%; both p < .001). CONCLUSION. Presurgical MRI-based staging features perform comparably to postsurgical pathologic staging features for predicting BCR. CLINICAL IMPACT. MRI staging can preoperatively identify patients at high BCR risk, helping to inform early clinical decision-making. TRIAL REGISTRATION. ClinicalTrials.gov NCT00026884 and NCT02594202.
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Affiliation(s)
- Katie M Merriman
- Molecular Imaging Branch, NCI, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Stephanie A Harmon
- Molecular Imaging Branch, NCI, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Mason J Belue
- Molecular Imaging Branch, NCI, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Enis C Yilmaz
- Molecular Imaging Branch, NCI, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Zoë Blake
- Urologic Oncology Branch, NCI, NIH, Bethesda, MD
| | - Nathan S Lay
- Molecular Imaging Branch, NCI, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Tim E Phelps
- Molecular Imaging Branch, NCI, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | | | | | - Yan Mee Law
- Department of Radiology, Singapore General Hospital, Singapore
| | | | - Bradford J Wood
- Center for Interventional Oncology, NCI, NIH, Bethesda, MD
- Department of Radiology, Clinical Center, NIH, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Branch, NCI, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | | | - Baris Turkbey
- Molecular Imaging Branch, NCI, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
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Belue MJ, Blake Z, Yilmaz EC, Lin Y, Harmon SA, Nemirovsky DR, Enders JJ, Kenigsberg AP, Mendhiratta N, Rothberg M, Toubaji A, Merino MJ, Gurram S, Wood BJ, Choyke PL, Turkbey B, Pinto PA. Is prostatic adenocarcinoma with cribriform architecture more difficult to detect on prostate MRI? Prostate 2023; 83:1519-1528. [PMID: 37622756 PMCID: PMC10840859 DOI: 10.1002/pros.24610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Cribriform (CBFM) pattern on prostate biopsy has been implicated as a predictor for high-risk features, potentially leading to adverse outcomes after definitive treatment. This study aims to investigate whether the CBFM pattern containing prostate cancers (PCa) were associated with false negative magnetic resonance imaging (MRI) and determine the association between MRI and histopathological disease burden. METHODS Patients who underwent multiparametric magnetic resonance imaging (mpMRI), combined 12-core transrectal ultrasound (TRUS) guided systematic (SB) and MRI/US fusion-guided biopsy were retrospectively queried for the presence of CBFM pattern at biopsy. Biopsy cores and lesions were categorized as follows: C0 = benign, C1 = PCa with no CBFM pattern, C2 = PCa with CBFM pattern. Correlation between cancer core length (CCL) and measured MRI lesion dimension were assessed using a modified Pearson correlation test for clustered data. Differences between the biopsy core groups were assessed with the Wilcoxon-signed rank test with clustering. RESULTS Between 2015 and 2022, a total of 131 consecutive patients with CBFM pattern on prostate biopsy and pre-biopsy mpMRI were included. Clinical feature analysis included 1572 systematic biopsy cores (1149 C0, 272 C1, 151 C2) and 736 MRI-targeted biopsy cores (253 C0, 272 C1, 211 C2). Of the 131 patients with confirmed CBFM pathology, targeted biopsy (TBx) alone identified CBFM in 76.3% (100/131) of patients and detected PCa in 97.7% (128/131) patients. SBx biopsy alone detected CBFM in 61.1% (80/131) of patients and PCa in 90.8% (119/131) patients. TBx and SBx had equivalent detection in patients with smaller prostates (p = 0.045). For both PCa lesion groups there was a positive and significant correlation between maximum MRI lesion dimension and CCL (C1 lesions: p < 0.01, C2 lesions: p < 0.001). There was a significant difference in CCL between C1 and C2 lesions for T2 scores of 3 and 5 (p ≤ 0.01, p ≤ 0.01, respectively) and PI-RADS 5 lesions (p ≤ 0.01), with C2 lesions having larger CCL, despite no significant difference in MRI lesion dimension. CONCLUSIONS The extent of disease for CBFM-containing tumors is difficult to capture on mpMRI. When comparing MRI lesions of similar dimensions and PIRADS scores, CBFM-containing tumors appear to have larger cancer yield on biopsy. Proper staging and planning of therapeutic interventions is reliant on accurate mpMRI estimation. Special considerations should be taken for patients with CBFM pattern on prostate biopsy.
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Affiliation(s)
- Mason J. Belue
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Zoë Blake
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Enis C. Yilmaz
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Yue Lin
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Stephanie A. Harmon
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Daniel R. Nemirovsky
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jacob J. Enders
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexander P. Kenigsberg
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Neil Mendhiratta
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael Rothberg
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Antoun Toubaji
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Maria J. Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sandeep Gurram
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Bradford J. Wood
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter L. Choyke
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Crooks DR, Cawthon GM, Fitzsimmons CM, Perez M, Ricketts CJ, Vocke CD, Yang Y, Middelton L, Nielsen D, Schmidt LS, Tandon M, Merino MJ, Ball MW, Meier JL, Batista PJ, Linehan WM. Cryptic splice mutation in the fumarate hydratase gene in patients with clinical manifestations of Hereditary Leiomyomatosis and Renal Cell Cancer. Hum Mol Genet 2023; 32:3135-3145. [PMID: 37561409 PMCID: PMC10630246 DOI: 10.1093/hmg/ddad131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/11/2023] Open
Abstract
Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is an autosomal dominant condition characterized by the development of cutaneous and uterine leiomyomas and risk for development of an aggressive form of papillary renal cell cancer. HLRCC is caused by germline inactivating pathogenic variants in the fumarate hydratase (FH) gene, which encodes the enzyme that catalyzes the interconversion of fumarate and L-malate. We utilized enzyme and protein mobility assays to evaluate the FH enzyme in a cohort of patients who showed clinical manifestations of HLRCC but were negative for known pathogenic FH gene variants. FH enzyme activity and protein levels were decreased by 50% or greater in three family members, despite normal FH mRNA expression levels as measured by quantitative PCR. Direct Nanopore RNA sequencing demonstrated 57 base pairs of retained intron sequence between exons 9 and 10 of polyadenylated FH mRNA in these patients, resulting in a truncated FH protein. Genomic sequencing revealed a heterozygous intronic alteration of the FH gene (chr1: 241498239 T/C) resulting in formation of a splice acceptor site near a polypyrimidine tract, and a uterine fibroid obtained from a patient showed loss of heterozygosity at this site. The same intronic FH variant was identified in an unrelated patient who also showed a clinical phenotype of HLRCC. These data demonstrate that careful clinical assessment as well as biochemical characterization of FH enzyme activity, protein expression, direct RNA sequencing, and genomic DNA sequencing of patient-derived cells can identify pathogenic variants outside of the protein coding regions of the FH gene.
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Affiliation(s)
- Daniel R Crooks
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Bethesda, MD 20892, United States
| | - Geetha Mariah Cawthon
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Bethesda, MD 20892, United States
| | - Christina M Fitzsimmons
- RNA Metabolism and Epitranscriptomics Unit, Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, 9000 Rockville Pike, Bethesda, MD 20892, United States
| | - Minervo Perez
- Chemical Biology Laboratory, National Cancer Institute, 1050 Boyles St., Frederick, MD 21072, United States
| | - Christopher J Ricketts
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Bethesda, MD 20892, United States
| | - Cathy D Vocke
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Bethesda, MD 20892, United States
| | - Ye Yang
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Bethesda, MD 20892, United States
| | - Lindsay Middelton
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Bethesda, MD 20892, United States
| | - Debbie Nielsen
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Bethesda, MD 20892, United States
| | - Laura S Schmidt
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Bethesda, MD 20892, United States
- Basic Science Program, Frederick National Laboratory for Cancer Research, 1050 Boyles St. Frederick, MD 21701, United States
| | - Mayank Tandon
- CCR Collaborative Bioinformatics Resource (CCBR), Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., 1050 Boyles St., Frederick, MD 21072, United States
| | - Maria J Merino
- Translational Surgical Pathology, Laboratory of Pathology Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, United States
| | - Mark W Ball
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Bethesda, MD 20892, United States
| | - Jordan L Meier
- Chemical Biology Laboratory, National Cancer Institute, 1050 Boyles St., Frederick, MD 21072, United States
| | - Pedro J Batista
- RNA Metabolism and Epitranscriptomics Unit, Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, 9000 Rockville Pike, Bethesda, MD 20892, United States
| | - William Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Bethesda, MD 20892, United States
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Li H, Argani P, Halper-Stromberg E, Lotan TL, Merino MJ, Reuter VE, Matoso A. Positive GPNMB Immunostaining Differentiates Renal Cell Carcinoma With Fibromyomatous Stroma Associated With TSC1/2/MTOR Alterations From Others. Am J Surg Pathol 2023; 47:1267-1273. [PMID: 37661807 PMCID: PMC10592185 DOI: 10.1097/pas.0000000000002117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Renal cell carcinoma with fibromyomatous stroma (RCCFMS) include ELOC/TCEB1 -mutated renal cell carcinoma (RCC) and those with TSC1/2 / MTOR alterations. Besides morphologic similarity, most of these tumors is known to be diffusely positive for carbonic anhydrase IX and cytokeratin 7 by immunohistochemistry. We previously showed strong and diffuse expression of GPNMB (glycoprotein nonmetastatic B) in translocation RCC and eosinophilic renal neoplasms with known TSC1/2/MTOR alterations. We retrospectively identified molecularly confirmed cases of TCEB1/ELOC -mutated RCC (7 tumors from 7 patients), and RCCFMS with alterations in TSC1/2/MTOR (6 tumors from 5 patients, 1 patient with tuberous sclerosis syndrome). In addition, we included 7 clear cell papillary renal cell tumors (CCPRCTs) and 8 clear cell RCC, as they can also present morphologic overlap with RCCFMS. Morphologically, RCCs with TSC1/2/MTOR alterations and those with TCEB1/ELOC mutations were indistinguishable and characterized by papillary, nested, or tubular architecture, with tumor cells with clear cytoplasm and low nuclear grade. By immunohistochemistry, cytokeratin 7 was positive in 5/7 (71%) of TCEB1/ELOC -mutated RCCs, 6/6 (100%) of RCCs with TSC1/2/mTOR alterations, and 7/7 (100%) of CCPRCTs ( P =not significant). Carbonic anhydrase IX was positive in 7/7 TCEB1/ELOC -mutated RCCs, 6/6 (100%) of RCCs with TSC1/2/MTOR alterations, and 7/7 (100%) of CCPRCTs ( P =NS). GPNMB was strongly and diffusely positive in all tumors with TSC1/2/MTOR alterations (6/6), while negative in all TCEB1/ELOC -mutated RCCs (0/6), or CCPRCTs (0/7) ( P =0.002). Two of 8 clear cell RCC showed focal weak staining, while 6/8 were negative. In conclusion, the results support the use of GPNMB to distinguish RCCFMS with TSC1/2/MTOR alterations from others with similar morphology.
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Affiliation(s)
- Huili Li
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
| | - Pedram Argani
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
- Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
| | | | - Tamara L. Lotan
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
- Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
| | - Maria J. Merino
- Translational Surgical Pathology, Laboratory of Pathology, National Institutes of health, Bethesda, MD 20892
| | - Victor E. Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10021
| | - Andres Matoso
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
- Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
- Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231
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9
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Enders JJ, Pinto PA, Xu S, Gomella P, Rothberg MB, Noun J, Blake Z, Daneshvar M, Seifabadi R, Nemirovsky D, Hazen L, Garcia C, Li M, Gurram S, Choyke PL, Merino MJ, Toubaji A, Turkbey B, Varble N, Wood BJ. A Novel Magnetic Resonance Imaging/Ultrasound Fusion Prostate Biopsy Technique Using Transperineal Ultrasound: An Initial Experience. Urology 2023; 181:76-83. [PMID: 37572884 DOI: 10.1016/j.urology.2023.06.036] [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] [Received: 04/11/2023] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE To report an initial experience with a novel, "fully" transperineal (TP) prostate fusion biopsy using an unconstrained ultrasound transducer placed on the perineal skin to guide biopsy needles inserted via a TP approach. METHODS Conventional TP prostate biopsies for detection of prostate cancer have been performed with transrectal ultrasound, requiring specialized hardware, imposing limitations on needle trajectory, and contributing to patient discomfort. Seventy-six patients with known or suspected prostate cancer underwent 78 TP biopsy sessions in an academic center between June 2018 and April 2022 and were included in this study. These patients underwent TP prostate fusion biopsy using a grid or freehand device with transrectal ultrasound as well as TP prostate fusion biopsy using TP ultrasound in the same session. Per-session and per-lesion cancer detection rates were compared for conventional and fully TP biopsies using Fisher exact and McNemar's tests. RESULTS After a refinement period in 30 patients, 92 MRI-visible prostate lesions were sampled in 46 subsequent patients, along with repeat biopsies in 2 of the 30 patients from the refinement period. Grade group ≥2 cancer was diagnosed in 24/92 lesions (26%) on conventional TP biopsy (17 lesions with grid, 7 with freehand device), and in 25/92 lesions (27%) on fully TP biopsy (P = 1.00), with a 73/92 (79%) rate of agreement for grade group ≥2 cancer between the two methods. CONCLUSION Fully TP biopsy is feasible and may detect prostate cancer with detection rates comparable to conventional TP biopsy.
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Affiliation(s)
- Jacob J Enders
- Center for Interventional Oncology, National Institutes of Health, Bethesda, MD; Urologic Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, MD
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, MD
| | - Sheng Xu
- Center for Interventional Oncology, National Institutes of Health, Bethesda, MD
| | - Patrick Gomella
- Urologic Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, MD
| | - Michael B Rothberg
- Urologic Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, MD
| | - Jibriel Noun
- Urologic Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, MD
| | - Zoe Blake
- Urologic Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, MD
| | - Michael Daneshvar
- Urologic Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, MD
| | - Reza Seifabadi
- Center for Interventional Oncology, National Institutes of Health, Bethesda, MD
| | - Daniel Nemirovsky
- Urologic Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, MD
| | - Lindsey Hazen
- Center for Interventional Oncology, National Institutes of Health, Bethesda, MD
| | - Charisse Garcia
- Center for Interventional Oncology, National Institutes of Health, Bethesda, MD
| | - Ming Li
- Center for Interventional Oncology, National Institutes of Health, Bethesda, MD
| | - Sandeep Gurram
- Center for Interventional Oncology, National Institutes of Health, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Antoun Toubaji
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Nicole Varble
- Center for Interventional Oncology, National Institutes of Health, Bethesda, MD; Philips Research North America, Cambridge, MA
| | - Bradford J Wood
- Center for Interventional Oncology, National Institutes of Health, Bethesda, MD; Urologic Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, MD; National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD.
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10
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Yilmaz EC, Harmon SA, Belue MJ, Merriman KM, Phelps TE, Lin Y, Garcia C, Hazen L, Patel KR, Merino MJ, Wood BJ, Choyke PL, Pinto PA, Citrin DE, Turkbey B. Evaluation of a Deep Learning-based Algorithm for Post-Radiotherapy Prostate Cancer Local Recurrence Detection Using Biparametric MRI. Eur J Radiol 2023; 168:111095. [PMID: 37717420 PMCID: PMC10615746 DOI: 10.1016/j.ejrad.2023.111095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To evaluate a biparametric MRI (bpMRI)-based artificial intelligence (AI) model for the detection of local prostate cancer (PCa) recurrence in patients with radiotherapy history. MATERIALS AND METHODS This study included post-radiotherapy patients undergoing multiparametric MRI and subsequent MRI/US fusion-guided and/or systematic biopsy. Histopathology results were used as ground truth. The recurrent cancer detection sensitivity of a bpMRI-based AI model, which was developed on a large dataset to primarily identify lesions in treatment-naïve patients, was compared to a prospective radiologist assessment using the Wald test. Subanalysis was conducted on patients stratified by the treatment modality (external beam radiation treatment [EBRT] and brachytherapy) and the prostate volume quartiles. RESULTS Of the 62 patients included (median age = 70 years; median PSA = 3.51 ng/ml; median prostate volume = 27.55 ml), 56 recurrent PCa foci were identified within 46 patients. The AI model detected 40 lesions in 35 patients. The AI model performance was lower than the prospective radiology interpretation (Rad) on a patient-(AI: 76.1% vs. Rad: 91.3%, p = 0.02) and lesion-level (AI: 71.4% vs. Rad: 87.5%, p = 0.01). The mean number of false positives per patient was 0.35 (range: 0-2). The AI model performance was higher in EBRT group both on patient-level (EBRT: 81.5% [22/27] vs. brachytherapy: 68.4% [13/19]) and lesion-level (EBRT: 79.4% [27/34] vs. brachytherapy: 59.1% [13/22]). In patients with gland volumes >34 ml (n = 25), detection sensitivities were 100% (11/11) and 94.1% (16/17) on patient- and lesion-level, respectively. CONCLUSION The reported bpMRI-based AI model detected the majority of locally recurrent prostate cancer after radiotherapy. Further testing including external validation of this model is warranted prior to clinical implementation.
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Affiliation(s)
- Enis C Yilmaz
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Stephanie A Harmon
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Mason J Belue
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Katie M Merriman
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Tim E Phelps
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Yue Lin
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Charisse Garcia
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States; Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Lindsey Hazen
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States; Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States; Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States; Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, MD, United States.
