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Panuganti BA, Carico C, Jeyarajan H, Flagg M, Tamayo P. Transcriptional subtypes of glottic cancer characterized by differential activation of canonical oncogenic programming. Head Neck 2023; 45:2851-2861. [PMID: 37682073 PMCID: PMC10901072 DOI: 10.1002/hed.27514] [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: 07/02/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND There is a paucity of data concerning molecular heterogeneity among glottic squamous cell carcinoma, and the clinical implications thereof. METHODS Data corresponding to glottic squamous cell carcinoma were derived from The Cancer Genome Atlas. The Onco-GPS computational methodology was levied to derive four patterns of transcriptional activity and three functional subtypes of glottic cancer. RESULTS Thirty glottic cancer samples stratified to three distinct oncogenic states (S0-S2) based on a Onco-GPS model containing four transcriptional components (F0-F3). Membership in S2 and association with transcriptional component F0 conveyed an invasive phenotype, with transcriptional activity strongly reflecting EMT programming (including TGF-B and NF-KB signaling). S2 membership also correlated with inferior disease-specific survival (HR 9.027, 95% CI 1.021-79.767), and higher incidences of extracapsular spread and perineural invasion. CONCLUSIONS We present a functional taxonomy of glottic cancer, with subtypes demonstrating differential upregulation of canonical oncogenic networks and survival implications.
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Affiliation(s)
- Bharat A Panuganti
- Department of Otolaryngology - Head and Neck Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Birmingham Veteran Affairs Health Care System, Birmingham, Alabama, USA
- The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Christine Carico
- The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Harishanker Jeyarajan
- Department of Otolaryngology - Head and Neck Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Mitchell Flagg
- University of California-San Diego School of Medicine, San Diego, California, USA
| | - Pablo Tamayo
- University of California-San Diego School of Medicine, San Diego, California, USA
- Moores Cancer Center, Center for Novel Therapeutics and Division of Genomics and Precision Medicine, University of California-San Diego School of Medicine, San Diego, California, USA
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2
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Voora RS, Panuganti BA, Flagg M, Nelson T, Kotha NV, Qiao EM, Qian AS, Kumar A, Stewart TF, Rose B, Califano J, Weissbrod PA, Mell LK, Orosco RK. Patterns of Failure After Definitive Treatment of T4a Larynx Cancer. Otolaryngol Head Neck Surg 2021; 167:274-285. [PMID: 34609937 DOI: 10.1177/01945998211049211] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Recurrence is known to predict laryngeal squamous cell cancer (LSCC) survival. Recurrence patterns in T4a LSCC are poorly characterized and represent a possible explanation for observed survival discrepancies by treatment rendered. STUDY DESIGN Retrospective database review. SETTING Veterans Affairs national database. METHODS Patients with T4a LSCC between 2000 and 2017 were identified and stratified by treatment (chemoradiotherapy [CRT] vs total laryngectomy + neck dissection + adjuvant therapy [surgical]). Primary outcomes were locoregional and distant recurrence. Secondary outcomes of overall mortality, larynx cancer mortality, and noncancer mortality were evaluated in Cox and Fine-Gray models. RESULTS A total of 1043 patients had comparable baseline demographics: 438 in the CRT group and 605 in the surgical group. Patients undergoing CRT had higher proportions of node positivity (64.6% vs 53.1%, P < .001). Locoregional and distant recurrence were less common in the surgical group (23.0% vs 37.2%, P < .001; 6.8% vs 13.3%, P < .001, respectively); however, distant metastatic rates did not differ within the N0 subgroup (P = .722). On multivariable regression, surgery demonstrated favorable locoregional recurrence (hazard ratio [HR], 0.49; 95% CI, 0.39-0.62; P < .001), distant recurrence (HR, 0.47; 95% CI, 0.31-0.71; P < .001), overall mortality (HR, 0.75; 95% CI, 0.64-0.87; P < .001), and larynx cancer mortality (HR, 0.69; 95% CI, 0.56-0.85; P < .001). CONCLUSION T4a LSCC survival discrepancies between surgical and nonsurgical treatment are influenced by varying recurrence behaviors. Surgery was associated with superior disease control and improved survival. Beyond the known benefit in locoregional control with surgery, there may be a protective effect on distant recurrence that depends on regional disease burden.