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11
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Lin Y, Belue MJ, Yilmaz EC, Harmon SA, An J, Law YM, Hazen L, Garcia C, Merriman KM, Phelps TE, Lay NS, Toubaji A, Merino MJ, Wood BJ, Gurram S, Choyke PL, Pinto PA, Turkbey B. Deep Learning-Based T2-weighted MR Image Quality Assessment and Its Impact on Prostate Cancer Detection Rates. J Magn Reson Imaging 2023:10.1002/jmri.29031. [PMID: 37811666 PMCID: PMC11001787 DOI: 10.1002/jmri.29031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Image quality evaluation of prostate MRI is important for successful implementation of MRI into localized prostate cancer diagnosis. PURPOSE To examine the impact of image quality on prostate cancer detection using an in-house previously developed artificial intelligence (AI) algorithm. STUDY TYPE Retrospective. SUBJECTS 615 consecutive patients (median age 67 [interquartile range [IQR]: 61-71] years) with elevated serum PSA (median PSA 6.6 [IQR: 4.6-9.8] ng/mL) prior to prostate biopsy. FIELD STRENGTH/SEQUENCE 3.0T/T2-weighted turbo-spin-echo MRI, high b-value echo-planar diffusion-weighted imaging, and gradient recalled echo dynamic contrast-enhanced. ASSESSMENTS Scans were prospectively evaluated during clinical readout using PI-RADSv2.1 by one genitourinary radiologist with 17 years of experience. For each patient, T2-weighted images (T2WIs) were classified as high-quality or low-quality based on evaluation of both general distortions (eg, motion, distortion, noise, and aliasing) and perceptual distortions (eg, obscured delineation of prostatic capsule, prostatic zones, and excess rectal gas) by a previously developed in-house AI algorithm. Patients with PI-RADS category 1 underwent 12-core ultrasound-guided systematic biopsy while those with PI-RADS category 2-5 underwent combined systematic and targeted biopsies. Patient-level cancer detection rates (CDRs) were calculated for clinically significant prostate cancer (csPCa, International Society of Urological Pathology Grade Group ≥2) by each biopsy method and compared between high- and low-quality images in each PI-RADS category. STATISTICAL TESTS Fisher's exact test. Bootstrap 95% confidence intervals (CI). A P value <0.05 was considered statistically significant. RESULTS 385 (63%) T2WIs were classified as high-quality and 230 (37%) as low-quality by AI. Targeted biopsy with high-quality T2WIs resulted in significantly higher clinically significant CDR than low-quality images for PI-RADS category 4 lesions (52% [95% CI: 43-61] vs. 32% [95% CI: 22-42]). For combined biopsy, there was no significant difference in patient-level CDRs for PI-RADS 4 between high- and low-quality T2WIs (56% [95% CI: 47-64] vs. 44% [95% CI: 34-55]; P = 0.09). DATA CONCLUSION Higher quality T2WIs were associated with better targeted biopsy clinically significant cancer detection performance for PI-RADS 4 lesions. Combined biopsy might be needed when T2WI is lower quality. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Yue Lin
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mason J. Belue
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Enis C. Yilmaz
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Stephanie A. Harmon
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Julie An
- Department of Radiology, University of California San Diego, San Diego, CA
| | - Yan Mee Law
- Department of Radiology Singapore General Hospital, Singapore
| | - Lindsey Hazen
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, MD
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Charisse Garcia
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, MD
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Katie M. Merriman
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Tim E. Phelps
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Nathan S. Lay
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Antoun Toubaji
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Maria J. Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bradford J. Wood
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, MD
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter L. Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
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12
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Schmidt LS, Vocke CD, Ricketts CJ, Blake Z, Choo KK, Nielsen D, Gautam R, Crooks DR, Reynolds KL, Krolus JL, Bashyal M, Karim B, Cowen EW, Malayeri AA, Merino MJ, Srinivasan R, Ball MW, Zbar B, Marston Linehan W. PRDM10 RCC: A Birt-Hogg-Dubé-like Syndrome Associated With Lipoma and Highly Penetrant, Aggressive Renal Tumors Morphologically Resembling Type 2 Papillary Renal Cell Carcinoma. Urology 2023; 179:58-70. [PMID: 37331486 PMCID: PMC10592549 DOI: 10.1016/j.urology.2023.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 03/14/2023] [Accepted: 04/10/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE To characterize the clinical manifestations and genetic basis of a familial cancer syndrome in patients with lipomas and Birt-Hogg-Dubé-like clinical manifestations including fibrofolliculomas and trichodiscomas and kidney cancer. METHODS Genomic analysis of blood and renal tumor DNA was performed. Inheritance pattern, phenotypic manifestations, and clinical and surgical management were documented. Cutaneous, subcutaneous, and renal tumor pathologic features were characterized. RESULTS Affected individuals were found to be at risk for a highly penetrant and lethal form of bilateral, multifocal papillary renal cell carcinoma. Whole genome sequencing identified a germline pathogenic variant in PRDM10 (c.2029 T>C, p.Cys677Arg), which cosegregated with disease. PRDM10 loss of heterozygosity was identified in kidney tumors. PRDM10 was predicted to abrogate expression of FLCN, a transcriptional target of PRDM10, which was confirmed by tumor expression of GPNMB, a TFE3/TFEB target and downstream biomarker of FLCN loss. In addition, a sporadic papillary RCC from the TCGA cohort was identified with a somatic PRDM10 mutation. CONCLUSION We identified a germline PRDM10 pathogenic variant in association with a highly penetrant, aggressive form of familial papillary RCC, lipomas, and fibrofolliculomas/trichodiscomas. PRDM10 loss of heterozygosity and elevated GPNMB expression in renal tumors indicate that PRDM10 alteration leads to reduced FLCN expression, driving TFE3-induced tumor formation. These findings suggest that individuals with Birt-Hogg-Dubé-like manifestations and subcutaneous lipomas, but without a germline pathogenic FLCN variant, should be screened for germline PRDM10 variants. Importantly, kidney tumors identified in patients with a pathogenic PRDM10 variant should be managed with surgical resection instead of active surveillance.
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Affiliation(s)
- Laura S Schmidt
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; Basic Science Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Cathy D Vocke
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Christopher J Ricketts
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Zoë Blake
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Kristin K Choo
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Deborah Nielsen
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Rabindra Gautam
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Daniel R Crooks
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Krista L Reynolds
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Janis L Krolus
- Molecular Histopathology Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Meena Bashyal
- Molecular Histopathology Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Baktiar Karim
- Molecular Histopathology Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Edward W Cowen
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Ashkan A Malayeri
- Radiology and Imaging Sciences, Clinical Research Center, National Institutes of Health, Bethesda, MD
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Ramaprasad Srinivasan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mark W Ball
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Berton Zbar
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
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Lay N, Anari PY, Chaurasia A, Firouzabadi FD, Harmon S, Turkbey E, Gautam R, Samimi S, Merino MJ, Ball MW, Linehan WM, Turkbey B, Malayeri AA. Deep learning-based decision forest for hereditary clear cell renal cell carcinoma segmentation on MRI. Med Phys 2023; 50:5020-5029. [PMID: 36855860 PMCID: PMC10683486 DOI: 10.1002/mp.16303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/15/2022] [Accepted: 01/04/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND von Hippel-Lindau syndrome (VHL) is an autosomal dominant hereditary syndrome with an increased predisposition of developing numerous cysts and tumors, almost exclusively clear cell renal cell carcinoma (ccRCC). Considering the lifelong surveillance in such patients to monitor the disease, patients with VHL are preferentially imaged using MRI to eliminate radiation exposure. PURPOSE Segmentation of kidney and tumor structures on MRI in VHL patients is useful in lesion characterization (e.g., cyst vs. tumor), volumetric lesion analysis, and tumor growth prediction. However, automated tasks such as ccRCC segmentation on MRI is sparsely studied. We develop segmentation methodology for ccRCC on T1 weighted precontrast, corticomedullary, nephrogenic, and excretory contrast phase MRI. METHODS We applied a new neural network approache using a novel differentiable decision forest, called hinge forest (HF), to segment kidney parenchyma, cyst, and ccRCC tumors in 117 images from 115 patients. This data set represented an unprecedented 504 ccRCCs with 1171 cystic lesions obtained at five different MRI scanners. The HF architecture was compared with U-Net on 10 randomized splits with 75% used for training and 25% used for testing. Both methods were trained with Adam using default parameters (α = 0.001 , β 1 = 0.9 , β 2 = 0.999 $\alpha = 0.001,\ \beta _1 = 0.9,\ \beta _2 = 0.999$ ) over 1000 epochs. We further demonstrated some interpretability of our HF method by exploiting decision tree structure. RESULTS The HF achieved an average kidney, cyst, and tumor Dice similarity coefficient (DSC) of 0.75 ± 0.03, 0.44 ± 0.05, 0.53 ± 0.04, respectively, while U-Net achieved an average kidney, cyst, and tumor DSC of 0.78 ± 0.02, 0.41 ± 0.04, 0.46 ± 0.05, respectively. The HF significantly outperformed U-Net on tumors while U-Net significantly outperformed HF when segmenting kidney parenchymas (α < 0.01 $\alpha < 0.01$ ). CONCLUSIONS For the task of ccRCC segmentation, the HF can offer better segmentation performance compared to the traditional U-Net architecture. The leaf maps can glean hints about deep learning features that might prove to be useful in other automated tasks such as tumor characterization.
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Affiliation(s)
- Nathan Lay
- Artificial Intelligence Resource, Molecular Imaging Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Pouria Yazdian Anari
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Aditi Chaurasia
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Stephanie Harmon
- Artificial Intelligence Resource, Molecular Imaging Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Evrim Turkbey
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Rabindra Gautam
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Safa Samimi
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Maria J. Merino
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Mark W. Ball
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - William Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Baris Turkbey
- Artificial Intelligence Resource, Molecular Imaging Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Ashkan A. Malayeri
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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Caamaño JN, Santiago-Moreno J, Martínez-Pastor F, Tamargo C, Salman A, Fernández Á, Merino MJ, Lacalle E, Toledano-Díaz A, Hidalgo CO. Use of the flavonoid taxifolin for sperm cryopreservation from the threatened Bermeya goat breed. Theriogenology 2023; 206:18-27. [PMID: 37172535 DOI: 10.1016/j.theriogenology.2023.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/24/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
Taxifolin is a plant flavonoid effective as an antioxidant. This study aimed to assess the effect of adding taxifolin to the semen extender during the cooling period before freezing on the overall post-thawing sperm variables of Bermeya goats. In the first experiment, a dose-response experiment was performed with four experimental groups: Control, 10, 50, and 100 μg/ml of taxifolin using semen from 8 Bermeya males. In the second experiment, semen from 7 Bermeya bucks was collected and extended at 20 °C using a Tris-citric acid-glucose medium supplemented with different concentrations of taxifolin and glutathione (GSH): control, 5 μM taxifolin, 1 mM GSH, and both antioxidants. In both experiments, two straws per buck were thawed in a water bath (37 °C, 30 s), pooled, and incubated at 38 °C. Motility (CASA) was assessed at 0, 2, and 5 h, and sperm physiology was assessed at 0 and 5 h by flow cytometry (viability, intact acrosome membrane, mitochondria membrane potential, capacitation, intracellular reactive oxygen species -ROS-, mitochondrial superoxide, and chromatin status). In experiment 2, an artificial insemination trial (AI) was included with 29 goats for testing the taxifolin 5-μM treatment on fertility. Data were analyzed with the R statistical environment using linear mixed-effects models. In experiment 1 and compared to the control, T10 increased progressive motility (P < 0.001) but taxifolin decreased total and progressive motility at higher concentrations (P < 0.001), both post-thawing and after the incubation. Viability decreased post-thawing in the three concentrations (P < 0.001). Cytoplasmic ROS decreased at 0 and 5 h at T10 (P = 0.049), and all doses decreased mitochondrial superoxide post-thawing (P = 0.024). In experiment 2, 5 μM taxifolin or 1 mM GSH (alone or combined) increased total and progressive motility vs. the control (P < 0.01), and taxifolin increased kinematic parameters such as VCL, ALH, and DNC (P < 0.05). Viability was not affected by taxifolin in this experiment. Both antioxidants did not significantly affect other sperm physiology parameters. The incubation significantly affected all the parameters (P < 0.004), overall decreasing sperm quality. Fertility after artificial insemination with doses supplemented with 5 μM taxifolin was 76.9% (10/13), not significantly different from the control group (69.2%, 9/13). In conclusion, taxifolin showed a lack of toxicity in the low micromolar range and could benefit goat semen cryopreservation.
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Affiliation(s)
- J N Caamaño
- Department of Animal Selection and Reproduction, Regional Service for Agrifood Research and Development (SERIDA), Gijón, Asturias, Spain.
| | | | - F Martínez-Pastor
- INDEGSAL, Universidad de León, León, Spain; Molecular Biology (Cell Biology), Universidad de León, León, Spain
| | - C Tamargo
- Department of Animal Selection and Reproduction, Regional Service for Agrifood Research and Development (SERIDA), Gijón, Asturias, Spain
| | - A Salman
- INDEGSAL, Universidad de León, León, Spain
| | - Á Fernández
- Department of Animal Selection and Reproduction, Regional Service for Agrifood Research and Development (SERIDA), Gijón, Asturias, Spain
| | - M J Merino
- Department of Animal Selection and Reproduction, Regional Service for Agrifood Research and Development (SERIDA), Gijón, Asturias, Spain
| | - E Lacalle
- INDEGSAL, Universidad de León, León, Spain
| | | | - C O Hidalgo
- Department of Animal Selection and Reproduction, Regional Service for Agrifood Research and Development (SERIDA), Gijón, Asturias, Spain
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Yilmaz EC, Shih JH, Belue MJ, Harmon SA, Phelps TE, Garcia C, Hazen LA, Toubaji A, Merino MJ, Gurram S, Choyke PL, Wood BJ, Pinto PA, Turkbey B. Prospective Evaluation of PI-RADS Version 2.1 for Prostate Cancer Detection and Investigation of Multiparametric MRI-derived Markers. Radiology 2023; 307:e221309. [PMID: 37129493 DOI: 10.1148/radiol.221309] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Background Data regarding the prospective performance of Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 alone and in combination with quantitative MRI features for prostate cancer detection is limited. Purpose To assess lesion-based clinically significant prostate cancer (csPCa) rates in different PI-RADS version 2.1 categories and to identify MRI features that could improve csPCa detection. Materials and Methods This single-center prospective study included men with suspected or known prostate cancer who underwent multiparametric MRI and MRI/US-guided biopsy from April 2019 to December 2021. MRI scans were prospectively evaluated using PI-RADS version 2.1. Atypical transition zone (TZ) nodules were upgraded to category 3 if marked diffusion restriction was present. Lesions with an International Society of Urological Pathology (ISUP) grade of 2 or higher (range, 1-5) were considered csPCa. MRI features, including three-dimensional diameter, relative lesion volume (lesion volume divided by prostate volume), sphericity, and surface to volume ratio (SVR), were obtained from lesion contours delineated by the radiologist. Univariable and multivariable analyses were conducted at the lesion and participant levels to determine features associated with csPCa. Results In total, 454 men (median age, 67 years [IQR, 62-73 years]) with 838 lesions were included. The csPCa rates for lesions categorized as PI-RADS 1 (n = 3), 2 (n = 170), 3 (n = 197), 4 (n = 319), and 5 (n = 149) were 0%, 9%, 14%, 37%, and 77%, respectively. csPCa rates of PI-RADS 4 lesions were lower than PI-RADS 5 lesions (P < .001) but higher than PI-RADS 3 lesions (P < .001). Upgraded PI-RADS 3 TZ lesions were less likely to harbor csPCa compared with their nonupgraded counterparts (4% [one of 26] vs 20% [20 of 99], P = .02). Predictors of csPCa included relative lesion volume (odds ratio [OR], 1.6; P < .001), SVR (OR, 6.2; P = .02), and extraprostatic extension (EPE) scores of 2 (OR, 9.3; P < .001) and 3 (OR, 4.1; P = .02). Conclusion The rates of csPCa differed between consecutive PI-RADS categories of 3 and higher. MRI features, including lesion volume, shape, and EPE scores of 2 and 3, predicted csPCa. Upgrading of PI-RADS category 3 TZ lesions may result in unnecessary biopsies. ClinicalTrials.gov registration no. NCT03354416 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Goh in this issue.
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Affiliation(s)
- Enis C Yilmaz
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P., P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.), Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892
| | - Joanna H Shih
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P., P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.), Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892
| | - Mason J Belue
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P., P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.), Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892
| | - Stephanie A Harmon
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P., P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.), Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892
| | - Tim E Phelps
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P., P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.), Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892
| | - Charisse Garcia
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P., P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.), Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892
| | - Lindsey A Hazen
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P., P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.), Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892
| | - Antoun Toubaji
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P., P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.), Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892
| | - Maria J Merino
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P., P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.), Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892
| | - Sandeep Gurram
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P., P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.), Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892
| | - Peter L Choyke
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P., P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.), Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892
| | - Bradford J Wood
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P., P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.), Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892
| | - Peter A Pinto
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P., P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.), Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892
| | - Baris Turkbey
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P., P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.), Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892
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Lang M, Schmidt LS, Wilson KM, Ricketts CJ, Sourbier C, Vocke CD, Wei D, Crooks DR, Yang Y, Gibbs BK, Zhang X, Klumpp-Thomas C, Chen L, Guha R, Ferrer M, McKnight C, Itkin Z, Wangsa D, Wangsa D, James A, Difilippantonio S, Karim B, Morís F, Ried T, Merino MJ, Srinivasan R, Thomas CJ, Linehan WM. High-throughput and targeted drug screens identify pharmacological candidates against MiT-translocation renal cell carcinoma. J Exp Clin Cancer Res 2023; 42:99. [PMID: 37095531 PMCID: PMC10127337 DOI: 10.1186/s13046-023-02667-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/06/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND MiT-Renal Cell Carcinoma (RCC) is characterized by genomic translocations involving microphthalmia-associated transcription factor (MiT) family members TFE3, TFEB, or MITF. MiT-RCC represents a specific subtype of sporadic RCC that is predominantly seen in young patients and can present with heterogeneous histological features making diagnosis challenging. Moreover, the disease biology of this aggressive cancer is poorly understood and there is no accepted standard of care therapy for patients with advanced disease. Tumor-derived cell lines have been established from human TFE3-RCC providing useful models for preclinical studies. METHODS TFE3-RCC tumor derived cell lines and their tissues of origin were characterized by IHC and gene expression analyses. An unbiased high-throughput drug screen was performed to identify novel therapeutic agents for treatment of MiT-RCC. Potential therapeutic candidates were validated in in vitro and in vivo preclinical studies. Mechanistic assays were conducted to confirm the on-target effects of drugs. RESULTS The results of a high-throughput small molecule drug screen utilizing three TFE3-RCC tumor-derived cell lines identified five classes of agents with potential pharmacological efficacy, including inhibitors of phosphoinositide-3-kinase (PI3K) and mechanistic target of rapamycin (mTOR), and several additional agents, including the transcription inhibitor Mithramycin A. Upregulation of the cell surface marker GPNMB, a specific MiT transcriptional target, was confirmed in TFE3-RCC and evaluated as a therapeutic target using the GPNMB-targeted antibody-drug conjugate CDX-011. In vitro and in vivo preclinical studies demonstrated efficacy of the PI3K/mTOR inhibitor NVP-BGT226, Mithramycin A, and CDX-011 as potential therapeutic options for treating advanced MiT-RCC as single agents or in combination. CONCLUSIONS The results of the high-throughput drug screen and validation studies in TFE3-RCC tumor-derived cell lines have provided in vitro and in vivo preclinical data supporting the efficacy of the PI3K/mTOR inhibitor NVP-BGT226, the transcription inhibitor Mithramycin A, and GPNMB-targeted antibody-drug conjugate CDX-011 as potential therapeutic options for treating advanced MiT-RCC. The findings presented here should provide the basis for designing future clinical trials for patients with MiT-driven RCC.
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Affiliation(s)
- Martin Lang
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, 39100, Italy
| | - Laura S Schmidt
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Basic Science Program, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Kelli M Wilson
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences (NCATS), Bethesda, MD, USA
| | - Christopher J Ricketts
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Carole Sourbier
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Cathy D Vocke
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Darmood Wei
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Daniel R Crooks
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Youfeng Yang
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Benjamin K Gibbs
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Xiaohu Zhang
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences (NCATS), Bethesda, MD, USA
| | - Carleen Klumpp-Thomas
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences (NCATS), Bethesda, MD, USA
| | - Lu Chen
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences (NCATS), Bethesda, MD, USA
| | - Rajarshi Guha
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences (NCATS), Bethesda, MD, USA
| | - Marc Ferrer
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences (NCATS), Bethesda, MD, USA
| | - Crystal McKnight
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences (NCATS), Bethesda, MD, USA
| | - Zina Itkin
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences (NCATS), Bethesda, MD, USA
| | - Darawalee Wangsa
- Genetics Branch, Cancer Genomics Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Danny Wangsa
- Genetics Branch, Cancer Genomics Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amy James
- Laboratory of Animal Sciences Program, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Simone Difilippantonio
- Laboratory of Animal Sciences Program, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Baktir Karim
- Laboratory of Animal Sciences Program, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Francisco Morís
- EntreChem SL, Vivero Ciencias de la Salud, Calle Colegio Santo Domingo Guzmán, Oviedo, AS, 33011, Spain
| | - Thomas Ried
- Genetics Branch, Cancer Genomics Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ramaprasad Srinivasan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Craig J Thomas
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences (NCATS), Bethesda, MD, USA
| | - W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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Akbulut D, Ball M, Raffeld M, Linehan M, Merino MJ. Abstract 1518: Benign oncocytic tumors in the setting of HLRCC syndrome. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-1518] [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: 04/07/2023]
Abstract
Abstract
Background: Renal cell carcinomas developing in patients with HLRCC syndrome are known to be aggressive single tumors of variable sizes, with a well-established morphology. Other morphological tumor types occurring in association with classic HLRCC tumors as independent neoplasias in this syndrome, have not been clearly recognized and described. We describe four patients with known HLRCC syndrome with confirmed germ line mutation who developed benign oncocytic renal tumors. Since HLRCC can also be oncocytic in many instances, it is important to be aware of the possible benign oncocytic tumors in this patient group.
Design: Four patients with known positive germ line FH mutation and known HLRCC syndrome developed associated or new oncocytic tumors. All tumors were morphologically evaluated, IHC staining was done for FH, 2SC, CKIT, CK7, PAX8 and molecular studies were performed with TSO-500 for the evaluation of other genes. Clinicopathological correlation was done in all cases.
Results: The tumors had been identified radiologically and were suspicious for malignancy. Age range was 37-73 years, and all the patients were female. Two patients had coexistent HLRCC cancers while two only had the oncocytomas. Localization was left kidney for all the masses, which were brown in color and well circumscribed and varied in size from 0.7 to 4 cm. In one patient, four separate masses were identified with different locations and sizes, but with the same morphology. This specific patient presented with two additional masses in the opposite kidney later. Tumors were composed of large oncocytic cells with prominent granular eosinophilic cytoplasm and dark pyknotic nuclei. No evidence of atypia, mitosis or necrosis was found. FH was positive, 2SC and CK7 were negative on IHC stains, whereas CKIT showed diffuse membranous positivity. Tumors were diagnosed as oncocytomas. All patients were positive for FH germ line mutation and the mutation was also identified in the tissues. Other molecular studies on the patient with multiple tumors showed additional pathogenic ERCC2 inactivating mutation, suggesting germline, which is rarely encountered in kidney tumors. All the patients are alive and free of disease up to 10 years after diagnosis.
Conclusion: HLRCC cancers can have a variety of morphologic patterns and frequently have oncocytic features. Clinical information, genetic testing and special techniques are helpful in the diagnosis of these high-grade tumors. Recognizing that other benign indolent tumors with oncocytic features can occur in this syndrome is important to avoid errors in diagnosis and treatment.
Citation Format: Dilara Akbulut, Mark Ball, Mark Raffeld, Marston Linehan, Maria J. Merino. Benign oncocytic tumors in the setting of HLRCC syndrome [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1518.
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Affiliation(s)
| | - Mark Ball
- 1National Cancer Institute, Bethesda, MD
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18
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Di Malta C, Zampelli A, Granieri L, Vilardo C, De Cegli R, Cinque L, Nusco E, Pece S, Tosoni D, Sanguedolce F, Sorrentino NC, Merino MJ, Nielsen D, Srinivasan R, Ball MW, Ricketts CJ, Vocke CD, Lang M, Karim B, Lanfrancone L, Schmidt LS, Linehan WM, Ballabio A. TFEB
and
TFE3
drive kidney cystogenesis and tumorigenesis. EMBO Mol Med 2023; 15:e16877. [PMID: 36987696 PMCID: PMC10165358 DOI: 10.15252/emmm.202216877] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/30/2023] Open
Abstract
Birt-Hogg-Dubé (BHD) syndrome is an inherited familial cancer syndrome characterized by the development of cutaneous lesions, pulmonary cysts, renal tumors and cysts and caused by loss-of-function pathogenic variants in the gene encoding the tumor-suppressor protein folliculin (FLCN). FLCN acts as a negative regulator of TFEB and TFE3 transcription factors, master controllers of lysosomal biogenesis and autophagy, by enabling their phosphorylation by the mechanistic Target Of Rapamycin Complex 1 (mTORC1). We have previously shown that deletion of Tfeb rescued the renal cystic phenotype of kidney-specific Flcn KO mice. Using Flcn/Tfeb/Tfe3 double and triple KO mice, we now show that both Tfeb and Tfe3 contribute, in a differential and cooperative manner, to kidney cystogenesis. Remarkably, the analysis of BHD patient-derived tumor samples revealed increased activation of TFEB/TFE3-mediated transcriptional program and silencing either of the two genes rescued tumorigenesis in human BHD renal tumor cell line-derived xenografts (CDXs). Our findings demonstrate in disease-relevant models that both TFEB and TFE3 are key drivers of renal tumorigenesis and suggest novel therapeutic strategies based on the inhibition of these transcription factors.
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Affiliation(s)
- Chiara Di Malta
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
- Medical Genetics Unit, Department of Medical and Translational Science, Federico II University, Naples, Italy
| | - Angela Zampelli
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
| | - Letizia Granieri
- Department of Experimental Oncology, European Institute of Oncology IRCCS (IEO), Milan, Italy
| | - Claudia Vilardo
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
| | - Rossella De Cegli
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
| | - Laura Cinque
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
| | - Edoardo Nusco
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
| | - Salvatore Pece
- Department of Experimental Oncology, European Institute of Oncology IRCCS (IEO), Milan, Italy
| | - Daniela Tosoni
- Department of Experimental Oncology, European Institute of Oncology IRCCS (IEO), Milan, Italy
| | | | - Nicolina Cristina Sorrentino
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Maria J Merino
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Deborah Nielsen
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ramaprasad Srinivasan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark W Ball
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christopher J Ricketts
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Cathy D Vocke
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Martin Lang
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baktiar Karim
- Molecular Histopathology Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Luisa Lanfrancone
- Department of Experimental Oncology, European Institute of Oncology IRCCS (IEO), Milan, Italy
| | - Laura S Schmidt
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Basic Science Program, Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD, USA
| | - W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrea Ballabio
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
- Medical Genetics Unit, Department of Medical and Translational Science, Federico II University, Naples, Italy
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
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19
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Phelps TE, Yilmaz EC, Harmon SA, Belue MJ, Shih JH, Garcia C, Hazen LA, Toubaji A, Merino MJ, Gurram S, Choyke PL, Wood BJ, Pinto PA, Turkbey B. Ipsilateral hemigland prostate biopsy may underestimate cancer burden in patients with unilateral mpMRI-visible lesions. Abdom Radiol (NY) 2023; 48:1079-1089. [PMID: 36526922 PMCID: PMC10765956 DOI: 10.1007/s00261-022-03775-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate the cancer detection rates of reduced-core biopsy schemes in patients with unilateral mpMRI-visible intraprostatic lesions and to analyze the contribution of systematic biopsy cores in clinically significant prostate cancer (csPCa) detection. METHODS 212 patients with mpMRI-visible unilateral intraprostatic lesions undergoing MRI/TRUS fusion-guided targeted biopsy (TBx) and systematic biopsy (SBx) were included. Cancer detection rates of TBx + SBx, as determined by highest Gleason Grade Group (GG), were compared to 3 reduced-core biopsy schemes: TBx alone, TBx + ipsilateral systematic biopsy (IBx; MRI-positive hemigland), and TBx + contralateral systematic biopsy (CBx; MRI-negative hemigland). Patient-level and biopsy core-level data were analyzed using descriptive statistics with confidence intervals. Univariable and multivariable logistic regression analysis was conducted to identify predictors of csPCa (≥ GG2) detected in MRI-negative hemiglands at p < 0.05. RESULTS Overall, 43.4% (92/212) of patients had csPCa and 66.0% (140/212) of patients had any PCa detected by TBx + SBx. Of patients with csPCa, 81.5% had exclusively ipsilateral involvement (MRI-positive), 7.6% had only contralateral involvement (MRI-negative), and 10.9% had bilateral involvement. The csPCa detection rates of reduced-core biopsy schemes were 35.4% (75/212), 40.1% (85/212), and 39.6% (84/212) for TBx alone, TBx + IBx, and TBx + CBx, respectively, with detection sensitivities of 81.5%, 92.4%, and 91.3% compared to TBx + SBx. CONCLUSION Reduced-core prostate biopsy strategies confined to the ipsilateral hemigland underestimate csPCa burden by at least 8% in patients with unilateral mpMRI-visible intraprostatic lesions. The combined TBx + SBx strategy maximizes csPCa detection.
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Affiliation(s)
- Tim E Phelps
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Enis C Yilmaz
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Stephanie A Harmon
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Mason J Belue
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Joanna H Shih
- Biometric Research Program, National Cancer Institute, NIH, Rockville, MD, USA
| | - Charisse Garcia
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
- Department of Radiology, Clinical Center, NIH, Bethesda, MD, USA
| | - Lindsey A Hazen
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
- Department of Radiology, Clinical Center, NIH, Bethesda, MD, USA
| | - Antoun Toubaji
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
- Department of Radiology, Clinical Center, NIH, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
- Molecular Imaging Branch, National Cancer Institute, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, MD, 20892-1088, USA.
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20
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Couvillon A, Turkbey B, Choyke PL, Lee-Wisdom K, McKinney Y, Sidlow R, Mullane MP, Giri VN, Morgan TM, Cheng HH, Merino MJ, Figg WD, Pinto PA, Dahut WL, Karzai F. Inherited risk for prostate cancer (PCa): Following the natural history of men with high-risk genetics using multiparametric MRI (mpMRI). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.390] [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: 03/17/2023] Open
Abstract
390 Background: PCa has inherited risk factors including high genetic risk variants such as BRCA1/2, HOXB13, and DNA mismatch repair genes. mpMRI has been shown to be effective for detection and staging of localized PCa. This study follows participants (prts), born biologically male, without a diagnosis of PCa with known germline pathogenic or likely pathogenic variants (PV) in BRCA1/2, MLH1, MSH2, MSH6, PMS2, EPCAM, HOXB13, ATM, NBN, TP53, CHEK2, PALB2, RAD51C/D, BRIP1, or FANCA-FANCM (NCT03805919). Methods: Up to 500 eligible prts 30-75 years old (yo) with a documented germline PV will enroll. Prts undergo biennial clinical exam and mpMRI, and annual PSA monitoring and are followed at 12-month intervals to determine PSA, prostate cancer diagnosis, and/or disease/survival status until death. Indication for prostate biopsy includes clinical or imaging findings. Biopsy specimens undergo molecular analyses. Results: To date, 175 prts have been enrolled: 169 (97%) White, 3 Hispanic (2%), 1 African American (1%), 1 Asian (1%), and 1 biethnic (1%). Median age is 47 yo. The most common monoallelic PV are: 48.6% BRCA2, 25.1% BRCA1, 6.3% CHEK2 and 5.7% MSH2. PVs in ATM, PALB2, HOXB13, PMS2, MLH1, MSH6, BRIP1, EPCAM and RAD51D are ≤4%. One subject carries three distinct PVs ( BRCA2, CHEK2, BRIP1). Indication for biopsy was found in 26.3% of prts with 22/46 (47.8%) with a PIRADS 4 lesion, 6/46 (13.0%) PIRADS 3 lesion, 12/46 (26.1%) elevated PSA (median=2.8 ng/mL) or 6/46 (13.0%) due to clinical discretion. Adenocarcinoma was diagnosed on 13/39 (33.3%) biopsies with median age at diagnosis=59 yo. 9/13 (69%) prts had a PSA <3 ng/ml at diagnosis. Nine prts were diagnosed with ISUP Grade Group (GG) 1, 3 with GG2, and 1 with GG3. Eight prts opted for active surveillance (AS), 2 for radiation therapy (RT), and 3 for prostatectomy (RP). Two prts on AS converted to definitive treatment (one RP and one RT) due to progression in GG on the year 1 AS biopsy. Conclusions: mpMRI screening in men with germline PV can be used for diagnosis and monitoring of PCa and facilitates detection below conventional PSA thresholds in a high genetic risk setting. Access to genetic testing and other variables need to be addressed in underrepresented minorities. Correlative studies, including cfDNA and PBMCs, are ongoing. Clinical trial information: NCT03805919 . [Table: see text]
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Affiliation(s)
- Anna Couvillon
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter L. Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Yolanda McKinney
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Robert Sidlow
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Veda N. Giri
- Yale School of Medicine and Yale Cancer Center, New Haven, CT
| | | | | | - Maria J. Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - William Douglas Figg
- Genitourinary Malignancies Branch, National Cancer Institue, National Institutes of Health, Bethesda, MD
| | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - William L. Dahut
- Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Fatima Karzai
- Genitourinary Malignancies Branch, NCI, NIH, Bethesda, MD
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21
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Vocke CD, Fleming LR, Piskorski AM, Amin A, Phornphutkul C, de la Monte S, Vilboux T, Duncan F, Pellegrino J, Braddock B, Middelton LA, Schmidt LS, Merino MJ, Cowen EW, Introne WJ, Linehan WM, Smith ACM. A diagnosis of Birt-Hogg-Dubé syndrome in individuals with Smith-Magenis syndrome: Recommendation for cancer screening. Am J Med Genet A 2023; 191:490-497. [PMID: 36513625 PMCID: PMC10117402 DOI: 10.1002/ajmg.a.63049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 12/15/2022]
Abstract
We report a series of four unrelated adults with Smith-Magenis syndrome (SMS) and concomitant features of Birt-Hogg-Dubé (BHD) syndrome based upon haploinsufficiency for FLCN and characteristic renal cell carcinomas and/or evidence of cutaneous fibrofolliculomas. Three of the cases constitute the first known association of histopathologically verified characteristic BHD-associated renal tumors in adults with SMS; the fourth was identified to have histologically confirmed skin fibrofolliculomas. Molecular analysis documented second-hit FLCN mutations in two of the three cases with confirmed BHD renal pathology. These cases suggest the need to expand management recommendations for SMS to include kidney cancer surveillance starting at 20 years of age, as per the screening recommendations for BHD syndrome.
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Affiliation(s)
- Cathy D Vocke
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Leah R Fleming
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA.,Department of Genetics, Saint Luke's Genetics and Metabolic Clinic, Boise, Idaho, USA
| | - Anna M Piskorski
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ali Amin
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Chanika Phornphutkul
- Division of Human Genetics, Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Suzanne de la Monte
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Thierry Vilboux
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA.,Medical Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
| | - Folami Duncan
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA.,Department of Pediatric Emergency Medicine, Johns Hopkins Children's Center, Baltimore, Maryland, USA
| | - Joan Pellegrino
- Medical Genetics, Upstate Medical University, Syracuse, New York, USA
| | - Bonnie Braddock
- Medical Genetics, Upstate Medical University, Syracuse, New York, USA
| | - Lindsay A Middelton
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Laura S Schmidt
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA.,Basic Science Program, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Maria J Merino
- Laboratory of Pathology Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Edward W Cowen
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, USA
| | - Wendy J Introne
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
| | - W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Ann C M Smith
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
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Anari PY, Lay N, Gopal N, Chaurasia A, Samimi S, Harmon S, Firouzabadi FD, Merino MJ, Wakim P, Turkbey E, Jones EC, Ball MW, Turkbey B, Linehan WM, Malayeri AA. An MRI-based radiomics model to predict clear cell renal cell carcinoma growth rate classes in patients with von Hippel-Lindau syndrome. Abdom Radiol (NY) 2022; 47:3554-3562. [PMID: 35869307 PMCID: PMC10645140 DOI: 10.1007/s00261-022-03610-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/28/2022] [Accepted: 07/03/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Upfront knowledge of tumor growth rates of clear cell renal cell carcinoma in von Hippel-Lindau syndrome (VHL) patients can allow for a more personalized approach to either surveillance imaging frequency or surgical planning. In this study, we implement a machine learning algorithm utilizing radiomic features of renal tumors identified on baseline magnetic resonance imaging (MRI) in VHL patients to predict the volumetric growth rate category of these tumors. MATERIALS AND METHODS A total of 73 VHL patients with 173 pathologically confirmed Clear Cell Renal Cell Carcinoma (ccRCCs) underwent MRI at least at two different time points between 2015 and 2021. Each tumor was manually segmented in excretory phase contrast T1 weighed MRI and co-registered on pre-contrast, corticomedullary and nephrographic phases. Radiomic features and volumetric data from each tumor were extracted using the PyRadiomics library in Python (4544 total features). Tumor doubling time (DT) was calculated and patients were divided into two groups: DT < = 1 year and DT > 1 year. Random forest classifier (RFC) was used to predict the DT category. To measure prediction performance, the cohort was randomly divided into 100 training and test sets (80% and 20%). Model performance was evaluated using area under curve of receiver operating characteristic curve (AUC-ROC), as well as accuracy, F1, precision and recall, reported as percentages with 95% confidence intervals (CIs). RESULTS The average age of patients was 47.2 ± 10.3 years. Mean interval between MRIs for each patient was 1.3 years. Tumors included in this study were categorized into 155 Grade 2; 16 Grade 3; and 2 Grade 4. Mean accuracy of RFC model was 79.0% [67.4-90.6] and mean AUC-ROC of 0.795 [0.608-0.988]. The accuracy for predicting DT classes was not different among the MRI sequences (P-value = 0.56). CONCLUSION Here we demonstrate the utility of machine learning in accurately predicting the renal tumor growth rate category of VHL patients based on radiomic features extracted from different T1-weighted pre- and post-contrast MRI sequences.