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Affiliation(s)
- Rohith S Voora
- School of Medicine, University of California San Diego, San Diego, California, USA.,Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Bharat A Panuganti
- Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA.,Moores Cancer Center, La Jolla, California, USA
| | - Mitchell Flagg
- School of Medicine, University of California San Diego, San Diego, California, USA.,Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
| | - Tyler Nelson
- School of Medicine, University of California San Diego, San Diego, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Nikhil V Kotha
- School of Medicine, University of California San Diego, San Diego, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Edmund M Qiao
- School of Medicine, University of California San Diego, San Diego, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Alexander S Qian
- School of Medicine, University of California San Diego, San Diego, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Abhishek Kumar
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Tyler F Stewart
- Moores Cancer Center, La Jolla, California, USA.,Divisions of Hematology-Oncology and Blood and Marrow Transplantation, University of California San Diego, San Diego, California, USA
| | - Brent Rose
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Moores Cancer Center, La Jolla, California, USA.,Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Joseph Califano
- Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Moores Cancer Center, La Jolla, California, USA
| | - Philip A Weissbrod
- Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA.,Moores Cancer Center, La Jolla, California, USA
| | - Loren K Mell
- Moores Cancer Center, La Jolla, California, USA.,Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Ryan K Orosco
- Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Moores Cancer Center, La Jolla, California, USA
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Pang J, Nguyen N, Luebeck J, Ball L, Finegersh A, Ren S, Nakagawa T, Flagg M, Sadat S, Mischel PS, Xu G, Fisch K, Guo T, Cahill G, Panuganti B, Bafna V, Califano J. Extrachromosomal DNA in HPV-Mediated Oropharyngeal Cancer Drives Diverse Oncogene Transcription. Clin Cancer Res 2021; 27:6772-6786. [PMID: 34548317 DOI: 10.1158/1078-0432.ccr-21-2484] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/20/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Human papillomavirus (HPV) plays a major role in oncogenesis and circular extrachromosomal DNA (ecDNA) is found in many cancers. However, the relationship between HPV and circular ecDNA in human cancer is not understood. EXPERIMENTAL DESIGN Forty-four primary tumor tissue samples were obtained from a cohort of patients with HPV-positive oropharynx squamous cell carcinoma (OPSCC). Twenty-eight additional HPV oropharyngeal cancer (HPVOPC) tumors from The Cancer Genome Atlas (TCGA) project were analyzed as a separate validation cohort. Genomic, transcriptomic, proteomic, computational, and functional analyses of HPVOPC were applied to these datasets. RESULTS Our analysis revealed circular, oncogenic DNA in nearly all HPVOPC, with circular human and human-viral hybrid ecDNA present in over a third of HPVOPC and viral circular DNA in remaining tumors. Hybrid ecDNA highly express fusion transcripts from HPV promoters and HPV oncogenes linked to downstream human transcripts that drive oncogenic transformation and immune evasion, and splice multiple, diverse human acceptors to a canonical SA880 viral donor site. HPVOPC have high E6*I expression with specific viral oncogene expression pattern related to viral or hybrid ecDNA composition. CONCLUSIONS Nonchromosomal circular oncogenic DNA is a dominant feature of HPVOPC, revealing an unanticipated link between HPV and ecDNA that leverages the power of extrachromosomal inheritance to drive HPV and somatic oncogene expression.