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Affiliation(s)
- Pouria Yazdian Anari
- Radiology and Imaging Sciences, Clinical Center (CC), National Institutes of Health, Bethesda, MD, USA
| | - Nathan Lay
- Artificial Intelligence Resource, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Nikhil Gopal
- Urologic Oncology Branch, Clinical Center, National Cancer Institute (NCI), National Institutes of Health, Bethesda, MD, USA
| | - Aditi Chaurasia
- Radiology and Imaging Sciences, Clinical Center (CC), National Institutes of Health, Bethesda, MD, USA
| | - Safa Samimi
- Radiology and Imaging Sciences, Clinical Center (CC), National Institutes of Health, Bethesda, MD, USA
| | - Stephanie Harmon
- Artificial Intelligence Resource, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | | | - Maria J Merino
- Pathology Department, Clinical Center, National Cancer Institutes (NCI), National Institutes of Health, Bethesda, MD, USA
| | - Paul Wakim
- Biostatistics and Clinical Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Evrim Turkbey
- Radiology and Imaging Sciences, Clinical Center (CC), National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth C Jones
- Radiology and Imaging Sciences, Clinical Center (CC), National Institutes of Health, Bethesda, MD, USA
| | - Mark W Ball
- Urologic Oncology Branch, Clinical Center, National Cancer Institute (NCI), National Institutes of Health, Bethesda, MD, USA
| | - Baris Turkbey
- Artificial Intelligence Resource, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - W Marston Linehan
- Urologic Oncology Branch, Clinical Center, National Cancer Institute (NCI), National Institutes of Health, Bldg. 10, Room 2 W-5940 and Room 1-5940, 10 Center Drive, Bethesda, MD, 20892, USA.
| | - Ashkan A Malayeri
- Radiology and Imaging Sciences, Clinical Center (CC), National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA.
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23
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Beck EJ, Mandalia S, Yfantopoulos P, Jones CI, Bremner S, Whetham J, Etcheverry F, Moreno L, Gonzalez E, Merino MJ, Leon A, Garcia F. Efficiency of the EmERGE Pathway to provide continuity of care for Spanish people living with medically stable HIV. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:388-395. [PMID: 35906033 DOI: 10.1016/j.eimce.2020.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/23/2020] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Calculate the efficiency of the EmERGE Pathway of Care for medically stable people living with HIV at the Hospital Clínic-IDIBAPS, Barcelona, Spain. METHODS 546 study participants were followed between 1st July 2016 and 30th October 2019 across three HIV outpatient clinics, but the virtual clinic was closed during the second year. Unit costs were calculated, linked to mean use outpatient services per patient year, one-year before and after the implementation of EmERGE. Costs were combined with primary and secondary outcomes. RESULTS Annual costs across HIV-outpatient services increased by 8%: €1073 (95%CI €999-€1157) to €1158 (95%CI €1084-€1238). Annual cost of ARVs was €7,557; total annual costs increased by 1% from €8430 (95%CI €8356-8514) to €8515 (95%CI €8441-8595). Annual cost for 433 participants managed in face-to-face (F2F) clinics decreased by 5% from €958 (95%CI 905-1018) to €904 (95%CI 863-945); participants transferred from virtual to F2F outpatient clinics (V2F) increased their annual cost by a factor of 2.2, from €115 (95%CI 94-139) to €251 (95%CI 219-290). No substantive changes were observed in primary and secondary outcomes. CONCLUSION EmERGE Pathway is an efficient and acceptable intervention. Increases in costs were caused by internal structural changes. The cost reduction observed in F2F clinics were off-set by the transfer of participants from the virtual to the F2F clinics due to the closure of the virtual clinic during the second year of the Study. Greater efficiencies are likely to be achieved by extending the use of the Pathway to other PLHIV.
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Affiliation(s)
- E J Beck
- NPMS-HHC CIC, London, UK; Department of Health Services Research and Policy, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | - C I Jones
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
| | - S Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
| | - J Whetham
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - F Etcheverry
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - L Moreno
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - E Gonzalez
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - M J Merino
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - A Leon
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - F Garcia
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
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Mehralivand S, Yang D, Harmon SA, Xu D, Xu Z, Roth H, Masoudi S, Sanford TH, Kesani D, Lay NS, Merino MJ, Wood BJ, Pinto PA, Choyke PL, Turkbey B. A Cascaded Deep Learning-Based Artificial Intelligence Algorithm for Automated Lesion Detection and Classification on Biparametric Prostate Magnetic Resonance Imaging. Acad Radiol 2022; 29:1159-1168. [PMID: 34598869 PMCID: PMC10575564 DOI: 10.1016/j.acra.2021.08.019] [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] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/08/2021] [Accepted: 08/21/2021] [Indexed: 01/08/2023]
Abstract
RATIONALE AND OBJECTIVES Prostate MRI improves detection of clinically significant prostate cancer; however, its diagnostic performance has wide variation. Artificial intelligence (AI) has the potential to assist radiologists in the detection and classification of prostatic lesions. Herein, we aimed to develop and test a cascaded deep learning detection and classification system trained on biparametric prostate MRI using PI-RADS for assisting radiologists during prostate MRI read out. MATERIALS AND METHODS T2-weighted, diffusion-weighted (ADC maps, high b value DWI) MRI scans obtained at 3 Tesla from two institutions (n = 1043 in-house and n = 347 Prostate-X, respectively) acquired between 2015 to 2019 were used for model training, validation, testing. All scans were retrospectively reevaluated by one radiologist. Suspicious lesions were contoured and assigned a PI-RADS category. A 3D U-Net-based deep neural network was used to train an algorithm for automated detection and segmentation of prostate MRI lesions. Two 3D residual neural network were used for a 4-class classification task to predict PI-RADS categories 2 to 5 and BPH. Training and validation used 89% (n = 1290 scans) of the data using 5 fold cross-validation, the remaining 11% (n = 150 scans) were used for independent testing. Algorithm performance at lesion level was assessed using sensitivities, positive predictive values (PPV), false discovery rates (FDR), classification accuracy, Dice similarity coefficient (DSC). Additional analysis was conducted to compare AI algorithm's lesion detection performance with targeted biopsy results. RESULTS Median age was 66 years (IQR = 60-71), PSA 6.7 ng/ml (IQR = 4.7-9.9) from in-house cohort. In the independent test set, algorithm correctly detected 111 of 198 lesions leading to 56.1% (49.3%-62.6%) sensitivity. PPV was 62.7% (95% CI 54.7%-70.7%) with FDR of 37.3% (95% CI 29.3%-45.3%). Of 79 true positive lesions, 82.3% were tumor positive at targeted biopsy, whereas of 57 false negative lesions, 50.9% were benign at targeted biopsy. Median DSC for lesion segmentation was 0.359. Overall PI-RADS classification accuracy was 30.8% (95% CI 24.6%-37.8%). CONCLUSION Our cascaded U-Net, residual network architecture can detect, classify cancer suspicious lesions at prostate MRI with good detection, reasonable classification performance metrics.
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Affiliation(s)
- Sherif Mehralivand
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland
| | - Dong Yang
- NVIDIA Corporation, Santa Clara, California
| | - Stephanie A Harmon
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland
| | - Daguang Xu
- NVIDIA Corporation, Santa Clara, California
| | - Ziyue Xu
- NVIDIA Corporation, Santa Clara, California
| | | | - Samira Masoudi
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland
| | - Thomas H Sanford
- Department of Urology, SUNY Upstate Medical University, Syracuse, New Yor
| | - Deepak Kesani
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland
| | - Nathan S Lay
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland.
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Valera V, Walter B, Merino MJ. Abstract 5831: Urinary exosome analysis as a marker of treatment response in bladder cancer patients. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5831] [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: 11/16/2022]
Abstract
Abstract
Introduction: Intravesical Bacillus Calmette-Guerin (BCG) is an effective immunotherapy for non-muscle invasive bladder cancer (NMIBC). However, BCG treatment failure will lead to recurrence and tumor progression. In this study, urinary exosomes content (miRNA profile) was evaluated as a possible marker of BCG treatment response in NMIBC patients.
Methods: Urine samples from patients with bladder cancer were collected at the time of surgery and during patient follow up to 1 year. Urine from healthy volunteers were also included. Clinical and pathological information such as tumor grade (High Grade (HG), Low Grade (LG)), depth of invasion (Ta, T1, CIS), and response to BCG treatment was also obtained. Exosome Isolation and total RNA extraction including microRNAs from cell-free urine after centrifugation were obtained. Library preparation for miRNA expression was done (QIAseq® miRNA Library) for Next-Generation Sequencing (NGS) analysis in a NextSeq 2000 single read platform, 75 bp with 15-20 million reads per sample. Reads were then queried against miRDeep2 software for identification. Only miRNAs having at least 20 counts considering all samples were included. After normalization, significantly and deferentially expressed microRNAs (>2-Fold) were selected for analysis. Bioinformatic analysis including sequence alignment was performed under the STAR-based approach. Identified microRNAs were then used to classify/predict the response to treatment and its relationship with other clinicopathologic variables.
Results: A total of 56 urine samples from 13 patients were available/used for analysis including 10 High Grade Ta and 3 High Grade T1 patients. Urine from normal healthy donors (N=3) was also included. Clinicopathological features were patients with HGTa=10, HGT1=3 and 3 control samples. Regarding treatment response 9 patients were BCG responders and 4 BCG unresponsive. When compared to BCG unresponsive patients, BCG responders showed 45 differentially expressed miRNAs. Statistically significant differentially expressed miRNAs (Fold-change >2, p value <0.05) were 12 miRNAs, upregulated were miR132-3p (p=0.042); miR-187-3p (p=0.021); miR-409-3p (p=0.043) and miR1301-3p (p=0.048). Downregulated miRNAs were miR-let7-5p (p=0.007), miR-3605-3p (p=0.047), miR-140-5p (p=0.031), miR-500a-5p (p=0.051), miR-629-5p (p=0.039), miR-454-3p (p=0.05), miR-2110 (p=0.049) and miR-30c-5p (p=0.03). Interestingly, miRPathDABv2.0 analysis predicted those microRNAs be related to cancer, including bladder cancer. They showed targeting important pathways as PI3K.Akt, Wnt/B catenin and P53 signaling related with disease progression and treatment response.
Conclusion: Our study supports the value of urinary exosomal microRNAs as non-invasive biomarkers to predict BCG treatment response in nonmuscle-invasive bladder cancer.
Citation Format: Vladimir Valera, Beatriz Walter, Maria J. Merino. Urinary exosome analysis as a marker of treatment response in bladder cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5831.
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Vocke CD, Ricketts CJ, Metwalli AR, Pinto PA, Gautam R, Raffeld M, Merino MJ, Ball MW, Linehan WM. Differential VHL mutation patterns in bilateral clear cell RCC distinguishes between independent primary tumors and contralateral metastatic disease. Urology 2022; 165:170-177. [PMID: 35469800 DOI: 10.1016/j.urology.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/24/2022] [Accepted: 04/03/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate whether bilateral, multifocal clear cell renal cell carcinoma (ccRCC) patients can be differentiated by VHL mutation analysis into cases that represent either multiple independently arising primary tumors, or a single primary tumor which has spread ipsilaterally as well as to the contralateral kidney. The nature of kidney cancer multifocality outside of known hereditary syndromes is as yet poorly understood. MATERIALS AND METHODS DNA from multiple tumors per patient were evaluated for somatic VHL gene mutation and hypermethylation. A subset of tumors with shared VHL mutations were analyzed with targeted, next-generation sequencing assays. RESULTS This cohort contained 5 patients with multiple tumors that demonstrated a shared somatic VHL mutation consistent with metastatic spread including to the contralateral kidney. In several cases this was substantiated by additional shared somatic mutations in ccRCC-associated genes. In contrast, the remaining 14 patients with multiple tumors demonstrated unique, unshared VHL alterations in every analyzed tumor, consistent with independently arising kidney tumors. None of these latter patients showed any evidence of local spread or distant metastasis. CONCLUSION The spectrum of VHL alterations within evaluated bilateral, multifocal ccRCC tumors from a single patient can distinguish between multiple independent tumor growth and metastasis. This can be performed using currently available clinical genetic tests and will improve the accuracy of patient diagnosis and prognosis, as well as informing appropriate management.
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Affiliation(s)
- Cathy D Vocke
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - Christopher J Ricketts
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - Adam R Metwalli
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - Peter A Pinto
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - Rabindra Gautam
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - Mark Raffeld
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892
| | - Mark W Ball
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892.
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Mehralivand S, Yang D, Harmon SA, Xu D, Xu Z, Roth H, Masoudi S, Kesani D, Lay N, Merino MJ, Wood BJ, Pinto PA, Choyke PL, Turkbey B. Deep learning-based artificial intelligence for prostate cancer detection at biparametric MRI. Abdom Radiol (NY) 2022; 47:1425-1434. [PMID: 35099572 PMCID: PMC10506420 DOI: 10.1007/s00261-022-03419-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To present fully automated DL-based prostate cancer detection system for prostate MRI. METHODS MRI scans from two institutions, were used for algorithm training, validation, testing. MRI-visible lesions were contoured by an experienced radiologist. All lesions were biopsied using MRI-TRUS-guidance. Lesions masks, histopathological results were used as ground truth labels to train UNet, AH-Net architectures for prostate cancer lesion detection, segmentation. Algorithm was trained to detect any prostate cancer ≥ ISUP1. Detection sensitivity, positive predictive values, mean number of false positive lesions per patient were used as performance metrics. RESULTS 525 patients were included for training, validation, testing of the algorithm. Dataset was split into training (n = 368, 70%), validation (n = 79, 15%), test (n = 78, 15%) cohorts. Dice coefficients in training, validation sets were 0.403, 0.307, respectively, for AHNet model compared to 0.372, 0.287, respectively, for UNet model. In validation set, detection sensitivity was 70.9%, PPV was 35.5%, mean number of false positive lesions/patient was 1.41 (range 0-6) for UNet model compared to 74.4% detection sensitivity, 47.8% PPV, mean number of false positive lesions/patient was 0.87 (range 0-5) for AHNet model. In test set, detection sensitivity for UNet was 72.8% compared to 63.0% for AHNet, mean number of false positive lesions/patient was 1.90 (range 0-7), 1.40 (range 0-6) in UNet, AHNet models, respectively. CONCLUSION We developed a DL-based AI approach which predicts prostate cancer lesions at biparametric MRI with reasonable performance metrics. While false positive lesion calls remain as a challenge of AI-assisted detection algorithms, this system can be utilized as an adjunct tool by radiologists.
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Affiliation(s)
| | - Dong Yang
- NVIDIA Corporation, Santa Clara, CA, USA
| | | | - Daguang Xu
- NVIDIA Corporation, Santa Clara, CA, USA
| | - Ziyue Xu
- NVIDIA Corporation, Santa Clara, CA, USA
| | | | | | - Deepak Kesani
- Molecular Imaging Branch, NCI, NIH, Bethesda, MD, USA
| | - Nathan Lay
- Molecular Imaging Branch, NCI, NIH, Bethesda, MD, USA
| | | | - Bradford J Wood
- Center for Interventional Oncology, NCI, NIH, Bethesda, MD, USA
- Department of Radiology, Clinical Center, NIH, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA
| | | | - Baris Turkbey
- Molecular Imaging Branch, NCI, NIH, Bethesda, MD, USA.
- Molecular Imaging Branch, National Cancer Institute, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, MD, 20892-1088, USA.
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Kinnaird A, Yerram NK, O’Connor L, Brisbane W, Sharma V, Chuang R, Jayadevan R, Ahdoot M, Daneshvar M, Priester A, Delfin M, Tran E, Barsa DE, Sisk A, Reiter RE, Felker E, Raman S, Kwan L, Choyke PL, Merino MJ, Wood BJ, Turkbey B, Pinto PA, Marks LS. Magnetic Resonance Imaging-Guided Biopsy in Active Surveillance of Prostate Cancer. J Urol 2022; 207:823-831. [PMID: 34854746 PMCID: PMC10506469 DOI: 10.1097/ju.0000000000002343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The underlying premise of prostate cancer active surveillance (AS) is that cancers likely to metastasize will be recognized and eliminated before cancer-related disease can ensue. Our study was designed to determine the prostate cancer upgrading rate when biopsy guided by magnetic resonance imaging (MRGBx) is used before entry and during AS. MATERIALS AND METHODS The cohort included 519 men with low- or intermediate-risk prostate cancer who enrolled in prospective studies (NCT00949819 and NCT00102544) between February 2008 and February 2020. Subjects were preliminarily diagnosed with Gleason Grade Group (GG) 1 cancer; AS began when subsequent MRGBx confirmed GG1 or GG2. Participants underwent confirmatory MRGBx (targeted and systematic) followed by surveillance MRGBx approximately every 12 to 24 months. The primary outcome was tumor upgrading to ≥GG3. RESULTS Upgrading to ≥GG3 was found in 92 men after a median followup of 4.8 years (IQR 3.1-6.5) after confirmatory MRGBx. Upgrade-free probability after 5 years was 0.85 (95% CI 0.81-0.88). Cancer detected in a magnetic resonance imaging lesion at confirmatory MRGBx increased risk of subsequent upgrading during AS (HR 2.8; 95% CI 1.3-6.0), as did presence of GG2 (HR 2.9; 95% CI 1.1-8.2) In men who upgraded ≥GG3 during AS, upgrading was detected by targeted cores only in 27%, systematic cores only in 25% and both in 47%. In 63 men undergoing prostatectomy, upgrading from MRGBx was found in only 5 (8%). CONCLUSIONS When AS begins and follows with MRGBx (targeted and systematic), upgrading rate (≥GG3) is greater when tumor is initially present within a magnetic resonance imaging lesion or when pathology is GG2 than when these features are absent.
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Affiliation(s)
- Adam Kinnaird
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Alberta Centre for Urologic Research and Excellence (ACURE), Edmonton, Alberta, Canada
- Cancer Research Institute of Northern Alberta (CRINA),Edmonton, Alberta, Canada
| | - Nitin K. Yerram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Luke O’Connor
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Wayne Brisbane
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Vidit Sharma
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Ryan Chuang
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Rajiv Jayadevan
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Michael Ahdoot
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael Daneshvar
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Alan Priester
- Department of Bioengineering, UCLA, Los Angeles, California
| | - Merdie Delfin
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Elizabeth Tran
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Danielle E. Barsa
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Anthony Sisk
- Department of Pathology & Laboratory Medicine, UCLA, Los Angeles, California
| | - Robert E. Reiter
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Ely Felker
- Department of Radiological Sciences, UCLA, Los Angeles, California
| | - Steve Raman
- Department of Radiological Sciences, UCLA, Los Angeles, California
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Peter L. Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maria J. Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford J. Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Leonard S. Marks
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
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Rudd ML, Hansen NF, Zhang X, Urick ME, Zhang S, Merino MJ, Mullikin JC, Brody LC, Bell DW. KLF3 and PAX6 are candidate driver genes in late-stage, MSI-hypermutated endometrioid endometrial carcinomas. PLoS One 2022; 17:e0251286. [PMID: 35081118 PMCID: PMC8791453 DOI: 10.1371/journal.pone.0251286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/05/2021] [Indexed: 12/24/2022] Open
Abstract
Endometrioid endometrial carcinomas (EECs) are the most common histological subtype of uterine cancer. Late-stage disease is an adverse prognosticator for EEC. The purpose of this study was to analyze EEC exome mutation data to identify late-stage-specific statistically significantly mutated genes (SMGs), which represent candidate driver genes potentially associated with disease progression. We exome sequenced 15 late-stage (stage III or IV) non-ultramutated EECs and paired non-tumor DNAs; somatic variants were called using Strelka, Shimmer, SomaticSniper and MuTect. Additionally, somatic mutation calls were extracted from The Cancer Genome Atlas (TCGA) data for 66 late-stage and 270 early-stage (stage I or II) non-ultramutated EECs. MutSigCV (v1.4) was used to annotate SMGs in the two late-stage cohorts and to derive p-values for all mutated genes in the early-stage cohort. To test whether late-stage SMGs are statistically significantly mutated in early-stage tumors, q-values for late-stage SMGs were re-calculated from the MutSigCV (v1.4) early-stage p-values, adjusting for the number of late-stage SMGs tested. We identified 14 SMGs in the combined late-stage EEC cohorts. When the 14 late-stage SMGs were examined in the TCGA early-stage data, only Krüppel-like factor 3 (KLF3) and Paired box 6 (PAX6) failed to reach significance as early-stage SMGs, despite the inclusion of enough early-stage cases to ensure adequate statistical power. Within TCGA, nonsynonymous mutations in KLF3 and PAX6 were, respectively, exclusive or nearly exclusive to the microsatellite instability (MSI)-hypermutated molecular subgroup and were dominated by insertions-deletions at homopolymer tracts. In conclusion, our findings are hypothesis-generating and suggest that KLF3 and PAX6, which encode transcription factors, are MSI target genes and late-stage-specific SMGs in EEC.
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Affiliation(s)
- Meghan L. Rudd
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Nancy F. Hansen
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Xiaolu Zhang
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Mary Ellen Urick
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Suiyuan Zhang
- Computational and Statistical Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Maria J. Merino
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | | | - James C. Mullikin
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- NIH Intramural Sequencing Center, National Human Genome Research Institute, National Institutes of Health, Rockville, Maryland, United States of America
| | - Lawrence C. Brody
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Daphne W. Bell
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, United States of America
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Welsh JA, Killingsworth B, Kepley J, Traynor T, Cook S, Savage J, Marte J, Lee MJ, Maeng HM, Pleet ML, Magana S, Gorgens A, Maire CL, Lamszus K, Ricklefs FL, Merino MJ, Linehan WM, Greten T, Cooks T, Harris CC, Apolo A, Abdel-Mageed A, Ivanov AR, Trepel JB, Roth M, Tkach M, Milosavljevic A, Théry C, LeBlanc A, Berzofsky JA, Ruppin E, Aldape K, Camphausen K, Gulley JL, Ghiran I, Jacobson S, Jones JC. MPA PASS software enables stitched multiplex, multidimensional EV repertoire analysis and a standard framework for reporting bead-based assays. Cell Rep Methods 2022; 2:100136. [PMID: 35474866 PMCID: PMC9017130 DOI: 10.1016/j.crmeth.2021.100136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/31/2021] [Accepted: 12/08/2021] [Indexed: 12/25/2022]
Abstract
Extracellular vesicles (EVs) of various types are released or shed from all cells. EVs carry proteins and contain additional protein and nucleic acid cargo that relates to their biogenesis and cell of origin. EV cargo in liquid biopsies is of widespread interest owing to its ability to provide a retrospective snapshot of cell state at the time of EV release. For the purposes of EV cargo analysis and repertoire profiling, multiplex assays are an essential tool in multiparametric analyte studies but are still being developed for high-parameter EV protein detection. Although bead-based EV multiplex analyses offer EV profiling capabilities with conventional flow cytometers, the utilization of EV multiplex assays has been limited by the lack of software analysis tools for such assays. To facilitate robust EV repertoire studies, we developed multiplex analysis post-acquisition analysis (MPAPASS) open-source software for stitched multiplex analysis, EV database-compatible reporting, and visualization of EV repertoires.
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Affiliation(s)
- Joshua A Welsh
- Translational Nanobiology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Vaccine Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Bryce Killingsworth
- Translational Nanobiology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Vaccine Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Julia Kepley
- Translational Nanobiology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tim Traynor
- Translational Nanobiology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sean Cook
- Translational Nanobiology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason Savage
- Translational Nanobiology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jenn Marte
- Clinical Immunotherapy Section, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Min-Jung Lee
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Hoyoung M Maeng
- Vaccine Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Michelle L Pleet
- Viral Immunology Section, Neuroimmunology Branch, NINDS/NIH, Bethesda, MD, USA
| | - Setty Magana
- Viral Immunology Section, Neuroimmunology Branch, NINDS/NIH, Bethesda, MD, USA
| | - André Gorgens
- Clinical Research Center, Department for Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Evox Therapeutics Ltd, Oxford, UK
| | - Cecile L Maire
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Katrin Lamszus
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Franz L Ricklefs
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Maria J Merino
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tim Greten
- Gastrointestinal Malignancy Section, Thoracic and Gastrointestinal Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tomer Cooks
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel
- Laboratory of Human Carcinogenesis, NCI-CCR, National Institutes of Health, Bethesda, MD 20892-4258, USA
| | - Curtis C Harris
- Laboratory of Human Carcinogenesis, NCI-CCR, National Institutes of Health, Bethesda, MD 20892-4258, USA
| | - Andrea Apolo
- Bladder Cancer Section, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institutes of Health, Bethesda, MD, USA
| | - Asim Abdel-Mageed
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, USA
| | - Alexander R Ivanov
- Barnett Institute and Department of Chemistry and Chemical Biology, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA
| | - Jane B Trepel
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Matthew Roth
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Mercedes Tkach
- Institut Curie, PSL Research University, INSERM U932, Paris, France
| | | | - Clotilde Théry
- Institut Curie, PSL Research University, INSERM U932, Paris, France
| | - Amy LeBlanc
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jay A Berzofsky
- Vaccine Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Eytan Ruppin
- Cancer Data Science Lab, National Cancer Institute, Bethesda, MD, USA
| | - Kenneth Aldape
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kevin Camphausen
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - James L Gulley
- Clinical Immunotherapy Section, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ionita Ghiran
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Steve Jacobson
- Viral Immunology Section, Neuroimmunology Branch, NINDS/NIH, Bethesda, MD, USA
| | - Jennifer C Jones
- Translational Nanobiology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Vaccine Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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Nikpanah M, Xu Z, Jin D, Farhadi F, Saboury B, Ball MW, Gautam R, Merino MJ, Wood BJ, Turkbey B, Jones EC, Linehan WM, Malayeri AA. A deep-learning based artificial intelligence (AI) approach for differentiation of clear cell renal cell carcinoma from oncocytoma on multi-phasic MRI. Clin Imaging 2021; 77:291-298. [PMID: 34171743 PMCID: PMC9990181 DOI: 10.1016/j.clinimag.2021.06.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/19/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the diagnostic performance of a deep convolutional neural network for differentiation of clear cell renal cell carcinoma (ccRCC) from renal oncocytoma. METHODS In this retrospective study, 74 patients (49 male, mean age 59.3) with 243 renal masses (203 ccRCC and 40 oncocytoma) that had undergone MR imaging 6 months prior to pathologic confirmation of the lesions were included. Segmentation using seed placement and bounding box selection was used to extract the lesion patches from T2-WI, and T1-WI pre-contrast, post-contrast arterial and venous phases. Then, a deep convolutional neural network (AlexNet) was fine-tuned to distinguish the ccRCC from oncocytoma. Five-fold cross validation was used to evaluate the AI algorithm performance. A subset of 80 lesions (40 ccRCC, 40 oncocytoma) were randomly selected to be classified by two radiologists and their performance was compared to the AI algorithm. Intra-class correlation coefficient was calculated using the Shrout-Fleiss method. RESULTS Overall accuracy of the AI system was 91% for differentiation of ccRCC from oncocytoma with an area under the curve of 0.9. For the observer study on 80 randomly selected lesions, there was moderate agreement between the two radiologists and AI algorithm. In the comparison sub-dataset, classification accuracies were 81%, 78%, and 70% for AI, radiologist 1, and radiologist 2, respectively. CONCLUSION The developed AI system in this study showed high diagnostic performance in differentiation of ccRCC versus oncocytoma on multi-phasic MRIs.
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Affiliation(s)
- Moozhan Nikpanah
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA. https://twitter.com/MoozhanNikpanah
| | - Ziyue Xu
- NVIDIA Corporation, Bethesda, MD, USA
| | | | - Faraz Farhadi
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA. https://twitter.com/Faraz_Farhadi
| | - Babak Saboury
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Mark W Ball
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. https://twitter.com/markballmd
| | - Rabindra Gautam
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bradford J Wood
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA. https://twitter.com/BradWoodMD
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, USA. https://twitter.com/radiolobt
| | - Elizabeth C Jones
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - W Marston Linehan
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Ashkan A Malayeri
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
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Giubellino A, Ricketts CJ, Moreno V, Linehan WM, Merino MJ. MicroRNA Profiling of Morphologically Heterogeneous Clear Cell Renal Cell Carcinoma. J Cancer 2021; 12:5375-5384. [PMID: 34405000 PMCID: PMC8364632 DOI: 10.7150/jca.52310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/23/2020] [Accepted: 12/26/2020] [Indexed: 01/05/2023] Open
Abstract
Intratumoral heterogeneity (IH) has been recently described as an important contributor to tumor growth through a branched rather than a linear pattern of tumor evolution for renal cell carcinoma. As to whether the miRNA profiling of the different and heterogeneous areas is the same or not, it is not known. This study analyzed the differences and similarities of the miRNA profiles in histologically distinct regions within several RCC tumors. The observed differences may have great implications for the development of predictive biomarkers and the identification of druggable targets with improvement of combinatorial therapeutic approaches for the effective treatment of kidney cancer, as well as for the identification of circulating malignant cells that can be useful to detect tumor recurrences.
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Affiliation(s)
- Alessio Giubellino
- Translational Surgical Pathology, Laboratory of Pathology, National Institutes of health, Bethesda, MD
| | - Christopher J Ricketts
- Urologic Oncology Branch National Cancer Institute, National Institutes of health, Bethesda, MD
| | - Vanessa Moreno
- Translational Surgical Pathology, Laboratory of Pathology, National Institutes of health, Bethesda, MD
| | - W Marston Linehan
- Urologic Oncology Branch National Cancer Institute, National Institutes of health, Bethesda, MD
| | - Maria J Merino
- Translational Surgical Pathology, Laboratory of Pathology, National Institutes of health, Bethesda, MD
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Dikoglu E, Naizhen X, O'Connor LP, Pinto P, Merino MJ. Abstract 360: The dilemma of the current diagnostic tests for MSI in prostate cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-360] [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: 11/16/2022]
Abstract
Abstract
Background:
Understanding the relationship between tumor genomics and the immune response in cancer has gotten more attention with the advance of immunotherapy. Microsatellite instability (MSI) is a molecular marker that provides prognostic and predictive information in many types of tumors including prostate cancer (PC). In PC, MSI-H and dMMR have been reported anywhere from 1% in primary tumors to up to 12% in metastasis. Reliable testing strategies for MSI/MMR status are critical for clinical management of patients with PC. MSI detection methods include PCR based molecular tests, NGS-based MSI detection or immunohistochemical staining (IHC). We observe technical difficulties in our daily practice with current molecular diagnostic tests.
Design:
We examined MMR protein expression (MSH2, MSH6, MLH1, PMS2) and PD-L1 by IHC in 30 PC.
Results:
Among 30 PC tested, 1 tumor (3%) was completely negative for MLH1 and PMS2 and 1 tumor (3%) revealed loss of PMS2 by IHC even though gene panel did not reveal any mutation in PMS2. The PD-L1 IHC was 44% positive, but the single MMR negative biopsy was PD-L1 negative. PD-L1 expression in PC samples did not show correlation with defective MMR expression.
Conclusion:
In our study, controversial results were obtained. Based on our experience; even though many exons of MMR genes are covered with these panels, there are some exons do not get enough coverage to be analyzed. This low coverage problem creates false negative results. There are also pseudogene pairs of these genes, especially PMS2. For some specific regions, even though there is enough coverage it is impossible to know if the pathogenic variant is on the PMS2 or the pseudogene without additional test. This result suffers from false positive results without a confirmatory test. It is also known that 5% to 11% of MSI-H cases demonstrate intact MMR staining and localization (proficient MMR, pMMR) due to retained antigenicity and nonfunctional protein. So far, in regular practice we use MMR analyzing strategies which set up for colon cancer where the tumor is uniform. PC is more complex; most of the time more than one clone is involving.We believe MSI detection for PC requires improvement the technics of detection, robust set up of testing strategy with high sensitivity and specificity, analyzing strategy and training of pathologists. Due to technical difficulties of the detection, we believe that the prevalence of MSI-high/dMMR PC might be higher than reported in the literature so far.
Citation Format: Esra Dikoglu, Xu Naizhen, Luke P. O'Connor, Peter Pinto, Maria J. Merino. The dilemma of the current diagnostic tests for MSI in prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 360.
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Affiliation(s)
| | - Xu Naizhen
- 2National Institutes of Health, Bethesda, MD
| | | | - Peter Pinto
- 2National Institutes of Health, Bethesda, MD
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Nikpanah M, Paschall AK, Ahlman MA, Civelek AC, Farhadi F, Mirmomen SM, Li X, Saboury B, Ball MW, Merino MJ, Srinivasan R, Jones EC, Linehan WM, Malayeri AA. 18Fluorodeoxyglucose-positron emission tomography/computed tomography for differentiation of renal tumors in hereditary kidney cancer syndromes. Abdom Radiol (NY) 2021; 46:3301-3308. [PMID: 33688985 DOI: 10.1007/s00261-021-02999-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/03/2021] [Accepted: 02/11/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess differences in FDG-PET/CT uptake among four subtypes of renal tumors: clear cell RCC (ccRCC), papillary type I and II RCC (pRCC), and oncocytoma. METHODS This retrospective study investigated 33 patients with 98 hereditary renal tumors. Lesions greater than 1 cm and patients with a timeframe of less than 18 months between preoperative imaging and surgery were considered. FDG-PET/CT images were independently reviewed by two nuclear medicine physicians, blinded to clinical information. Volumetric lesion SUVmean was measured and used to calculate a target-to-background ratio respective to liver (TBR). The Shrout-Fleiss intra-class correlation coefficient was used to assess reliability between readers. A linear mixed effects model, accounting for within-patient correlations, was used to compare TBR values of primary renal lesions with and without distant metastasis. RESULTS The time interval between imaging and surgery for all tumors had a median of 77 (Mean: 139; Range: 1-512) days. Intra-class reliability of mean TBR resulted in a mean κ score of 0.93, indicating strong agreement between the readers. The mixed model showed a significant difference in mean TBR among the subtypes (p < 0.0001). Pairwise comparison showed significant differences between pRCC type II and ccRCC (p < 0.0001), pRCC type II and pRCC type I (p = 0.0001), and pRCC type II and oncocytoma (p = 0.0016). Furthermore, a significant difference in FDG uptake was present between primary pRCC type II renal lesions with and without distant metastasis (p = 0.023). CONCLUSION pRCC type II lesions demonstrated significantly higher FDG activity than ccRCC, pRCC type I, or oncocytoma. These findings indicate that FDG may prove useful in studying the metabolic activity of renal neoplasms, identifying lesions of highest clinical concern, and ultimately optimizing active surveillance, and personalizing management plans.