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Affiliation(s)
- John Pang
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California
| | - Nam Nguyen
- UC San Diego Jacobs School of Engineering, Department of Computer Science and Engineering, La Jolla, California
| | - Jens Luebeck
- Bioinformatics & Systems Biology Graduate Program, University of California at San Diego, La Jolla, California
| | - Laurel Ball
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California
| | - Andrey Finegersh
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California
| | - Shuling Ren
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California
| | - Takuya Nakagawa
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California
| | - Mitchell Flagg
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California
| | - Sayed Sadat
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California
| | - Paul S Mischel
- Stanford University School of Medicine, Department of Pathology, ChEM-H, Stanford, California
| | - Guorong Xu
- UC San Diego School of Medicine, Center for Computational Biology and Bioinformatics, La Jolla, California
| | - Kathleen Fisch
- UC San Diego School of Medicine, Center for Computational Biology and Bioinformatics, La Jolla, California
| | - Theresa Guo
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California.,Johns Hopkins University School of Medicine, Otolaryngology-Head and Neck Surgery, Baltimore, Maryland
| | - Gabrielle Cahill
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California
| | - Bharat Panuganti
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California
| | - Vineet Bafna
- UC San Diego Jacobs School of Engineering, Department of Computer Science and Engineering, La Jolla, California.
| | - Joseph Califano
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California. .,Bioinformatics & Systems Biology Graduate Program, University of California at San Diego, La Jolla, California
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4
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Voora RS, Panuganti B, Flagg M, Kumar A, Qian AS, Kotha NV, Qiao EM, Weissbrod PA, Rose B, Orosco RK. Salvage Following Transoral Laser Microsurgery for Early Glottic Cancer in National Veteran Database. Laryngoscope 2021; 131:2766-2772. [PMID: 34296772 DOI: 10.1002/lary.29740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/07/2021] [Accepted: 06/28/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Transoral laser microsurgery (TLM) is commonly utilized for early glottic cancer and offers favorable oncologic and functional outcomes. However, the survival implications of salvage therapy for recurrent or persistent disease have not been definitively characterized. STUDY DESIGN Retrospective, national database cohort study. METHODS Data were extracted from Veterans Health Affairs (VHA) Informatics and Computing Infrastructure (VINCI) concerning the TLM-based management of T1-T2 glottic squamous cell carcinoma patients between 2000 and 2017. Patients were characterized as either requiring TLM-only, or in cases of persistent or recurrent local disease, TLM plus change in treatment modality (radiotherapy, chemoradiotherapy, or open surgery). Predictors of overall survival (OS), cancer-specific survival (CSS), and salvage-free survival were evaluated via Cox and Fine-Gray models. RESULTS About 553 patients (70.9% T1a, 13.4% T1b, 15.7% T2) were included, with a median follow-up time of 74.5 months. The need for non-TLM salvage increased along with more advanced disease (11.7% T1a, 29.7% T1b, 32.2% T2). Compared to patients with T1a disease, those with T1b and T2 tumors initially treated with TLM had a significantly higher probability of receiving non-TLM salvage (T1b: HR 2.70, 95% CI: 1.61-4.54; T2: HR 3.02, 95% CI: 1.88-4.84). In a multivariable model, receipt of non-TLM salvage was not a significant predictor of either OS (HR = 0.91, 95% CI: 0.62-1.33, P = .624) or CSS (HR 1.21 95% CI 0.51-2.86, P = .667). CONCLUSION The majority of patients with early glottic cancer that are managed with TLM do not require additional salvage therapy. When non-TLM salvage was required, there was no decrement in OS or CSS. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Rohith S Voora
- University of California, San Diego School of Medicine, La Jolla, California, U.S.A.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, U.S.A.,Veterans Affairs San Diego Healthcare System, San Diego, California, U.S.A
| | - Bharat Panuganti
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, U.S.A.,Moores Cancer Center, La Jolla, California, U.S.A
| | - Mitchell Flagg
- University of California, San Diego School of Medicine, La Jolla, California, U.S.A.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, U.S.A
| | - Abhishek Kumar
- Veterans Affairs San Diego Healthcare System, San Diego, California, U.S.A.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, U.S.A
| | - Alexander S Qian
- University of California, San Diego School of Medicine, La Jolla, California, U.S.A.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, U.S.A
| | - Nikhil V Kotha
- University of California, San Diego School of Medicine, La Jolla, California, U.S.A.,Veterans Affairs San Diego Healthcare System, San Diego, California, U.S.A.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, U.S.A