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Mehralivand S, George AK, Hoang AN, Rais-Bahrami S, Rastinehad AR, Lebastchi AH, Ahdoot M, Siddiqui MM, Bloom J, Sidana A, Merino MJ, Choyke PL, Shih JH, Turkbey B, Wood BJ, Pinto PA. MRI-guided focal laser ablation of prostate cancer: a prospective single-arm, single-center trial with 3 years of follow-up. ACTA ACUST UNITED AC 2021; 27:394-400. [PMID: 34003127 DOI: 10.5152/dir.2021.20095] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE We aimed to assess post-interventional and 36-month follow-up results of a single-center, single-arm, in-bore phase I trial of focal laser ablation (FLA) guided by multiparametric magnetic resonance imaging (mpMRI). METHODS FLA procedures were done in-bore MRI using a transperineal approach. Primary endpoints were feasibility and safety expressed as lack of grade 3 complications. Secondary endpoints were changes in international prostate symptom score (IPSS), sexual health inventory for men (SHIM), quality of life (QoL) scores, and serum prostate specific antigen (PSA) levels. Treatment outcomes were assessed by combined mpMRI-ultrasound fusion-guided and extended sextant systematic biopsy after 12, 24, and optionally after 36 months. RESULTS Fifteen participants were included. Seven patients (46.67%) had Gleason 3+3 and 8 patients (53.33%) had Gleason 3+4 cancer. All patients tolerated the procedure well, and no grade 3/4 complications occurred. All grade 1 and 2 complications were transient and resolved completely. There was no significant change in mean IPSS from baseline (-1, p = 0.460) and QoL (0, p = 0.441) scores following FLA but there was a significant drop in mean SHIM scores (-2, p = 0.010) compared to pretreatment baselines. Mean PSA significantly decreased after FLA (-2.5, p < 0.001). Seven out of 15 patients (46.67%) had residual cancer in, adjacent, or in close proximity to the treatment area (1 × 4+3=7, 1 × 3+4=7, and 5 × 3+3=6). Four out of 15 patients (26.67%) underwent salvage therapy (2 repeat FLA, 2 radical prostatectomy). CONCLUSION After 3 years of follow-up we conclude focal laser ablation is safe and feasible without significant complications.
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Affiliation(s)
- Sherif Mehralivand
- Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany;Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA;Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Arvin K George
- Department of Urology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Soroush Rais-Bahrami
- Department of Urology and Radiology, University of Alabama, Birmingham, Alabama, USA
| | | | - Amir H Lebastchi
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael Ahdoot
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Jonathan Bloom
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Abhinav Sidana
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Joanna H Shih
- Division of Cancer Treatment and Diagnosis, Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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O'Connor LP, Lebastchi AH, Fasaye GA, Dikoglu E, Daneshvar MA, Ahdoot M, Merino MJ, Pinto PA. 'Case of the Month' from the National Cancer Institute, Bethesda, MD, USA: investigating genetic aberrations in a patient with high-risk prostate cancer. BJU Int 2021; 127:171-174. [PMID: 33547722 DOI: 10.1111/bju.15273] [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: 11/28/2022]
Affiliation(s)
- Luke P O'Connor
- Center for Cancer Research, Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amir H Lebastchi
- Center for Cancer Research, Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Grace-Ann Fasaye
- Center for Cancer Research, Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Esra Dikoglu
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael A Daneshvar
- Center for Cancer Research, Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Ahdoot
- Center for Cancer Research, Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter A Pinto
- Center for Cancer Research, Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Harmon SA, Gesztes W, Young D, Mehralivand S, McKinney Y, Sanford T, Sackett J, Cullen J, Rosner IL, Srivastava S, Merino MJ, Wood BJ, Pinto PA, Choyke PL, Dobi A, Sesterhenn IA, Turkbey B. Prognostic Features of Biochemical Recurrence of Prostate Cancer Following Radical Prostatectomy Based on Multiparametric MRI and Immunohistochemistry Analysis of MRI-guided Biopsy Specimens. Radiology 2021; 299:613-623. [PMID: 33847515 DOI: 10.1148/radiol.2021202425] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Although prostate MRI is routinely used for the detection and staging of localized prostate cancer, imaging-based assessment and targeted molecular sampling for risk stratification are an active area of research. Purpose To evaluate features of preoperative MRI and MRI-guided biopsy immunohistochemistry (IHC) findings associated with biochemical recurrence (BCR) of prostate cancer after surgery. Materials and Methods In this retrospective case-control study, patients underwent multiparametric MRI before MRI-guided biopsy followed by radical prostatectomy between 2008 and 2016. Lesions were retrospectively scored with the Prostate Imaging Reporting and Data System (PI-RADS) (version 2) by radiologists who were blinded to the clinical-pathologic results. The IHC staining, including stains for the ETS-related gene, phosphatase and tensin homolog, androgen receptor, prostate specific antigen, and p53, was performed with targeted biopsy specimens of the index lesion (highest suspicion at MRI and pathologic grade) and scored by pathologists who were blinded to clinical-pathologic outcomes. Cox proportional hazards regression analysis was used to evaluate associations with recurrence-free survival (RFS). Results The median RFS was 31.7 months (range, 1-101 months) for 39 patients (median age, 62 years; age range, 47-76 years) without BCR and 14.6 months (range, 1-61 months) for 40 patients (median age, 59 years; age range, 47-73 years) with BCR. MRI features that showed a significant relationship with the RFS interval included an index lesion with a PI-RADS score of 5 (hazard ratio [HR], 2.10; 95% CI: 1.05, 4.21; P = .04); index lesion burden, defined as ratio of index lesion volume to prostate volume (HR, 1.55; 95% CI: 1.2, 2.1; P = .003); and suspicion of extraprostatic extension (EPE) (HR, 2.18; 95% CI: 1.1, 4.2; P = .02). Presurgical multivariable analysis indicated that suspicion of EPE at MRI (adjusted HR, 2.19; 95% CI: 1.1, 4.3; P = .02) and p53 stain intensity (adjusted HR, 2.22; 95% CI: 1.0, 4.7; P = .04) were significantly associated with RFS. Conclusion MRI features, including Prostate Imaging Reporting and Data System score, index lesion burden, extraprostatic extension, and preoperative guided biopsy p53 immunohistochemistry stain intensity are associated with biochemical relapse of prostate cancer after surgery. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Costa in this issue.
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Affiliation(s)
- Stephanie A Harmon
- From the Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute (S.A.H.); Molecular Imaging Branch (S.A.H., S.M., Y.M., T.S., J.S., P.L.C., B.T.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), and Urologic Oncology Branch (S.M., P.A.P.), National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Building 10, Room B3B85, Bethesda, Md 20892; Center for Prostate Disease Research, John P. Murtha Cancer Center, Department of Surgery, Uniformed Services University of the Health Sciences (W.G., D.Y., J.C., I.L.R., S.S., A.D., I.A.S.) and Urology Service (I.L.R.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Genitourinary Pathology, Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - William Gesztes
- From the Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute (S.A.H.); Molecular Imaging Branch (S.A.H., S.M., Y.M., T.S., J.S., P.L.C., B.T.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), and Urologic Oncology Branch (S.M., P.A.P.), National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Building 10, Room B3B85, Bethesda, Md 20892; Center for Prostate Disease Research, John P. Murtha Cancer Center, Department of Surgery, Uniformed Services University of the Health Sciences (W.G., D.Y., J.C., I.L.R., S.S., A.D., I.A.S.) and Urology Service (I.L.R.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Genitourinary Pathology, Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Denise Young
- From the Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute (S.A.H.); Molecular Imaging Branch (S.A.H., S.M., Y.M., T.S., J.S., P.L.C., B.T.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), and Urologic Oncology Branch (S.M., P.A.P.), National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Building 10, Room B3B85, Bethesda, Md 20892; Center for Prostate Disease Research, John P. Murtha Cancer Center, Department of Surgery, Uniformed Services University of the Health Sciences (W.G., D.Y., J.C., I.L.R., S.S., A.D., I.A.S.) and Urology Service (I.L.R.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Genitourinary Pathology, Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Sherif Mehralivand
- From the Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute (S.A.H.); Molecular Imaging Branch (S.A.H., S.M., Y.M., T.S., J.S., P.L.C., B.T.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), and Urologic Oncology Branch (S.M., P.A.P.), National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Building 10, Room B3B85, Bethesda, Md 20892; Center for Prostate Disease Research, John P. Murtha Cancer Center, Department of Surgery, Uniformed Services University of the Health Sciences (W.G., D.Y., J.C., I.L.R., S.S., A.D., I.A.S.) and Urology Service (I.L.R.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Genitourinary Pathology, Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Yolanda McKinney
- From the Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute (S.A.H.); Molecular Imaging Branch (S.A.H., S.M., Y.M., T.S., J.S., P.L.C., B.T.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), and Urologic Oncology Branch (S.M., P.A.P.), National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Building 10, Room B3B85, Bethesda, Md 20892; Center for Prostate Disease Research, John P. Murtha Cancer Center, Department of Surgery, Uniformed Services University of the Health Sciences (W.G., D.Y., J.C., I.L.R., S.S., A.D., I.A.S.) and Urology Service (I.L.R.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Genitourinary Pathology, Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Thomas Sanford
- From the Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute (S.A.H.); Molecular Imaging Branch (S.A.H., S.M., Y.M., T.S., J.S., P.L.C., B.T.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), and Urologic Oncology Branch (S.M., P.A.P.), National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Building 10, Room B3B85, Bethesda, Md 20892; Center for Prostate Disease Research, John P. Murtha Cancer Center, Department of Surgery, Uniformed Services University of the Health Sciences (W.G., D.Y., J.C., I.L.R., S.S., A.D., I.A.S.) and Urology Service (I.L.R.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Genitourinary Pathology, Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Jonathan Sackett
- From the Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute (S.A.H.); Molecular Imaging Branch (S.A.H., S.M., Y.M., T.S., J.S., P.L.C., B.T.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), and Urologic Oncology Branch (S.M., P.A.P.), National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Building 10, Room B3B85, Bethesda, Md 20892; Center for Prostate Disease Research, John P. Murtha Cancer Center, Department of Surgery, Uniformed Services University of the Health Sciences (W.G., D.Y., J.C., I.L.R., S.S., A.D., I.A.S.) and Urology Service (I.L.R.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Genitourinary Pathology, Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Jennifer Cullen
- From the Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute (S.A.H.); Molecular Imaging Branch (S.A.H., S.M., Y.M., T.S., J.S., P.L.C., B.T.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), and Urologic Oncology Branch (S.M., P.A.P.), National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Building 10, Room B3B85, Bethesda, Md 20892; Center for Prostate Disease Research, John P. Murtha Cancer Center, Department of Surgery, Uniformed Services University of the Health Sciences (W.G., D.Y., J.C., I.L.R., S.S., A.D., I.A.S.) and Urology Service (I.L.R.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Genitourinary Pathology, Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Inger L Rosner
- From the Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute (S.A.H.); Molecular Imaging Branch (S.A.H., S.M., Y.M., T.S., J.S., P.L.C., B.T.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), and Urologic Oncology Branch (S.M., P.A.P.), National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Building 10, Room B3B85, Bethesda, Md 20892; Center for Prostate Disease Research, John P. Murtha Cancer Center, Department of Surgery, Uniformed Services University of the Health Sciences (W.G., D.Y., J.C., I.L.R., S.S., A.D., I.A.S.) and Urology Service (I.L.R.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Genitourinary Pathology, Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Shiv Srivastava
- From the Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute (S.A.H.); Molecular Imaging Branch (S.A.H., S.M., Y.M., T.S., J.S., P.L.C., B.T.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), and Urologic Oncology Branch (S.M., P.A.P.), National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Building 10, Room B3B85, Bethesda, Md 20892; Center for Prostate Disease Research, John P. Murtha Cancer Center, Department of Surgery, Uniformed Services University of the Health Sciences (W.G., D.Y., J.C., I.L.R., S.S., A.D., I.A.S.) and Urology Service (I.L.R.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Genitourinary Pathology, Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Maria J Merino
- From the Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute (S.A.H.); Molecular Imaging Branch (S.A.H., S.M., Y.M., T.S., J.S., P.L.C., B.T.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), and Urologic Oncology Branch (S.M., P.A.P.), National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Building 10, Room B3B85, Bethesda, Md 20892; Center for Prostate Disease Research, John P. Murtha Cancer Center, Department of Surgery, Uniformed Services University of the Health Sciences (W.G., D.Y., J.C., I.L.R., S.S., A.D., I.A.S.) and Urology Service (I.L.R.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Genitourinary Pathology, Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Bradford J Wood
- From the Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute (S.A.H.); Molecular Imaging Branch (S.A.H., S.M., Y.M., T.S., J.S., P.L.C., B.T.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), and Urologic Oncology Branch (S.M., P.A.P.), National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Building 10, Room B3B85, Bethesda, Md 20892; Center for Prostate Disease Research, John P. Murtha Cancer Center, Department of Surgery, Uniformed Services University of the Health Sciences (W.G., D.Y., J.C., I.L.R., S.S., A.D., I.A.S.) and Urology Service (I.L.R.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Genitourinary Pathology, Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Peter A Pinto
- From the Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute (S.A.H.); Molecular Imaging Branch (S.A.H., S.M., Y.M., T.S., J.S., P.L.C., B.T.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), and Urologic Oncology Branch (S.M., P.A.P.), National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Building 10, Room B3B85, Bethesda, Md 20892; Center for Prostate Disease Research, John P. Murtha Cancer Center, Department of Surgery, Uniformed Services University of the Health Sciences (W.G., D.Y., J.C., I.L.R., S.S., A.D., I.A.S.) and Urology Service (I.L.R.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Genitourinary Pathology, Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Peter L Choyke
- From the Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute (S.A.H.); Molecular Imaging Branch (S.A.H., S.M., Y.M., T.S., J.S., P.L.C., B.T.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), and Urologic Oncology Branch (S.M., P.A.P.), National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Building 10, Room B3B85, Bethesda, Md 20892; Center for Prostate Disease Research, John P. Murtha Cancer Center, Department of Surgery, Uniformed Services University of the Health Sciences (W.G., D.Y., J.C., I.L.R., S.S., A.D., I.A.S.) and Urology Service (I.L.R.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Genitourinary Pathology, Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Albert Dobi
- From the Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute (S.A.H.); Molecular Imaging Branch (S.A.H., S.M., Y.M., T.S., J.S., P.L.C., B.T.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), and Urologic Oncology Branch (S.M., P.A.P.), National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Building 10, Room B3B85, Bethesda, Md 20892; Center for Prostate Disease Research, John P. Murtha Cancer Center, Department of Surgery, Uniformed Services University of the Health Sciences (W.G., D.Y., J.C., I.L.R., S.S., A.D., I.A.S.) and Urology Service (I.L.R.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Genitourinary Pathology, Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Isabell A Sesterhenn
- From the Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute (S.A.H.); Molecular Imaging Branch (S.A.H., S.M., Y.M., T.S., J.S., P.L.C., B.T.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), and Urologic Oncology Branch (S.M., P.A.P.), National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Building 10, Room B3B85, Bethesda, Md 20892; Center for Prostate Disease Research, John P. Murtha Cancer Center, Department of Surgery, Uniformed Services University of the Health Sciences (W.G., D.Y., J.C., I.L.R., S.S., A.D., I.A.S.) and Urology Service (I.L.R.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Genitourinary Pathology, Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Baris Turkbey
- From the Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute (S.A.H.); Molecular Imaging Branch (S.A.H., S.M., Y.M., T.S., J.S., P.L.C., B.T.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), and Urologic Oncology Branch (S.M., P.A.P.), National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Building 10, Room B3B85, Bethesda, Md 20892; Center for Prostate Disease Research, John P. Murtha Cancer Center, Department of Surgery, Uniformed Services University of the Health Sciences (W.G., D.Y., J.C., I.L.R., S.S., A.D., I.A.S.) and Urology Service (I.L.R.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Genitourinary Pathology, Joint Pathology Center, Silver Spring, Md (I.A.S.)
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Wilkinson S, Ye H, Karzai F, Harmon SA, Terrigino NT, VanderWeele DJ, Bright JR, Atway R, Trostel SY, Carrabba NV, Whitlock NC, Walker SM, Lis RT, Abdul Sater H, Capaldo BJ, Madan RA, Gulley JL, Chun G, Merino MJ, Pinto PA, Salles DC, Kaur HB, Lotan TL, Venzon DJ, Choyke PL, Turkbey B, Dahut WL, Sowalsky AG. Nascent Prostate Cancer Heterogeneity Drives Evolution and Resistance to Intense Hormonal Therapy. Eur Urol 2021; 80:746-757. [PMID: 33785256 DOI: 10.1016/j.eururo.2021.03.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients diagnosed with high risk localized prostate cancer have variable outcomes following surgery. Trials of intense neoadjuvant androgen deprivation therapy (NADT) have shown lower rates of recurrence among patients with minimal residual disease after treatment. The molecular features that distinguish exceptional responders from poor responders are not known. OBJECTIVE To identify genomic and histologic features associated with treatment resistance at baseline. DESIGN, SETTING, AND PARTICIPANTS Targeted biopsies were obtained from 37 men with intermediate- to high-risk prostate cancer before receiving 6 mo of ADT plus enzalutamide. Biopsy tissues were used for whole-exome sequencing and immunohistochemistry (IHC). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We assessed the relationship of molecular features with final pathologic response using a cutpoint of 0.05 cm3 for residual cancer burden to compare exceptional responders to incomplete and nonresponders. We assessed intratumoral heterogeneity at the tissue and genomic level, and compared the volume of residual disease to the Shannon diversity index for each tumor. We generated multivariate models of resistance based on three molecular features and one histologic feature, with and without multiparametric magnetic resonance imaging estimates of baseline tumor volume. RESULTS AND LIMITATIONS Loss of chromosome 10q (containing PTEN) and alterations to TP53 were predictive of poor response, as were the expression of nuclear ERG on IHC and the presence of intraductal carcinoma of the prostate. Patients with incompletely and nonresponding tumors harbored greater tumor diversity as estimated via phylogenetic tree reconstruction from DNA sequencing and analysis of IHC staining. Our four-factor binary model (area under the receiver operating characteristic curve [AUC] 0.89) to predict poor response correlated with greater diversity in our cohort and a validation cohort of 57 Gleason score 8-10 prostate cancers from The Cancer Genome Atlas. When baseline tumor volume was added to the model, it distinguished poor response to NADT with an AUC of 0.98. Prospective use of this model requires further retrospective validation with biopsies from additional trials. CONCLUSIONS A subset of prostate cancers exhibit greater histologic and genomic diversity at the time of diagnosis, and these localized tumors have greater fitness to resist therapy. PATIENT SUMMARY Some prostate cancer tumors do not respond well to a hormonal treatment called androgen deprivation therapy (ADT). We used tumor volume and four other parameters to develop a model to identify tumors that will not respond well to ADT. Treatments other than ADT should be considered for these patients.