| | - Edmund M Qiao
- University of California, San Diego School of Medicine, La Jolla, California, U.S.A.,Veterans Affairs San Diego Healthcare System, San Diego, California, U.S.A.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, U.S.A
| | - Philip A Weissbrod
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, U.S.A.,Moores Cancer Center, La Jolla, California, U.S.A
| | - Brent Rose
- Veterans Affairs San Diego Healthcare System, San Diego, California, U.S.A.,Moores Cancer Center, La Jolla, California, U.S.A.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, U.S.A
| | - Ryan K Orosco
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, U.S.A.,Veterans Affairs San Diego Healthcare System, San Diego, California, U.S.A.,Moores Cancer Center, La Jolla, California, U.S.A
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5
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Sisterson ND, Carlson AA, Rutishauser U, Mamelak AN, Flagg M, Pouratian N, Salimpour Y, Anderson WS, Richardson RM. Electrocorticography During Deep Brain Stimulation Surgery: Safety Experience From 4 Centers Within the National Institute of Neurological Disorders and Stroke Research Opportunities in Human Consortium. Neurosurgery 2021; 88:E420-E426. [PMID: 33575799 DOI: 10.1093/neuros/nyaa592] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 06/17/2020] [Accepted: 11/20/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Intraoperative research during deep brain stimulation (DBS) surgery has enabled major advances in understanding movement disorders pathophysiology and potential mechanisms for therapeutic benefit. In particular, over the last decade, recording electrocorticography (ECoG) from the cortical surface, simultaneously with subcortical recordings, has become an important research tool for assessing basal ganglia-thalamocortical circuit physiology. OBJECTIVE To provide confirmation of the safety of performing ECoG during DBS surgery, using data from centers involved in 2 BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative-funded basic human neuroscience projects. METHODS Data were collected separately at 4 centers. The primary endpoint was complication rate, defined as any intraoperative event, infection, or postoperative magnetic resonance imaging abnormality requiring clinical follow-up. Complication rates for explanatory variables were compared using point biserial correlations and Fisher exact tests. RESULTS A total of 367 DBS surgeries involving ECoG were reviewed. No cortical hemorrhages were observed. Seven complications occurred: 4 intraparenchymal hemorrhages and 3 infections (complication rate of 1.91%; CI = 0.77%-3.89%). The placement of 2 separate ECoG research electrodes through a single burr hole (84 cases) did not result in a significantly different rate of complications, compared to placement of a single electrode (3.6% vs 1.5%; P = .4). Research data were obtained successfully in 350 surgeries (95.4%). CONCLUSION Combined with the single report previously available, which described no ECoG-related complications in a single-center cohort of 200 cases, these findings suggest that research ECOG during DBS surgery did not significantly alter complication rates.
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Affiliation(s)
- Nathaniel D Sisterson
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - April A Carlson
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ueli Rutishauser
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Center for Neural Science and Medicine, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Computation and Neural Systems, Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, California, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mitchell Flagg
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Nader Pouratian
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Yousef Salimpour
- Department of Neurological Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - William S Anderson
- Department of Neurological Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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6
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Voora RS, Panuganti B, Flagg M, Kumar A, Kotha NV, Qiao EM, Qian AS, Nelson TJ, Weissbrod PA, Stewart TF, Rose BS, Mell LK, Califano JA, Orosco RK. Patterns of failure after definitive treatment for T4a larynx cancer in the Veterans Affairs Health System. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18006 Background: Both chemoradiotherapy (CRT) and total laryngectomy (TL) with adjuvant therapy are curative-intent treatment options for patients with T4a larynx cancer. Disease recurrence is a known negative prognosicator, but differences in recurrence patterns and the subsequent survival associations are not well characterized. To address this knowledge gap, we present long-term recurrence and survival outcomes from a novel longitudinal data source. Methods: Retrospective study of non-metastatic T4a larynx cancer patients diagnosed between 2000-2017 who underwent curative-intent treatment (TL with adjuvant therapy or primary CRT) from the VA Informatics and Computing Infrastructure database. Adjuvant therapy consisted of either postoperative radiotherapy (RT) or CRT. Fine-Gray and Cox models were used to evaluate