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Affiliation(s)
- Scott Wilkinson
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA
| | - Huihui Ye
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Pathology and Department of Urology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Fatima Karzai
- Genitourinary Malignancies Branch, National Cancer Institute, Bethesda, MD, USA
| | - Stephanie A Harmon
- Molecular Imaging Branch, National Cancer Institute, Bethesda, MD, USA; Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Nicholas T Terrigino
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA
| | - David J VanderWeele
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA; Department of Medicine, Feinberg School of Medicine, Chicago, IL, USA
| | - John R Bright
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA
| | - Rayann Atway
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA
| | - Shana Y Trostel
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA
| | - Nicole V Carrabba
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA
| | - Nichelle C Whitlock
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA
| | | | - Rosina T Lis
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA
| | | | - Brian J Capaldo
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA
| | - Ravi A Madan
- Genitourinary Malignancies Branch, National Cancer Institute, Bethesda, MD, USA
| | - James L Gulley
- Genitourinary Malignancies Branch, National Cancer Institute, Bethesda, MD, USA
| | - Guinevere Chun
- Genitourinary Malignancies Branch, National Cancer Institute, Bethesda, MD, USA
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Daniela C Salles
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Harsimar B Kaur
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Tamara L Lotan
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David J Venzon
- Biostatistics and Data Management Section, National Cancer Institute, Rockville, MD, USA
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, Bethesda, MD, USA
| | - William L Dahut
- Genitourinary Malignancies Branch, National Cancer Institute, Bethesda, MD, USA
| | - Adam G Sowalsky
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA.
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39
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Bloom JB, Daneshvar MA, Lebastchi AH, Ahdoot M, Gold SA, Hale G, Mehralivand S, Sanford T, Valera V, Wood BJ, Choyke PL, Merino MJ, Turkbey B, Parnes HL, Pinto PA. Risk of adverse pathology at prostatectomy in the era of MRI and targeted biopsies; rethinking active surveillance for intermediate risk prostate cancer patients. Urol Oncol 2021; 39:729.e1-729.e6. [PMID: 33736975 DOI: 10.1016/j.urolonc.2021.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/25/2020] [Revised: 02/11/2021] [Accepted: 02/21/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Men with intermediate risk (IR) prostate cancer (CaP) are often excluded from active surveillance (AS) due to higher rates of adverse pathology (AP). We determined our rate of AP in men who underwent multiparametric MRI (MpMRI) with combined biopsy (CB) consisting of targeted biopsy (TB) and systematic biopsy (SB) prior to radical prostatectomy (RP). METHODS A retrospective review was conducted of men with Gleason Grade Group (GG) 2 disease who underwent RP after SB alone or after preoperative MRI with CB. AP was defined as either pathologic stage T3a (AP ≥ T3a) or pathologic stage T3b (AP ≥ T3b) and/or GG upgrading. Rates of AP were determined for both groups and those who fit the National Comprehensive Cancer Network (NCCN) definition of favorable IR (FIR) or the low volume IR (LVIR) criteria. Multivariable logistic regression was used to determine predictive factors. RESULTS The overall rate of AP ≥ T3b was 21.2% in the SB group vs. 8.6% in the MRI with CB group, P = 0.006. This rate was lowered to 6.8% and 5.6% when men met the definition of NCCN FIR or LVIR, respectively. Suspicion for extraprostatic extension (EPE) (OR 7.65, 95% CI 1.77-33.09, P = 0.006) and positive cores of GG 2 on SB (OR 1.43, 95% CI 1.05-1.96, P = 0.023) were significant for predicting AP ≥ T3b. CONCLUSIONS Rates of AP at RP after MRI with CB are lower than studies prior to the adoption of this technology, suggesting that more men with IR disease may be considered for AS. However, increasing cores positive on SB and MRI findings suggestive of EPE remain unsafe.
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Affiliation(s)
- Jonathan B Bloom
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Michael A Daneshvar
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Amir H Lebastchi
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Michael Ahdoot
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Samuel A Gold
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Graham Hale
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Sherif Mehralivand
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Thomas Sanford
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Vladimir Valera
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Howard L Parnes
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany.
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40
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Yang Y, Ricketts CJ, Vocke CD, Killian JK, Padilla-Nash HM, Lang M, Wei D, Lee YH, Wangsa D, Sourbier C, Meltzer PS, Ried T, Merino MJ, Metwalli AR, Ball MW, Srinivasan R, Linehan WM. Characterization of genetically defined sporadic and hereditary type 1 papillary renal cell carcinoma cell lines. Genes Chromosomes Cancer 2021; 60:434-446. [PMID: 33527590 PMCID: PMC8251606 DOI: 10.1002/gcc.22940] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 01/03/2023] Open
Abstract
Renal cell carcinoma (RCC) is not a single disease but is made up of several different histologically defined subtypes that are associated with distinct genetic alterations which require subtype specific management and treatment. Papillary renal cell carcinoma (pRCC) is the second most common subtype after conventional/clear cell RCC (ccRCC), representing ~20% of cases, and is subcategorized into type 1 and type 2 pRCC. It is important for preclinical studies to have cell lines that accurately represent each specific RCC subtype. This study characterizes seven cell lines derived from both primary and metastatic sites of type 1 pRCC, including the first cell line derived from a hereditary papillary renal carcinoma (HPRC)‐associated tumor. Complete or partial gain of chromosome 7 was observed in all cell lines and other common gains of chromosomes 16, 17, or 20 were seen in several cell lines. Activating mutations of MET were present in three cell lines that all demonstrated increased MET phosphorylation in response to HGF and abrogation of MET phosphorylation in response to MET inhibitors. CDKN2A loss due to mutation or gene deletion, associated with poor outcomes in type 1 pRCC patients, was observed in all cell line models. Six cell lines formed tumor xenografts in athymic nude mice and thus provide in vivo models of type 1 pRCC. These type 1 pRCC cell lines provide a comprehensive representation of the genetic alterations associated with pRCC that will give insight into the biology of this disease and be ideal preclinical models for therapeutic studies.
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Affiliation(s)
- Youfeng Yang
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher J Ricketts
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Cathy D Vocke
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - J Keith Killian
- Genetics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Hesed M Padilla-Nash
- Genetics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Martin Lang
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Darmood Wei
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Young H Lee
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Darawalee Wangsa
- Genetics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Carole Sourbier
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Paul S Meltzer
- Genetics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Thomas Ried
- Genetics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adam R Metwalli
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark W Ball
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ramaprasad Srinivasan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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41
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Owens-Walton J, Gurram S, Merino MJ, Linehan WM, Ball MW. Macronodular adrenal hyperplasia masquerading as an upper pole renal mass. Urol Case Rep 2021; 37:101603. [PMID: 33665124 PMCID: PMC7900682 DOI: 10.1016/j.eucr.2021.101603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 11/05/2022] Open
Abstract
Macronodular hyperplasia (MAH) of the adrenal gland is a rare disease usually presenting with Cushing Syndrome. Although usually readily apparent on imaging, an adrenal tumor in an asymptomatic patient may be mistaken for a renal tumor. We present a patient with combined macro- and micro-nodular adrenal hyperplasia masquerading as an upper pole renal mass. The patient underwent a robotic partial nephrectomy and partial adrenalectomy without complication.
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Affiliation(s)
- Jeunice Owens-Walton
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - W Marston Linehan
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark W Ball
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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42
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Beck EJ, Mandalia S, Yfantopoulos P, Jones CI, Bremner S, Whetham J, Etcheverry F, Moreno L, Gonzalez E, Merino MJ, Leon A, Garcia F. Efficiency of the EmERGE Pathway to provide continuity of care for Spanish people living with medically stable HIV. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(20)30422-5. [PMID: 33549335 DOI: 10.1016/j.eimc.2020.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/13/2020] [Accepted: 11/23/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Calculate the efficiency of the EmERGE Pathway of Care for medically stable people living with HIV at the Hospital Clínic-IDIBAPS, Barcelona, Spain. METHODS 546 study participants were followed between 1st July 2016 and 30th October 2019 across three HIV outpatient clinics, but the virtual clinic was closed during the second year. Unit costs were calculated, linked to mean use outpatient services per patient year, one-year before and after the implementation of EmERGE. Costs were combined with primary and secondary outcomes. RESULTS Annual costs across HIV-outpatient services increased by 8%: €1073 (95%CI €999-€1157) to €1158 (95%CI €1084-€1238). Annual cost of ARVs was €7,557; total annual costs increased by 1% from €8430 (95%CI €8356-8514) to €8515 (95%CI €8441-8595). Annual cost for 433 participants managed in face-to-face (F2F) clinics decreased by 5% from €958 (95%CI 905-1018) to €904 (95%CI 863-945); participants transferred from virtual to F2F outpatient clinics (V2F) increased their annual cost by a factor of 2.2, from €115 (95%CI 94-139) to €251 (95%CI 219-290). No substantive changes were observed in primary and secondary outcomes. CONCLUSION EmERGE Pathway is an efficient and acceptable intervention. Increases in costs were caused by internal structural changes. The cost reduction observed in F2F clinics were off-set by the transfer of participants from the virtual to the F2F clinics due to the closure of the virtual clinic during the second year of the Study. Greater efficiencies are likely to be achieved by extending the use of the Pathway to other PLHIV.
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Affiliation(s)
- E J Beck
- NPMS-HHC CIC, London, UK; Department of Health Services Research and Policy, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | - C I Jones
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
| | - S Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
| | - J Whetham
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - F Etcheverry
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - L Moreno
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - E Gonzalez
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - M J Merino
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - A Leon
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - F Garcia
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
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Crooks DR, Maio N, Lang M, Ricketts CJ, Vocke CD, Gurram S, Turan S, Kim YY, Cawthon GM, Sohelian F, De Val N, Pfeiffer RM, Jailwala P, Tandon M, Tran B, Fan TWM, Lane AN, Ried T, Wangsa D, Malayeri AA, Merino MJ, Yang Y, Meier JL, Ball MW, Rouault TA, Srinivasan R, Linehan WM. Mitochondrial DNA alterations underlie an irreversible shift to aerobic glycolysis in fumarate hydratase-deficient renal cancer. Sci Signal 2021; 14:14/664/eabc4436. [PMID: 33402335 DOI: 10.1126/scisignal.abc4436] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Understanding the mechanisms of the Warburg shift to aerobic glycolysis is critical to defining the metabolic basis of cancer. Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is an aggressive cancer characterized by biallelic inactivation of the gene encoding the Krebs cycle enzyme fumarate hydratase, an early shift to aerobic glycolysis, and rapid metastasis. We observed impairment of the mitochondrial respiratory chain in tumors from patients with HLRCC. Biochemical and transcriptomic analyses revealed that respiratory chain dysfunction in the tumors was due to loss of expression of mitochondrial DNA (mtDNA)-encoded subunits of respiratory chain complexes, caused by a marked decrease in mtDNA content and increased mtDNA mutations. We demonstrated that accumulation of fumarate in HLRCC tumors inactivated the core factors responsible for replication and proofreading of mtDNA, leading to loss of respiratory chain components, thereby promoting the shift to aerobic glycolysis and disease progression in this prototypic model of glucose-dependent human cancer.
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Affiliation(s)
- Daniel R Crooks
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Nunziata Maio
- Molecular Medicine Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20892, USA
| | - Martin Lang
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Christopher J Ricketts
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Cathy D Vocke
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Sandeep Gurram
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Sevilay Turan
- Sequencing Facility, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, MD 21701, USA
| | - Yun-Young Kim
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - G Mariah Cawthon
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Ferri Sohelian
- Electron Microscopy Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, MD 21702, USA
| | - Natalia De Val
- Electron Microscopy Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, MD 21702, USA
| | - Ruth M Pfeiffer
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
| | - Parthav Jailwala
- CCR Collaborative Bioinformatics Resource (CCBR), Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, MD 21702, USA.,Advanced Biomedical Computational Science, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, MD 21702, USA
| | - Mayank Tandon
- CCR Collaborative Bioinformatics Resource (CCBR), Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, MD 21702, USA.,Advanced Biomedical Computational Science, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, MD 21702, USA
| | - Bao Tran
- Sequencing Facility, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, MD 21701, USA
| | - Teresa W-M Fan
- Center for Environmental and Systems Biochemistry, Department of Toxicology and Cancer Biology and Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Andrew N Lane
- Center for Environmental and Systems Biochemistry, Department of Toxicology and Cancer Biology and Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Thomas Ried
- Genetics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Darawalee Wangsa
- Genetics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Ashkan A Malayeri
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Maria J Merino
- Genitourinary Pathology Section, Laboratory of Pathology, National Cancer Institute, Bethesda, MD 20892, USA
| | - Youfeng Yang
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Jordan L Meier
- Epigenetics and Metabolism Section, Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, MD 21702, USA
| | - Mark W Ball
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Tracey A Rouault
- Molecular Medicine Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20892, USA
| | - Ramaprasad Srinivasan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA.
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Merino MJ, Ricketts CJ, Moreno V, Yang Y, Fan TW, Lane AN, Meltzer PS, Vocke CD, Crooks DR, Linehan WM. Multifocal Renal Cell Carcinomas With Somatic IDH2 Mutation: Report of a Previously Undescribed Neoplasm. Am J Surg Pathol 2021; 45:137-142. [PMID: 33165095 PMCID: PMC7736215 DOI: 10.1097/pas.0000000000001611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Renal cell carcinoma (RCC) is a heterogenous disease composed of several different cancer types characterized by distinct histologies and genetic alterations, including mutation of the Krebs cycle enzyme genes for fumarate hydratase and succinate dehydrogenase (SDH). This report describes a patient with multifocal renal tumors that presented with a novel, biphasic histologic morphology with one component consisting of small cells growing in a diffuse pattern occasionally forming glandular and cystic structures, reminiscent of type 1 papillary RCC, and the other component having larger cells with abundant eosinophilic and clear cytoplasm and appearing in a solid pattern of growth. Genetic analysis of multiple tumors showed that all had a somatic mutation of the IDH2 gene that created the known pathogenic, gain-of-function p.R172M alteration that results in abnormal accumulation of the oncometabolite 2-hydroxyglutarate (2-HG). Analysis of multiple tumors demonstrated highly elevated levels of 2-HG and a CpG island methylator phenotype that is characteristic of 2-HG-related inhibition of the Ten-eleven translocation (TET) family of DNA demethylases. In combination with fumarate hydratase-deficient and succinate dehydrogenase-deficient RCCs that have increased levels of the fumarate and succinate oncometabolites, respectively, the mutation of isocitrate dehydrogenase 2 represents the third Krebs cycle enzyme alteration to be associated with oncometabolite-induced RCC tumorigenesis. This study associates the discovery of a new histologic presentation of RCC with the first report of an IDH2 gain-of-function mutation in RCC.
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Affiliation(s)
- Maria J. Merino
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Christopher J. Ricketts
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Vanessa Moreno
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Ye Yang
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Teresa W.M. Fan
- Center for Environmental and Systems Biochemistry, Department of Toxicology and Cancer Biology and Markey Cancer Center, University of Kentucky, Lexington, Kentucky 40536, USA
| | - Andrew N. Lane
- Center for Environmental and Systems Biochemistry, Department of Toxicology and Cancer Biology and Markey Cancer Center, University of Kentucky, Lexington, Kentucky 40536, USA
| | - Paul S. Meltzer
- Genetics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Cathy D. Vocke
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Daniel R. Crooks
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - W. Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
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Matlac DM, Hadrava Vanova K, Bechmann N, Richter S, Folberth J, Ghayee HK, Ge GB, Abunimer L, Wesley R, Aherrahrou R, Dona M, Martínez-Montes ÁM, Calsina B, Merino MJ, Schwaninger M, Deen PMT, Zhuang Z, Neuzil J, Pacak K, Lehnert H, Fliedner SMJ. Succinate Mediates Tumorigenic Effects via Succinate Receptor 1: Potential for New Targeted Treatment Strategies in Succinate Dehydrogenase Deficient Paragangliomas. Front Endocrinol (Lausanne) 2021; 12:589451. [PMID: 33776908 PMCID: PMC7994772 DOI: 10.3389/fendo.2021.589451] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/29/2021] [Indexed: 12/12/2022] Open
Abstract
Paragangliomas and pheochromocytomas (PPGLs) are chromaffin tumors associated with severe catecholamine-induced morbidities. Surgical removal is often curative. However, complete resection may not be an option for patients with succinate dehydrogenase subunit A-D (SDHx) mutations. SDHx mutations are associated with a high risk for multiple recurrent, and metastatic PPGLs. Treatment options in these cases are limited and prognosis is dismal once metastases are present. Identification of new therapeutic targets and candidate drugs is thus urgently needed. Previously, we showed elevated expression of succinate receptor 1 (SUCNR1) in SDHB PPGLs and SDHD head and neck paragangliomas. Its ligand succinate has been reported to accumulate due to SDHx mutations. We thus hypothesize that autocrine stimulation of SUCNR1 plays a role in the pathogenesis of SDHx mutation-derived PPGLs. We confirmed elevated SUCNR1 expression in SDHx PPGLs and after SDHB knockout in progenitor cells derived from a human pheochromocytoma (hPheo1). Succinate significantly increased viability of SUCNR1-transfected PC12 and ERK pathway signaling compared to control cells. Candidate SUCNR1 inhibitors successfully reversed proliferative effects of succinate. Our data reveal an unrecognized oncometabolic function of succinate in SDHx PPGLs, providing a growth advantage via SUCNR1.