primary outcomes – time to locoregional recurrence and distant recurrence. Secondary outcomes included overall survival (OS), cancer-specific survival (CSS), non-cancer specific survival (NCSS), and disease-free survival (DFS). These multivariable models accounted for age, race, alcohol history, smoking status, education and income, Charlson-Deyo score, N-classification, and tumor subsite. Results: The study included 1,114 patients with a median follow-up time of 63.3 months among those alive at last follow up. In the TL group, adjuvant RT was used in 69% and adjuvant CRT was used in 31%. Median time to first recurrence was 24.4 months with overall incidence of 28.5% locoregional and 9.5% distant recurrence. Primary CRT patients had higher rates of locoregional (37.2 vs. 22.9%) and distant recurrence (13.3 vs. 7.0%) (p < 0.0001). Median OS was 27.3 months for CRT (95% CI: 23.6-32.4 months) and 47.5 months (95% CI: 39.6-52.1 months) for TL. Median DFS was 14.1 months for CRT (95% CI:12.5-17.2 months) and 37.9 months (95% CI 31.2-47.5 months) for TL. On multivariable analysis compared to CRT, TL was associated with longer time to locoregional (HR 0.50, 95% CI:0.40-0.61) and distant recurrence (HR 0.50, 95% CI:0.34-0.73). Having N+ disease increased risk of distant recurrence (HR 2.20, 95% CI:1.42-3.41). TL was associated with improved OS (HR 0.78, 95% CI:0.67 – 0.91), CSS (HR 0.73, 95% CI:0.59 – 0.89), and DFS (HR 0.58, 95% CI 0.49-0.69) compared to CRT; NCSS was equivalent between groups (HR 1.09, 95% CI:0.88-1.35). Of the CRT patients with locoregional failures, 67/163 (41.1%) were salvaged with surgery. Conclusions: In this cohort of T4a larynx cancer patients, surgical management demonstrated favorable recurrence and survival results. TL with adjuvant therapy was associated with significantly lower incidence of both locoregional and distant recurrence and increased OS, CSS and DFS compared to CRT. Lower probability of disease recurrence, in addition to a survival advantage, should be considered as an important advantage to up-front surgery.
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Affiliation(s)
| | | | | | | | - Nikhil V. Kotha
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Edmund M. Qiao
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Alexander S. Qian
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
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Flagg M, Fang LK, Khawaji A, Alshehri A, Choi MY, Narezkina A, Feld GK. CLO21-013: Atrial Fibrillation With Ibrutinib Therapy: Potential Pharmacologic Interactors in a Single-Institution Retrospective Study. J Natl Compr Canc Netw 2021. [DOI: 10.6004/jnccn.2020.7763] [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: 11/17/2022]
Affiliation(s)
- Mitchell Flagg
- 1The University of California San Diego Health System, La Jolla, California
| | | | | | - Asim Alshehri
- 2University of California San Diego, La Jolla, California
| | - Michael Y. Choi
- 3Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Anna Narezkina
- 2University of California San Diego, La Jolla, California
| | - Gregory Kent Feld
- 1The University of California San Diego Health System, La Jolla, California
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8
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Panuganti BA, Finegersh A, Flagg M, Tu X, Orosco R, Weissbrod PA, Califano J. Prognostic Significance of HPV Status in Laryngeal Squamous Cell Carcinoma: A Large-Population Database Study. Otolaryngol Head Neck Surg 2020; 165:113-121. [PMID: 33256521 DOI: 10.1177/0194599820976178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To explore the survival implications of human papillomavirus (HPV) positivity and subtype in larynx cancer through a national cancer database. To investigate staging discrepancies in larynx cancer associated with HPV status. STUDY DESIGN Retrospective observational cohort study. SETTING National Cancer Database. METHODS Data were extracted concerning adults with known HPV status who were treated between 2010 and 2016 for laryngeal squamous cell carcinoma. Patients without known HPV subtype were excluded. Cox multivariable regression models were fit to evaluate the survival impact of HPV status, characterized as a binary variable (HPV+ vs HPV-) and by subtype. Two- and 5-year survival rates were calculated via the Kaplan-Meier method and compared by stage between the HPV+ and HPV- cohorts per the log-rank test. RESULTS Patients with HPV+ larynx cancer were younger (60.5 vs 64.3 years, P < .001), more likely to have private insurance (37.2% vs 31.2%, P < .001), more commonly White (84.6% vs 82.4%, P = .013), and more likely to present with nodal disease (42.6% vs 33.0%, P < .001). HPV positivity and HPV subtype 16 were associated with improved overall survival. One-stage discrepancies in 5-year survival were observed between the HPV+ and HPV- cohorts: stage II HPV+ (69.45%) vs stage I HPV- (65.77%); stage IV HPV+ (47.67%) vs stage III HPV- (46.80%). CONCLUSIONS HPV positivity and infection with HPV subtype 16 are correlated with improved overall survival in patients with laryngeal squamous cell carcinoma, manifesting with a 1-stage incremental survival advantage. Future prospective studies are indicated to corroborate the findings from this large-population database retrospective study.
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Affiliation(s)
- Bharat A Panuganti
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, USA
| | - Andrey Finegersh
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, USA
| | - Mitchell Flagg
- School of Medicine, University of California-San Diego, San Diego, California, USA
| | - Xin Tu
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California-San Diego, San Diego, California, USA
| | - Ryan Orosco
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, USA
| | - Philip A Weissbrod
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, USA
| | - Joseph Califano
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, USA
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Kashanian A, Malekmohammadi M, Flagg M, Riskin-Jones H, Sparks H, Pouratian N. Clinically-Weighted Probabilistic Tractography Mapping of Pallidal Deep Brain Stimulation for Parkinson's Disease. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lopez Ramos C, Brandel MG, Rennert RC, Hirshman BR, Wali AR, Steinberg JA, Santiago-Dieppa DR, Flagg M, Olson SE, Pannell JS, Khalessi AA. The Potential Impact of "Take the Volume Pledge" on Outcomes After Carotid Artery Stenting. Neurosurgery 2020; 86:241-249. [PMID: 30873551 PMCID: PMC7308658 DOI: 10.1093/neuros/nyz053] [Citation(s) in RCA: 2] [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] [Received: 09/27/2018] [Accepted: 01/31/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The "Volume Pledge" aims to centralize carotid artery stenting (CAS) to hospitals and surgeons performing ≥10 and ≥5 procedures annually, respectively. OBJECTIVE To compare outcomes after CAS between hospitals and surgeons meeting or not meeting the Volume Pledge thresholds. METHODS We queried the Nationwide Inpatient Sample for CAS admissions. Hospitals and surgeons were categorized as low volume and high volume (HV) based on the Volume Pledge. Multivariable hierarchical regression models were used to examine the impact of hospital volume (2005-2011) and surgeon volume (2005-2009) on perioperative outcomes. RESULTS Between 2005 and 2011, 22 215 patients were identified. Most patients underwent CAS by HV hospitals (86.4%). No differences in poor outcome (composite endpoint of in-hospital mortality, postoperative neurological or cardiac complications) were observed by hospital volume but HV hospitals did decrease the likelihood of other complications, nonroutine discharge, and prolonged hospitalization. From 2005 to 2009, 9454 CAS admissions were associated with physician identifiers. Most patients received CAS by HV surgeons (79.2%). On multivariable analysis, hospital volume was not associated with improved outcomes but HV surgeons decreased odds of poor outcome (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.59-0.97; P = .028), complications (OR 0.56, 95% CI 0.46-0.71, P < .001), nonroutine discharge (OR 0.70, 95% CI 0.57-0.87; P = .001), and prolonged hospitalization (OR 0.52, 95% 0.44-0.61, P < .001). CONCLUSION Most patients receive CAS by hospitals and providers meeting the Volume Pledge threshold for CAS. Surgeons but not hospitals who met the policy's volume standards were associated with superior outcomes across all measured outcomes.