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Affiliation(s)
- Dieter M. Matlac
- Neuroendocrine Oncology and Metabolism, Medical Department I, Center of Brain, Behavior, and Metabolism, University Medical Center Schleswig-Holstein Lübeck, Lübeck, Germany
| | - Katerina Hadrava Vanova
- Institute of Biotechnology, Czech Academy of Sciences, Prague-West, Czechia
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Nicole Bechmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Susan Richter
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Julica Folberth
- Institute for Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Lübeck, Germany
| | - Hans K. Ghayee
- Department of Medicine, Division of Endocrinology, University of Florida and Malcom Randall VA Medical Center, Gainesville, FL, United States
| | - Guang-Bo Ge
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Luma Abunimer
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | | | - Redouane Aherrahrou
- Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany
- Department of Biomedical Engineering, Centre for Public Health Genomics, University of Virginia, Charlottesville, VA, United States
| | - Margo Dona
- Division of Endocrinology 471, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ángel M. Martínez-Montes
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Bruna Calsina
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Maria J. Merino
- Laboratory of Surgical Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Markus Schwaninger
- Institute for Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Lübeck, Germany
| | | | - Zhengping Zhuang
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Jiri Neuzil
- Institute of Biotechnology, Czech Academy of Sciences, Prague-West, Czechia
- School of Medical Science, Griffith University, Southport, QLD, Australia
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Hendrik Lehnert
- Neuroendocrine Oncology and Metabolism, Medical Department I, Center of Brain, Behavior, and Metabolism, University Medical Center Schleswig-Holstein Lübeck, Lübeck, Germany
| | - Stephanie M. J. Fliedner
- Neuroendocrine Oncology and Metabolism, Medical Department I, Center of Brain, Behavior, and Metabolism, University Medical Center Schleswig-Holstein Lübeck, Lübeck, Germany
- *Correspondence: Stephanie M. J. Fliedner,
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Coskun M, Mehralivand S, Shih JH, Merino MJ, Wood BJ, Pinto PA, Barrett T, Choyke PL, Turkbey B. Impact of bowel preparation with Fleet's™ enema on prostate MRI quality. Abdom Radiol (NY) 2020; 45:4252-4259. [PMID: 32211948 DOI: 10.1007/s00261-020-02487-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIM To investigate the effects of cleansing Fleet's™ enema (FE) on rectal distention and image quality of diffusion-weighted imaging (DWI) in prostate magnetic resonance imaging (MRI). METHODS This study included 117 prospectively accrued active surveillance patients who underwent prostate MRI both without (prep-) and with bowel preparation consisting of FE (prep+) obtained within 12 months of each other. The anterior-posterior (AP) diameter of the rectum, degree of perceived distention in the rectum and image quality scores were assessed by two independent readers for both (prep- and prep+) scans. DWI distortion was assessed quantitatively using the degree of anatomic mismatches between images obtained at different b values and the T2-weighted MRI. DWI artifact was qualitatively scored based on the presence of blurring, poor signal-to-noise, and artifact lines. The difference in rectal AP diameters between the two methods was tested by the paired Wilcoxon rank test. Stuart Maxell test was used in comparing rectal distention, DWI distortion, and artifact. Reader agreement was estimated by kappa statistics. p values < 0.05 were considered statistically significant. RESULTS Mean rectal AP diameter was significantly larger in prep- compared with prep+ scans (p = 0.002). Subjective scores demonstrated inter-reader variability. For instance, the rectal distention score was significantly lower in prep+ for reader 2 (p < 0.001) whereas it was not significant for reader 1 (p = 0.09). Reader 2 also found significant improvement in DWI distortion (p = 0.02) in prep+ scans. There was no significant difference between prep- and prep+ in DWI distortion and artifacts for reader 1 (p = 0.17 and p = 0.49, respectively), or DWI artifacts for reader 2 (p = 0.55). Kappa scores were moderate for rectal distension, but weak for DWI distortion, and artifacts. CONCLUSION Bowel preparation with enema prior to prostate MRI may diminish rectal gas but has modest effects on DWI distortion and overall image quality. The value of bowel prep is not conclusively validated in this study.
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Affiliation(s)
- Mehmet Coskun
- Department of Radiology, Health Science University Dr. Behçet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Sherif Mehralivand
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joanna H Shih
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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Apolo AB, Nadal R, Girardi DM, Niglio SA, Ley L, Cordes LM, Steinberg SM, Sierra Ortiz O, Cadena J, Diaz C, Mallek M, Davarpanah NN, Costello R, Trepel JB, Lee MJ, Merino MJ, Bagheri MH, Monk P, Figg WD, Gulley JL, Agarwal PK, Valera V, Chalfin HJ, Jones J, Streicher H, Wright JJ, Ning YM, Parnes HL, Dahut WL, Bottaro DP, Lara PN, Saraiya B, Pal SK, Stein MN, Mortazavi A. Phase I Study of Cabozantinib and Nivolumab Alone or With Ipilimumab for Advanced or Metastatic Urothelial Carcinoma and Other Genitourinary Tumors. J Clin Oncol 2020; 38:3672-3684. [PMID: 32915679 PMCID: PMC7605393 DOI: 10.1200/jco.20.01652] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE We assessed the safety and efficacy of cabozantinib and nivolumab (CaboNivo) and CaboNivo plus ipilimumab (CaboNivoIpi) in patients with metastatic urothelial carcinoma (mUC) and other genitourinary (GU) malignances. PATIENTS AND METHODS Patients received escalating doses of CaboNivo or CaboNivoIpi. The primary objective was to establish a recommended phase II dose (RP2D). Secondary objectives included objective response rate (ORR), progression-free survival (PFS), duration of response (DoR), and overall survival (OS). RESULTS Fifty-four patients were enrolled at eight dose levels with a median follow-up time of 44.6 months; data cutoff was January 20, 2020. Grade 3 or 4 treatment-related adverse events (AEs) occurred in 75% and 87% of patients treated with CaboNivo and CaboNivoIpi, respectively, and included fatigue (17% and 10%, respectively), diarrhea (4% and 7%, respectively), and hypertension (21% and 10%, respectively); grade 3 or 4 immune-related AEs included hepatitis (0% and 13%, respectively) and colitis (0% and 7%, respectively). The RP2D was cabozantinib 40 mg/d plus nivolumab 3 mg/kg for CaboNivo and cabozantinib 40 mg/d, nivolumab 3 mg/kg, and ipilimumab 1 mg/kg for CaboNivoIpi. ORR was 30.6% (95% CI, 20.0% to 47.5%) for all patients and 38.5% (95% CI, 13.9% to 68.4%) for patients with mUC. Median DoR was 21.0 months (95% CI, 5.4 to 24.1 months) for all patients and not reached for patients with mUC. Median PFS was 5.1 months (95% CI, 3.5 to 6.9 months) for all patients and 12.8 months (95% CI, 1.8 to 24.1 months) for patients with mUC. Median OS was 12.6 months (95% CI, 6.9 to 18.8 months) for all patients and 25.4 months (95% CI, 5.7 to 41.6 months) for patients with mUC. CONCLUSION CaboNivo and CaboNivoIpi demonstrated manageable toxicities with durable responses and encouraging survival in patients with mUC and other GU tumors. Multiple phase II and III trials are ongoing for these combinations.
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Affiliation(s)
- Andrea B. Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Rosa Nadal
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Daniel M. Girardi
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Scot A. Niglio
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Lisa Ley
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Lisa M. Cordes
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Seth M. Steinberg
- Biostatistics and Data Management Section, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Olena Sierra Ortiz
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jacqueline Cadena
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Carlos Diaz
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Marissa Mallek
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Nicole N. Davarpanah
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Rene Costello
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jane B. Trepel
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Min-Jung Lee
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Maria J. Merino
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mohammad Hadi Bagheri
- Clinical Image Processing Service, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Paul Monk
- Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Ohio State University, and the Comprehensive Cancer Center, Columbus, OH
| | - William D. Figg
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - James L. Gulley
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Piyush K. Agarwal
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Vladimir Valera
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Heather J. Chalfin
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jennifer Jones
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Howard Streicher
- Investigational Drug Branch, Cancer Therapy Evaluation Program, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - John J. Wright
- Investigational Drug Branch, Cancer Therapy Evaluation Program, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Yangmin M. Ning
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Howard L. Parnes
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - William L. Dahut
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Donald P. Bottaro
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Primo N. Lara
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | - Biren Saraiya
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Mark N. Stein
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Amir Mortazavi
- Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Ohio State University, and the Comprehensive Cancer Center, Columbus, OH
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O'Connor LP, Wang AZ, Yerram NK, Long L, Ahdoot M, Lebastchi AH, Gurram S, Zeng J, Harmon SA, Mehralivand S, Merino MJ, Parnes HL, Choyke PL, Shih JH, Wood BJ, Turkbey B, Pinto PA. Changes in Magnetic Resonance Imaging Using the Prostate Cancer Radiologic Estimation of Change in Sequential Evaluation Criteria to Detect Prostate Cancer Progression for Men on Active Surveillance. Eur Urol Oncol 2020; 4:227-234. [PMID: 33867045 DOI: 10.1016/j.euo.2020.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/07/2020] [Accepted: 09/17/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND The ability of serial magnetic resonance imaging (MRI) to capture pathologic progression during active surveillance (AS) remains in question. OBJECTIVE To determine whether changes in MRI are associated with pathologic progression for patients on AS. DESIGN, SETTING, AND PARTICIPANTS From July 2007 through January 2020, we identified all patients evaluated for AS at our institution. Following confirmatory biopsy, a total of 391 patients who underwent surveillance MRI and biopsy at least once were identified (median follow-up of 35.6 mo, interquartile range 19.7-60.6). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS All MRI intervals were scored using the "Prostate Cancer Radiologic Estimation of Change in Sequential Evaluation" (PRECISE) criteria, with PRECISE scores =4 considered a positive change in MRI. A generalized estimating equation-based logistic regression analysis was conducted for all intervals with a PRECISE score of <4 to determine the predictors of Gleason grade group (GG) progression despite stable MRI. RESULTS AND LIMITATIONS A total of 621 MRI intervals were scored by PRECISE and validated by biopsy. The negative predictive value of stable MRI (PRECISE score <4) was greatest for detecting GG1 to?=?GG3 disease (0.94 [0.91-0.97]). If 2-yr surveillance biopsy were performed exclusively for a positive change in MRI, 3.7% (4/109) of avoided biopsies would have resulted in missed progression from GG1 to?=?GG3 disease. Prostate-specific antigen (PSA) density (odds ratio 1.95 [1.17-3.25], p?=? 0.01) was a risk factor for progression from GG1 to =GG3 disease despite stable MRI. CONCLUSIONS In patients with GG1 disease and stable MRI (PRECISE score <4) on surveillance, grade progression to?=?GG3 disease is not common. In patients with grade progression detected on biopsy despite stable MRI, elevated PSA density appeared to be a risk factor for progression to?=?GG3 disease. PATIENT SUMMARY For patients with low-risk prostate cancer on active surveillance, the risk of progressing to grade group 3 disease is low with a stable magnetic resonance image (MRI) after 2?yr. Having higher prostate-specific antigen density increases the risk of progression, despite having a stable MRI.
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Affiliation(s)
- Luke P O'Connor
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alex Z Wang
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nitin K Yerram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lori Long
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Ahdoot
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amir H Lebastchi
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Johnathan Zeng
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stephanie A Harmon
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Bethesda, MD, USA
| | - Sherif Mehralivand
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Howard L Parnes
- Division of Cancer Prevention, National Cancer Institutes, National Institutes of Health, Bethesda, MD, USA
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joanna H Shih
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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49
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Karzai F, Walker SM, Wilkinson S, Madan RA, Shih JH, Merino MJ, Harmon SA, VanderWeele DJ, Cordes LM, Carrabba NV, Bright JR, Terrigino NT, Chun G, Bilusic M, Couvillon A, Hankin A, Williams MN, Lis RT, Ye H, Choyke PL, Gulley JL, Sowalsky AG, Turkbey B, Pinto PA, Dahut WL. Sequential Prostate Magnetic Resonance Imaging in Newly Diagnosed High-risk Prostate Cancer Treated with Neoadjuvant Enzalutamide is Predictive of Therapeutic Response. Clin Cancer Res 2020; 27:429-437. [PMID: 33023952 DOI: 10.1158/1078-0432.ccr-20-2344] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/26/2020] [Accepted: 10/01/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE For high-risk prostate cancer, standard treatment options include radical prostatectomy (RP) or radiotherapy plus androgen deprivation therapy (ADT). Despite definitive therapy, many patients will have disease recurrence. Imaging has the potential to better define characteristics of response and resistance. In this study, we evaluated prostate multiparametric MRI (mpMRI) before and after neoadjuvant enzalutamide plus ADT. PATIENTS AND METHODS Men with localized intermediate- or high-risk prostate cancer underwent a baseline mpMRI and mpMRI-targeted biopsy followed by a second mpMRI after 6 months of enzalutamide and ADT prior to RP. Specimens were sectioned in the same plane as mpMRI using patient-specific 3D-printed molds to permit mpMRI-targeted biopsies to be compared with the same lesion from the RP. Specimens were analyzed for imaging and histologic correlates of response. RESULTS Of 39 patients enrolled, 36 completed imaging and RP. Most patients (92%) had high-risk disease. Fifty-eight lesions were detected on baseline mpMRI, of which 40 (69%) remained measurable at 6-month follow-up imaging. Fifty-five of 59 lesions (93%) demonstrated >50% volume reduction on posttreatment mpMRI. Three of 59 lesions (5%) demonstrated growth in size at follow-up imaging, with two lesions increasing more than 3-fold in volume. On whole-mount pathology, 15 patients demonstrated minimal residual disease (MRD) of <0.05 cc or pathologic complete response. Low initial mpMRI relative tumor burden was most predictive of MRD on final pathology. CONCLUSIONS Low relative lesion volume at baseline mpMRI was predictive of pathologic response. A subset of patients had limited response. Selection of patients based on these metrics may improve outcomes in high-risk disease.
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Affiliation(s)
- Fatima Karzai
- Genitourinary Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | | | - Scott Wilkinson
- Laboratory for Genitourinary Cancer Pathogenesis, NCI, NIH, Bethesda, Maryland
| | - Ravi A Madan
- Genitourinary Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Joanna H Shih
- Division of Cancer Treatment and Diagnosis, Biometric Research Program, NCI, NIH, Rockville, Maryland
| | | | - Stephanie A Harmon
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, Maryland
| | - David J VanderWeele
- Laboratory for Genitourinary Cancer Pathogenesis, NCI, NIH, Bethesda, Maryland
| | - Lisa M Cordes
- Genitourinary Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Nicole V Carrabba
- Laboratory for Genitourinary Cancer Pathogenesis, NCI, NIH, Bethesda, Maryland
| | - John R Bright
- Laboratory for Genitourinary Cancer Pathogenesis, NCI, NIH, Bethesda, Maryland
| | - Nicolas T Terrigino
- Laboratory for Genitourinary Cancer Pathogenesis, NCI, NIH, Bethesda, Maryland
| | - Guinevere Chun
- Genitourinary Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Marijo Bilusic
- Genitourinary Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Anna Couvillon
- Genitourinary Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Amy Hankin
- Genitourinary Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Monique N Williams
- Genitourinary Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Rosina T Lis
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Huihui Ye
- Department of Pathology, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | | | - James L Gulley
- Genitourinary Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Adam G Sowalsky
- Laboratory for Genitourinary Cancer Pathogenesis, NCI, NIH, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Program, NCI, NIH, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, NCI, NIH, Bethesda, Maryland
| | - William L Dahut
- Genitourinary Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland.
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50
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Tuncer S, Mehralivand S, Harmon SA, Sanford T, Brown GT, Rowe LS, Merino MJ, Wood BJ, Pinto PA, Choyke PL, Turkbey B. Apical periurethral transition zone lesions: MRI and histology findings. Abdom Radiol (NY) 2020; 45:3258-3264. [PMID: 31468153 DOI: 10.1007/s00261-019-02194-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Apical periurethral transition zone (TZ) cancers can pose unique problems for surgery and radiation therapy. Here, we describe the appearance of such cancers on multiparametric MRI (mpMRI) and correlate this with histopathology derived from MRI-targeted biopsy. MATERIALS AND METHODS Between May 2011 and January 2019, a total of 4381 consecutive patients underwent 3 T mpMRI. Of these, 53 patients with 58 apical periurethral TZ lesions underwent TRUS/MRI fusion-guided biopsy and 12-core systematic TRUS-guided biopsy. Correlation was made with patient age, PSA, PSA density, whole prostate volume, and Gleason scores. RESULTS A total 53 men (median age 68 years, median PSA 7.94 ng/ml) were identified as having at least one apical periurethral TZ lesion on mpMRI and 5 (9%) patients had more than one apical periurethral lesion. Thus, 58 lesions were identified in 53 patients. Of these 37/53 patients (69%) and 40/58 lesions were positive at biopsy for prostate cancer. Seven were diagnosed by 12-core systematic TRUS-guided biopsy and 34 were diagnosed by TRUS/MRI fusion-guided biopsy. Gleason score was ≥ 3 + 4 in 34/58 (58%) lesions. CONCLUSION Identification of apical periurethral TZ prostate cancers is important to help guide surgical and radiation therapy as these tumors are adjacent to critical structures. Because of the tendency to undersample the periurethral zone during TRUS biopsy, MRI-guided biopsy is particularly helpful for detecting apical periurethral TZ prostate cancers many of which prove to be clinically significant.
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Affiliation(s)
- Sena Tuncer
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sherif Mehralivand
- Molecular Imaging Program, NCI, NIH, 10 Center Drive, Room B3B85, Bethesda, MD, 20892, USA
| | - Stephanie A Harmon
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, NCI, NIH, Bethesda, MD, USA
| | - Thomas Sanford
- Molecular Imaging Program, NCI, NIH, 10 Center Drive, Room B3B85, Bethesda, MD, 20892, USA
| | - G Thomas Brown
- Cognitive Science Branch, National Library of Medicine, Bethesda, MD, USA
| | | | | | - Bradford J Wood
- Center for Interventional Oncology, NCI and Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA
| | - Peter L Choyke
- Molecular Imaging Program, NCI, NIH, 10 Center Drive, Room B3B85, Bethesda, MD, 20892, USA
| | - Baris Turkbey
- Molecular Imaging Program, NCI, NIH, 10 Center Drive, Room B3B85, Bethesda, MD, 20892, USA.
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