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Affiliation(s)
- Christian Lopez Ramos
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Michael G Brandel
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Robert C Rennert
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Brian R Hirshman
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Arvin R Wali
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Jeffrey A Steinberg
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | | | - Mitchell Flagg
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Scott E Olson
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - J Scott Pannell
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Alexander A Khalessi
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
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Zheng F, Yu MK, Kim M, Ono K, Flagg M, Kreisberg JF, Krogan N, Ideker T. Abstract 1317: Multi-scale mapping of the physical and functional architecture of the cancer cell. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-1317] [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
Cancer is governed by modular systems of genes, the composition and organization of which remains poorly understood. Here, we integrate physical and functional networks from a wide range of molecular studies to assemble a comprehensive multi-scale map of human cancer cell biology. This map consists of a hierarchical catalog of protein complexes, signaling pathways and inter-pathway crosstalk implicated in cancer, and it suggests many uncharacterized functional modules as intriguing hypotheses for further validation. Analysis of the pattern of somatic mutations in The Cancer Genome Atlas (TCGA) reveals that these mutations target systems of varying scales above the level of individual genes. The map also provides a platform to integrate and interpret new 'omics data; we integrate new protein-protein interactions identified using AP-MS in multiple breast cancer cell lines, revealing how different functional modules are rewired in cancer cells. A general model browsing tool has been created to visualize and navigate these hierarchical cancer maps. This multi-scale mapping approach elucidates the molecular heterogeneity of cancer, connects tumor genotypes to phenotypes and, ultimately, enables a platform for cancer precision medicine.
Citation Format: Fan Zheng, Michael K. Yu, Minkyu Kim, Keiichiro Ono, Mitchell Flagg, Jason F. Kreisberg, Nevan Krogan, Trey Ideker. Multi-scale mapping of the physical and functional architecture of the cancer cell [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1317.
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Affiliation(s)
- Fan Zheng
- 1University of California, San Diego, La Jolla, CA
| | | | - Minkyu Kim
- 2University of California, San Francisco, San Francisco, CA
| | | | | | | | - Nevan Krogan
- 2University of California, San Francisco, San Francisco, CA
| | - Trey Ideker
- 1University of California, San Diego, La Jolla, CA
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Akhavan D, Pourzia AL, Nourian AA, Williams KJ, Nathanson D, Babic I, Villa GR, Tanaka K, Nael A, Yang H, Dang J, Vinters HV, Yong WH, Flagg M, Tamanoi F, Sasayama T, James CD, Kornblum HI, Cloughesy TF, Cavenee WK, Bensinger SJ, Mischel PS. De-repression of PDGFRβ transcription promotes acquired resistance to EGFR tyrosine kinase inhibitors in glioblastoma patients. Cancer Discov 2013; 3:534-47. [PMID: 23533263 DOI: 10.1158/2159-8290.cd-12-0502] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
UNLABELLED Acquired resistance to tyrosine kinase inhibitors (TKI) represents a major challenge for personalized cancer therapy. Multiple genetic mechanisms of acquired TKI resistance have been identified in several types of human cancer. However, the possibility that cancer cells may also evade treatment by co-opting physiologically regulated receptors has not been addressed. Here, we show the first example of this alternate mechanism in brain tumors by showing that EGF receptor (EGFR)-mutant glioblastomas (GBMs) evade EGFR TKIs by transcriptionally de-repressing platelet-derived growth factor receptor β (PDGFRβ). Mechanistic studies show that EGFRvIII signaling actively suppresses PDGFRβ transcription in an mTORC1- and extracellular signal-regulated kinase-dependent manner. Genetic or pharmacologic inhibition of oncogenic EGFR renders GBMs dependent on the consequently de-repressed PDGFRβ signaling for growth and survival. Importantly, combined inhibition of EGFR and PDGFRβ signaling potently suppresses tumor growth in vivo. These data identify a novel, nongenetic TKI resistance mechanism in brain tumors and provide compelling rationale for combination therapy. SIGNIFICANCE These results provide the fi rst clinical and biologic evidence for receptor tyrosinekinase (RTK) "switching" as a mechanism of resistance to EGFR inhibitors in GBM and provide a molecular explanation of how tumors can become "addicted" to a non amplified, nonmutated, physiologically regulated RTK to evade targeted treatment.
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Affiliation(s)
- David Akhavan
- Medical Scientist Training Program, David Geffen School of Medicine
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